Judson Howe Before you were running Your Local Epidemiologist, who were you trying to be?
Katelyn Jetelina Who was I trying to be? I actually always wanted to be a physician. I wanted to go to med school. I got a pre-med. I did a geography major undergrad, and I ended up, before I went to med school — so I've always wanted to be in health, and I've always wanted to be helping people and really advocating for a patient or person — and then before I went to med school, everyone usually takes a gap year, and then so I went and got my master's in public health. During that time, I fell in love with the idea of not just treating a person one-on-one like we do in medicine, which is obviously very important, but the ability to treat millions at a time in population health and in public health. I continued to get my PhD, went and worked at the World Health Organization in Geneva, and literally have never looked back. Stats and the intersection between statistics and geography and person and medicine and policy has always been something that gets me really excited.
Judson Howe I've a few friends of mine who have made a similar transition from the medical school track to a not-medical school track. Take me to that moment where you made that same transition and what was the dynamics around that transition?
Katelyn Jetelina It kind of just happened. I don't think it was ever a decision I sat at a table and made. But when I got my master's, I was like, this is just hitting the surface. I really want to go deeper. It's like, OK, go deeper. You have to get your PhD. Then I got my PhD, and then you go into your postdoc, and it kind of just happened. So I don't know if it was ever a decision beyond the light going off in my head around one-on-one versus one-on-population. And that's what made me fall in love with it.
Judson Howe One of the things that has been coming out of this series has been this conversation around where does public health end? What are the boundaries? If you were to put a box around public health, where does that box end for Katelyn?
Katelyn Jetelina Everything is public health. I think the challenge, I mean, you think about social determinants of health, right? Housing impacts health. Gun violence impacts health, cancer, smoking, car seats. It's really everything. I actually think that's our challenge, because it's so broad, it's really hard to focus on one specific thing. But if you start really thinking about it and looking at the news, everything can touch public health in one way or another. And to me, that's exciting because I'll never not have a job. It'll always be there. I think traditionally everyone thinks of infectious diseases, but it really is broader than that. In general, the role of public health is to figure out etiology, the cause of a disease, the patterns behind that disease, and prevention, preventing it before it even happens. That, again, is very different than medicine, where I see medicine as more reactive.
Judson Howe We're in this era in the United States history where there's this skepticism around institutions, governmental entities, science more broadly, and public health seems to kind of be at the center of that. I think we saw that during the pandemic. Have you also noticed that in your work, a transition from maybe like public health to more around trust in the work that you do?
Katelyn Jetelina Yeah, I think so. I think there's been a few transitions over the past six, seven, 10 years in public health. One, which makes a lot of people in public health uncomfortable, is just the visibility of our work. Traditionally and historically, public health has been invisible, right? When did everyone ever really think about how many times a seatbelt saved your life, or how many times fluoride in the water prevented you getting cavities at the dentist, or air filters are preventing illnesses in schools, right? When public health works, it's invisible. The problem is that if it's invisible, it's easy to brush off. And that's what we've really been seeing. But public health mistrust was blown up during COVID, right? Some things rightfully so, some not rightfully so, but also has been part of this larger theme, like you mentioned, of mistrust in institutions overall. We've seen this in mass media. We've seen it in healthcare institutions, like health systems. We are now seeing it in public health. We're seeing it in democracy. And so we're part of this huge shift in our culture. And I can't say it's been fun, but I've certainly learned a lot along the way.
Judson Howe Where do you think this mistrust is coming from? What's the root of it?
Katelyn Jetelina I think the root of it is that trust, what we’ve seen is it erodes pretty slowly over time. If we're being honest with ourselves, like truly honest with ourselves, our institutions are about 20 years behind. They haven't adapted to what is needed in the world today. They're unprepared for the speed and the complexity and the participation that Americans and humans demand of their institutions, as well as people can't really see themselves in them, and they can't feel themselves in them. And I think that when institutions fail to adapt over time, people get left behind. That erodes trust. And this is where we see ourselves now across all institutions, whether it's academia or nonprofits or mass media or public health or whatever, you name it. It's a similar theme throughout.
Judson Howe You mentioned this lack of adaptability or agility in large institutions. If you're running CDC, what are you changing the next year inside the organization to make it more adaptable or more trustworthy?
