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Yahoo
26-03-2025
- Health
- Yahoo
Would work requirements for Medicaid lead to higher employment? Evidence says no
Mike DeWine sounded so reasonable as he recently explained why Ohio would benefit from attaching work requirements to Medicaid. The governor argued that the state has 'a responsibility to make sure as many Ohioans as possible are on a pathway to financial independence.' He added that the requirements would 'promote self-sufficiency,' 'purpose and pride,' while improving the 'well-being' of the state's workforce. Maureen Corcoran, the state Medicaid director, touted the opportunity to encourage 'healthier communities' and a 'thriving' state economy. The proposed requirement calls for adult recipients up to age 55 to be employed, enrolled in school or job training or a recovery program, or have a serious mental or physical illness. Those who benefit offering something in return, essentially health care for work, unless they qualify for an exemption − what's not to like? This is one of those examples of what may sound fair-minded, yet upon closer inspection falls apart. In seeking federal permission to attach the requirements, the governor and fellow Republicans in command of the legislature run counter to evidence established through years of experience. Work requirements do not deliver as promised. They do little to increase employment. More, they often have the perverse effect of diminishing health care as those eligible encounter administrative barriers and find themselves without access to the coverage they need. Consider the outcome in Arkansas, which launched work requirements in 2018. Things quickly turned sour. Roughly 18,000 recipients lost coverage within one year. They did so not so much because they failed to meet the requirement to work at least 20 hours per week. Rather, they struggled with the maze of documentation. Some lacked internet service or ran into trouble verifying exemptions. A 2020 study published in Health Affairs found no increase in employment. What it did discover is that those Arkansas residents between ages 30 and 49 who lost coverage faced adverse outcomes in the shape of increased medical debt, plus delayed care and medication due to cost. Worth emphasizing is that most Medicaid recipients already work. Thus, the work requirements target a sliver of those in the program. A study by the Center on Budget and Policy Priorities cites how the requirements are more likely to harm people with disabilities, women, rural residents and those performing low-wage jobs with unreliable hours. Many may not qualify for an exemption, yet they are hardly shiftless or somehow undeserving. Estimates are around 62,000 Ohioans could lose their health coverage under the work requirements. One analysis puts the number in the hundreds of thousands. Poverty is complicated. Unfortunately, advocates for work requirements often suggest the remedy is simple. They invite the impression of moral failure: The poor are lazy and need only a push or a kick. As a result, their policy-making looks more like punishment than problem-solving. Enhance lives by denying health care coverage? If anything, Medicaid puts people in a position to find work and sustain employment. For starters, they are healthier. More broadly, they are empowered to succeed, health care serving as part of a larger support system. This is the thinking behind the $1,000 child tax credit for low-income and middle-class families proposed by the governor in his state budget plan. Such measures, including food assistance, really do promote financial independence and the 'well-being' of the workforce, not to mention the community as a whole. No surprise, then, that a 2023 Congressional Budget Office analysis also concluded that the punitive approach would add to the uninsured and deliver 'no change' in employment for Medicaid recipients. As Farah Khan of the Brookings Institution recently argued, better to target the structural barriers to employment through steps such as effective job training, child care, transportation assistance — and access to health care. As it is, the assumption at the root of work requirements is that people will find employment and thus qualify for coverage. The trouble is, the evidence reveals that would not be the outcome. Why not skip the turmoil and ensure the coverage is there? The Medicaid expansion, set in motion by the Obama White House and a Democratic Congress, and embraced by John Kasich during his time as governor, was a signal achievement for Ohio. Most important, it brought treatment to many Ohioans with mental illness. The work requirements would erode this advance. They aren't the only harm looming. The Republican majority in U.S. House has unveiled a budget framework that all but guarantees deep reductions in Medicaid, almost certainly through similar work requirements. The Energy and Commerce Committee has the task of finding $880 billion in spending cuts. Virtually all the spending the panel oversees involves Medicare and Medicaid. Yet the same reality applies. Will lawmakers follow their ideological leanings or the evidence that work requirements do not work? Michael Douglas is a former Beacon Journal editorial page editor. He can be reached at mddouglasmm@ This article originally appeared on Akron Beacon Journal: Proposed Medicaid work requirements in Ohio would cause harm | Opinion
