196. Devi Sridhar

19:01Devi Sridhar:And so I feel there we do need to look at the role of social media companies, the different ways that teens are interacting on this. It is a black box for parents who may not even know what their kids are doing on their phones, if they're being cyberbullied, how they're communicating with each other. like Snapchat, everything disappears. So as a parent, even if you look at your kid's phone, you have no idea what content they're looking at or been exposed to. And I think that is bipartisan in the States. And I think here as well, you're seeing regardless of your political kind of affiliation, there is this kind of consensus that smartphones are harmful in the way they're being used for teens.

19:38Rachel Johnson:And it's interesting that the grand zero seems to be the introduction of the smartphone and how they are degrading the nourishing human connections. And I can't lose that opportunity to ask you about your human connections, Debbie. Have you partnered? Do you have children? I mean, have you seen you? You know, do you have real life experience in any of these things?

20:02Devi Sridhar:So I'm not going to. So I should mention and I'll talk a bit about social media that during starting at the pandemic. And since then, I have received so much abuse, kind of death threats. Can I talk about it a bit in the book in terms of my mental health? and saying, of course, my mental health was, and I'm sure, you know, yourself as a public figure have also been on the end of all of a sudden someone sends a tweet and then like 5000 people reshare it. And you're like, why am I suddenly this object of hate? And so based on that, I actually don't talk at all about my personal life just to protect the people in my life who from that kind of vitriol that I've received.

20:41Devi Sridhar:So yeah, I'm sorry, but I'm not going to go there.

20:43Rachel Johnson:Was that because you're one of the so-called, you know, the experts during the pandemic and you were you know you were a face of of the covid pandemic you know with your you could speak to what was going on and explain it and from a global health and public health perspective um why do you think you became the object of public hatred for that so i think it's i've thought about this a lot and

21:08Devi Sridhar:i think it's mixed i think one thing is if you are in the public eye and any role um you get a certain degree of hate, whether you're a news presenter, a journalist, a sports person, an actress. If people see you, probably eight people forget you. One person really likes you and one person hates you. It's just the distribution. So I think when I when I see kind of that, I'm like, oh, actually, can I think of a public figure that hasn't received the level of vitriol? And maybe it's accentuated if you're a woman, perhaps, because there's more sexist things you can say towards, I guess, a woman and different harmful things.

21:46Devi Sridhar:Of course, it's linked to COVID. I mean, during the pandemic, I think it was kind of three groups I could see coming together. One was those who were against vaccines and against kind of a strong push for COVID vaccines, and saw me as part of that group, which was kind of trying to, you know, advocate for why vaccines were really important. And I think, you know, I don't want to say anti-vaxxer, because it kind of, I think, can feel degrading to those who are vaccine hesitant. So I just say people who were like, Why am I being pushed this when I don't want it? I think another group was people who questioned lockdown, felt very much like their freedoms were taken away, didn't understand it.

22:20Devi Sridhar:I mean, my position was very, I would say, nuanced in that I hoped we didn't need lockdowns. Were there other ways we could have avoided lockdowns? There are major harms of lockdowns, but I guess it's very hard to get nuance through when you go into a lockdown because there's no other option at that point. And you're thinking, oh, actually, this is where we're at with the health care system. And then I think the third was because in various points I was, you know, seen as being tied to one political party or another, you end up getting the hate from another one. So in Scotland, because, you know, there was an S &P government in charge, you might get people who are like, why are you working with the S &P?

22:55Devi Sridhar:And what I didn't understand is that I also briefed Labour ministers. I briefed Conservative ministers. I briefed the Lib Dems. I briefed the Greens. I literally as a scientist was like, I'm happy to say the same thing. I went to the COVID recovery group and spoke to them about kind of the views and the evidence. But I think whatever the kind of government is in charge, you kind of get linked to them where, you know, the thing I've said is I would have worked with any government who had been in charge at that point. And with those leaders to try to find a solution because, you know, so many lives and livelihoods were at stake in this crisis.