Katelyn Jetelina I was at CDC. In about 2021, I believe, I got a phone call from the CDC director at the time, Rochelle Walensky, called my cell phone and I thought it was a prank. I was like, why are you calling? And she said, Katelyn, can you please come to CDC and help us strengthen scientific communication? And so I like walked right in there. I thought, I know exactly what to do. I'm going to solve the world. No problem. And three years later, after I was DOGE’ed by Elon Musk, I realized how it humbled me, how hard it is to change an institution. It's like trying to move an iceberg. It is just so hard. And there's so many reasons for that. But at CDC, some reasons are politics. You cannot ignore how politics are played. Whether it's a Republican or Democratic administration, politics play a huge role. To culture, internal culture is always hard to change. I think that's one of the things that need to rapidly change within public health. Our systems are outdated, right? Traditionally, institutions — I'm in scientific communication, so I think very long and hard about information flow — but institutions traditionally have been used to information flow from the ivory towers all the way down, right? There's information flows from the top down in this linear fashion. CDC says something and then everyone acts and everyone trusts it. And that's just not where we are in the 21st century. We need feedback loops. We need partnerships with trusted messengers. We need better data on narratives spreading in social media. And we had none of that. We have none of that infrastructure in public health. When I left CDC, I realized that CDC has a really big role in communication, especially around policy and guidance. That can be a whole lot more transparent. But also, there's a huge role in infrastructure that needs to be built outside of the U.S. government so you have public-private partnerships, because I truly believe you cannot solve all of the problems within CDC. So if I were in charge of CDC, well, CDC, I don't know, my answer would have been different a year ago than it may be in three years. But I think it is culture. I think it is strengthening. I don't know. How much in the weeds do you want this? So I think it's strengthening core capabilities. CDC is really, really strong in deep vertical pockets of scientific knowledge, right? You have the world experts in Mpox, monkeypox, and then you have the world experts in flu, and you have the world experts in COVID. The problem is there's no horizontals across that. So operationally, comms, data. And so when you have one emergency like COVID, all of the lessons learned don't get translated to the next emergency, which was monkeypox or Mpox. And that doesn't get translated to H5N1, which is flu. One thing that I think desperately was needed, and we were working towards this with Mandy Cohen, it was actually the most exciting of the work, was creating a mesh of core capabilities that intersected with the strong vertical capabilities. I think right now CDC is really hyper-focused on just surviving. What this will look like in three, ten years, I'm not sure, and I sure hope I'm at the table to help re-imagine what CDC could be, but there's a lot that can change in the meantime.
Judson Howe Go deeper. You kind of hinted at it, but you said you walked in with different set of ideas to CDC day one on what needed to be done. Maybe lay out for me some of the biggest surprises you saw when you got inside those doors and were sitting at a table that you hadn't been expected to sit at, that very few people get to sit at.
Katelyn Jetelina You know, I didn't realize — and I'm going to sound so naive walking in those doors — how political public health is. Public health has always seen politics as the third rail, right? Don't touch it lest you get burned. But that ignores that the third rail actually powers the train, that public health is inherently political. It's never been partisan, but it's inherently political. It's part of a massive system. If we wanted to talk about one thing, but The White House was dealing with China and another thing, they didn't want us talking about that because there's other huge players happening. So that was one big realization I had. The other was speed. I could not believe how slow CDC was, because of the bureaucracy, because of clearance. Getting a bureaucracy to go faster is incredibly challenging. That was something I'm very able to do outside of the government. Those were two things. Culture, I was really surprised about how much I had to educate other scientists about the importance of scientific communication and what that actually looks like, that communication is actually not just PR and marketing and branding. It's something that needs to be integrated in all of our systems, whether we're creating a dashboard or going on a panel. I'd say those were the three biggest surprises. But I learned a lot, that's for sure.
Judson Howe I try not to inject myself too much in this, but I just will connect with you for a moment. I was the president of several hospitals in the middle of the pandemic. And I saw it go from the hero of biomedical science bringing the vaccine to the communities where people were lining up irrespective of political ideology to receive this miracle vaccine, to within, I think six to nine months, you saw this rapid shift towards skepticism around the science and specifically in this case mRNA technology, and yet here you're talking about the politics being a being a major factor in large agencies. I just want to resonate really closely on when you said the third rail is not just the electrocution rail but it's also the powering rail. I'm going to carry that one with me, that's really powerful. I want to dive deeper into the moment of where did the CDC go wrong? Or maybe that's not the right question. Where did the aggregation of public health conversation in the United States go wrong in the heat of that moment, now that we're five or six years out from that moment? I'm thinking 2021 is kind of what I'm thinking.
Katelyn Jetelina How long do you have? I first want to say that I think public health actually got a lot right. We do not give enough credit to the decision makers that had to make really hard decisions on very, very little information going 2,000 miles per hour. We were losing 3,500 people a day at the height of 2020. And so one, I just I think that — and I was at some of those tables — they were really hard decisions. I was in Texas, and we had to decide in August of 2020 whether we're opening schools or not. It was like a trust jump, you just didn't know how this is going to turn out. There's this revisionist history that happens after a big health emergency or like a big pandemic. I want us to be really careful about not revising history.
Judson Howe Help us.
Katelyn Jetelina With that said, there are mistakes that could have been prevented that wasn't because we didn't have enough science. And that wasn't because of a lot of things. I think one of the things I made a mistake about, and I try to admit this as much as I want, is lab leak theory.
Judson Howe I don't know what that means.
