In New Role, Dr. Wafaa El-Sadr Seeks to Harness University Knowledge to aid COVID-19 Response

Zachey Kliger (MPA ’22) interviews Dr. Wafaa El-Sadr about her career accomplishments, and how her experience working on the HIV pandemic has prepared her for COVID-19.

Dr. Wafaa El-Sadr, a University Professor of Epidemiology and Medicine at Columbia University, the director of ICAP at Columbia University, and the director of the Global Health Initiative at the Mailman School of Public Health, was appointed in January by President Lee Bollinger to serve as the next Director of Columbia World Projects. Dr. El-Sadr will assume the role on March 1.

CWP is an initiative focused on bringing Columbia’s academic resources to bear on the significant challenges facing humanity. Avril Haines, the previous Director of CWP, took a leave of absence to serve in the Biden-Harris administration, and was confirmed by the U.S. Senate on January 20 as Director of National Intelligence. 

I had a chance to speak with Dr. El-Sadr over Zoom earlier this week, roughly one year after the first reported COVID case in the United States. She greeted me with a warm smile from her office on the Columbia University Medical Center campus. We talked about her career accomplishments, the importance of global collaboration, and her outlook on the COVID-19 pandemic. 

The following has been edited and condensed for clarity.

Q: You currently are a Professor of Epidemiology and Medicine at Columbia’s Mailman School of Public Health, and the Director of ICAP and the Global Health Initiative (GHI) at Columbia. You also serve on the President’s Advisory Task Force on COVID-19, and recently accepted an appointment to be the next Director of Columbia World Projects. Do you find connections and similarities between all of these roles?

A: There are some really interesting connections across all of these roles. I find that I enjoy the mix of the different positions and what they offer me. I enjoy teaching students, and I enjoy doing research. And I also enjoy designing health programs and being a part of teams that implement programs and answer big questions. Each of these roles in some way fulfills something that I enjoy, and I like having the mix of interesting challenges. 

Q: Did you always have an interest in infectious diseases? What drew you to study HIV and Tuberculosis early in your career?

A: I was born and raised in Egypt. Having grown up in a low-income country, I think I gravitated towards the major public health threats that I was most familiar with. In Egypt, infectious disease was a very prominent health threat. So I think that contributed to my interest in infectious disease specifically, but also to my interest in public health and population health overall.

Then, during my training I specialized in infectious disease, and I was freshly minted when HIV came on the scene here in NYC. Obviously for many of us in infectious disease we gravitated towards trying to tackle the big pandemic of our generation. There were compelling reasons for people like myself to become involved both in terms of taking care of people living with HIV and also doing research on HIV, and so on. It was kind of fortuitous that HIV came on the scene right as I was beginning my career in infectious diseases.

Q: What inspired your decision in 2003 to take what you had learned as the Director of Infectious Diseases at Harlem Hospital and apply it to the global fight against HIV?

A: I think in part because I am an immigrant to this country I’ve always been connected to the world. And not just where I came from but broadly speaking.

Tackling HIV in Harlem was not easy. It was a very stigmatized disease. There was a lot of discrimination against people living with HIV, particularly in disenfranchised communities like Harlem. And many people with HIV in that community were forgotten. My early career at Harlem Hospital was really enmeshed with trying to develop high-quality programs that provided services that patients needed, as well as building bridges with the community to gain their trust. 

With the advent of effective treatments for HIV in the U.S., I felt that I wanted to take some of the lessons I had learned at Harlem Hospital to other parts of the world. At the time there was a huge disparity between the U.S. and Western Europe – where people could gain access to these lifesaving treatments – and other parts of the world, where millions and millions of people with HIV had absolutely no chance of getting treatment. That’s what motivated the establishment of ICAP: To try to show that by working on the ground and supporting people on the ground, similar progress could be made in tackling HIV in Africa.

Q: Is there an accomplishment or career achievement you are most proud of?

A: I think of [my work at Harlem Hospital and in sub-Saharan Africa] as very pivotal moments in my career, and they are very similar in some ways. It was very satisfying to be able to establish a program that was comprehensive, humane, and high quality for people in Harlem. And similarly, it was an amazing opportunity to be able to actually demonstrate proof of concept for our programs in Africa – to show that it was possible. Both of those were pivotal moments in my career.

Q: I’d like to shift gears to COVID-19 and your new role. Is a global pandemic like COVID-19 something you had feared or thought about ever prior to last year?

A: Yeah. I think for people like myself who are in the infectious disease world and have lived through HIV, and have seen the emergence of other epidemics like the first SARS epidemic and the H1N1 influenza pandemic, these kinds of outbreaks are really not beyond the realm of reality. We always felt we should do everything possible to prepare for such epidemics, both from a prevention and response standpoint. This whole area of emerging pathogens or emerging infections is something we always worry about actually.

