Global health expert Jim Yong Kim on vaccines, ground games and which countries are going to get back to normal fastest

In the last few weeks, I’ve started to get an unusual feeling: Hope. Hope that the scientific community might have found us a path to put the pandemic behind us. Hope that deaths and sickness might slow. Hope that we can climb out of the deep economic hole the pandemic and our response to it has put us into.

But is that feeling warranted? I turned to the one person I knew who would be able to provide straight answers to both the economic and health prognosis: The former head of The World Bank, Dr. Jim Yong Kim.

Jim is a global health expert who has helped guide countries through five previous pandemics. A physician and anthropologist, he co-founded Partners in Health (check out the great documentary on his work, Bending the Arc) in his late 20s to tackle infectious disease in Haiti. He famously challenged medical and NGO orthodoxy by setting beyond-ambitious treatment plans for populations that had been thought of as too expensive or too challenging to deal with. At the World Health Organization, where he oversaw the HIV/AIDS division, he launched a successful two-year plan to treat three million HIV-infected people in developing countries with antiretroviral treatments. 

Jim is equally adept at navigating the economic implications of the pandemic. During his six-year tenure as the head of The World Bank, he revamped the organization to focus on eliminating — not easing, but eliminating — extreme poverty. And he made it easier to do so by raising $13 billion, which allowed The World Bank to nearly double its annual lending. In early 2019, Jim left to join private equity firm Global Infrastructure Partners. But when COVID turned into a pandemic, he was pulled back into his original role. Governments (most notably, Massachusetts, where Jim helped set up the contact tracing operation) started calling him asking for his help.

I did the same.

Here’s some of what Dr. Kim had to say about where we’re headed, why the US is still likely have at least another year living and working in COVID conditions, and what’s needed to speed that up. You can find excerpts below (edited for clarity), watch the original Live interview or download the latest This is Working podcast.

On the state of vaccines:

“So if you look at the three vaccines, two of them are with a completely different technology — a technology that we've never used to make vaccines before — where literally the messenger RNA is injected into the system and it turns the cells into factories for the so-called spike protein on the coronavirus. And the results are very, very encouraging. If you compare the two groups, the one that got the vaccine and the one that got the placebo, 95% of the cases are in the group that got the placebo. This is really, really encouraging. 

“The downside of it is that one, the Pfizer vaccine, requires it to be kept in temperatures of -70 degrees Celsius. The Moderna is a little bit better, but still requires something like -20 degrees. It can survive in a refrigerator for a longer period of time than Pfizer, but still makes it difficult, for example, in developing countries. 

“Now, the one that's coming out of AstraZeneca and Oxford is even more encouraging, in the sense that you can store it between 2 to 8 degrees Celsius. So in other words, in a refrigerator. And so, this could be used in developing countries. But the one thing that I want to remind everybody of, and the WHO said this, is having the vaccine is like building the base camp on Mount Everest. You still have to climb Mount Everest.” 

On the logistical challenges of getting vaccines out:

“The next steps are going to be to get it out there and not just in the fanciest health centers that can keep something at -70 degrees Celsius. A 90% effective vaccine needs about 70% or more of the people [in a population] to have gotten the vaccine. [That’s how you] actually reach what we are calling herd immunity — where there are enough people who are immune in a population so that it's very difficult for the virus to spread.”

On what we don’t know:

“There are people who have seen their level of antibody to COVID drop even after they've had the disease. And so if these people are losing their antibody levels having been exposed to the entire virus, what will happen if you're just exposed to the spike protein? Now, it could be that it's more powerful. It could be that it's longer lasting. It could be all those things. We still don't know. 

“What happens when you study something for just 10 months — which is about where we are — is that you just don't have all the answers. How is it going to work in elderly people? How's it going to work in nursing homes? How long will the protection last? We still don't know these things. But overall I have to say it's been amazing. And now that we've got this mRNA technology, the question is, my goodness, what other things we use this for, especially for diseases that affect mostly developing countries? It's very exciting.” 

On the countries most likely to return to normal first:

“It turns out that in politics and in pandemics, the ground game is absolutely critical. China, Hong Kong, South Korea, New Zealand, Australia, Singapore and then there are some countries in Europe that are also doing a very good job. Germany is doing a much, much better job than most. In Africa, Rwanda has kept their death levels and their infection levels extremely low... Those are the communities that are going to be able to deliver the vaccine most effectively. And they're the ones that are going to get back to normal economic activity fastest.”