Katelyn Jetelina There are two theories on how COVID-19 started. Was it a lab leak in Wuhan or a natural spillover from a bat or an animal? At first, all of public health really dismissed the lab leak theory, including myself. I didn't do it publicly, but certainly in the back of my mind. One reason I remember distinctly why was because of the messenger. It was because it was Trump. It was because it was wrapped up in all of these politics and conspiracy theories. And it was communicated like that from public health, that this was a natural spillover, this wasn't a lab leak. When in reality, we will never know, and it is a spectrum of possibilities. Now, I'm probably at about 70% chance it was a natural spillover, but, you know, 30% chance it probably could be a lab leak. So I think one thing we could have done and should have done much better is communicating uncertainty. This is what we know. This is what we don't know. And this is how we're finding answers. We could have done that with the lab leak. We could have done that with masks. We could have done that with vaccines. We could have done that with really everything. Because when you frame it as what do you know? What do you not know? And how are you finding answers? One, you're being honest, right? We don't know everything, especially during an emergency. And two, you're inviting the public along for the scientific discovery ride. And they're able to adjust quicker with more information and more pieces of information. So I think communicating uncertainty, I hope, is a lesson learned for the next emergency or even every day.
Judson Howe Zoom in on that lab leak, would that have changed any of the interventions that were being made off of limited science? Or was it just purely a credibility?
Katelyn Jetelina No. It's not even credibility. I think it was trust. I think that broke a lot of trust because the message people heard if they believed in the lab leak theory is, you're not right. We're the experts. You need to listen to us. And then over time, we're like, holy shit, it could have been a lab leak, right? That would lose my trust if I was the general public too. I think that being honest and being human about what is going on is one of the things we miss, as well as I truly believe one of the reasons why Your Local Epidemiologist (my newsletter) became so big was because there was such a gap between what people were hearing or being given versus the questions they actually had, the nuance that was necessary, and the translation of what was going on as well.
Judson Howe Even now, I've seen academic papers that you've been writing as recently as I think November in the NEJM, New England Journal of Medicine. You're still writing academically, but then over here, you're in this Your Local Epidemiology space. How different are those two worlds? How do you combine those two?
Katelyn Jetelina Oh my God. So different. I started out in academia. I was a professor of epidemiology. I had a research lab. I had grad students. I loved teaching. Teaching is like my love. If you can't tell now, I have a newsletter, I'm teaching the world about public health. I study violence epidemiology, actually. I started the newsletter when I was at the University of Texas Health Science Center, but there was a point where the innovation and freedom and platform that I created had to be separated from an institution. I have so many thoughts on academic institutions. There needs to be a lot of improvement there as well. In the end I have so much more autonomy outside of an institution. It's way more risky. It's more scary, but it allows me to say what I want to say. During the pandemic, I remember being told I can't say the word “mask” on TV because I was at a public university that got funding from Abbott in Texas. Again, politics, it gets messy when you're at an institution, and the freedom outside of one is something I will always embrace.
Judson Howe How impactful are those incentives? You mentioned a large corporation in this case, and you mentioned the academic institution. So how impactful are incentives to maybe compromising trust at the public level? And how have they affected maybe behavior in your career or things you've been willing to say?
Katelyn Jetelina The incentives aren't there for scientific communication. It's one of the reasons I left. You know, I was going up for tenure and my newsletter, which reached hundreds of millions of eyeballs in 132 countries was one bullet point on my CV under community service, right? The incentive structure isn't there. This is where I think academia can absolutely adapt as quickly as possible. You mentioned I wrote a New England Journal of Medicine article. Now I'm at the Yale School of Public Health under Dean Megan Ranney. She and I are so aligned about what's needed in this space, how to reimagine academic institutions, what skills we want to provide students, what are students demanding, listening to them as well. I think that I'm happy to be a part of strengthening institutions too, right? I have this rule with my kids at home, and it's a rule for myself too, that you can't complain without a solution. And so I deeply feel that I can't complain about CDC or academic institutions without being part of the solution too. It's been fun, but yeah, I wear many hats.
Judson Howe I want to dive deeper on, because I'm feeling it a little bit myself, but go deeper into the sense of fear or risk as you have made some of those pivots towards independence. Go deeper on those emotions for me.
Katelyn Jetelina I will say the hardest decision I have ever made was jumping from academia into the unknown, right? I'm an entrepreneur, and there's a lot of risk to that. There's a lot of risk to that. Academia is incredibly comfortable. I had two little babies at home, right? It gives you health insurance, it's just very comfortable. Actually, before the pandemic, I thought I was going to be there until I was 80, right? With socks and sandals and going for it, but it was clear to me at least where I wanted to make the most impact is I had to create that space and place to do it myself, and it was a leap of faith and it was terrifying. It was terrifying I would say on two levels –— I'm curious what your experience has been — but one, it’s risk, it's risk professionally. I have gotten death threats, people show up at my house, we have FBI involved and police. But I will say the thing that hurts the most is a thousand paper cuts from colleagues that don't understand the value of what I'm trying to build.
Judson Howe Give me an example one of those paper cuts.
Katelyn Jetelina A paper cut would be like don't take Katelyn seriously, she's just writing a blog. Or Katelyn doesn't know what she's talking about because mRNA actually does blah blah blah, it doesn't do something I translated for more of the general public. There's this culture within scientists, I would say, that needs to change around the value of engagement with the public, and that just takes time. So there's professional risk there that's hurt me a lot, I think. And then I said personal risk, too. Not only financially, but the safety of me and my family.