New York Times
21-03-2025
- Health
- New York Times
Obamacare Could See Big Changes in 2026
A shorter open enrollment period, less help choosing a plan, higher health insurance premiums for many people — those are just a few changes now brewing that could affect your health insurance for 2026 if you have coverage through the Affordable Care Act marketplace. One shift is the scheduled end of more generous financial subsidies that, in recent years, have allowed many more people to qualify for marketplace plans with lower or no monthly premiums. What's more, the Trump administration, through the Centers for Medicare and Medicaid Services, proposed a new rule on March 10 involving about a dozen changes affecting enrollment and eligibility in the marketplaces. The agency, which oversees the marketplaces, said the rule was intended to improve affordability while 'maintaining fiscal responsibility.' Some health insurance experts, however, say the changes could make it more challenging for people to enroll in or renew coverage. If it becomes final, the rule will 'restrict marketplace eligibility, enrollment and affordability,' according to an analysis in the journal Health Affairs that was co-written by Katie Keith, director of the Health Policy and the Law initiative at Georgetown University Law Center. The public still has a few weeks to comment on the proposal. The administration is likely to move quickly to write a final version because insurers are now developing rates for health plans for 2026, Ms. Keith said. Here are some of the possible changes to look out for. Enhanced premium help, first offered in 2021 as part of the federal government's pandemic relief program, was extended through 2025 by the Inflation Reduction Act. The more generous subsidies increased aid to low-income people who already qualified for financial help under the Affordable Care Act, and added aid for those with higher incomes (more than $60,240 for individual coverage in 2025 coverage) who didn't previously qualify. The extra subsidies, given in the form of tax credits, helped marketplace enrollment balloon to some 24 million people this year, from about 12 million in 2021. The average enhanced subsidy, which varies by a person's income, is about $700 per year, said Cynthia Cox, a health care expert at KFF, a nonprofit research group. Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times. Thank you for your patience while we verify access. Already a subscriber? Log in. Want all of The Times? Subscribe.
Axios
12-03-2025
- Health
- Axios
AI failed to detect critical health conditions: study
AI systems designed to predict the likelihood of a hospitalized patient dying largely aren't detecting worsening health conditions, a new study found. Why it matters: Some machine learning models trained exclusively on existing patient data didn't recognize about 66% of injuries that could lead to patient death in the hospital, according to the research published in Nature's Communications Medicine journal. State of play: Hospitals increasingly use tools that harness machine learning, a subset of AI that focuses on systems that continuously learn and adjust as they're given new data. A separate study recently published in Health Affairs found that about 65% of U.S. hospitals use AI-assisted predictive models, most commonly to figure out inpatient health trajectories. Zoom in: Researchers looked at several machine learning models commonly cited in medical literature for use in predicting patient deterioration and fed them publicly available sets of data about the health and metrics of patients in ICUs or with cancer. The researchers then created test cases for the models to predict potential health issues and risk scores if some patient metrics were altered from the initial data set. The models for in-hospital mortality prediction could only recognize an average of 34% of patient injuries, the study found. What they're saying:"We are asking the models to make big decisions, and so we really need to figure out ... in what kind of situations they can perform," said Danfeng (Daphne) Yao, an author of the study and a computer science professor at Virginia Tech University. It's extremely important for technology being used in patient care decisions to incorporate medical knowledge, Yao said. The study shows that "purely data-driven training alone is not sufficient," she added. What we're watching: Large language models — think ChatGPT-type AI systems — could be more useful in medical settings if they're trained on medical literature. But more research on their trustworthiness is needed before they're deployed in clinical settings, the study says.
