COVID VaccinesReturn to WorkMental Health

‘Every mayor will tell you they’re being overwhelmed by good intentions’—A Q&A with Steve Davis on coronavirus efforts

April 26, 2020, 5:00 PM UTC

Steve Davis stepped down from his role as the CEO of PATH, the Seattle-based global health nonprofit with operations in more than 70 countries, at the end of 2019. But Davis, who is a lecturer on social innovation at Stanford University and just finished writing a book, quickly found himself fighting on multiple fronts in the world’s battle against COVID-19.

A co-chair of the World Health Organization’s digital health technical advisory group, Davis has been active in supporting the global body’s pandemic response efforts. A member of the Center for Strategic and International Studies Commission on Strengthening America’s Health Security, Davis was also involved in briefing US political leadership on the novel coronavirus in early February. In Seattle, he’s deeply involved, too, in part through the work of Challenge Seattle which has brought together the public and private sectors to support the city’s efforts. (Read Fortune’s feature on Seattle’s pandemic response here.)

Davis spoke to Fortune earlier this month about the pandemic, the problem of too many well-intentioned tech companies, and the urgent need to share—rather than reinvent—local outbreak response strategies.

This interview has been edited for clarity and length.

How have you been involved in responding to this pandemic?

I’ve been pulled in, actually more than full time, between the regional response and the global response to the pandemic. Regionally, as a Challenge Seattle member and engaging with the former governor and the mayor and political leaders on a wide range of things to help organize. And then globally, I’ve spent most of my time because I’m the co-chair of WHO’s digital health technical advisory group. Dr. Tedros [Adhanom, Director-General of the WHO] asked me to come to Geneva a couple months ago when this started breaking out but I chose happily to stay and do Zoom calls in Seattle and not in a hotel in Geneva. So I’m mainly working with the WHO and a variety of others on private sector engagement and tech company engagement. There are a lot of offers to help, which is wonderful, but there needs to be some coherence there.

Tell us about the WHO work. What are you seeing in terms of technology and its role in supporting this pandemic response?

This has truly been a phenomenal digital pandemic. Everyone is on Zoom and online education and all that, but also the ways that we’re able to bring the full arsenal of digital tools against it—everything from the modeling and predictive tools, everybody knows how to visualize the flattening curve, to a lot of interesting telemedicine tools and contract tracing tools.  

I’ve been the co-chair of this commission for six months or so. Through the chief scientific officer, Dr. Soumya Swaminathan, we’re engaged in calls working with a great group of people from around the world. As COVID started becoming more apparent around the first of the year—the people from China on the commission were fully on COVID then—we were very aware that there was a lot to be done. And by January or early February, we were pivoting our conversations—What do we need to be doing? How do we set ourselves up? It became apparent that this was getting to be a bigger and bigger problem globally, and the next thing I knew I was pretty much doing this full time.

Our goal has really been, one, to provide advice to really help support the strategic response by WHO and member states around the world in terms of what kind of digital and data capabilities they need and what tools are out there. We’re creating a clearinghouse to make it more accessible, particularly as we go into more vulnerable states and resource-poor settings where this is certainly going to emerge even worse. So, how do we keep from reinventing the wheel and everybody creating their own tool?  

The other is bringing together private sector leaders in technology. We held a roundtable I helped chair a couple weeks ago to have a serious conversation. A lot of people are offering to do all sorts of things. There’s no lack of enthusiasm and willingness. But we need to create a stronger agenda on what’s really needed because it’s somewhat of—you’d almost call it a luxury problem. We have so many ideas and big companies, small companies, hackers, social entrepreneurs saying, ‘Here’s this tool’, ‘Here’s this tool,’ ‘I’ve developed this app.’ It has the risk of being a liability. African ministers of health are saying, ‘We don’t even know where to start, and we’re going to Twitter to figure out what works.’ And that’s across not just patient-facing things like contact tracing or testing, but it’s supply chain management, it’s communication to your citizens, the broad range of things that digital tools can help with.

How is the world managing that?

How they’re managing is pretty crazily to be honest. Every public health department or mayor will tell you that they’re being overwhelmed by good intentions. There are efforts, and we’re trying to do it at the global level, to create and/or support a network of clearinghouses. The state of California has launched something similar to say if you have ideas, bring them here, and then [we’ll] try to vet them. The problem, of course, is who and what is the qualification for vetting. This is where WHO gets involved because a lot of people want to be endorsed by WHO, and WHO simply doesn’t have the capacity at this moment to do a lot of that. We’re trying to figure out, how do we support this network of clearinghouses? A lot if it is fairly random. Here in Seattle, we’re lucky that the Department of Health is throwing those ideas over toward the Gates Foundation to say ‘Can you help us select here?’