Judson Howe What is driving at the root of that personal risk? What do you think is making people cross that threshold towards personal risk in the general population?
Katelyn Jetelina It's changed over time. I will say during COVID, people were really angry. They were angry, they were frustrated, they were confused. One way to bring out that was to point it to anyone that was a public facing figure. I think that that's just one part of the job of being out there. I certainly wasn't the only one that got that. I have many, many, many colleagues, sometimes even more serious encounters than what I ever experienced. But people didn't feel heard, and that bottled up, and I truly think that's how it was unleashed. It went first from never-maskers as usually the people that would target me to then anti-vaxxers and now it's more like political, but I think it's just part of the job. The thing that sucks though is usually when you're in an institution, they help protect you around some of these personal risks. The University of Texas was so helpful for me on a lot of these things. They took it very seriously. When you jump out into the ether by yourself, you feel so much more vulnerable because you are, and it's a risk that you just have to take.
Judson Howe I just didn't think about the safety side.
Katelyn Jetelina Yeah, I don't know, it is —
Judson Howe I’m sorry that you’re going through that, have gone through that.
Katelyn Jetelina Thank you.
Judson Howe I want to go a little bit deeper on this academic to the shadow shade towards being a blogger, right? We were chatting about this a little the other day for us. You know, oh, how's your podcast going? How's that working out for you?
Katelyn Jetelina I think they're secretly jealous.
Judson Howe Exactly. Okay. Todd and I were also talking last night about the massive difference in the worlds of academic research and also the paradox there, which is it's probably the least influential, but the rigor is high and here you have — not that your blog is this way — but less rigor more impact.
Katelyn Jetelina But if you can marry those two, that's magical, right? I think that that's where we have to figure out how to do that, is how to bring more science to the people and people to the science.
Judson Howe I'm sensing this world where we have a lot of rigor in a scientific method in the academic research process but maybe less impact than the researcher would love to see from the amount of work that has gone into the research. And over on the other side you've made the transition also into mass communication of science to folks, with maybe a reduction in rigor from the academic side. How do we marry those two together for maximum impact going forward?
Katelyn Jetelina In research, there's this thing called T4, which is called translational research, right? It's like, how do you bring it from the bench to the people? There's a whole field around how you translate science to the real world. I think the challenge, though, is people don't see themselves in the research. They don't know that it's happening. They don't know how much value it is to take part in a survey because once you take a survey, you have no idea what happens with that data and how it informs people. I actually got my postdoc in stakeholder engagement with police officers and research. We need to create these feedback loops. Police officers would take these surveys, really hard surveys around trauma and PTSD. I couldn't believe how honest they were in these surveys. But that directly impacted police department policies around mental health. Helping them connect how this research funded by the NIH then can impact — and we’re part of the same team — their departmental policies is something I think we need to do far more in research, whether we call that dissemination or communication or stakeholder engagement. There's many different words for it, but really, truly have them as a partner and feed that back to them and to show appreciation. So that when NIH does get cut by 50%, they are just as angry because they saw themselves in that. I think that the disconnect between people, the real people and institutions, whether it's academia or CDC or health systems, is so disconnected that that's where we see ourselves right now. And people want to destroy those institutions. And quite frankly, I don't know if I blame them all the time, too.
Judson Howe I sense a deep sense of empathy even when you were talking about violence a moment ago. Where does that empathy come from?
Katelyn Jetelina I don't know, I just care about the world! I have two little girls … I'll tell you where it comes from, actually. I grew up in southern California in a very very liberal family, we're talking very liberal family. Then I went to Arizona for my undergrad and then grad school in Texas. In Texas is when the pandemic hit, and I was at the front line in a red state. I will forever ever be grateful to be an epidemiologist in Texas during that time, or in a red state during that time, because I was forced to listen. I was forced to understand where people were coming from, and understand the fears and frustrations, and understand where the questions were coming from, and understand why people decided not to get a vaccine and not hold them to that. I truly think it was that real world experience of being thrown into the field in a time where lives mattered has taught me that a lot. I'll tell you where else has taught me is the MAHA movement. I've been having a lot of conversations with them. I know we're going to get into that, but listening is like 80% of the formula here. Truly understanding where questions and concerns and confusion is coming from, and co-development and partnership is, one, how you build trust and two, how you actually save lives here. I guess I've just learned it over time. I've also learned that screaming into the void doesn't work. Maybe it'll make you go viral on Instagram and that feels good to go viral, I guess, but what does that actually achieve? I'm not sure. If I'm in it for the impact, and to advocate for the patient on the ground, I guess that's where I learned it from.
Judson Howe What impact are you trying to have?
Katelyn Jetelina Healthier lives. Specifically, in scientific communication, all I want is for people to have evidence-based information to make decisions off of. They can make their own decisions, obviously. All I want them to have is good information to make those decisions based off of, not of fear, not of rumors, not of falsehoods. That's my life goal, is to figure out how to get translated science in a timely actionable manner to people so they feel empowered to protect their family.
Judson Howe Is the issue with the public making good decisions the lack of credible information, or is it the lack of maybe a skill set or training on how to use information to make decisions? Where's the bigger weakness do you think right now?