Boston Globe
27-02-2025
- Health
- Boston Globe
On COVID's 5 year anniversary: ‘We screwed up' says Dr. Ashish Jha
Listen to more 'Say More' episodes at The following is a lightly edited transcript of the Feb. 27 episode of the 'Say More' podcast. Shirley Leung: Welcome to 'Say More' from Boston Globe Opinion. I'm Shirley Leung. Is 5 years a long time or a short time? I honestly can't decide. It's the amount of time that has passed since those first cases of COVID. I, like most people, never want to think about COVID again. But the cold reality is that pandemics may be more common in our future, and we need to learn from our mistakes. To do that, I'm joined by Ashish Jha who is a physician and Dean of the Brown School of Public Health. You'll remember him. He was one of the doctors who was on TV all the time, telling us the latest science. He also worked in the White House managing the COVID response under President Biden. Welcome, Ashish. Leung: So, can you take me back to the first days of the pandemic in 2020? What do you remember about how those days unfolded? It feels like a movie, right, looking back? Ashish Jha : It does feel like a movie. There's so many different moments that I can think back to. I remember back in early January, first becoming aware of the outbreak in Wuhan and then the first cases that arrived in the U.S. At the end of January, I wrote a piece that I've often reflected on, and I don't know about regretted, but certainly I got some key things wrong in it. I wrote a piece for Health Affairs in which I said, 'We're looking at a likely global pandemic, but America is going to do fine.' Talk about getting that catastrophically wrong. So, as you might imagine, I've thought a lot about 'Why did I get that so wrong?' And then I was watching the US response in February, and it felt like a sort of a slow motion train wreck. And I kept thinking 'It can't be this bad. It can't be this bad. It's not really this bad. No, I'm missing something really important here.' For me, the date that I remember really well is February 26 because that was the day a reporter called me to talk about what was happening with testing. And I came to realize, 'Oh, my God, we have totally missed the window for being ready for this virus.' We had a month essentially to prepare, and we screwed up our testing response. And that is what set us up for a horrible March, horrible April, and in many ways, all of the problems that came in the weeks and months ahead. So there are these moments that demarcate the early days of the pandemic. The other moment was March 10th, when I said, I think for the first time publicly, 'We need to have a national shutdown for two weeks in order to stand up testing.' People talk about shutdowns, and I say, it was for a limited time, and it was for a reason. The reason we needed a shutdown was because it was clear that the virus had spread so far across the country. Until we got testing back up and running, it was going to be hard to know where the virus was spreading and where the virus was not. And of course, we didn't fix testing for a very long time, arguably for like a year. It is interesting to go back and look at those moments and think about the comments we were making, what we were thinking — what I was thinking — and think about what we got right and wrong. Related : Leung: Now this idea of shutting down the economy for two weeks, where did that come from? Jha: So that is the most draconian thing you can do, and you want to do that under the most extreme circumstances. What we knew on March 10th, was that the virus was spreading out of control. We did not have a lot of knowledge about how the virus spread, clearly human to human, but the mechanisms were still not widely known. But we could see what it had done in Northern Italy. It had totally destroyed hospitals. People were dying in large numbers. We had seen what had happened in Wuhan and the draconian way they had to shut things down. You could see what was happening in Iran. And so if you want to prevent human to human transmission, you've got to get humans to stop interacting with each other. And how do you do that? You ask people to stay home. Now, I am very clear that that is something you should use rarely. It has a lot of side effects. I often describe it as like chemotherapy, like chemo is very toxic and you use chemo only when you really have to. It's sort of that kind of thing. But again, for a very limited period of time. If you have widespread testing, then it's totally safe for people to get out and start interacting, because you can test people and you know who's infected and who's not. Then people who are infected can stay home, and people who are not infected can go about their daily business. You can actually run your economy quite effectively. We didn't have that. And so for me, the goal was 'Let's do this for two weeks, to get this thing fixed, and then we can go back to being normal.' Leung: Of course that's not what happened. And I know you come here today to talk about some mea culpa of sorts. What were the other big mistakes made by public health experts and government officials in dealing with COVID? Jha: If I take a step back, I would say the biggest mistake in the pandemic was the speed with which we learned and changed our actions. What I mean by that is the slowness, the inability to pivot. This was a dynamic virus. We were learning as we were going and as we learned new things, our policies should have been updated much faster than they were. And I'll give you a couple of examples. So in February, it wasn't totally clear how the virus spread, even in March. And there was all this stuff about, 'Do you have to wash your hands and do you have to clean your groceries?' That