Ten Whats With...Laurie Garrett
from Politics, Power, and Preventive Action and Center for Preventive Action

Ten Whats With...Laurie Garrett

Laurie Garrett. Courtesy of Laurie Garrett.

Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations in New York. Ms. Garrett is the only writer ever to have been awarded all three of the Big "Ps" of journalism: the Peabody, the Polk, and the Pulitzer. Her expertise includes global health systems, chronic and infectious diseases, and bioterrorism. Her latest book was just published this month: I Heard the Sirens Scream: How Americans Responded to the 9/11 and Anthrax Attacks.

What is the most interesting project you are currently working on?

We’re trying to come up with a way to create a global mechanism to ensure drug safety at a time when the entire marketplace for manufacture and distribution of pharmaceuticals and medicines is changing very dramatically. With the raw ingredients portion of that marketplace increasingly under monopoly control of China and India and very poorly regulated, and organized crime moving very big into this space, complete with bar-coded labeling that exactly reproduces legitimate labels for a legitimately produced product.

One of the most dramatic changes that has occurred  in the last five years is that China and India in particular have really moved in, in a targeted way, on specific raw ingredients, so that now China controls 100% of the sales of salicylic acid, and so if you ingest anything with aspirin in it you ingest China. And the Indians are moving into the minerals, so that if you take any supplement with magnesium in it or calcium in it, you’re ingesting India.

And so this takes us to that space that is about global governance, and trying to create unique mechanisms that avoid treaties, avoid disputes and breakdowns on different power blocks around the world, and put human safety at the top.

What got you started in your career?

I was working in the newspaper business for many years on health and science. I reached a point where about half my time was overseas, a lot of it in Africa. And the newspaper industry was dying. I knew that there wasn’t going to be a way, a magic solution, and I worked in a newspaper controlled by the Tribune Corporation. I reached a point where I was actively thinking, “OK I have to leap in another direction.” And then the Council called me up and asked me if I would apply for this position, and that’s how I ended up here.

What advice would you give to young people in your field?

The newspaper field, don’t do it. Rethink. Do art history. I’m sure there’s another field equally lucrative!  In the field of global health, national security thinking,  first you might rethink that option because there aren’t a lot of slots. But if I were to be starting all over again now and I were in my 20s, I would put far greater emphasis on language skills. I really honed in on my science, every day I’m glad I know. Everybody needs to study a great deal more science.

But I wish I had Mandarin under my belt. I wish that I had not just street Swahili but that I could really speak Swahili. Similarly, I wish my Spanish wasn’t Spanglish. Languages are going to be more important in time, not less. I feel like the Internet is creating this English-based playing field. But when you want to know what’s going on, you’re going to drill down in the tongue of the people you’re talking with. That’s going to be the game changer going forward

What person, book, or article has been most influential on your thinking?

In 1989 there was an extraordinary meeting in Washington DC at the National Academy of Sciences. I had been for quite some time saving a theory that had been bubbling in my mind that we had mistakenly abandoned the war on infectious diseases and become very cocky that everything would just boil down now to cancer and heart disease.  I kept finding out about these weird outbreaks of things that nobody could explain and that had no name, or the name was something unpronounceable and multi-syllabic and no one knew what to do.  I felt that there were major ecological shifts going on that were responsible for these disease emergencies.

This had just been this thing percolating in the back of my mind that I had been doing a lot of writing about but not really sharing with anybody. Then there was this meeting called on emerging viruses organized by someone who did have a big impact on me going back to my Stanford days—Joshua Lederberg—and all these virologists came together. Nobody knew anybody else’s viruses.  One by one they all got up over the course of four days and said I’m seeing more disease problems and strange things happening with my class of virus or my class or my class. And by the end of the meeting everybody was pretty scared. There was this universal sense that something terrifying was going on.