Katelyn Jetelina The problem right now, which is very different than like the 70s and 80s, is we have information abundance. The problem is not information. In fact, it's oversaturated. The challenge is that people don't need more data and facts. They need narrators, they need storytellers, and they need navigators right now, to help make sense of the chaos. And this is somewhere we in public health are not trained on at all. I was never trained on this, right? The information landscape has just dramatically shifted. There's this curiosity-driven class that demands more questions, I think rightfully so, or demands more answers because they have questions, and I think rightfully so. We in public health and institutions and health systems have not stepped up into that, and because we haven't stepped up, there's voids. What fills the voids? It's falsehoods and rumors. We need to do better. I think that's where we're about 20 years behind. It's not going to be fixed tomorrow, but we can be doing things right now.
Judson Howe Let's go back to trust then, because that keeps coming up over and over in this conversation, and it actually did with some of our other episodes around primary care, as the silent or missing social determinant of health, is trust at the bedside. So that theme has been coming up. So back to trust. I want to ask specifically if, when the next pandemic — and God willing, it doesn't break out this year — but let's say there's a pandemic that breaks out and Katelyn Jetelina is asked to lead the national response. You, knowing what you know now, what are the top two or three things that you're going to do to make sure that we keep trust at the center of the national response?
Katelyn Jetelina If I had a scientific communications hat on during that response, I think the number one thing I would do is a weekly press conference. I couldn't believe CDC didn't do this during the COVID pandemic. Trust isn't declared, it's demonstrated. It’s demonstrated over and over and over again through a set of acts, through authenticity, through being human, through being transparent, through communicating uncertainty. People don't trust a brick wall, right? Humans trust humans. That's my number one thing. I'd get in front every week and just explain to people what we know, what we don't know, and how we're finding answers. The WHO actually did this during the pandemic, and I thought it was brilliant of them. Maria Tedros and Mike, top three scientists at the WHO, showed up every single week. You got used to seeing Maria's hair and how she ended up curling it differently the next week. You just got to know her because she kept showing up, and even if they had nothing to say they were there to answer questions. The second thing I think I would do is what I'm doing right now with the state of California, is figure out how to systematically listen a whole lot better on needs, on reactions, on information voids, on anticipating needs when something comes down the pipeline. One thing I still cannot believe we didn't do during the pandemic was we had nine months of creating this incredible vaccine using biotechnology. We threw all of our money at biotechnology. We did not think twice about behavioral science at that moment, and realizing that, hey, guess what, people actually may have questions about mRNA. Does it change your DNA? That's a pretty good question to me. Why did we not anticipate that? Or, why is this so fast? Is it still safe? How effective is it going to be? We could have done that nine months before that vaccine rollout, but we didn't. And so at the vaccine rollout, all of us in public health were surprised when only 40% of people really lined up for the vaccine. I would have more anticipation, more participation from the public and more visibility in how decisions were being made in real time.
Judson Howe Let's go back. I don't think we've quite pulled out the origins of YLE. How did you make the pivot from public health researcher/ scientist to what was the very beginnings of Your Local Epidemiologist?
Katelyn Jetelina It was organic. Actually, the dean of my school came to me and she said she knew I loved teaching and she said Katelyn can you just update faculty staff and students on what the heck is going on with this COVID thing and so I did. That was March of 2020. I sent emails out every single day about what the heck was happening. Really ugly Excel graphs. If you look back at my first emails, they're kind of funny. But just a few sentences on what I was watching and also what I was doing as a mom. At the time I had an eight-month-old and I was also pregnant and my husband was a police officer, so there was a lot happening at home too that I was trying to explain. In those emails, I signed it “love, your local epidemiologist” because that's who I was to them, right, my students and teachers or colleagues. Then a few days later, one of my students came to me and she said, Dr. Jetelina, can you just please put this on social media so I don't have to keep copying and pasting this for my family and friends? I distinctly remember looking at my husband and saying, what the hell? I'll only have to do this for six weeks max. And then surely someone's going to pick up the baton and actually explain to the public what's going on in a timely, in an understandable, and in an actionable manner. And that didn't happen. it grew and it grew and it grew and it grew. And it turned into this newsletter that went international. And now it's turned into a large team with lots of different programs under it. And it's still going strong even after the pandemic.
Judson Howe How has your scope or focus changed from the early days to what it is today?
Katelyn Jetelina Oh my God. It's changed so much. It was just COVID — not just COVID — it was COVID content every other day. It was just COVID everywhere. Then the emergency ended and I was like, you know what? I bet you no one wants to hear from an epidemiologist ever again, they're just burnt out. But I thought, let me see if I can show people that public health goes beyond a pandemic and goes beyond infectious diseases. And so I started talking about other things. I said earlier, I was a violence epidemiologist. I started talking about mass shootings. And I started talking about mental health. And I started talking about reproductive health. You can tell I pick really easy subjects. It was a little whiplash for people. They're like, why the heck are you starting to talk about other things other than COVID? But slowly and surely, I would say I succeeded. It's never decreased in readership. It's only exponentially increased. To me, that shows me a few things. One, I worked my butt off. But two, there was this huge gap that needed to be filled. I just happened to stumble upon it. Now it happens to be my life work. And it's been an incredibly wild ride, but I believe in it, and it's been fun. It's been really fun to do.