What we don’t want to do and what we learned in the Ebola crisis really profoundly is that introducing a new tool or a new application, even if it’s really effective and cool, is not easy to do in the best circumstances.  Anytime you do that, particularly at the systemic level, it requires a lot of change management and reeducation. Doing that in Africa in the middle of a pandemic is not easy to do at all. So one of the things we’re particularly keen on, while we appreciate all the new innovations, we’re trying to really support African ministers of health to say: What are the things that are already being used? And how can you leverage those where you’re not trying to introduce so much change management?’ That’s a critical area.

But then there’s been some really nice stories of success. Tencent in China developed a great app that is citizen-facing and quite comprehensive about the disease—what to do, what’s going on in the region, etc. Of course, they were able to do some things with their rules [in China] that we can’t do, but we’ve actually seen that app, based on our efforts, being deployed in Hindi and modified for the Indian context. And then we’ve actually connected it into what WHO has created so we’re seeing some aggregation or synthesis. But you can imagine the variety of things—I’m being pitched 10 or 15 times a day by people. Some pretty amazing ideas with some really good thinkers behind it. Some of it as fundamental as what is the simplest way to help contact tracers keep track of their material and make sure that data is interoperable with the health system.

How are you thinking about where we are in the course of this pandemic? And how do you expect the situation will play out, particularly in more vulnerable countries?

It’s the billion-dollar question. I’m not an epidemiologist. I thought that we would be facing this longer out. The rapid speed at which this really turned from, ‘Okay, there’s a problem over in China,’ into ‘Wow, look at what’s going on in the world,’ it’s just really extraordinary. Now, in hindsight, you think of epidemiology, we were probably naive about that. It wasn’t unpredictable at all. People have been saying this. I’ve been on studies and commissions, I’ve been on stages at Davos saying this stuff is going to happen. But, just suddenly it came and the bizarreness of it—you know it’s easy to sit as a privileged white guy here in Seattle on stages of Davos saying, ‘This is what we ought to do,’ but then suddenly I’m sitting and telling my own son he needs to wear a face mask to go to work today. That kind of pivot is really jarring and humbling and actually quite good for us in the long run to understand how this turned the world upside down.

But, along with most public health leaders, I’m very concerned about what this next wave looks like. We’re not going to have a vaccine for probably 18 months or so. Maybe there will be some breakthroughs, but I’ve been involved with PATH—we have the biggest portfolio of vaccines for the developing world—and it takes a long time to get them deployed. So, we’ve really got to double down on not just getting the vaccine but figuring out manufacturing ability and how billions of people get it quickly. It’ll take a while. What’s going on Africa and India and parts of South Asia—the good news is they’re jumping on it faster than we did by far. The U.S. will be seen as the outlier on almost every level at the end of this. We’re seeing our numbers of both deaths and cases are the highest in the world because we didn’t do what we needed to do as a country fast enough.

So the good news is, they’re on it. The problem is, as you can imagine, the context is just so different. Social distancing in a township in South Africa is pretty hard to do. The amount of testing capability is minimal. I think Bill Gates and others and I are very worried about this potential humanitarian crisis we face in the next six to 12 months. I was on a call of the [CSIS] commission with people who are very close to this piece of that puzzle, and they’re very worried that this could be a humanitarian crisis beyond what we’ve ever seen.

Are there lessons from recent Ebola outbreaks that are instructive for this moment?

I talk with colleagues from Africa about this every day. They say with Ebola we learned things like no matter what tool you’re using you need community engagement. It all starts there. We learned that the hard way over and over with Ebola where the SWAT team coming in is required, but unless you have a community supporting you and translating and interpreting what this means, the community can really reject it. The idea to be smart about how aggressive you are with new tools was really critical. You have to plug into existing infrastructure. With Ebola, we learned more than anything—I’m looking at it through a digital lens— the tool is great, but unless you’ve got human capacity and, and almost a culture of data that is authorized to actually make decisions based on data, it doesn’t matter how good your data tool is.

 I don’t think Ebola is terribly instructive on a lot of the other pieces. We actually learned a little bit better about contact tracing there but this is such a different disease, the way it spreads and also frankly and happily it’s not as fatal. With Ebola, the fatality rate is so high once you get it, whereas here—I don’t mean to diminish the death at all—but it’s so much more about overwhelming the health system. That’s where the risk is in Africa.  

How would you assess Seattle’s response?

There will be a million different reports and commissions and studies about who did what when and who is responsible, but certainly we waited too long. Everybody did. We didn’t realize, once the first case was exported here, just how sort of impossible it was going to be to contain it, which I think was the larger story.  