23:28Devi Sridhar:So I think it was kind of a mix of those things, which, again, nuance is so hard. And I think social media, because it's anonymous, is so hateful sometimes, where I just wonder how many of those people would say that to my face. And I don't know if you ever feel that way as well, where you're like, actually, would you say that to my face? Because I don't think people would. I think there's something about the anonymity and the medium that means people can be way more horrible than they'd ever be in person.

23:54Rachel Johnson:You are up in Scotland. And of course, the pandemic response was a matter of for the devolved governments, the four nations. And so you were part of the Scottish government's COVID-19 advisory group. But I wonder if you have anything to say about Baroness Hallett's recent report on the government handling of the of the pandemic. Of course, I mean, feel free to say say whatever you like. I've written myself about the Hallett report. You know, this is a safe space. You can be very honest about it. My only comment about it to me is it seemed to me she took a slightly illogical position in the latest report that came out last week.

24:36Rachel Johnson:She said one, 23 ,000 lives could have been lost because the government locked down too late. And also, too, that lockdowns should have been avoided. It seemed to me a slightly contradictory position. Do you see any consistency there yourself?

24:53Devi Sridhar:Well, I guess this is the tricky thing, which is that lockdowns should be avoided. And I hope that that was one of the main lessons that we think about the public health infrastructure that could be in place. I mean, the analogy I try to give is imagine you have like a fish tank and one of those fish is infectious and infecting the others. You can either, you know, find the one that's infectious in that tank and take it out. And everyone else stays all the other fish stay in the aquarium and they're happy. or you can lock down each of those fish because you say, oh, any of them could be infectious.

25:24Devi Sridhar:And that was why testing was so important and having surveillance over actually who has who's infectious. How do we isolate them so that it might infringe the minority who say, oh, I have to stay home or I can't see other people. But the majority then you can keep in a position where they're not, you know, not having to be on their own. And so I think they're like, for me, the really big lesson is about testing capacity, which is what the countries did who didn't have to lock down. By January 2nd, 3rd, they were already like, who are our testing manufacturers? How do we get the reagents? How do we set up the stations?

26:00Devi Sridhar:How do we detect things at airports faster? So that's where it's going to come from. Right. It's people traveling. And how do we try to keep our levels low enough so the health system doesn't collapse, which was the real bind of of covid? It was how do you deal with the hospitalization rates, which means your hospitals are full for anyone, whether you have an asthma attack, a car accident or a heart attack. So I think that is what I hope would be one of the takeaways. It's about how do we avoid a lockdown? Because I think now there's some kind of thing about, oh, now we finally realize lockdowns were harmful.

26:35Devi Sridhar:I think everyone knew they were harmful going into it. I think there was huge awareness of the harms of school closures going into it. This has been done before in West Africa during Ebola. It's been done before, you know, when SARS and school closures have been done before. There is evidence before going into COVID that this was harmful to children and the longstanding consequences. But because there wasn't infrastructure in place to do it any other way, we ended up in a lockdown. And I guess the thing with lockdowns is if you're going to do it, you better go early before that curve goes up. And I think that's kind of what the point was trying to say.

27:09Devi Sridhar:Once you're going to do it, do it fast and do it early because it makes it shorter. So it sounds a bit illogical, but I guess for me, the real lesson should be, what do we need to be building so we never have to go into that kind of draconian response, which it was, or into school closures, which were really horrific for some children who were not in the best home situations.

27:47Rachel Johnson:In terms of the pandemic preparedness of this government, if it read the Hallett report, they wouldn't read in that report that lockdowns should be avoided at all costs, that the test and tracing system should be ready to go as soon as a new virus rocks up. and what about also I don't think the the report really tackles the kind of semi-lockdown which is maybe what the Barrington declaration suggested which was to to tell those who are elderly or vulnerable to whatever this virus is and we knew quite quickly with COVID-19 they should shield and let the world, the other fish, carry on swimming inside the fishbowl?

28:36Devi Sridhar:Yeah, so the issue with the Great Barrington Declaration and shielding, and I did think about this like a lot at the time as a practical solution, because in public health, you do have different risk profiles and you do target them. The example being recently when MPOX was in Britain, there was a very targeted campaign, vaccination campaign to Ohio's community. So that is classically how public health does work. It goes after risk groups and it says, how do we actually target our efforts towards those? But I think the problem with COVID is how do you actually get away from multi-generational households, care homes, as we learn, how we live?