Judson Howe Do you ever have moments where you're like, I'm done?
Katelyn Jetelina Oh, yeah. Oh, my God. Yes. I would say maybe twice a year. You know, especially 2025. It felt very much like COVID. Well, I would say COVID made 2025 look easy, and that's because COVID was one thing, and 2025 was so much to try to cover.
Judson Howe Be more specific about what in 2025.
Katelyn Jetelina Well you had the election, and then you had DOGE, and I'm in the middle of a field with the huge target on its back from this administration. And in 2025, you had us leaving WHO, you had NIH being cut, you had one-third of CDC workforce being cut, you had the One Big Beautiful Bill that cut Medicaid, you had almost a mass shooting at CDC, you had vaccines with RFK, you have MAHA. Some of Maha has some really good ideas, but how do you like make sense of all that? It was really hard last year. I think it's going to get harder. It just reminds me of what COVID was like, that we need narrators and people to help make sense of this. Most importantly, people out there willing to put their neck out there, be courageous and stick up for the patient, stick up for the people, regardless of what you agree or disagree with the institutions about.
Judson Howe What has this taken from you personally to keep this going?
Katelyn Jetelina Oh, you should ask my husband this question. It's exhausting. I've sacrificed a lot. My kids wonder why mommy works all the time. But it's also needed in this moment, and I figure you know I can sleep when I die. It’s a sacrifice and it's a labor of love, that's for sure. But it's impactful, and that's what keeps it going. Hearing stories around how this work actually matters is the only thing that keeps it going.
Judson Howe Where is it going? Where is this thing going to be in five years?
Katelyn Jetelina I made a distinct decision about a year ago that I'm going to throw all of my finances, all of my heart, into building a place and space where scientific communication needs to live. That means strengthening my own team so it's not a one-woman show. It was a one-woman show for a long time, but that's not sustainable. Also to elevating other voices out there, teaching others how to do this, elevating them with my platform, and then helping institutions become more trustworthy from what I have learned. We'll see where that goes but I definitely feel like I'm in a jungle with a machete, like you just don't know where the path is going to go.
Judson Howe Lay out for us then, how are you currently, and how do you want to be, helping governmental entities and academic entities become better communicators and more trustworthy?
Katelyn Jetelina I think the most important thing, like I said earlier, is listening. We need to have better listening infrastructure so we can surface confusion and dissent but also ideas, up to the people that make decisions. One thing that I've started is this project called Project Stethoscope. The idea is to triangulate data from social listening to understand how people are receiving information, what narratives are out there, primary data collection, surveying people once a week to understand where confusion is, what their questions are that's not being relayed in like mass media, for example, and then creating networks of trusted messengers as well. I think the thing that institutions really need to build, and they don't know how to build it, is feedback loops up to the decision makers and back down and back up and back down to the people.
Judson Howe Why is that hard?
Katelyn Jetelina It's just never been something we've done. Traditionally, institutions are ivory towers. It's this top-down approach. They don't have the capacity to do it, as well as it's not a core capability. I think unless we see that communication has to be a core capacity within institutions, where people will actually invest in it, we won't get out of this trust problem. People have to feel heard. They have to feel seen, as well as decisions have to be reflective of the feedback they receive.
Judson Howe What advice would you give to a physician, nurse practitioner, advanced practitioner on the front lines of this? And I'm thinking the exam room, where they're dealing with growing mistrust, utilization of AI for self-diagnosis. What would your advice be for them to combat, and, like you said, for the larger entities to become more trustworthy and better communicators?
Katelyn Jetelina I don't know. I sound like a broken record, but I think the first thing is lean in with empathy, to understand that there's reasons people believe in certain things and realize that it's a really ugly chaotic information landscape out there and people are just trying to do the best that they can do. The thing I remind myself most of is, no one wants to die. Let's just start there, and we can move up from there. The second is listening. I think that the more we can give ears to people the better. That's sometimes hard in a clinic, right? You only have 10 minutes, or you have to get through do you want the vaccine or not, a we-need-to-move kind of thing. It's going to take reimagining how we interact with the public, reimagining the systems to move from there. I think right now there's so much, not I think, I know, there's so much attention on how do we combat mis- and disinformation? Like how do we do it? How do we do it? But I see mis- and disinformation as the tip of an iceberg, that actually what's below the surface, I would say about 80% of decisions made are from below the surface, which is questions, concerns, and confusion. And we have to fill that gap if we want mis- and disinformation to decrease. And so with nurse practitioners on the front line, with physicians, clinicians, I would say your number one goal is for you to keep the trusted relationship with the patient. Your number one goal is not to get them vaccinated. You want them to keep coming to you because if you lose that trust, they're going to go somewhere else. And the most trusted people right now are people on the front line.