Q: A year into this pandemic, is there anything that has surprised you (positively or negatively) about the global response?

A: It’s interesting. I always say that it’s not often in history that two pandemics occur simultaneously. But that’s what we’re living through now. The HIV pandemic hasn’t gone away. And now there’s the COVID pandemic. There are lessons to be learned from both. For example, one of the most disappointing aspects of the COVID response, at least in the U.S., has been the lack of a coherent, comprehensive response across the whole country. Obviously, you have to adapt to various parts of the country, because NYC is quite different from rural Iowa. Nonetheless, there needs to be a cohesive response that takes into account the diversity of the country. We’ve kind of fractured our response and lost precious time. 

The other thing that’s been disappointing has been the realization that the disinvestment in public health, something many of us have been talking about for years and years, has come back to haunt us. There’s been a lot of attention around health insurance and health care access specifically, but much less attention paid to the public health infrastructure of the country. Now, when we have to tackle a pandemic like COVID-19, suddenly you see all the pain points. Had we had a robust public health system, we would have been better positioned to be nimbler and respond more effectively. 

One other thing I’ve learned from my work on HIV is the value of leadership. Having outspoken leadership on the HIV pandemic has made a huge difference, not just for people living with HIV but also in terms of the success of the HIV response. In terms of COVID I feel like we’re now struggling with how to get vaccines to people who need the vaccines. We’re re-discovering the importance of engaging communities from day one. We’re seeing that you can’t cut corners. You have to do it early and often, and keep building on these relationships. 

Q: One of the common threads throughout your career has been your focus on the underserved communities most impacted by HIV and other infectious diseases, from Harlem to Sub-Saharan Africa. How concerned are you about unequal access to COVID treatments and vaccines? 

A: I am very concerned. If we don’t make this a priority and actively try to think about it every day, I think unfortunately we’re going to see what we’ve been seeing, which is the disproportionate mortality in certain communities, limited access to some of the treatments, and so on. If you just keep going with business as usual, we know what’s going to happen.

Particularly as it pertains to the vaccine, I personally feel like we should have started this work way back last summer. We knew the studies were happening for various vaccines, so it shouldn’t have come as a surprise that we would have vaccines ready to go. It’s unfortunate that now the vaccines are here and we’re just starting the efforts to engage communities. I think this work should have really started six months ago or even earlier.

Q: Why was there a delay?

A: We were struggling. We were struggling with testing and scaling up of testing. We were struggling with hospitals that were full of patients. We were struggling with trying to get consensus around if people should wear masks or not wear masks. We were struggling with advising communities about opening up bars, cafes, gyms and so on. We were struggling with a lot of issues. We didn’t have a plan, and we were struggling with division and confusion. In a way, we couldn’t think ahead. We were tackling the crisis of the day.

Q: Why did you decide to serve as the Director of Columbia World Projects, and what is your focus as you take on this new role? 

A: Columbia World Projects is such an expansive initiative at the University. It’s really at the core of what I strongly believe in. The idea behind CWP is that Universities should reach beyond their walls and turn the knowledge that they generate into action that solves world problems. This very much resonates with what I strongly believe in, which is using knowledge and research to change policy, implement programs, scale up interventions, and so on. I think for those reasons I thought it was a natural progression of what I like doing and what I want to do.

Q: What is your outlook on the pandemic over the next 6-12 months? Are you optimistic about the vaccine deployment? Are you concerned about these new variants of the virus?

A: I am an optimistic person, through and through. I don’t feel like everything is lost. In this country, there is the promise of a new administration that is coming in with a much more coherent, cohesive plan that’s attuned to public health principles. I think that will be very valuable.

I also think there is evidence of global solidarity to some extent. We need a lot more of this. But there are conversations about how we can make sure other countries have access to vaccines. I do worry though that we may have a repeat of what I saw in the early 2000s with HIV treatment, where we have something so valuable, but it doesn’t reach all the people who need it. I hope that there will be the same kind of vigor and global commitment to the COVID vaccine that there was for HIV treatments.

Q: What do you hope the global health community and global community at large learns from this pandemic?

A: One important lesson is that viruses know no borders. An outbreak like COVID-19 or others cannot be contained in one place. People can’t feel safe behind walls. If it’s there it’s everywhere. That’s a very important lesson.

Another important lesson to be learned is the importance of investment in public health. This is not just an issue in the U.S. but elsewhere. And the hope is that between pandemics we won’t let public health wither again because of the perception that infectious diseases are a thing of the past. I hope there will be a serious investment in resources, in people who want to do public health work, and in the data, surveillance and training systems that are necessary to tackle these challenges.

The third lesson I hope we learn is the importance of global collaboration. I find that one of the silver linings with COVID-19 has been the tremendous collaboration among scientists and researchers around the world. I hope that the importance of working together and sharing information to solve common problems is one of the lessons that will endure beyond the pandemic.