There was this argument that suddenly took place between two Nobel Laureates—Josh Lederberg and Howard Temin—and it was that Temin posed the question, “Could HIV mutate into a virus that was aerosol-transmissible, and what would that mean for the world?” And they took opposite positions on it. Howard Temin, who had the brain that could do really complex mathematical calculation out loud in like a minute, came up with an odds ratio—I can’t remember exactly what it was, I think it was one in one trillion--and Lederberg said, “I’m not going to lose sleep over it.” And Temin said, “Fine I’ll lose sleep for the both of us.” And we all walked out of that meeting completely like the ground had been pulled out from under us, and that was a game changer for me.

The other huge game changer for me was in 1979 I lived in Zambia, and one of my roommates in this house I ended up living in was a guy named Mac. I didn’t know anything about him. He was South African, but he refused to discuss South Africa until I read the entire Oxford history three volume set on the history of South Africa. Then for hours on end we would discuss the geopolitics of Africa. He made me see Africa in a completely different way, totally changed my worldview. Well he was Mac Maharaj, leader of the underground of the military division of the African National Congress--which I did not know at the time--and went on to be in Nelson Mandela’s cabinet.  He forced me to--typical college grad from the United States with absolutist world views—to throw all that out, start all over again. It was a really dramatic shift.

What was the last book you finished?

I just read The Last Gunfight, and it’s the true story of Wyatt Earp and the O.K. Corral.

What is the most overlooked threat to U.S. national interests?

It is how the US is viewed in the rest of the world. I feel health is a piece of that.For a long time we talked about it in the context of “soft power.” But I think the average American just has no clue what the rest of the world thinks of America and what the word means in their minds and how they envision our role in the world, and how much of all that goes wrong on the planet they believe we are responsible for.

So I feel like our foreign policy always has blinders on it, and there’s a real failure to understand that some seemingly very trivial $10 million program in a very small country can have this profound impact on the image of America and therefore whether a company can come in and deal in a fair marketplace, whether students want to come and study in America and vicariously absorb American values.  Because it’s so mushy and ephemeral, and you can’t address it by buying bullets and weapons, and it ends up being that kind of thing where the Bush administration had one person to do it and it was Karen Hughes.

I wrote a large analysis of what this "American image" issue might look like in the context of foreign aid, or foreign assistance if you will. I came out the day after the Obama Inauguration. I thought it was very hard to argue for a direct relationship between aid and American image. The connect is obviously there, but it shouldn’t actually be the reason we do it. We shouldn’t be providing antiretrovirals to make America look good. We should be doing it to save those lives. So it’s a struggle of exactly how you do you raise these issues and offer up solutions without ending up corrupting the mission.

I always said that ultimately no one should ever be allowed to graduate with a degree in anything to do with international studies, public health, maybe even medicine, without doing a couple of semesters in a desperately poor country. Even going to France for two months might open some eyes. But understanding what it means to be poor, where it’s really poor.

What is the most inflated threat to U.S. national interests?


What is the most significant emerging global challenge?

I do believe that we’re seeing a host of highly complex and probably unpredictable new threats emerging by the mix of shifts in climate and severe weather events, and human encroachment into all sorts of difference ecospheres. And all kinds of things are emerging that we really don’t have the toolkit to either comprehend properly or do anything about.

So for example there are probably a good one hundred reasons for why the coral reefs of the planet are dying. But what does it mean to the planet if we don’t have coral reefs? What happens to all the cultures that are fish dependent societies, starting with Japan and working out to the islands? They’re going to run out of food. But what actually happens to the ocean, and to all coastal ecologies, when there are no coral reefs? And then when you start thinking further about that and take one ecology after another, I think this is the next great nightmare.

A perfect example of this—I have this movie coming out, I contributed to it—called Contagion. One  project for the movie was to come up with the origin of this virus and its mode of transmission, and then work with another scientist who actually designed the virus itself, and we came up with the whole premise of the plot. It’s all about wild fruit bats.

We have to make people understand what’s going on with bats, because almost every one of the scary new diseases comes from fruit bats. But their ecologies are being destroyed and are incredibly fragile because they have very narrow diets--maybe four or five types of fruits--and they all grow at the top of canopies of the rain forests, and the top of the canopies of rain forests are getting the bulk of any warming trend, and rain forests are getting constricted.

