“2022 Monkeypox Outbreak: Situational Awareness” with Syra Madad [Zoom]

[from Harvard Kennedy School’s Belfer Center, part of Harvard University]

Thursday, July 21, 2:30-4:00 PM EDT

RSVP (Required)

The 2022 Monkeypox outbreak continues to expand with case counts mounting in many countries. This seminar will cover where we are in the global fight against monkeypox, where we may be headed as a nation, and what we need to do right now to mitigate the growing threat of monkeypox. Join Belfer Fellow Dr. Syra Madad in conversation with Kai Kupferschmidt, Dr. Krutika Kuppalli, Dr. Anne Rimoin, Dr. Boghuma Kabisen Titanji, and Dr. Jay K. Varma.

About the Speakers

Dr. Anne Rimoin is a Professor of Epidemiology at the UCLA Fielding School of Public Health. She is the Gordon-Levin Endowed Chair in Infectious Diseases and Public Health. Dr. Rimoin is the director of the Center for Global and Immigrant Health and is an internationally recognized expert on emerging infections, global health, surveillance systems, and vaccination.

Rimoin has been working in the DRC since 2002, where she founded the UCLA-DRC Health Research and Training Program to train U.S. and Congolese epidemiologists to conduct high-impact infectious disease research in low-resource, logistically-complex settings.

Dr. Rimoin’s research focuses on emerging and vaccine-preventable diseases. It has led to fundamental understandings of the epidemiology of human monkeypox in post-eradication of smallpox, long-term immunity to Ebola virus in survivors and durability of immune response to Ebola virus vaccine in health workers in DRC. Her current research portfolio includes studies of COVID-19, Ebola, Marburg, Monkeypox and vaccine-preventable diseases of childhood.

Boghuma Kabisen Titanji (MD, MSc., DTM&H, PhD) is a Cameroonian born physician-scientist and Assistant Professor of Medicine at Emory University in Atlanta. She obtained her MD from the University of Yaoundé I in Cameroon and worked for two years after graduation as a medical officer, before pursuing post-graduate research training in London, United Kingdom. As an awardee of the prestigious Commonwealth Scholarship program, she obtained a Masters Degree in Tropical Medicine and International Health from the London School of Hygiene and Tropical Medicine, a diploma in Tropical Medicine and Hygiene from the Royal College of Physicians and a Ph.D. in Virology from University College London. Dr. Titanji joined Emory University School of Medicine in 2016 where she completed a residency in Internal Medicine, on the ABIM research pathway and a fellowship Infectious Diseases. She has three parallel career interests: translational and clinical research in HIV and emerging virus infections, science communication, and global health. Her clinical focus is general infectious diseases and people with HIV. Her current research focuses on chronic inflammation as a mediator of cardiovascular disease in people with HIV. She is passionate about leveraging translational research to improve the care of people with HIV, global health equity and using science to influence health policy through science communication and advocacy.

Jay K. Varma, MD is a Professor of Population Health Sciences and Director of the Cornell Center for Pandemic Prevention and Response at Weill Cornell Medicine. Dr. Varma is an expert on the prevention and control of diseases, having led epidemic responses, developed global and national policies, and led large-scale programs that have saved hundreds of thousands of lives in China, Southeast Asia, Africa, and the United States. After graduating magna cum laude with highest honors from Harvard, Dr. Varma completed medical school, internal medicine residency, and chief residency at the University of California, San Diego School of Medicine. From 2001-2021, he worked for the U.S. Centers for Disease Control and Prevention with postings in Atlanta, Thailand, China, Ethiopia, and New York City. From April 2020 – May 2021, he served as the principal scientific spokesperson and lead for New York City’s COVID-19 response. Dr. Varma has authored 143 scientific manuscripts, 13 essays, and one book.

Kai Kupferschmidt is a science journalist based in Berlin, Germany. He is a contributing correspondent for Science where he often covers infectious diseases. Kai received a diploma in molecular biomedicine from the University of Bonn, Germany and later visited the Berlin Journalism School. He has won several awards for his work, including the Journalism Prize of the German AIDS Foundation. Together with two colleagues he runs a podcast on global health called Pandemia [German]. He has also written two books, one about infectious diseases and one about the science of the color blue.

Krutika Kuppalli, MD, FIDSA is a Medical Officer for Emerging Zoonotic Diseases and Clinical Management in the Health Emergencies Program at the World Health Organization where she currently supports activities for the Monkeypox outbreak and COVID-19 pandemic. She completed her Internal Medicine residency and Infectious Diseases fellowship at Emory University, a Post-Doctoral Fellowship in Global Public Health at the University of California, San Diego and the Emerging Leader in Biosecurity Fellowship at the Johns Hopkins Center for Health Security. Dr. Kuppalli currently serves on the American Society of Tropical Medicine and Hygiene (ASTMH) Trainee Committee and is the Chair of the Infectious Diseases Society of America (IDSA) Global Health Committee.