Judson Howe When I look across the landscape of public health at the local governmental level. I'm talking like counties, etc, there seems to be a chronic underinvestment that's happening at that level. And we haven't talked about it in this conversation, but how do we go about better resourcing public health directors and public health physicians that are kind of there trying to stem and be the bridge between these larger entities that may be better funded, and working with smaller populations of communities and county supervisors, etc, to do this? What can we better do to support them in their work?
Katelyn Jetelina We need to get innovative. I think we need to get innovative on financial structures. I think one way to do that, what we desperately need is the integration of public health and health care. I think that there's lots of ideas kind of floating around there. One is like public health bonds. Health systems helping to pay and recognizing that public health upstream helps reduce health care costs in the long run and figuring out how we can better align. I think also the onus isn't just on other people. Local small public health institutions need to start making the invisible visible as well. People need to see what they're doing, feel what they're doing, feel a part of what they're doing, and that is very different than we've ever done in public health. If people don't feel and see it, it will never be funded. The third, I would say, is also we need to vote for people that see value in it too.
Judson Howe Isn't that the feedback loop, the ballot box?
Katelyn Jetelina It could be. It could be. You know, the ballot box. I mean, there's so many different reasons why someone goes to a ballot box. I don't know if it'll ever be about public health. But I think people need to recognize that public health is inherently political. And we need to lean in on that.
Judson Howe Do you think that this erosion in trust is reversible? Or is this the permanent state of the future?
Katelyn Jetelina Oh, my God. I hope it's not the state of the future. I mean, we'd be screwed. When we look back at the COVID-19 pandemic, the number one predictor on why a country did well was not GDP, was not how fast they got a vaccine, was not how much vaccines they had, but was trust. And it was trust in one another and trust in the government. We have no choice if we want to survive to figure this out. I think it's absolutely possible. There are things that I'm doing right now. I think the challenge right now is people feel paralyzed. They don't know where to go. They don't know what to do. But just start doing something differently, just one small thing, and those small things start adding up. If anything, it gives people hope and it keeps that engine going. I absolutely think it's reversible. Yeah.
Judson Howe We've talked about the local level. We've talked a bit about the U.S. governmental level, but do the states play a role in this as well? And what would you say, if a governor called you tomorrow? What would your advice be for them in this space?
Katelyn Jetelina I would say states play even a bigger role right now than they ever have before. We see that with states stepping up within the vaccine space, for example. We're going to see that with Medicaid dollars as well. This is becoming such a state policy landscape. We're going to see so much variability across states as well. Governors, I mean, Newsom called me, and I was like, we need to do this. And he was like, I'm down, let's do it. We need to start building trust, and we need to start doing things differently, and we need to have the courage to do it. I will say it's not just Newsom. There are many, many, just many states calling, because people know this. They know they need to do something differently. The challenge is what do we do? Where do we start? And with what resources? And so we'll see. But yeah, I do have hope. I do think institutions, they’d better be getting the hint about where we are right now and really starting to change how they talk about things, how they advocate for the patient and the person, and really some self-reflection on where they need to go to survive.
Judson Howe Do you have any concrete stories of how you've made an impact or YLE has made an impact? Give me one.
Katelyn Jetelina Sure. I mean, one person —
Judson Howe That was a little bit demanding. I'm sorry.
Katelyn Jetelina No, it's okay. I love it. Like I said, this is what fuels my tank. One person reached out and she was saying, you know, I got my dad to start reading your newsletter during the pandemic every single day. My dad has never had one vaccine in his life, but he got a COVID vaccine because of you. That was all worth it. Another example is a chief finance officer emailed me, say like a year ago. He said, Katelyn, I include YLE in my stock reports to my 100,000 employees because it's important for my employees to have ultimate health. And there are impacts we never get to see, but when we get to see them, oh my, it's so rewarding.
Judson Howe I love that. I'm pretty curious about healthcare costs and equity in this country. And yet I feel one of the biggest problems we have is the solutions sit out here, outside the four walls of providers and hospitals, and maybe inside of this other space, which I thought was public health. But it's also transportation. It's community food systems. It's all the stuff that public health says it's theirs. And public health, if you let them, they would say everything is theirs.
Katelyn Jetelina We would.
Judson Howe And, while that's true factually, not having the border almost weakens its ability to drive. And I'm not trying to opine too much. But I do want to understand from Dr. Jetelina's perspective, how do we go about making health care just a little bit more affordable? And don't boil the ocean but give me like a couple things and speak to me like I'm a hospital president that's got to bend the cost curve a little bit.
Katelyn Jetelina One of the coolest things I've seen is Medicaid waivers. There's been a few pilots. North Carolina, for example, did this. North Carolina has had this program called HOP, which what they did was use Medicaid dollars to, I'm going to botch this, Mandy Cohen's going to be so mad at me, but to pay for groceries for people with chronic health problems. What that recognized was that we can use money to prevent chronic health diseases. So they prevent the outcomes of chronic health so they don't end up going to the hospital in the first place. The problem with this is the chicken or the egg challenge, right? How can you take care of a very sick population while taking money away from that for prevention? Because it's going to be delayed, right? But I think that the more, like I said, innovative finance structures we have around prevention, the better. I would love to see more programs like that.