These bats are now going into human populated areas, they would never go into such a terrain if they weren’t starving. And there they are passing their viruses onto our domestic livestock--and so Ebola, Marburg, SARS, Lyssa, Hendra, just about that has emerged as a significant viral threat with the exception of Influenza--is coming from these bats. There is something going on that we just don’t get. And if it’s bats today what is it tomorrow?

I think for example with the opening of the Northwest Passage, the seasonal melt of the arctic, what are we releasing? What has been frozen in that tundra for ten million years? When I was involved in a project where they were thawing wooly mammoths way back when, I said just be careful you don’t also thaw what also killed those mammoths.

Josh Lederberg again, his first great project that got him his national security clearance and made him the top secret science advisor to every president from JFK on, was that when Kennedy said we should go to the moon he said “Well, there’s a two way street about this. If there is any life on the moon and we take our microbes, we’ll probably kill it. And conversely if there is life on the moon, it’s likely to be microbial and we won’t see it, but we might bring it back.”

That was the basis of that movie “Andromeda Strain”--it was a real program. Everything that came back from the space suits, to dust samples, all went through deep subterranean laboratory analysis to make sure it wasn’t affected.

What would you research if given two years and unlimited resources?

I came up with this Doc in a Box idea a few years ago, and a few groups have tried to implement it. There are some Doc in a Boxes in Haiti, Uganda, and Kenya, but nobody’s really grasped onto the full concept of what I was arguing. What I was arguing was the future to solving our extraordinary shortage of healthcare workers and the inability to bring basic health to rural and poor areas. My scheme involved creating franchise models that were controlled along the same ways that McDonalds ensures that every franchise meets certain standards and with the same priority to inventory procurement, branding, all of that. For neighborhood health clinics, targeted for the poorest countries in the world and designed in such a way that people with nothing more than a high school education could execute all the necessary functions in a quality way. So the diagnostics are designed with that in mind, all the reporting automatically is via cell phone, so all patient files are in a central hub with doctors monitoring the performance of the community health workers in their boxes.

And it’s never happened because—everybody that reads about it goes “God that’s so perfect”—and my whole idea was to do it with abandoned shipping containers, and I was able to do a prototype and we actually parked it in front the Council. Then MIT got together with a group in Boston and they did a super one.

But my whole premise was that the total conversion for a standardized Doc in a Box has to come in at less than 10,000 dollars, and it has to be doable in a poor country so that it’s also an employer. You’re taking abandoned shipping containers and you go through it like a factory, and they come up with two or three standard designs, and then the franchisee is getting his part of the franchise, and the box is their clinic and it’s the waiting room, and it gets located on some franchise turf. Then they’re all connected and they have solar panels.

But everyone is fixated on the box and the idea of taking a shipping container and turning it a one million dollar clinic, but that misses the whole point.So if I had two years and plenty of resources I’m sure I could make Doc in a Box work.

What are three central findings of your book that the readers would find most interesting?

The book deals with 9/11 and anthrax.  The first central finding is that we have mistakenly seen these as two separate events and talked about them separately. The whole body of analysis and literature is either about 9/11 or anthrax. But in terms of what they were experienced as by the American people, by frightened humans all over the planet, they were a single continuous event. They represented an arc that fundamentally altered our political world view as a nation. The arc started off with 9/11 being a focus of spectacular unity--a unity of political solidarity, a unity of thought, a unity of purpose--which Americans have not experience in a long time, probably since World War II.

But as anthrax happened that unity went completely in the opposite direction because government had no unified response to anthrax. It proved incompetent. Bush ordered a gag order on the scientists that worked for the federal government so there was no answer to basic questions individuals had like, “How dangerous is my mail?”