29:10Devi Sridhar:And the additional issue that we didn't know exactly who was at risk. So even if we could say there's a general idea of like if you're a certain age or a certain chronic disease that you might be at higher risk, There were a lot of people who ended up in hospital who didn't even know they had an underlying condition. And research now shows, you know, done during the pandemic, a really smart project set up, which looked at people who tested positive but never sought hospital care and people who tested positive and ended up in ICU. And what they found is there is a gene that actually does make you susceptible to having basically a cytokine storm.

29:47Devi Sridhar:Your immune system overreacts, which lends you to ICU. How would you even know if you had that gene at that point? And then you say, OK, imagine we could do that. Imagine we did have a genetic test where we could say, take the test. If you're positive, you keep working. That would have taken out an estimated, it was a colleague of mine, Jill Pellett-Glasgow, who did this analysis, about 50 % of people already. So already you basically have a lockdown of half the population. And in that, we've looked at this for schools in Scotland. OK, imagine we take out all the risk groups. We couldn't have a large enough workforce to deliver schools.

30:19Devi Sridhar:with out worth removing all those kind of individuals. And then it kind of reminded me of what Cuba did with HIV, which again was the international community condemned it. Cuba said it was a success, which is during HIV, they went door to door testing people. And if you tested positive for HIV, you were removed from your house and you were put into a quarantine. They didn't call it a quarantine. They called it an HIV resort. And you could live there with other people who are HIV positive, because that was a way to prevent HIV spreading through a house, through a community, through, you know, wider.

30:54Devi Sridhar:And the families that tore apart and the human rights that were taken away from people who did test positive, the fear they had of government authorities. So I guess the point being that even taking that down that path of, could we identify people, even if we could identify them and test, what do you do at that point? Well, we have taken all those people and put them into, you know, COVID camps where people have accepted losing partners in that kind of way to for a stretch um i don't know so i think

31:21Rachel Johnson:practically it's hard yeah i mean we're looking back on it now do you understand that the architects of the great barrington declaration because the the powers of the state over the over human freedoms was absolute and it was unprecedented i mean lockdowns were unprecedented the way Every country, almost every country apart from Sweden, maybe the state of Florida in the US, and I'm not sure what the others are. But it was an unprecedented time. And do you think that the world has collectively come to any conclusion about what it should do next when the next global pandemic comes down the line?

32:01Rachel Johnson:I know you've given 10 recommendations after post the Ebola outbreak in West Africa. But in your view, you know, has the country, has the world forgotten about the pandemic? And is it therefore will the next one take us just as by surprise as the last one did?

32:22Devi Sridhar:Yeah, so I think scientifically we have learned. And so what gives me hope is that if you look at the scientific side, what most governments have agreed on is what's called the 100 day challenge, which is how do you prepare diagnostics like rapid tests or saliva tests or whatever it might be?

32:41Devi Sridhar:antivirals or some kind of medication or a possible vaccine. So how do you get that ready within 100 days? And if that's when, how do you make that faster? So how do you get the sequencing in quicker? How do you get your platforms? Think about the manufacturing. So I think there has been a lot of work done in the scientific community to say that, for example, if H5N1 bird flu suddenly starts transmitting human to human, we would move pretty quickly to have scientific products ready. Like we would have a rapid test. We would have a vaccine. We would have you know, we know where the manufacturing is.

33:12Devi Sridhar:So I think there I think we have learned politically. I don't think there's been an appetite to want to do that because it was such a traumatic and horrible period for a lot of people. And I think you can probably criticize most government responses. I think there are a couple which were outstanding. But what's interesting is even the ones that you might say were outstanding, there are people who criticize them, who were losers in that particular choice that government made. So I'll give you an example. South Korea never had a lockdown, but they had very intensive test and trace. But that meant that people, for example, there was a spreading event at a gay nightclub.