was because we had a mental model that was built on the flu, and with the influenza a lot of it spreads through the hands and through surfaces. So it made sense in early February and early March, to make that an issue. I would say by late March, early April, it was clear that was not how things were spreading. Washing hands is always a good thing, don't get me wrong, but washing hands and cleaning your groceries is certainly not going to do much. That message should have gone out by late March, early April. But, it didn't. It took a long time. So, that was one mistake. Another one, and I'll own up to this, not happily, but I will be very clear on this. In the summer of 2020, I wrote a Boston Globe op-ed talking about how to open schools in the fall. And I said, 'We can open schools with a lot of mitigation, but if we don't have mitigation, masking and testing, then schools are gonna become a hotbed for spread, and we should be careful.' Well, guess what? Massachusetts largely did not open schools in the fall, but Rhode Island did, and Florida did. And what did we learn? In the first month of those schools being reopened, we did not see a massive spread of the virus. So by the end of September, I went from saying 'We have to be super cautious' to saying, 'Actually, I was wrong. Schools are not a major source of spread. We have to switch on this, people. We have a month of data from a whole bunch of states and we have to open up all those schools.' And unfortunately, that's not what happened in Massachusetts, we didn't shift. My kids, who were in the Newton Public Schools, didn't go back to school until the spring, and that was part time. They didn't go back to full until a year later. That's crazy. It's a marker of being way too slow to learn and change. And I can give you a dozen more examples of our inability to pivot. When something changes making sense, yet we keep doing it, then we're actually going against the scientific process at that point. Leung: So can I just give you guys a little credit? When I think back, when you were trying to pivot…I mean it's hard for me as a parent to get my two kids to do something. I can't imagine telling a whole state or a whole country to pivot at a time when they're not sure what's going on, and they've never been through this. So I can understand why it was so difficult to get people to pivot in that amount of time. Jha: Yeah, I mean it's always hard to get people to pivot. I think that is true. I think there were two other things that were a problem. One is, if you ask people to pivot, you have to give them a reason, an explanation. You can't just be like, 'Yesterday I said red, today I'm saying blue.' When you give advice, you should explain what is behind that advice, so that when you ask people to pivot, you can explain what is changing your thinking. And we didn't often do that. The second part is that the CDC, which was supposed to be our premier public health agency, is supposed to be the entity giving advice. Random public health experts are not supposed to be the primary source. The primary source is supposed to be the CDC, and the CDC was awful on this stuff. Leung: And this was when Trump was still in office Jha: Yes, Trump was still in office. The CDC was extremely slow. They were getting a lot of things wrong. I wish I could say that the CDC got magically better under President Biden, but it didn't. The CDC continued to struggle with its science and its messaging. The last point I'll make on this, is it's easy to turn this into a political issue of the right or the left. When I look at the mistakes that were made throughout the whole pandemic from 2020 through '22 and '23, when we kind of ended the public health emergency, the mistakes were pretty bipartisan. There were a lot of problems on the left as well as on the right. When I left the White House, I wrote a piece for the Boston Globe about the moment we were in, this was in summer of '23. I talked about how essentially for most people, we have to go back to normal. There were people on the left who were incredibly angry. And they were like, 'What happened to that guy who was saying all this in 2020?' And I'm like, 'What happened to that guy was that three years passed.' We all got vaccinated. Large proportion of people got infected. We've built up population immunity. You should not have the same policy in 2020 that you have in 2023. So that inability to pivot continues to plague us, and we've got to do a better job on that next time. Leung: The lasting impact of that is that a lot of Americans still don't trust science, it's really destroyed our relationship with science. How do you regain people's trust of science? Jha: I think by reminding people and reframing this as not trust the science, but trust the scientific process. That is different. There's a sense that science gives you the answer. Actually, science helps you answer questions, and it is rare that something is truly settled. I'll give you one that is truly settled. Vaccines don't cause autism. That's pretty settled at this point, right? That's pretty settled. And that the gravity is real, and that the earth is round. There are these things that are pretty settled. But, much of science is a discovery and ongoing improvements, and often people in public health would give the best evidence to that moment as settled science. We know for sure the right answer is X, and then the evidence would change. Then all of a sudden, it wasn't so clear. So what I have said to people is, I've never loved the phrase 'trust of science,' and I don't use it. I think the key is to help people understand how the scientific process works, why it's been such a force for good in the world. It is what has caused human longevity