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