And as it took on the actual institutions of government, shut down Congress, shut down the Supreme Court, shut down the State Department, step by step it created-- it utterly dissolved--that unified moment and created a sense of fearfulness combined with a sense that the experts didn’t know what they were talking about. And of course it got used in the confusion for political purposes, so that “Oh the spores were quote unquote weaponized, so it had come from Iraq” or something. All of which turned out to be a lie.

The second big finding in the book was that, this was not only an arc in terms of how it was experienced and felt and how it took the nation. But I argue there is very good reason to believe the same people executed both acts.  Certainly the FBI drove the wrong man to kill himself, and he was not the first. There were eleven publicly targeted individuals, all of whose lives were destroyed by the FBI. Two committed suicide under the pressure, three of whom were top Johns Hopkins public health experts who were deported to Pakistan. And only one of whom really got revenge in a legal settlement that allows him to rebuild his life.

I argue and present the evidence for the case that Al-Qaeda was behind the anthrax. The only argument the FBI has put forward to counter that and explain why they dropped that entire avenue of research in less than a year is: Al-Qaeda always claims credit for everything they do and they didn’t claim credit for this, therefore they didn’t do it. I was willing to buy into that for a long time, but then I realized anthrax was a failure. They intended that Tom Daschle himself opens his own mail and dies, Patrick Leahy himself opens his own, Tom Brokaw opens his own mail and dies. These were really specific targets, and they didn’t imagine the postal workers dying. It didn’t work the way they wanted it to, it wasn’t something to be proud of. And it took a long time for everybody to realize the real costs of the anthrax which actually far exceed the real costs of 9/11.

The third huge revelation in the book was in terms of New York’s ability to respond to the double attack. What were the things that drove New Yorkers into post-traumatic stress—which was a huge amount—and other negative responses? But also what signaled resilience and really brought New York back from the brink?

All the cards indicated New York ought not to have been able to come back from the brink. You had four local elections because everything that could go wrong with elections for city council and mayor did go wrong. Everybody forgets that 9/11 was election day, so the election got voided. And then there was a runoff and then another runoff and then another runoff and we ended up with this guy who looked like he was a dude who just bought the mayor’s office. He turned out to be a great mayor, but none of the tea leaves would have looked that way then.

It has been amazing to see the things that really mattered. One of the most important events to pull New Yorkers out of their funk was the Yankees going to the World Series. Giuliani gets credit, but the credit should be focused on about five days. There are all sorts of other things that really made a huge difference that are never part of anybody’s multibillion dollar discussion of preparedness.

The book ends up looking at how we’ve spent billions of dollars on biopreparedness that utterly transformed and arguably destroyed the Center for Disease Control. We utterly transformed and arguably destroyed a lot of local public health. We shifted police and fire departments all over the country out of this notion that somehow there was a magic formula that would protect every bridge, every schoolchild, every national monument, every thing somebody thought was a likely target. And in the end we spent ourselves into hell and scared the heck out of ourselves.

But the real elements of preparedness and the message that mattered and came through in Washington and New York and elsewhere, where either 9/11 or anthrax resonated, was of the solidarity within communities. And the ability of people as a first response to think about their neighbor.  I show that on 9/11 that is precisely what happened. The little old blue haired ladies were on the Brooklyn Bridge handing out eye wash. That went across the whole of America. In fact the problem was government had no capacity to absorb--and still doesn’t--that extraordinary volunteerism energy, that need to be of value, that need to be of purpose that Americans had.

We had thousands of men lining up in front of the Jacob Javits Center volunteering to work at Ground Zero, and nobody could figure out what to do with them. We had more blood donated than anybody could possibly process. It extended out with college students saying, “Just tell me what career, I’ll do it.” And the only place that had a call was military. And that spirit of volunteerism and patriotism has truly been extraordinary for our armed forces. But we’ve never offered that in any meaningful way on the civilian side. We never figured out how to tap into that.

So here we are at a time when the average age of a Red Cross volunteer is seventy-five. Katrina happens and they’re coming out in their walkers to figure out what to do in a flood. Why is it we’ve never figured out that a twenty-two year old wants to be of use.  Our government hasn’t got a clue.