The Review Interviews Dr. Jay Bhattacharya

The Review Interviews Dr. Jay Bhattacharya

The Review recently sat down with Dr. Jay Bhattacharya to discuss some of his recent work in health policy, as well as his perspectives on the state of free speech in academia. Dr. Bhattacharya is a Professor of Medicine at Stanford and the director of the Center on the Demography and Economics of Health and Aging. He is also a Research Associate with the National Bureau of Economic Research and a Senior Fellow at the Stanford Institute for Economic Policy Research.

Dr. Bhattacharya was attacked over his early opposition to lockdowns and recognition of exaggerated COVID-19 mortality rates. This resulted in backlash from the academic community and, more specifically, Stanford. Since the pandemic’s onset, he has become an inspiration for those seeking academic freedom on increasingly censored campuses.

Stanford Review: Let’s start with a bit of background. You graduated from Stanford with four degrees, a BA and MA in Economics, an MD, and a Ph.D. in Economics. Your career has centered around health policy and the economics of healthcare. Having initially studied to become a physician, what drew you to the economics/policy world of healthcare, above all else? Why is that angle of healthcare so important in your opinion?

Dr. Bhattacharya: Having always been interested in science generally, particularly chemistry, I was pre-med. I initially only took economics to satisfy an undergraduate requirement but ended up falling in love with it. In trying to balance pre-med and economics, Alan Garber (a prominent health economist who is now Provost of Harvard University) was a huge influence. He showed me that it was possible to mix these two interests of mine.

To answer the second question, economics is extremely useful in thinking about the largest problems in medicine — such as inequality, preventing wastage, etc. Medicine itself is a game of tradeoffs, of examining the benefits relative to the harms. Economic tools and frameworks are perfectly suited for these types of problems. In using economics, I found a great opportunity to use something I love, research, and apply it to another thing I love, which is helping people.

Stanford Review: This health policy angle is what put you in the spotlight in the early days of the pandemic. You, alongside Doctors Martin Kuldorf and Sunetra Gupta, authored the Great Barrington declaration. Could you describe what you were proposing with regards to COVID-19 policy?

Dr. Bhattacharya: For the last 20 years, I’ve been working in economic epidemiology (since the early days of HIV). During the H1N1 pandemic, we realized that the mortality rate was much lower than was initially reported. They used seroprevalence studies to back up their claims, so I decided that it could be done for COVID-19 as well. In a large seroprevalence study we did, we found that the COVID-19 mortality rate was far lower than the WHO estimate of 3-4% (closer to 0.2%). Moreover, we found that there was an enormous age gradient; the elderly are the ones actually at risk. We saw 75-80% of deaths in elderly populations and 40% in nursing homes alone.

At the same time, there are terrible consequences of lockdowns. Lockdown-induced school closures have the long-term effect of a total of 5.5 million life years lost from kids around the world. 4.5 million kids in Uganda will never go back to school, which is an enormous cost for a disease that doesn’t significantly affect them. People skipped basic cancer screenings which led to a higher incidence of cancer. There was massive economic dislocation, especially for the working class that couldn’t engage in in-person work — malnutrition and starvation caused the deaths of 230,000 in South Asia, halted routine immunizations led polio and malaria (which had almost been eliminated) to resurge.

Combining these two findings: the real mortality rate and the effects of widespread lockdowns, we proposed a much better strategy — focused protection of the vulnerable population (the elderly) and a lift on lockdowns for the rest of the population. Protect those who are at risk for serious disease and mitigate the harms of lockdowns by allowing the rest of society to resume normal function.

Stanford Review: Could you speak a bit more about the seroprevalence study you used to back up your claims regarding the true mortality rate? How was it conducted and what did it find?

Dr. Bhattacharya: The goal was to measure the fraction of the population that had antibodies indicating COVID-19 exposure in April 2020. It found that 3% of Santa Clara county had evidence of COVID-19 exposure, which was 40-50 times more infections than reported cases. Using the true number of infections, we found that the infection fatality rate was actually close to 0.2%, with a steep age gradient.