Judson Howe Yeah. I'm going to be more specific visually on this one. And that is, if you're a health system CEO, we're in San Diego. So you're a Scripps CEO and you walk into your CFO's office and he's like, you've been out there talking kumbaya stuff for too long. We've got a spreadsheet here that says we need to cover these gaps here. How would you talk to your CFO to say this is why this is important?
Katelyn Jetelina It reduces costs. If we invest in a public health program, say we want, as a health system, we want to invest in a grocery store for our patients in our hospital, that will turn into saved costs and more profit for the hospital in the long run. Well, I don't know about profit. But I think that you have to talk to them about their bottom line for them to actually care.
Judson Howe So it sounds like we have to align incentives.
Katelyn Jetelina Oh, my gosh. Yes. Align incentives, align data, align vision. One thing that I continue to be aghast about is how we don't have a shared vision on what does it actually mean to be healthy in America? And what is it going to take to get there? We just need a vision too and agreement, and get the fleet moving in the same direction, is what's needed right now.
Judson Howe Up in northern Cal, we had large risk-based models, right, so CFOs, CEOs aligned around bending the cost curve. Outside of Kaiser and a few big markets like the 99 corridor and the northwestern corridor, there's pockets of capitation but it's not big enough to move the needle. If I was Gavin, I'd be going hard at that right now. At a macro level in the biggest state, aligning the bottom line incentives. Because what's happening right now in the big systems, the faith-based, even Kaiser cheats at this a little bit, you can cut this one out, we're not really going at bending the cost curve. We're not really aligned around getting better outcomes. We're still fee-for-service driven, and post-pandemic the pendulum is swinging back to “we have to get back to our core product” and our core product is keeping our ORs running efficiently, keeping our beds full. That's what we know, and the leadership of health systems across the state is shifting back that direction, shy of maybe Kaiser, but I have energy around that. We have a moment where we could do a ton about that right now, and I’m afraid it's going to close on us if we don't start getting really serious about it.
Katelyn Jetelina I don't know if it's going to close. I think we're at a tipping point with the American people, that people are just fed up with these systems. What is it the number? You know this better than me, but like 70 percent of people are in debt from medical bills?
Judson Howe I’ve seen it from 60 to 80 percent, some numbers in those thresholds.
Katelyn Jetelina That's not okay. How is how are we living in a country where that is okay? I’m surprised first of all that no party has really taken this up and run with it yet. I think whoever does is going to win the next presidential election, because this is unsustainable. And with MAHA movement, with this distrust in institutions, I think people really want someone out there fighting for them, particularly around health care costs. So I don't know if it's going to go away. I'll be really curious to see how it goes through the midterms as well as the general election. But this is like the problem we need to solve in the United States. And so we'll see. You know, I think there's a lot of opportunity, like you said, with the state of California or even on a national level to really lean in. It's just a matter of who capitalizes on that and puts a finger to it.
Judson Howe In closing, map out President Katelyn Jetelina’s vision for us over the next four years. What do we all need to be doing? And give us like a little toolbox of things you want us all doing as well.
Katelyn Jetelina Next four years. I think one is we have to figure out what we're saving and what we're letting go. And to me, at least in public health, I can't speak for health care, but in public health, I think that is data systems. We need to preserve as much as possible. I think we need to lean in on communications and engagement. Put moats around that. If there's nothing else you can fund, fund those things. I think the second thing is one thing that's been killing me, and I want people to change this, I see it all over LinkedIn, is fighting for their institutions, fighting for the NIH grants, fighting for science with a capital S, instead of fighting for the people and fighting for their health. That's a small tweak, but it would go a really long way in people seeing us fighting for them. Third, we need a plan. You know, there's a reason why Project 2025 has been so well executed, because they were working on it for years. Where is our plan? What are we going to do with the health system? What is the goal in three years if there's a different administration, rubbles all on the floor, how are we going to reimagine this system? That's an incredible opportunity, and actually you can see it gets me really excited. I mean, the system sucked before, right? We're not going back to 2019, we're not going back to 2020.
Judson Howe Yeah, sometimes it feels like we're defending the old system that we collectively agree was broken.
Katelyn Jetelina It was so broken, and it's hard for me — you know in public health, we're so good at defense. we're not good at offense. And because we're so good at defense, it looks like —and it probably is — everyone's defending the status quo without realizing the status quo sucked in the first place. We need an offense. We need to figure out what is our shared vision? what is our plan, if we had a blank slate? and how we listen to people and activate people with a grassroots movement at the same time? So we have our work cut out for us, but there is opportunity. There is a lot of hope. And I always, without getting too political, I always remind myself right now that in history, after there's a dark time, there's always a period of enlightenment. And I'm very much looking forward to that period of enlightenment.
Judson Howe How can those watching this episode today become aware and connected with your work?
Katelyn Jetelina You can google me. No, I have a newsletter called Your Local Epidemiologist. That's probably the best way to connect. I’m there every week so you'll hear my voice in your inbox if you sign up.
Judson Howe I want to thank you for what you're doing, and I can promise you you're making a huge impact, Dr. Jetelina.
Katelyn Jetelina Thank you, thanks for having me.