Podcast

Episode: 102 |
Josh Sharfstein:
Public Health Crisis Management:
Episode
102

HOW TO THRIVE AS AN
INDEPENDENT PROFESSIONAL

Josh Sharfstein

Public Health Crisis Management

Show Notes

Our guest today is Dr. Joshua Sharfstein, the author of a fantastic new book titled The Public Health Crisis Survival Guide: Leadership and Management in Trying Times, published by Oxford University Press.

This book is a great read for any leader, not just those in public health, since the lessons are so broadly applicable, and the stories are so fascinating.  Also recommended for consultants who want to know how to advise a client through a crisis.

Josh is a physician and a public health leader who has held senior leadership roles at the city, state, and federal level.  He’s been the Commissioner of Health for the City of Baltimore, the Principal Deputy Commissioner at the FDA, and the Secretary of the Maryland Department of Health and Mental Hygiene. And he is currently a Vice Dean at the John Hopkins Bloomberg School of Public Health.

In this episode, Josh shares stories of crises he faced – include one on the very first day on the job.

The Public Health Crisis Survival Guide is not a dry manual – it is full of absolutely amazing stories – including the story of Frances Kelsey, the heroine of the FDA, who saved an untold number of American children from being born with birth defects because of her courageous refusal to approve thalidomide, despite industry pressure.

The book has very practical advice on how to recognize a crisis, manage a crisis, communicate through a crisis, and work to prevent the next crisis, and it is highly recommended.

One weekly email with bonus materials and summaries of each new episode:

Show Host: Hello, Josh. It is great to have you on the show.
Josh Sharfstein: Thanks for inviting me.
Show Host: Josh, what are some reasons that a company or an organization might be facing a crisis, but not realize it?
Josh Sharfstein: Well, I think that when people are imagining what their jobs are going to be, they are thinking about the things they want to accomplish, they have their plans, they have their strategies, that is how they think of their job. And then, what they find when they’re in an organization, in my case I’m thinking a lot about public health agencies, that all kinds of things interrupt that. And some of those things, people just want to brush aside, they want to keep focused on the reason they’re there, at what they want to accomplish.
Josh Sharfstein: But, as these things intrude, some of them can be quite disruptive. And it’s very important to pay attention to them, and, in fact, the argument that make in the book is that, it’s really important to think of them not just as interruptions, because those are things that can really make or break a career. So, I think the fundamental reason that people miss crises is it’s just not in their field of vision. They are trying to accomplish something, they have a strategy, they want to execute. And yet, there are things that are coming in from the side, and they just want to push them away, and they’re not really realizing that there’s a lot of danger, and also a lot of opportunity in what’s happening.
Show Host: And I love that chapter in your book, which I mentioned in the intro, The Public Health Crisis Survival Guide. And while the title has public health crisis in it, it’s, I think, a fantastic book for anyone to read, even if they have nothing to do with public health, because it’s such a fantastic kind of short, easily-readable, full of high-value information about how to identify and handle a crisis, for any kind of organization.
Show Host: And this chapter that you have on recognizing a crisis, was really cool, I thought. You mentioned a bunch of reasons, like bias towards the usual, cultural bias, poor information flow, it’s not our job, people just not paying attention to it. You’ve held several really senior leadership roles in public health. In Baltimore, I think, running public health for Maryland, and then at the FDA. Talk to us about one or two of the crises that you faced.
Josh Sharfstein: Sure. In terms of recognizing a crisis, I was sitting at my desk as the health commissioner of Baltimore City, kind of trying to get through all the usual work, thinking about what I wanted to accomplish, and where things were, and I got a call from the city lawyers’ office, and they said that they just wanted me to know, nothing to worry about, they were going test some soil in a park, in downtown Baltimore, this park, which is known as Swann Park, was famous for baseball players. There’ve been baseball fields for, like, a century. I think Al Kaline played on the field, or somebody in his generation.
Josh Sharfstein: And the law department was involved in some litigation that stretched back 30 years, because nextdoor to the park was a chemical factory. And, in the course of the litigation, there was some data that emerged that there was a lot of arsenic in the soil in the park, 30 years before. And the law department said, look, we’ve consulted with some technical experts, they say, there’s nothing to worry about now. The arsenic’s almost certainly gone, but, just out of an abundance of caution, we’ve sent some tests, and the tests will be back at 10:00 in the morning. Tomorrow. It was, like, 6:00 at night. I’m sitting at my desk.
Josh Sharfstein: And so, it was just a heads-up to the health commissioner, but nothing to worry about. And I hung up the phone, and I sat there, and I just stopped, like, why am I the last one to know? And I decided to call the 24 hour line at the Centers for Disease Control, and just run it by the environmental person on-call. And she was really nice, and she basically said that technical consultant is totally wrong, that there’s a 100% chance if there’s arsenic in the park 30 years ago, that it’s still there. The levels 30 years ago where somewhere in the ballpark of 20,000 parts per million, and the normal is less than 20.
Josh Sharfstein: So, it was a lot of arsenic, at the time. And she just said to me, look, arsenic doesn’t go anywhere, so they’re going to find it. They’re going to find very high levels of arsenic in the park tomorrow morning at 10:00 AM. So, then I was totally aggravated, because now it’s 8:00, I can’t get home, and why did I have to find this out so late? They should have told me as soon as those documents became available, and I as just feeling sorry for myself at my desk, and I called, actually, a faculty member here at the School of Public Health, to complain, and have him say, poor Josh, poor Josh.
Josh Sharfstein: And he basically kind of gave me a kick in the butt and said, you are the luckiest guy I’ve ever seen. And I said, what do you mean? He said, you know that there’s going to be a crisis tomorrow when this happens, and you’ve got a 12-hour headstart. And that gave me the chance to call the CDC person back, get a commitment that they would send a team to assess the actual risks to health, which we could announce. Prepare a press release that we were going to close the park. Alert everyone. Actually create signs that we were going to close the park, and, sure enough, when the numbers came back crazy high, we just executed that plan. We announced not only that the CDC was going to come in, but that we would have a investigation into how this could have happened, and why nobody heard about it for 30 years. And it turned into a very positive thing.
Josh Sharfstein: So, anyway, maybe that’s a long story, but it sort of shaped my understanding of, boy, if you can tell that there’s a crisis coming, it really helps. And when you stop and focus on it, you can turn it from something that would be, otherwise, just a crazy interruption to your day, into something that you can actually turn into a positive that builds confidence in your leadership.
Show Host: Yeah, so people can say, wow, he’s taking action right, look how squared away. How does one get prepared for a role like being the public health commissioner of Baltimore? I mean, because you’re a doctor, you’ve been writing a lot, you’re certainly deep knowledgeable at public health, but how prepared did you feel when you actually were on the job, day one? And, is there any way to prepare for a job like that?
