Dr. Oxiris Barbot: How Can We Prepare Our Cities to Tackle Pandemics?

It’s been more than a year and a half since the coronavirus pandemic spread across the globe, and while some aspects of the crisis have been brought under control, others remain extremely difficult to manage. 

Navigating the pandemic, particularly at its outset, required resourceful experts who could make decisions of enormous consequence with limited data or precedent.  

In today’s podcast, we speak to Dr. Oxiris Barbot, who served as Health Commissioner for New York City from 2018 to 2020, about the lessons she learned during those harrowing first months of the pandemic, and the life-saving decisions she was forced to make. Dr. Barbot also walks us through her strategies for countering our ongoing challenges with COVID-19, such as the Delta variant, the logistics of vaccinating young children and how to ensure we consider racial equity in our approach to fighting the pandemic. 

ABOUT DR. OXIRIS BARBOT: Dr. Oxiris Barbot is a physician, public health practitioner and leader at the intersection of public health and healthcare delivery. She was health commissioner for New York City from 2018 to 2020, where she was instrumental in directing the city’s response to the first wave of the pandemic.  

Dr. Barbot previously served as the Commissioner of Health for Baltimore City and as the Medical Director for the New York City public school system. She is currently Senior Fellow for Public Health and Social Justice at the JPB foundation and an adjunct assistant professor at Columbia University’s Mailman School of Public Health. 

---

Podcast Transcript

 