The technology to measure antibodies was given to us by Major League Baseball, who had a stockpile of test kits to use at games. The test kit was manufactured in China and at that time, it was difficult to know how accurate the tests were. The problem with any kit is that there can be false positives and false negatives; to get good estimates you need to know what the true rates are. To check these rates, we used blood from 2018 (that could not have had COVID) as a negative control and blood from recovered COVID patients as a positive control and made sure to incorporate the rates into our mortality estimate. Many labs around tested this kit using a similar procedure and it was eventually authorized for use by the FDA.

Stanford Review: What made you realize in the earliest days of the pandemic that there was a serious problem with the way policymakers were addressing COVID-19?

Dr. Bhattacharya: The primary cause for concern was the measure of disease risk. The early estimates were dramatically overstated, which prompted panic. The WHO had done something similar in the H1N1 days; they fell prey to under ascertainment bias — not including huge swaths of people that were infected with COVID-19 and did not die. Moreover, I recognized that we had very little reason to believe that a policy of universal lockdown would succeed. It was known that many people couldn’t afford to work from home for such a long time, which meant that there could never really be a true “universal” lockdown. Plus, we’ve never followed a policy of universal lockdowns; in just about all the pandemics of the past, we’ve followed focused protection (e.g. H1N1 in 2009).

Stanford Review: Why did we lockdown this time when we hadn’t in the past?

Dr. Bhattacharya: Policymakers looked at China in January of 2020. They saw that lockdowns led to zero COVID. At the same time, they were looking at Italy and saw that COVID spread rapidly among the elderly populations, which overwhelmed hospitals and led to a lot of deaths — a policy disaster. The combination of these two observations led policymakers to pick lockdowns in a state of panic. However, this is just the proximate cause. The deeper cause is that this time around, we have a technology that allows working from home for the laptop class: people whose jobs can in fact be done online, and the prospect of having a vaccine relatively soon makes people believe that we can solve the disease much quicker.

Stanford Review: Critics say that your findings are based on a study that is erroneous and unthorough and that your team was too quick to jump to publication. Why do you think that is?

Dr. Bhattacharya: With the publication of this type of study, the way it usually works is peer review, which takes time and occurs behind closed doors. In the last few years, another path to publication has emerged: open science and pre-prints. Rather than immediately sending a manuscript to a journal first, you get public comments and feedback before you send it to publishers. This process makes research transparent to the public and collects their feedback, which makes it more enjoyable to do research. Much of the response we received was positive; open review allowed others to check our work, which allowed us to quickly publish a revised version that incorporated people’s suggestions.

Given that it was a state of emergency, we really needed to know how prevalent COVID-19 actually was, how infectious it was, and how deadly it was. These key data points drove forecasting, models, and ultimately pandemic policy. The reason that people freaked out is that the paper’s implication was that lockdowns were not the right policy to pursue and that it was too late to stop the disease from spreading. Because so many were committed to the lockdown policy, the negative feedback was largely from those who didn’t believe the result (which negated the view upon which lockdown policies were built).

Stanford Review: You talk about how we needed to know some key facts about COVID-19 in the beginning to determine effective policy. Why didn’t public health agencies conduct these studies given how important they were?

Dr. Bhattacharya: Our public health agencies have failed. It was, in fact, their job to do seroprevalence studies and find this data as well as to research early treatments. They should have asked so many fundamental questions, such as those regarding the true infection rate, the true mortality rate, the effects of lockdowns, etc., but failed to do so. The causes of their failure are varied. These likely include bureaucratic dysfunction, financial interests of vaccine manufacturers, the failure of regulatory agencies in evaluating treatments, etc. But, the primary problem was hubris. They thought that they had the answer: lockdowns. Their objective then became to keep the public compliant with a policy they had put in place, rather than to find the best policy for the situation based on the facts.

Stanford Review: Your work didn’t just draw criticism online; the Stanford community also reacted. How did they react? What did they say and what actions did they take?