Dr. Kuppalli was previously awarded the NIH Fogarty International Clinical Research Fellowship and conducted research in Southern India to understand barriers to care and how emerging infections impacted persons living with HIV/AIDS. She was the medical director of a large Ebola Treatment Unit in Sierra Leone during the 2014 West Africa Ebola outbreak, helped lead the development and implementation of pandemic response preparedness activities in resource limited settings, and has consulted on the development of therapeutics for emerging pathogens. Her clinical and research interests focus on health systems strengthening in resource limited settings, research and clinical care for emerging infections, outbreak preparedness and response, and policy. She has worked in numerous countries including Ethiopia, India, Sierra Leone, Uganda, and Haiti.

During the COVID-19 pandemic Dr. Kuppalli served as a consultant for the San Francisco Department of Health and helped develop and operationalize a field hospital. She served as an expert witness to the U.S. Congress, Financial Services Committee Task Force on Artificial Intelligence (AI) about how digital technologies may be leveraged for exposure notification and contact tracing to improve the pandemic response. She also collaborated with the Brennan Center for Justice to develop guidelines to inform “Healthy in-person Voting” in advance of the 2020 U.S. election and testified before the U.S. House Select Subcommittee regarding these recommendations. Prior to her position at WHO, she was the medical lead for COVID-19 vaccine rollout at the Medical University of South Carolina (MUSC) and helped coordinate vaccine education events for the staff and community and oversaw the reporting of adverse vaccine events.

Since joining WHO in August 2021, Dr. Kuppalli has been part of the WHO headquarters incident management team (IMST) for COVID-19, the clinical characterization and management working group for COVID-19, the COVID-19 therapeutics steering committee, and is the technical focal point for the post COVID-19 condition (Long COVID) steering committee. She is a member of the secretariat on the scientific advisory group on the origins of emerging and re-emerging infectious diseases (SAGO) which was convened by the Director General to understand and investigate the origins of SARS-CoV-2 and other novel pathogens. More recently since the development of the multi-country monkeypox outbreak she has been part of the IMST at WHO as one of the clinical management focal points. In this capacity she was part of the WHO core group that helped write the recently published Clinical Management and Infection Prevention and Control guidelines for Monkeypox and advising on the clinical endpoints for the global CORE therapeutics protocol.

Dr. Kuppalli is recognized as a scientific expert in global health, biosecurity and outbreak response. She was recognized by NPR Source of The Week early in the pandemic as an expert to follow and named to Elemental’s 50 Experts to Trust in a Pandemic. She has been a frequent contributor to numerous domestic and international media outlets including The New York Times, NPR, Reuters, The Washington Post, Vox, Stat News, San Francisco Chronicle, Forbes, NBC Bay Area, BBC News.

COVID-19 and “Naïve Probabilism”

[from the London Mathematical Laboratory]

In the early weeks of the 2020 U.S. COVID-19 outbreak, guidance from the scientific establishment and government agencies included a number of dubious claims—masks don’t work, there’s no evidence of human-to-human transmission, and the risk to the public is low. These statements were backed by health authorities, as well as public intellectuals, but were later disavowed or disproven, and the initial under-reaction was followed by an equal overreaction and imposition of draconian restrictions on human social activities.

In a recent paper, LML Fellow Harry Crane examines how these early mis-steps ultimately contributed to higher death tolls, prolonged lockdowns, and diminished trust in science and government leadership. Even so, the organizations and individuals most responsible for misleading the public suffered little or no consequences, or even benefited from their mistakes. As he discusses, this perverse outcome can be seen as the result of authorities applying a formulaic procedure of “naïve probabilism” in facing highly uncertain and complex problems, and largely assuming that decision-making under uncertainty boils down to probability calculations and statistical analysis.

This attitude, he suggests, might be captured in a few simple “axioms of naïve probabilism”:

Axiom 1: more complex the problem, the more complicated the solution.

This idea is a hallmark of naïve decision making. The COVID-19 outbreak was highly complex, being a novel virus of uncertain origins, and spreading through the interconnected global society. But the potential usefulness of masks was not one of these complexities. The mask mistake was consequential not because masks were the antidote to COVID-19, but because they were a low cost measure the effect of which would be neutral at worst; wearing a mask can’t hurt in reducing the spread of a virus.

Yet the experts neglected common sense in favor of a more “scientific response” based on rigorous peer review and sufficient data. Two months after the initial U.S. outbreak, a study confirmed the obvious, and masks went from being strongly discouraged to being mandated by law. Precious time had been wasted, many lives lost, and the economy stalled.

Crane also considers another rule of naïve probabilism:

Axiom 2: Until proven otherwise, assume that the future will resemble the past.