to double in the last 120 years. The scientific process is awesome, but you have to explain it to people, you have to explain how it works. I think over time we can rebuild people's trust in that process, but it's going to take all of us talking differently and engaging differently. Leung: So how do you win over the Joe Rogan types, the ones who are out there on his podcast and others who are losing faith in doctors and public health experts like yourself? Jha: I think by engaging with people. I'll tell you, one of the things I think we don't do enough of is talking to people who disagree with us. It's not in order to persuade them, but in order to engage and understand them and build relationships. One of the things we absolutely need to stop doing in the public health world is talking about anti-science people or shaming people who don't agree with us. You'll never persuade anybody by shaming people, that's just not a good strategy. You have to engage people, you have to understand them. People like Joe Rogan have a very big following. If he's willing to have public health experts on, we should go on and talk to him and understand his perspective, share ours, and start building those relationships because that's what's going to get us back in the long run. I am not naive about this. This is not going to get all fixed in the next couple of years or the next five. This is a work of a generation. But that work begins today. Leung: We talked a little bit about the politics of COVID, and there was a time when we did all come together in the early days when people were social distancing, they were masking, there was Operation Warp Speed to get COVID vaccines, but then we started fighting each other. And we still seem to be fighting each other. So, were you surprised how politicized things got? Jha: I was surprised at how quickly we lost that sense of unity. I was both surprised and disappointed that not only I got politicized, but got partisanized because public health has actually not been super partisan in our country. There's been a partisan element to it, and there's always people who believe in more government, less government, more individual freedom, that's obviously been a thread that's existed. But I remind my friends in public health that if you go back to, 2018, 2019, before the pandemic, but not that long ago, and you ask the question, 'Which state had some of the highest vaccination rates for kids?' Mississippi was actually in the top three. Leung: Oh, I would not have guessed that. Jha: California was often near the bottom. That does not fit with our political understanding of things. If you look today at vaccination rates for two and three year olds, this is before they're ready to go to school and have school mandates. Texas has much higher vaccination rates than California. Today, post pandemic. So what I want us to do is get away from our understanding of these issues as Democrat, Republican, red and blue, and understand it's much more complicated than that. My goal is not to improve vaccination rates in red states or blue states, but we've got to do it everywhere. That means we have to engage people across the political spectrum. Ultimately, what I'd like to do, is de-link partisan identity with public health. People in public health say, 'Republicans are less likely to get vaccinated.' I'm like, 'Why is that a useful framework?' Because I don't want somebody who's a Republican to say, 'Well, people like me are not likely to get vaccinated.' That's not a useful framework, so we should not emphasize that. And I'm not even sure it's true. Instead, we should be talking about what everybody needs to be doing. Leung: During the pandemic, did you feel yourself being used in a political way? Jha: Sure. I mean, certainly in 2020 and I would say much of 2021, I was very much a punching bag from the political right because I was an advocate of public health measures. I got death threats. I had periods of time where I had like police parked outside my house. Then, I would say in 2022 when I went to the White House and started working on pulling down a lot of the measures and ending the public health emergency, most of the attacks started coming from the left. The far left really started going after me. So, I felt like I was a foil for whatever anger people had. But at the end of the day, what I was trying to do was trying to do the best for my family, for my country, saying things that I believed were true at the time, trying to explain what was happening. Obviously at the White House, I was also trying to implement policy that I thought was aligned with the best public health science, knowing that in our political world, people will use that however they want to further whatever gains they want to make. Leung: During the pandemic, public leaders like yourself went viral. Whether it was your op-eds in the Globe or other outlets, all of you became talking heads on TV. So what was that like being thrust into the limelight, guiding the country during this public health emergency? I imagine your life wasn't like this before, right? Jha: No, it was quite unexpected. I will tell you, just on a personal level, when things started early March — I started doing some TV interviews, started talking about what was happening and then it kept going, going, increasing. And at one point, by mid-March, my assistant who was tracking things called me late in the evening, and said, 'By the way, just so you know, we got 160 media inquiries today. And you did, 46 of them.' Jha: And I was like, 'Okay, that's why I feel exhausted.' And, we tracked that I was doing like 30 to 40 a day, seven days a week. Now in my mind I thought, 'This is short term and pretty soon we're gonna start seeing