Josh Sharfstein: Well, that’s one reason why I teach this course at the Johns Hopkins Bloomberg School of Public Health on crisis management, because I didn’t really feel like there was much preparation that I’d had before I went into a job like this. And I actually think in the standard public health curriculum, it’s all about the, what you want to do, what’s your strategy, what are your top priorities, what the strategic plan, kind of thinking, and not so much that, there’s a 100% chance you’ll get interrupted as you’re trying to move that forward.
Josh Sharfstein: And how are you going to handle that, and are you ready to pause and say, wait, is this something that could actually either knock me way of course, or be a great opportunity and I need to pay more attention to it? So, on my first day on the job, immediately, weird things started happening. I walked into my office, and the phone was ringing, and it was a Baltimore Sun reporter, who said, there’s a woman in Baltimore who was knocked over on the street by a rabid raccoon, who drooled on her face, and she’s totally exposed to rabies, and she was promised by your department that it would get her all the shots she needs, but you have missed the deadline.
Josh Sharfstein: And the reporter was, like, I have two questions. Number one, do you always miss the deadlines? And number two, is she going to get rabies? And I was, like, right there I had the good sense to say a few words that I’ve used to good effect, it should be in everyone’s repertoire, I will get right back to you. So, I was, like, I hung up the phone, I was, like, what in the world’s going on?
Josh Sharfstein: And I got everyone together right away, this was before I did anything else, to talk about rabies, and, it turns out, the number of cases had really gone up. It’d doubled in Baltimore. And we’d run out, primarily because we were promising that anyone in the city could get it from the health department, but we didn’t have enough for everyone in the city, and we didn’t need enough for everyone in the city, because people who had insurance could just go to the hospital, or a clinic, to get it.
Josh Sharfstein: So, we changed our policy. We did a press release telling everyone that rabies had gone up, and everyone should be careful, and know the symptoms, and all that. And so, we made sure that the person was able to get the treatment in the hospital as soon as possible, and, thank God, she did not get rabies. And so, we managed to kind of turn things around. That was day one.
Josh Sharfstein: Day two, day two, the newspaper started with a story that the health department was … My health department, that I was now in charge of, was citing college students for giving food to people who were homeless downtown, because they didn’t comply with the hand-washing regulation. Which, I mean, I didn’t know what there was a hand-washing regulation, but you can’t give out food unless there’s some place you can you wash your hands.
Josh Sharfstein: And the students’ argument was, we’re making the sandwiches in a kitchen, wrapping them, and driving downtown and handing them out. Why in the world would we need to wash our hands? Which, to me, seemed like a pretty strong argument. You know? Why are we citing them if it makes no sense? And so, the story was about how the students were planning civil disobedience against the health department. And I brought the team together that was working on that, and it was just sort of, like, have any of you talked to the students? No, no, no, no, no, we hear they’re being advised by a communist.
Josh Sharfstein: I was, like, they just want to give food to people who are homeless. So, I called up the president of the university, and said, I want to talk to the students. And he arranged for me to talk to the students, and introduced me to someone who ran the Center for Service Learning at the school. And I just sat there and listened to the students, and the students said, look, Dr. Sharfstein, I have been in college for three years. I’m going into my … Or, three and a half years. The whole time I’ve been in college, I’ve had three different majors. I’ve had two boyfriends. I’ve had five different addresses, if you count the summers.
Josh Sharfstein: But every single Monday night, I go to the same corner and give food to the same people. It’s more a part of my college experience than anything else, and you’re not taking it away from me. And I went back to city hall, and I was, like, uh, we’re going to lose this one. We need to rethink what’s happening here. And we wound up making an arrangement with a nearby church, we added city services, we were able to do a bunch of things. And in the interim, we let them keep feeding the same people.
Josh Sharfstein: And in the end, not only did we get a good editorial in the paper, did the students thank us, but some of those students went on to volunteer with the city. And one of them wound up even running homeless services for the City of Baltimore, years later. So, it was a total positive by the end. And I’m not even done with my first week. One of my chapters is just about my first week on the job, but I’ll stop there.
Show Host: You’re just, like, can I just get my business card first, and get my name on the door, and get my email set up? No. Facing crisis from day one. So, you’ve already started talking about it, we’ve talked about recognizing a crisis. Let’s talk about, kind of, crisis management. And you have a really cool chapter about the incident command system, which is obviously applicable to public health, but probably a good idea for just about any company to be thinking about setting up.
Show Host: If you’re a chemical company, or if you’re a manufacturing company, or, really, anything, having some kind of incident command system, separate from your normal chain of command. Talk about that a little bit. What is it, and how do you set it up, and what’s the purpose of it?
Josh Sharfstein: Sure. And part of the book actually goes through some of its uses outside of medicine and public health. Incident command actually started with firefighters. And the problem was that more than one fire company would show up at an event, and they didn’t know how to work together. And so, there was chaos, and the result of that is people were in danger, and the fires not getting put out. And so, they developed a way of having a universal management structure that different types of people could plug into.