Dr. Bhattacharya: I’ve been at Stanford for 35 years, both as a student and as a faculty member. Stanford’s motto is “the winds of freedom blow,” and for the last two years, they have not blown. The regulation of the study [and] the way Stanford treated the investigators violated our academic freedom in very concrete ways. The consequences to me have involved the loss of friendships with people who should have upheld Stanford’s academic vision, a tremendous amount of anxiety, and disappointment with the university. Stanford should have been a bastion for free inquiry into COVID policy. To give some sense of this, Stanford has not held a single substantive discussion on COVID-19 policy since the start of the pandemic. Other universities have done much better, and it is a tremendous sadness to me that Stanford has failed in this way.

The environment within Stanford to discuss controversial topics that used to exist no longer does, which has made it very difficult for me to do my job. Frankly, Stanford has become a hostile work environment.

Stanford Review: Did the reaction to your work and the response to you personally reveal larger issues in the academic community?

Dr. Bhattacharya: This collapse in our ability to have [an] open discussion about pandemic policy is far beyond just Stanford. Many people who signed the Great Barrington declaration have written to me about what they’ve faced at their institutions. Tens of thousands of scientists and doctors have signed. Many have lost their jobs for expressing concerns about COVID policies, for dissident opinions. It has happened in the United States, in Europe, and around the world. The freedom of inquiry in epidemiology and in biological sciences is at a historical low.

Stanford Review: Who is responsible for this decline in academic freedom?

Dr. Bhattacharya: I’m not sure who exactly is to blame, but I will say that it is the job of university leadership to stand up for the basic mission of a university, which is to let the winds of freedom blow. University leadership that does not do that has failed in its fundamental job. All it would take to reverse this culture of suppression is leadership within top institutions like Stanford to stand up and say that this is an incredibly important value — a fundamental value that we are ready to defend.

Stanford Review: Today, in the waning days of the pandemic, what changes would you like to see in the public health establishment and in academic communities as a whole so as to foster more productive policy discussions, surrounding health and [more] generally?

Dr. Bhattacharya: The failure of public health to manage the pandemic properly has damaged the lives of an enormous number of people by failing to protect vulnerable populations and by the direct harms of lockdowns. This has led to a collapse in trust in public health, which is a critical problem that must be solved immediately. But, it will be very challenging because public health has made basic mistakes in policy and science. To repair the damage, public health will have to conduct an honest evaluation of its failure and take systemic action to prevent such failure from occurring ever again. It should not involve finger-pointing, but it should involve brutal honesty about what went wrong and prominently feature voices who were not in charge.

We also need fundamental reform of the national agencies in charge of health infrastructure, such as the NIH, the FDA, [and] CDC. This involves honest self-evaluation and fundamental reform because these agencies revealed their incapability in handling the pandemic.

Universities should engage in considerable self-reflection and recommit themselves to the values that make a university what it is. One example of a key issue is mandates for vaccines as well as boosters for young people. The universities have ignored scientific facts such as those who have recovered from COVID already have immunity and are at very low risk of serious disease. However, university administrators have immiserated student life around the idea that students were at high risk of this disease when they were clearly not. They required vaccines when there was no necessity to do so on the basis of the faulty notion that the vaccine stops disease transmission (it doesn’t). Universities have made the main purpose of student life to avoid a single, low-risk disease rather than the plurality of true purposes, such as learning from other students and faculty.

Stanford Review: What advice do you have for students who have bold ideas but are afraid to speak their minds in today’s sociopolitical climate?

Dr. Bhattacharya: Be brave. You have tremendous opportunities as a Stanford student, you’re gifted in all kinds of ways. Use that for good, which involves not caring so much what people think about you, saying what you believe to be true, and thereby using your gifts to make the world a better place.

If there’s any hope for the future, it’s young, bright people entering these fields. It’s simply amazing to spend a career learning about incredible things and using them for the public good. There really isn’t a better way to spend a life.

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