33:48Devi Sridhar:All of those people were outed to their families, to their communities, because they were traced to that nightclub. So all of a sudden they might say, actually, I don't want the state interfering. I rather would have been locked down than actually been traced to where I was and what I was doing in my personal kind of time. So I guess the point being that politically, I think it is challenging. And I don't know if we would do better right now. I think there is a real maybe we do worse because people are fatigued. They're tired. They're fed up.

34:13Rachel Johnson:But Debbie, the lockdown and its associated costs cost£411 billion. OK, we cannot afford another lockdown unless it's far better, surely, to deal with the novel virus before it spreads now. And so that's where I would want the focus to be, because this country's, you know, there is no money left, as you know. We've just we've just there's been the budget this week. There's no money left. What's going to happen when we have to pay for the next pandemic?

34:57Devi Sridhar:Well, I guess there the emphasis has to be on early interventions, early sequencing. Something I pushed early on was also catching imported cases. Like we basically had probably one of the most relaxed airport policies than any country in the world, even compared to African countries or, you know, places that you think, why would they be screening people? I think their early action, early intervention using precise public health tools would save you that kind of money rather than having to go for a draconian, expensive solution that I think, you know, I had. I mean, if you can look back, they're all now public now at the Scottish government notes and the advisory groups I was in.

35:36Devi Sridhar:And early on, I was saying, can we avoid this? Is there earlier action that we can do? Can we get our testing systems? Because I think that is the only way to avoid something where health care systems are collapsing. No one knows what to do. There's fear. And so you end up in a lockdown. Although I should notice, because I'm from Florida, that they did have at the start a government lockdown and then the government released it quickly. And it was kind of seen as a more libertarian kind of do what you want. But actually, local businesses still struggled because people didn't know what to believe.

36:05Devi Sridhar:And they kind of were in a free for all. So actually, it's not like the economy looks like it would in normal times. And actually, a lot of businesses said that restaurants, hairdressers tried to open and they just couldn't because there wasn't enough footfall. There wasn't enough people willing to come out. So keeping confidence is really important as well, that whatever you choose to do as government that actually people trust it's in the best interests of the population and not just saying, oh, do whatever you want. If you get sick, it's your fault kind of thing, which I think Florida went to go into because you had a lot of distrust over like, what should I do?

36:36Devi Sridhar:And then people making individual decisions, which still impacted businesses. So it was a bit like what happened in Britain with Omicron when there was a lot of nervousness and people started canceling Christmas parties and all that kind of stuff, even though governments hadn't said anything about what to do. It was that kind of people move sometimes before the government does if they feel they have information that impacts what they want to do with their health and their family's health.

36:58Rachel Johnson:Do you think that this country would accept total state direction again, being told only to go out once, not to go to school, basically impose a total lockdown again after the last one?

37:18Devi Sridhar:um probably not if you just had like i guess government leaders go on tv and say to people stay home i think in the end if they saw loved ones neighbors family members getting sick if they started hearing about what was happening in hospitals i think if scientists were out you know and saying this is what's happening these are the facts you know laying it out people might make their own choices over where they see and what they do. And so I don't think it'd be easy for a top down approach anymore. I just think there's been such a loss of trust in that. But I think it might happen anyways, depending how bad the disease is and how deadly it is, how sick people get, because people start to make their own choices for their own health.

38:02Devi Sridhar:Yeah.

38:02Rachel Johnson:We saw that right at the beginning of 2020, when people just stopped going out, they started cancelling things. I cancelled a book party, which was scheduled for March the 19th. And we locked down on March the 23rd. You know, people were making their own decisions. And then, of course, they were they were stopped in that by by the by the Tory government under my brother, who told them what to do and what not to do for the next two or three years. Anyway, moving on, you you're very much a kind of prodigy. I mean, you're only 40 now and you're the youngest Rhodes Scholar. your sit as the chair of public health in the university of edinburgh it's been an amazing career devy and um what do you want to do next so i um it's funny i'm not somebody who's ever

38:51Devi Sridhar:planned five or ten years in the future i guess i just want to continue i really like teaching the next generation of students so i continue to do that university keep writing books about new ideas making people see the world slightly differently, come away with like, oh, I didn't think about that or and keep engaging on public health topics just to have more kind of rational, nuanced, respectful debate where you can say, actually, how do we reach a ground where we may not agree on everything, but actually we can see that we respect each other's views and where we're coming from. So I guess that's where I'm at.