Eric Jaffe:	We make decisions every day. While some of them are small, many can have a huge impact on our own lives and those around us. But how often do we stop to think about how we make decisions? Welcome to Deciding Factors, a podcast from GLG. I’m your host, Eric Jaffe. In each episode, I’ll talk to world class experts and leaders in government, medicine, business, and beyond who can share their firsthand experiences and explain how they make some of their biggest decisions. We’ll give you fresh insights to help you tackle the tough decisions in your professional life.
	It’s been more than a year and a half since the coronavirus pandemic spread across the globe. And while some aspects of the crisis have been brought under control, others remain extremely difficult to manage. While the pandemic has been global, our on the ground response has been managed mostly at the local level, community by community. My guest today is in a unique position to explain how urban can respond effectively to ever shifting data and to navigate current and future challenges, including the Delta variant and the logistics of vaccinating young children.
	Dr. Oxiris Barbot is a physician, public health practitioner, and leader at the intersection of public health and healthcare delivery. She was health commissioner from New York City from 2018 to 2020, where she was instrumental in directing the city’s response to the first wave of the pandemic. Dr. Barbot previously served as the commissioner of health for Baltimore City and as the medical director for the New York City public school system. She is currently senior fellow for public health and social justice at the JPB Foundation and an adjunct assistant professor at Columbia University’s Mailman School of Public Health. Listen in as Dr. Barbot and I reflect on lessons she learned, as well as the decisions she made in the first months of the pandemic, her advice around effectively vaccinating children, and the role of equity in fighting COVID-19 and more.
	Dr. Barbot, welcome to Deciding Factors. So great to have you on.
Dr. Barbot:	Thank you, Eric. It’s great to be with you.
Eric Jaffe:	You played an instrumental role in managing New York City’s initial response when COVID first hit back in March of 2020, and New York was the global epicenter of the pandemic. Can you provide some context around what you faced at the time and what you think civic leaders are going through right now?
Dr. Barbot:	Sure. That was a time when we knew very little about coronavirus and our main goal was really balancing the public’s health and safety with the health of the economy. We’re still very much in the middle of a crisis. And the virus that we had back in early 2020 is actually different now. The Delta variant is much more transmissible.
Eric Jaffe:	I’d to drill down a little bit into what it was like back in March of 2020. I was in New York at the time. It was a very scary time here in New York. And of course all over the world, as we learn more about what COVID was, and there was a lot that wasn’t known. To be in a position like the one you were in, you’re dealing with a lot of uncertainty, limited information. Can you walk us through what it was like in those early days?
Dr. Barbot:	Sure. I think the most important lesson, if you will, in looking back is that those early days, in retrospect, they were a masterclass in making decisions with imperfect data. It was a masterclass, not only in making decisions with imperfect data, but with data that seemed to change on an almost hourly basis. And so, one of the challenges that was certainly present from the very beginning was communicating that to the public in a way that didn’t scare the bejesus out of people. Because one of the things that I was very mindful of was being transparent with New Yorkers about what we knew, what we didn’t know, and to share with them that as information became available, as new data points became known, that we would adjust our strategy to meet that new reality, if you will.
	And even to this day, people comment from all over the country about how different New York was, is, in terms of, for example, mask adherence and many of the other non-pharmaceutical interventions as we call them, social distancing as compared to other parts of the country, the south, the west, the Midwest. I think that made a huge difference in our response. And we were able to flatten the transmission curve because of New Yorkers.
Eric Jaffe:	Reflecting on the role and the pressures that you were under. What do you think the public fails to understand or appreciate about the nature of decision making for public servants and leaders?
Dr. Barbot:	I think pre COVID one of the most important things from my perspective as a leader in decision making is knowing how to recognize the inconsequential, being able to ignore it, and moving through the noise to get through to your goal, right? And so COVID was the opposite of that. We had so much what I’ll call noise in data and everything from talking about hydroxychloroquine as a potential therapeutic all the way through to having to deal with answering in a very professional way that it was not a good idea to inject bleach as a treatment for COVID. We couldn’t have one decision one day, change it completely the other day, without setting a framework for New Yorkers to understand that yes, that could very well be the case, but we weren’t going to do that without sharing with them the whys.
Eric Jaffe:	I wonder if we could just go back to the beginning of the pandemic, March 2020, are there any memories, maybe one or two personal memories that you have that stand out from that period of time?
Dr. Barbot:	Yeah. Eric, I think that the most sort of searing memory, if you will, of that time is just day after day in February, really thinking about the fact that we didn’t have the tests that we needed in order to make sure that whether or not COVID had already gotten to the city, which it likely had. And so it felt like we were going into battle without our most important tool. And then, into March just every day that we didn’t close the schools just really sat with me in a way that I will never forget, right?
	Every day that we delayed potentially put so many people at risk for contracting the infection and having bad outcomes. And those are times obviously that none of us will forget. And my hope is that we will learn those lessons for the future crisis because we will be back there again. And the importance of acting swiftly and decisively in the face of imperfect data is much better than delaying actions to get the quote unquote perfect data because that perfect data comes at a very high cost.
Eric Jaffe:	One recent development is the FDA essentially said that protection can be offered to children between the ages of five and 11 by the COVID vaccines developed by Pfizer and BioNtech, despite the fact that there is some risk of a heart related side effect. I guess what’s your reaction to that story and that FDA ruling.
Dr. Barbot:	So I am thrilled that the vaccine is on the horizon for children, five to 11. And there’s been talk about the concerns about myocarditis, but the reality is that the risks to children from the virus, both in terms of getting myocarditis are much high than they are with a vaccine. And in both situations, it’s a rare occurrence.
Eric Jaffe:	What are the factors that local health authorities and leaders weigh when they’re considering vaccine mandates for school aged children?