daily briefings from the CDC. It'll be really high quality information. And then people won't have to call me or they might call me every once in a while for an alternative take.' Those daily briefings from the CDC never showed up. Leung: We had daily briefings from Governor Baker, though. Jha: Yes, that was true! And I thought he was great, and Monica Bharel was his health commissioner and she was, and is, awesome. But at the national level, it was coming out of the Trump White House, and President Trump was giving briefings. And there was a lot of information coming out of those briefings that was not quite accurate, and so it never really slowed down. Actually, I remember talking to my family and then some friends in May, saying 'I gotta stop. I'm just exhausted. I can't keep doing this.' And what was surprising to me, was a lot of people said to me, 'No, you can slow down, but engaging the public is part of public health. And in a public health crisis, helping people understand what's happening the moment we're in and how we move forward, is actually doing public health. Communication is not a side point in public health, it is actually central to public health, especially in a crisis where information is not flowing in a way that is useful.' And there were also information vacuums. Information vacuums also create opportunities for people to spread bad information. I think a lot of us were trying to figure out how we share as much good information with all of the shortcomings that we all had. But it was a complicated time. Leung: You've talked about how health experts need more humility when it comes to communicating about science. Perhaps one of the most controversial areas of COVID was its origins. Was it a man-made virus that started in a lab in Wuhan, China? Or was it a virus that jumped from bats to humans? So what happened? What's your take on what really started COVID? Jha: Yeah, if you had asked me this question in 2021 or early '22, I would say it was more likely than not a natural spillover. Why did I say that? Because most pandemics begin with natural spillovers. So if you don't know, that's probably the most likely thing, right? So dismissing the lab leak theory and saying that it was anti-science or propaganda was wrong, it was not. It was just less likely. When I walked into the Biden White House as the COVID response coordinator, if you had said to me, 'Give me odds, Ashish, of is this natural or lab leak?' I would have said 80 percent likelihood it's natural, 20 percent lab leak. On the day that I walked out of the Biden White House, if you had asked me to give the same assessment, I would have said 60 percent lab leak, 40 percent natural. So I flipped. Leung: Is that where you are now? Jha: That's where I am now. Mostly because I haven't gotten any new information in the last year. There are two points there. One is, we have to be able to change our minds as new information comes in. Why did I go from 80 to 20, to 40 to 60, right? The reason is, I got access to a whole lot of information I didn't have before, and as I saw the information and consumed it, I came to believe that lab leak was quite possible, even more likely. Leung: When scientists talk about a lab leak, what do they mean by that? Jha: There are a couple of ways of thinking about what could have happened under the lab leak theory. Some people have described it as, 'Was this engineered in a lab?' I don't think so. We don't have any evidence that somehow there were scientists trying to engineer a virus. But what absolutely is possible is that they were working on this virus. Leung: But, why would they be working on a virus? Jha: So, scientists work on viruses all the time, because you want to study them. You want to study their pathogenicity. How do they infect people? How do they cause illness? That's a really important part of studying viruses. That's a good thing to be doing. We want to be doing that because that's what helps us develop drugs and vaccines and tests. So it's entirely possible that there was a novel virus in bats that they were working on and studying, and they potentially didn't have very good kind of controls like we do here. It's possible that the virus wasn't controlled effectively and leaked, and then infected lab workers could have gone home and then infected family and friends, and it could have set off a pandemic. That I think is probably the more likely scenario than not at this moment. But the truth is, we will not know unless there is more transparency from the Chinese government. And I think we have to continue pushing for more data and evidence on this issue. Leung: Is it worth knowing what happened? Does it concern you that we don't know how this global pandemic, that killed so many people, started? Jha: I think in that question, you've captured the key points here. One is, there are people who say, 'Well, why do we care? Don't we want to improve lab safety and work on natural spill overs? Why don't we assume it's either and and try to prevent both?' Fine. But the truth is, that probably between 20 and 30 million people around the world died of SARS-CoV-2. The official statistics are much lower, but that's probably the right range of how many people actually died of this virus. I think we owe it to them. I think we owe it to all the devastation that this virus caused to figure out where it started. I do think it's important to get to the bottom of this. I don't know if we will, but I think it's incredibly important that we keep trying and we certainly made a lot of effort when I was in the Biden White House. My sense is that that effort has to continue, but that it's going to be hard unless the Chinese government comes clean with more data. Leung: So I remember