39:23Devi Sridhar:And also trying to keep up with my goal to get to 100.

39:26Rachel Johnson:I know I was going to say you've only got another 60 years to achieve your goals, Debbie. Now, listen, we do ask our guests, what has been your most difficult time? When have you had to be most difficult? Often the first thing that comes into your mind is the real answer.

39:46Devi Sridhar:Yeah, so for me, it actually is tied probably to COVID. And it was early on when I could hear the scientific advice coming from, you know, the chief medical officer and the chief scientific advisor about herd immunity. and we all have to get it and get it over with. And I was sitting there because I always generally had got on with senior colleagues. I'm very respectful to hierarchy. I listen and I try to engage. And I just spent a day talking to international colleagues in the States and South Korea and Japan and across China, just saying, what am I not seeing? Like I'm missing something. And I got to the conclusion that actually they had maybe seen this the wrong way.

40:29Devi Sridhar:So I went out and really put my head on the line, still still paying for it in various ways. But in academia to go against, I guess, senior figures in the field to say, I don't think you're seeing this in the right way. And I do think I was seen as difficult, problematic. Who is this young person? She doesn't even come from our country. You know, why is she? Why is she on TV? Shut up and go away. I got but it was just too important. I wouldn't have probably done it if it wasn't about international kind of policy learnings. And I'd worked in a number of other countries and just thought, what are we doing?

41:03Devi Sridhar:Why are we going down this path? And if I didn't feel that so many lives and livelihoods were at stake. So I think probably there, like that recognition, that moment, which is like, if I go public, if I say these things on X and on, you know, in newspaper articles. And if I do make a fuss now saying, oh, I don't really think this is going well, I am going to take the consequences to my academic career. And I just said, well, this is the kind of moments which you actually go into public health for, which is about truth and about values and about speaking your mind, even if it means you might, you know, not get that grant or you may not, you know, get that award or you may not, you know, be overlooked for being on that advisory group.

41:41Devi Sridhar:I kind of was like, I'll take the hit. I'll I'll be difficult. and looking back, I'm glad I said something because I think you did need to have a chorus of voices coming out kind of challenging the advice that was being given early on, which some of it was, in retrospect, I hope they can look back and think a little bit problematic. Do you feel that you were right? On that point, yeah. I think, looking back, we did need to move early. We should have gone for containment. We gave up too early. the idea of herd immunity was you know made no sense for a virus which you can't really get lifelong immunity for even if they had an unknown you know people were getting it several times i remember exactly so i feel like to go that risk it was risky to do it and i think why would you go for such a risky thing when you didn't have enough data okay when you were worried that maybe

42:33Rachel Johnson:you would be penalized for speaking your truth your you know what you your honest assessment of the situation. Is that how it works in academia?

42:44Devi Sridhar:Well, I think it probably works like that in every business, right? Which is that you work for senior people. I've always heard early on, make your boss look good, respect authority, show up, work hard, listen, learn. And that's what I've done my whole career. And so to have people who I did really respect and really think, wow, what's happening here? And Sage was so secretive. No one knew who was on it. I couldn't even figure who I could speak to on stage to be like, what are you doing? I don't understand this. It was hard. And I guess at a certain point, you have to say, well, you know, I'm going to live by my values and be authentic.

43:23Devi Sridhar:And if even people disagree or dislike me, at least they know what I stand for. Well, we certainly do.

43:28Rachel Johnson:Devi Shridhar, thank you very much indeed for being this week's Difficult Woman. We appreciate you joining us. Thank you.

43:36Devi Sridhar:Thank you very much.

43:50Rachel Johnson:I have to say, I think that Ms. Sridhar is probably right. I don't think the country will willingly submit to a lockdown again. I won't anyway. Thank you for listening to another episode of my Difficult Women podcast. Just remember to download and subscribe wherever you do get your podcasts. to make sure the latest episode is always ready to go every Friday afternoon. Bye.