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well as we talk about the fth anniversary of the Corona virus pleasure to be joined by Ezekiel Emanuel who's
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Vice Provost for Global initiatives here at the University of Pennsylvania and also professor of Healthcare Management
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here at the Wharton School Zeke great to talk to you again how are you sir good good how do you look back at the the
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window the the and the impact of the covid-19 pandemic but even more so what do you think healthc care has learned
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from that period of time well it's a good question one of the thing I think is clearly and I feel
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uh uh comfortable saying it we we've learned about allocating scarce resources or rationing we've learned how
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the principles we need the ethical principles we need to bring to bear which groups get prioritization and
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which get further down the list um and I think that's actually been a big contribution because it's not just
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relevant to Corona virus um and vaccines and the pandemic it's relevant to lots
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of other things that the exact same framework is useful for like gp1s uh that are in shortage um I think we've
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also learned a lot about targeting high-risk groups and the importance of doing that um I would say uh we have
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learned a lot about the need for data the need for forecasting uh the need to have good resilient Supply chains that
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doesn't mean we've actually put that knowledge into action and that I think is the big
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disappointment that we have in the end not really um changed much of our systems as a matter of fact under the
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current Administration we seem to be undermining the preparation but even under the Biden uh team they wanted to
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put it in the back mirror and so lots of the things that we need to do in this country you know more resilient Supply
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chains more domestic production of generics uh having a domestic production of uh uh n95 masks and on and on we
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really haven't done those kinds of things we you know had a flurry of of uh domestic producers of n95s very good
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producers as a matter of fact and then we just let them Wither on the bind because it's a penny cheaper or a few
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cents cheaper per mask to buy it from China that is uh very shortsighted and unfortunately I think they're
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shortsighted in many many context has has one there's a there obviously was a
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lot of discussion when you talk about the vaccines and the development of the vaccines at the speed at which those
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products were developed and as well brought to Market is there an element that of that that you expect we will see
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continue to play into our health care sector in the years ahead well you know again this is a very interesting things
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we were able to Jin up you know uh um testing and production of the MRNA vaccines um we were not able to sort of
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rapidly test lots of different interventions in our our clinical research Enterprise and structure was
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maladapted to urgently testing things and I think we haven't fixed that a serious problem in my humble opinion um
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you know frankly I do think academic medical centers have some uh responsibility to Bear each one of want
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to get attention want to claim credit and the collaboration just wasn't as effective as it should be uh second
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thing I would say is it showed that the FBA FDA can act quickly but that requires resources it requires lots of
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people working and you know we're going backwards we're not going forwards we're
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reducing the number of people working that'll slow up the uh uh review times
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um I think it shows you that we can do these things but these are our intensive Endeavors similarly at the uh CDC the
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monitoring systems for Global uh uh infectious threats dismantling it the new uh forecasting Center there
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dismantling it we're not keeping the infrastructure that we need to rapidly respond to threats and I think that's
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the worst outcome uh uh similarly I would say that we learned uh again learned but didn't take into
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action you know we need better ventilation in our public buildings especially our schools we allocated a
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lot of money but did not mandate that that money be spent on upgrades to the uh uh um systems for uh you know air
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handling and HVAC and I think that's you know schools could have could have should have done that um but we didn't
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for the hospitals uh and with all of those different elements that you mentioned a moment
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ago are we headed towards kind of a a regeneration of the hospital system in terms of how it runs and all the
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technology and all these components that will come into play as well um I think hospitals are
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struggling um uh you know we've had a it probably don't know for most people
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we've had a a steady decline in the number of people admitted to the hospital um the peak was 1981 actually
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obviously there was a big bump during covid uh but the fact is that uh uh more and more care is being shifted out of
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hospital to the outpatient setting where you can do surgeries now that no one ever conceived of doing 20 30 years ago
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in the outpatient setting and um that actually makes the sort of whole economic model of hospitals a little
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more difficult uh um and the preparation you can't have lots of hospital bed just
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waiting um and one of the big problems at hospitals is moving patients who are ready for discharge don't need the
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hospital intensive treatment out of the hospital that system is broken also so if if we have another pandemic at some
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point are are we yeah that I was going to say sh your head it's it's not we're
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not nearly prepared enough are we we're not nearly prepared and I would say that
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the big problem there is going to be just the human resources we worked our our medical staffs to the Bone and um
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there's a lot of burnout there there's a lot of sort of uh feeling of overwork um and not appreciated uh yes
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early on people were appreciating them but afterwards it wasn't the case um I
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will note one of the terrible ironies I'm I was trying to figure out the right word
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three or four or five five probably four or five decades ago uh the president of
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the Beth Israel Hospital in Boston wrote a article about the rights of patients and the fact that Health Systems had to
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recognize rights now you go into hospitals and there's you know here's what patients can't do they can't abuse
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staff blah blah blah um 180 degree turnaround and I think it it reflects the sort of frustration with the health
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care System uh now and and Co only made it Zeke always great to talk to you and get your Insight thanks very much take
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care see you you got it Ezekiel Emanuel Vice provos for uh Global initiatives here at the University of Pennsylvania
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and professor of Healthcare Management here at the Wharton School