In the COVID-19 pandemic, of course, there was at first no data that masks work, no data that travel restrictions work, no data of human-to-human transmission. How could there be? Yet some naïve experts took this as a reason to maintain the status quo. Indeed, many universities refused to do anything in preparation until a few cases had been detected on campus—at which point they had some data, as well as hundreds or thousands of other as yet undetected infections.

Crane touches on some of the more extreme examples of his kind of thinking, which assumes that whatever can’t be explained in terms of something that happened in the past is speculative, non-scientific and unjustifiable:

“This argument was put forward by John Ioannidis in mid-March 2020, as the pandemic outbreak was already spiralling out of control. Ioannidis wrote that COVID-19 wasn’t a ‘once-in-a-century pandemic,’ as many were saying, but rather a ‘once-in-a-century data-fiasco’. Ioannidis’s main argument was that we knew very little about the disease, its fatality rate, and the overall risks it poses to public health; and that in face of this uncertainty, we should seek data-driven policy decisions. Until the data was available, we should assume COVID-19 acts as a typical strain of the flu (a different disease entirely).”

Unfortunately, waiting for the data also means waiting too long, if it turns out that the virus turns out to be more serious. This is like waiting to hit the tree before accepting that the available data indeed supports wearing a seatbelt. Moreover, in the pandemic example, this “lack of evidence” argument ignores other evidence from before the virus entered the United States. China had locked down a city of 10 million; Italy had locked down its entire northern region, with the entire country soon to follow. There was worldwide consensus that the virus was novel, the virus was spreading fast and medical communities had no idea how to treat it. That’s data, and plenty of information to act on.

Crane goes on to consider a 3rd axiom of naïve probabilism, which aims to turn ignorance into a strength. Overall, he argues, these axioms, despite being widely used by many prominent authorities and academic experts, actually capture a set of dangerous fallacies for action in the real world.

In reality, complex problems call for simple, actionable solutions; the past doesn’t repeat indefinitely (i.e., COVID-19 was never the flu); and ignorance is not a form of wisdom. The Naïve Probabilist’s primary objective is to be accurate with high probability rather than to protect against high-consequence, low-probability outcomes. This goes against common sense principles of decision making in uncertain environments with potentially very severe consequences.

Importantly, Crane emphasizes, the hallmark of Naïve Probabilism is naïveté, not ignorance, stupidity, crudeness or other such base qualities. The typical Naïve Probabilist lacks not knowledge or refinement, but the experience and good judgment that comes from making real decisions with real consequences in the real world. The most prominent naïve probabilists are recognized (academic) experts in mathematical probability, or relatedly statistics, physics, psychology, economics, epistemology, medicine or so-called decision sciences. Moreover, and worryingly, the best known naïve probabilists are quite sophisticated, skilled in the art of influencing public policy decisions without suffering from the risks those policies impose on the rest of society.

Read the paper. [Archived PDF]

Education: Disease, History and Lit

The Italian writer Giovanni Boccaccio lived through the plague as it ravaged the city of Florence in 1348. The experience inspired him to write The Decameron.

The Plague of 1665 in England was a major upheaval affecting Isaac Newton’s life.

The 1984 movie, A Passage to India (David Lean) set in 1920s India, has a scene where the ever-present lethal threat of cholera is discussed as Doctor Aziz lies sick of a fever.

The W. Somerset Maugham novel, The Painted Veil (2006 movie) is also about cholera in the Chinese countryside in the 1920s.

Manzoni’s 1827 The Betrothed, the most famous classic novel of Italian literature, centers on the plague to drive the story.


Etymologically, the term “pest” derives from the Latin word “pestis” (pest, plague, curse). Hardly any disease had such cultural and historical relevance as the bubonic plague. Throughout the centuries, the plague was the most terrifying infectious contagious disease which generated a series of demographic crises. The plague epidemics influenced the evolution of society biologically and culturally speaking. The Black Death was one of the most devastating pandemics in human history, is estimated to have killed 30%–60% of Europe’s population, reducing the world’s population from an estimated 450 million to between 350 and 375 million in 1400. This has been seen as having created a series of religious, social and economic upheavals, which had profound effects on the course of European history. It took 150 years for Europe’s population to recover.

The plague returned at various times, killing more people, until it left Europe in the 19th century. Modern epidemiology (Dr. John Snow, London) has its roots in cholera management and water sanitation as well as waste management.

Education involves seeing disease as a major protagonist in all history and not as a footnote.

The classic Plagues and Peoples should accordingly be studied by every student: Plagues and Peoples is a book on epidemiological history by William Hardy McNeill, published in 1976.

It was a critical and popular success, offering a radically new interpretation of the extraordinary impact of infectious disease on cultures and world history itself.