Dr. Barbot:	It’s a very charged area as you can well imagine. I draw on the experience that I had managing New York City’s largest measles outbreak in the last 30 years. It actually happened a few months before COVID hit. And we had to compel people to be immunized who hadn’t been immunized against measles in that situation in order to bring that outbreak to an end. And so, the things that we have to take into consideration when considering mandates are really the importance of ensuring first and foremost, that parents have information that’s based on science, where they can feel ultimately good about immunizing their kids and that they don’t feel coerced. Right? And so in this situation, I’m not sure that jumping to mandates is the first thing that I would do.
	I would certainly make it as easy as possible for families to have their children immunized. I would make sure that I flooded, quote unquote, the airwaves with as much science based information as possible for parents to be able to use it, to engage their neighbors and their families in conversations about why it’s important to have their children immunized. I would do everything possible to then neutralize lies and misinformation on social media, around issues related to vaccine safety. And I would engage trusted messengers in all aspects of society to really reinforce the importance of getting children vaccinated. And then, the second phase of what I would do is I would start limiting the access that children had, who were not immunized. So for example, limiting their access to extracurriculars and to a great extent that mirrors somewhat of what we’ve been doing at the national level. And it certainly is consistent with the theory behind behavioral economics.
	Certainly within that, I would make sure that we addressed access issues. And then as the last phase, I would then consider mandates. And in that time, be able to enlist as many individuals, communities, parts of society to really reinforce the importance of the notion of mandating vaccinations. So that’s kind of a long answer, but it’s a really, I think, complicated issue that we learned from previous experience and experience now with mandating vaccines in different settings, that it can cut both ways and it’s not just about vaccines. It’s about ensuring that we take a layered approach that incorporates vaccines, masks, social distancing, good ventilation, to bring this pandemic to an end.
Eric Jaffe:	I wanted to touch on equity issues. I know that’s been a through line in your career and something you’re passionate about. In particular in New York, a New York Times story in August cited city data, which showed that only 28% of black New Yorkers aged 18 to 44 fully vaccinated. There is some reporting that suggests that that percentage has come up in recent months. Can you just talk about what you think we’ve learned about equity during COVID, care access, trust of the medical system and expertise, health outcomes disparities? I know it’s a big topic, but I’d love to hear your kind of high-level thoughts.
Dr. Barbot:	Yeah. It’s a huge topic. And so Eric, what I will say is that at the very beginning of COVID, we were getting results on lab tests. And fully, I would say about 60% of the lab results we were getting didn’t have data on race, but the data that we were seeing was very much skewed towards black and brown New Yorkers being disproportionately affected both in terms of infections, hospitalizations, and deaths.
	And so it was important for us to act decisively early, even though we didn’t have the full data picture. I think the important point to sort of keep in mind is that operationalizing an equity approach entails all of us and it entails doing extra things, quote unquote, for the people that are most affected. And so to use the example of vaccines early on, we very rightly highlighted the fact that there were disparities in access to vaccinations for black and brown communities, but that there were also historical issues that made it more challenging for black and brown Americans.
	And in this situation, black and brown New Yorkers to fully embrace vaccinations, history of distrust of the medical system, structural racism, et cetera. And there were resources that were directed to communities and engaging trusted messengers. And that strategy has paid off because what we’re seeing is the disparities in uptake between black and brown Americans and white Americans is the increasing significantly. We haven’t eliminated it, but it’s decreasing significantly. And that in great respects was a similar approach we took at the very beginning of COVID, where we initiated an equity action plan that focused on the 29 zip codes that accounted for more than 50% of the early deaths in COVID, and that were primarily black and brown communities. And what we did was we directed additional resources to engage communities around educational efforts, around outreach efforts, to direct PPE to those communities, to ensure that we worked with social service providers.
	So that families that had challenges, isolating, and safe quarantining safely because of unstable housing, because of lack of access to food, because of any other social issues and linking those individuals to services. And in the end, ensuring that we significantly slowed transmission and really stopped the high number of people dying in those communities. So in the end addressing equity issues requires intentionality. It’s not enough to talk the talk, you got to walk the walk. Incorporating social risk factors into clinical risk factors is critical for having a holistic response to an event. Be it a crisis like COVID or being a more long term crisis, like let’s say, opioid overdose deaths or any other kind of crisis.
	And so that then brings us to different solutions for the long term that don’t just focus on the healthcare system, right? Because if we keep just focusing on the healthcare system to fix, quote unquote, these health inequities, then we’re never going to get to where we need to get because the underlying drivers lie in those structural racism components of housing, transportation, and the support systems that allow communities to be vibrant.
Eric Jaffe:	Well, Dr. Barbot thank you so much. I think this was a fascinating conversation. I really appreciate you coming on the show today. Thank you again.
Dr. Barbot:	Thank you, Eric. It was my pleasure.
Eric Jaffe:	That was Dr. Oxiris Barbot, New York City’s health commissioner from 2018 to 2020, among many other roles. One of my biggest takeaways from our conversation was that making tough is like a muscle that one must exercise to get stronger. For many of us, the idea of making decisions at the outset of COVID would’ve been daunting enough to be paralyzing, but Dr. Barbot was able to make life saving decisions under a set of constantly changing circumstances.
	We hope you’ll join us next time for a brand-new episode of Deciding Factors featuring another one of GLGs network members. Every day, GLG facilitates conversations with experts across nearly every industry and geography, helping our clients with insight that leads to true clarity. Feel free to leave us a review on Apple Podcast. We’d love to hear from you or email us at decidingfactors@glgroup.com if you have feedback or ideas for future show topics. For Deciding Factors in GLG, I’m Eric Jaffe. Thanks for listening.