On why the US isn't on the list:

“I think the military has been doing a good job in terms of the logistics of delivering the vaccine. And right now, it seems like the number of people who say they're going to get the vaccine has been going up. Fifty percent said that they were going to get it a few months ago. But people who are going to be suspicious of a vaccine, whether it's from one group that still doesn't think COVID is a big issue or another group — and this is communities of color, people living in much more difficult circumstances — that have their own set of suspicions. And so the way you get past that is by having a really strong ground game, a public health system that's doing testing and contact tracing and supported isolation. In other words, putting people in isolation and quarantine, but supporting them if they don't have enough food, if they don't have diapers for their children. This kind of system is necessary in every state for us to get the vaccine out. And unfortunately, we don't have that in place in most of the United States.”

On needed legislation in the U.S.:

“As part of the second stimulus package, there was $75 billion for something called TTSI: Testing, tracing and supported isolation. This was incredibly important. $75 billion is not enough. There should be more, but it was an incredibly important first step. 

“That kind of money could be used to build systems. Sen. Kirsten Gillibrand is talking about a health worker corps of hundreds of thousands. I think it actually needs to be bigger than that. In Massachusetts, Partners In Health is running the contact tracing program. And here's some of the things we found: 20% of all the people we contact need food assistance. So this is not just a program to trace your contacts in order to get information to stop the virus. It's also a program to make sure that if you're sick yourself, or if you've been exposed, that you can isolate or quarantine, and that we will support you with food, diapers, whatever you need. And that has made a huge difference to people who don't have two homes and five bedrooms. People who have to go to work every day. 

“And so we found that the contact tracing program directly speaks at social inequalities and it is a blow for social justice. Second thing, it's an employment program. So many people with lots of good skills are unemployed. We pay $35 an hour in Massachusetts. So it's a relatively good job, and they can get overtime. And they have the dignity of having the job. 

“The third thing is that if you spend this kind of money on people who are working to help curb the epidemic, it turns out also to be fiscal stimulus. Because when you give the people money in their salary, they actually spend it on the kinds of things that we need spending on to get the economy back up and running. 

“So to me, it's a no brainer. It's a no brainer that we do this because it's jobs, it's social justice and it's fiscal stimulus. But certain leaders in the Senate have literally carved those items out of the fiscal stimulus bill. So I hope it's put back in. Because I keep telling my friends, business leaders, hey guys, this is not a financial or economic crisis, it's a public health crisis. It makes no sense to try to put out a fire with measures that in fact are not getting at the cause of the fire.”

On the business community’s response:

“They're basically looking at what's happening with viruses, with the vaccines and treatments and their assumption is that once we have a vaccine it's over. But the scientist who has developed the Pfizer vaccine has been saying, 'Look, we’re not going to get this to everybody for a long time. And the first signs of normal life in the hardest hit areas — including the United States — is going to be next winter.' So at least another year. 

“You want to speed that up? The way to speed that up is to build public health systems that can put out outbreaks, that can deliver vaccines, that can help people stay safe.”

Finally, we talked a little about his career. I asked Jim how he decides on how to leave jobs. He said he got great advice on leaving The World Bank from his leadership coach, Marshall Goldsmith:

“He said, 'Look, things are probably not going to get better for you after the [$13 billion] capital increase and things definitely could get worse. And so if you're ready to do something else, now's the time to do it.'

“And what Marshall said that this always, always, always elicits a reaction from leaders. 'Well, but my board loves me, they tell me that they can't do without me, there are so many projects that I want to finish.' And so Marshall says, 'Okay, so look, as much as everyone loves you, once you announce you're leaving, I give you two weeks and they'll hardly remember who you are.' Because these institutions persist. These institutions continue to grow and develop. And so it was right at that moment that I had a conversation with the founder of the company I work with now, Global Infrastructure Partners, Bayo Ogunlesi is his name. He's originally from Nigeria and he's been one of the most successful infrastructure investors. 

“I would have happily stayed at the World Bank longer, but it was just absolutely the right moment because this guy who'd been so successful in infrastructure in OECD countries was now moving into emerging markets aggressively. And so it was the right time.”

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