when COVID first hit, it killed people in their twenties and thirties. They had strong lungs. Why isn't COVID killing us like it was five years ago? Jha: Well, the main reason is immunity. The population of America, and much of the world, has a very high degree of immunity against this virus. The reason pandemics happen is you have a novel virus, a new virus, infecting a population that has no immunity against that virus. That's where we were in 2020. At this point, vast majority of Americans have gotten vaccinated multiple times. Most people have been infected multiple times. Leung: And that's how you build immunity, through having it and the vaccine? Jha: Yeah, and it's always better to build it through the vaccine than through infections because the vaccines are much safer than an infection. But at this point, I'd say a majority of Americans have probably had both. And what that means is next time you get infected with SARS-CoV-2, your body's like, 'Ah, familiar ground. We've been here.' It generates a nice antibody response. You get your T cells working. For a vast majority of people, it's very, very mild. For a small proportion of people, especially the elderly, it can still be a lot. And if you don't have a boosted immune cell, you didn't get your booster, we know that that means you're more likely to get super sick and die if you're elderly and high risk. Young, healthy people at this point, it's not really even clear that they need an annual booster because again, they've got enough immunity built up. Leung: I'm glad you said that. This was the first year where I have not gotten a COVID vaccine. I got my flu shot. So it's okay if I'm healthy? Jha: Look, the official CDC recommendation is everybody should get one. I will tell you what I've done in my family. I have three kids: 13, 18 and almost 20. They all get their flu shots every year. I said to all three of my kids, 'On COVID shots, your choice, if you want to get it, you should feel free.' This was the first year that I did not weigh in. All three of my kids were like, 'There's a shot you don't think I need to get? Delighted to skip it!' But I'm 54, I got mine. My wife is the same age as I am, she got hers. So part of it is, we have to be able to sort of think about this stuff. For my 20 year old daughter: eh. Maybe it would make her marginally better off, but not a big deal. For my 80 year old mom: critical. Leung: So, I remember during the pandemic there was a lot of talk about how pandemics were going to be more common. So how probable is it that we're going to see another pandemic in our lifetimes? Jha: In 2018, I remember doing an interview with a Washington Post reporter, and I remember saying, 'We are sort of entering an age of pandemics.' We have seen over the last 30 years, a number of novel viruses infecting humans go way up. SARS-CoV-2 is the latest example. There's SARS 1, there's MERS. There's a whole bunch of other things. So we know this is happening. What's driving it? Habitat destruction, deforestation, climate change. Animals are moving, humans are moving… globalization. Just take China, SARS-CoV-1 in 2003 and SARS-CoV-2 2019. Domestic travel went up about 20 fold in China, and global travel went up about 40 fold. That means local outbreaks become global outbreaks much, much faster. Urbanization, the majority of the world now lives in cities, that means viruses, once they get into cities, spread much more effectively. So all of these factors are driving the risk of pandemics. One last point I'll make, and it's something that we haven't really talked about, but I think it's actually an even bigger threat than a global pandemic. In the last decade we have learned, as a humanity, how to engineer biology. The last time we learned how to engineer a field, physics in the 1920s and 1930s, led to the nuclear weapons of the 1940s. There is no question in my mind, we are going to see biological weapons that look very different than anything we've seen before in the upcoming years and decades. There's very good evidence that there are a lot of rogue states that are working on that. So I have shifted my kind of thinking about this, not so much like about bioterrorism or pandemics, but we are entering an age of biological threats. If we're going to be serious as a society, we have to come up with a strategy for how we detect those threats, how we respond to those threats. I think it's all doable, but we have to get very serious about this. In some ways, we have to put the fights of COVID behind us and think critically and smartly about how we move forward. Leung: Do you think the US is better prepared for the next pandemic? Jha: We are better prepared, yes. There are a lot of people in public health who are like, 'No, we're even worse off than we were five years ago.' That's just not true. We have a surveillance system we didn't have before. We have wastewater surveillance that lets us detect things. Testing infrastructure has gotten better. We have proven to people that we can build vaccines very, very quickly. Now whether we're going to actually get people to take those vaccines, that's a different issue, and we've talked about building confidence in the scientific method. So there are real challenges. The thing I worry about is that because people are frustrated and angry about what happened with COVID, they're going to want to pull back all of that. We've got to make sure we don't do that. So if we stick with what we have and continue investing, we are better prepared now and we can continue to get better prepared. But that takes active work. It's not just going to stay on its own. Kara Mihm of the Globe staff contributed to this report. Shirley Leung is a Business columnist. She can be reached at