I’m on a national health security commission—the [Center for Strategic & International Studies] has a bipartisan congressional commission on national security, and, on the day of the acquittal of Trump’s impeachment, we were having this odd hearing in the Senate hearing room with a variety of congressmen and senators. What was interesting is we were still talking to congressmen and senators of both parties and people from the administration that this idea that we’re going to contain this— we needed to move from containment strategy to mitigation. I think that idea that we could keep containing this somehow just permeated for too long almost everywhere in this country.

It happened here in Seattle, but then, I think, quickly once the Life Center cases started, there was a quick call like ‘Whoa, this is not going to go away.’ I think Seattle and Washington State will end up getting pretty good scores on pulling people together very quickly, getting some of the business community and the political community and the public health community aligned as much as that’s possible to do. Getting big businesses to get people to start staying home reasonably early. By early March or late February, I was on calls about PPE. So once it started and we got our act together, we flattened [the curve] pretty well. But it’s still out there, and it’s still a problem. I’m also part of the task force on the recovery plan. And it’s much harder, even in a state like Washington, to figure out how to open this up than to shut it down.

How are you thinking about the timing and process of recovery?

The governor is coordinating with governors of other states, but he’s really looking hard at balancing the economic issues and the public health issues. We’re fortunate in this state to have some really great leadership across the board. I give a lot of credit to the former governor [Challenge Seattle CEO Chris Gregoire]. But we also happen to be a place where you’ve got some great universities and great foundations and public health organizations. Our approach isn’t business versus public health—in fact, if you don’t do the public health right, it will hurt business. On the other hand, the business community has a voice. So we’re working with the governor’s office to try to recommend what is the right criteria and the right pace and the right approach for turning on the dials. It’s not a switch—it’s a bunch of dials.

We’re working also on how we set up a really rigorous testing and contact tracing capability that has more surge capacity. And we’re very concerned, just to be really clear, about the equity issues in all of this. This is already an epidemic that has super exposed the flaws in our own health systems— which show how a lot of vulnerable people don’t get services, aren’t getting insured. The numbers are beginning to show the demographics of this.

It’s much easier to say Microsoft go back on because you can all work from home, and that’s great. They’ll probably be working from home for quite a while, but it’s much harder to say mom-and-pop grocery or janitor, you can go back to work. So those things we really have to work on.

How will the contract tracing work?

It’s probably a little premature. That will be driven by the Department of Health, but there is a conversation to create some surge capacity, and we’re putting together a proposal that will rely on both professionals and volunteers. It’s going to require a committed workforce for a certain period of time. When you look around the country and what’s happening, there’s sort of a fortuitous thing about these kind of programs where you are kind of—I hate to say it—but are hitting two birds with one stone. We need to have a surge capacity for contact tracing, and it needs to be trained and managed by the Department of Health and overseen. But we also have a lot of people from community health centers and others that are laid off or unemployed right now, so trying to pivot that kind of workforce into this kind of work will be important.

Globally or locally, what issues are top of mind for you right now?

I do worry that this is a global pandemic—and thankfully global leadership is on it—but it’s playing out very, very much locally. One of the things we’re seeing is that the lack of connectivity between local solutions is slowing us down. I’m sitting here on the Washington State recovery plan, and we’re like, ‘Can we just like sit down with California or Massachusetts and Oregon and do it together?’ Obviously you can’t really do it that way, but we do need to do a better job right now—whether you’re talking about the recovery plan or sharing information about technology tools—because I think we’re just reinventing the wheel over and over and over and it’s painful. In a way it’s unavoidable in the middle of a crisis, but if I think as we go into this post-peak recovery, or whatever they want to call it, we need to bulk up our sharing and knowledge. Certainly we’re trying to encourage open sourcing of tools and things like that so everybody doesn’t have to reinvent.

More coronavirus coverage from Fortune:

Bill Gates explains how to beat the coronavirus pandemic
—The U.S. is learning why limiting hospital beds carries a steep cost
Instacart to hire 250,000 more workers amid soaring demand
—What to know if your small business is applying for Round 2 PPP loans from the SBA
14% of women considered quitting their jobs because of the coronavirus pandemic
—The 3-pronged approach to defeating the coronavirus
—Why the coronavirus crisis makes moral leadership more important than ever
—PODCAST: COVID-19 might have upended the concept of the best companies of the year
—VIDEO: 401(k) withdrawal penalties waived for anyone hurt by COVID-19

Subscribe to Outbreak, a daily newsletter roundup of stories on the coronavirus pandemic and its impact on global business. It’s free to get it in your inbox.