Josh Sharfstein: And the idea starts with the insight that it’s not the usual chain of command. It’s a different chain of command for a particular incident. And the second thing is that there’s someone in charge, which is very important, because we’ve probably all been in situations where a bunch of people thought they were in charge, but the result of that is often chaos. So, you have one person who’s the incident commander at all times.
Josh Sharfstein: Now, that role can change. And, in fact, the third principle, really, is that it’s about the role, not the person. So, whoever is the incident commander at that moment is really in charge, and if you need to reach the person in charge, you don’t say, where’s Will? You say, where’s the incident commander? In fact, people even sometimes wear vests that say, incident commander. And then, the incident commander sets up the response as needed, with certain types of roles. Could be, one role is the public information officer, to deal with the press, on role is the head of operations, which will actually be doing the work with an operations team.
Josh Sharfstein: Usually there’s a safety officer, just to make sure everybody’s safe. A logistics team to support the operations team. And a planning office, which reviews the data, and actually can think about what’s necessary, what’s working, and what’s not working. And so, by thinking about that, and, again, each of those roles is the role, and people can go in and out of it. What that means is, you always have a functional management team when you need it, for a particular problem.
Josh Sharfstein: And you can use it for lots of different things. I think it’s great for fires. It’s really helped for fires. But, and, you might use it in a hurricane, in a public health setting, for example. We certainly did. But, I’ve found that you could use it for a bunch of other things, even really complicated projects that are really urgent and important, that just don’t really work with people’s usual day jobs.
Josh Sharfstein: And so, an example of that would be, we had a new vaccine requirement in Maryland, for middle school students. And that meant that a whole bunch, thousands of kids, needed to get new vaccines in order to go to school. Well, how are you going to get those vaccines to them? They don’t all have doctors appointments. So, we set up an incident command system. We had one person responsible for that, and, even though it wasn’t running 24 hours a day, everyone had a role on the team.
Josh Sharfstein: They created a operations team that set up vaccination clinics. They created a public relations team that told communities about the requirement, and where to get vaccine. And by the time school rolled around, we went from thousands and thousands of kids who could have been kept out of school, to just a few hundred that we could kind of pick off, and help when they showed up for school.
Josh Sharfstein: Another county in Maryland, at the same time, did not take that level of urgency for this, and just tried to say, well, I mean, we’ve got clinics. People can go to the website. It should be fine. And what happened was, thousands of kids were out of compliance, and the courts started getting involved, and the parents all got ordered to court, and the Washington Post was writing articles about it, and it’s so embarrassing to the county, and everybody. Whereas we had been able to get organized.
Josh Sharfstein: So, that’s not really like an infectious disease outbreak, but it, nonetheless, that management structure really helped us.
Show Host: Yeah, and I can imagine it’d be very applicable for all sorts of areas outside of public health. If a company’s recalling a defective product, or even if a company’s, let’s say, changing a ERP system, and switching from one to another, on day one, and two, there’s going to be all sorts of crises. Or, even if there’s some kind of scandal, or if there’s some kind of accusation in the press that you need to be able to respond to, real time, and communicate with the board, or with shareholders, or with the press about some kind of crisis like that.
Show Host: Talk about communications. So, incident command structure, you mentioned the communication officer, what are some lessons learned that you’ve had from getting the communications out?
Josh Sharfstein: Sure, well, in my communications chapter, I reviewed a lot of the communications literature from business crisis communications, which is very interesting, and it’s obviously a pretty well-developed field. The Centers for Disease Control has a great communications guide. And they have some basic rules. Be first. Be right, I think, is one of the other ones. Make sure you’re accurate. Express empathy. Are examples of those. And I think that I view those as sort of the 101 of communications. Even though you can look around and realize that a lot of people haven’t passed the one-on-one in communications.
Josh Sharfstein: That you see people, for example, using multiple spokespeople for different crises, and they start saying different things. And then everybody gets confused, and it just makes everyone look bad, or people start accusing each other of things. And it’s not working particularly well. I think the core of crisis communications 101, is credibility. If you don’t have credibility, you can not communicate in a crisis. People do not believe anything that you’re saying.
Josh Sharfstein: And keeping credibility, making sure you don’t blow your credibility, aligning with people who are credible to improve your credibility, that is the most important thing. You’re basically cooked without credibility. And I’ve seen that happen to people in the public health world, for sure. And it’s tempting to sort of tell people something that you hope to be true, even if you’re 100% sure, it sounds good. But if you start going down that road, you’re really playing with matches, because if it turns out you’re wrong, and you’ve told everyone, you’ve given your word, and it really damages your credibility, it’s really, really hard.
Josh Sharfstein: So, that’s really the one-one-one. Be right. Communicate early and often. Be credible. Be reasonable. Have your best communicator out there consistently, to the extent you possibly can. And then, there’s sort of communications 201, which is really about the politics. You can do all those 101 things right, and yet, there’s some just completely different kind of factor that knocks you off course. And public health, it’s often about politics. People have predetermined ideas about what works, and what doesn’t, even if it’s not based evidence. People have biases.
Josh Sharfstein: And you also have the issue of politicians, when you’re talking about the public sector. And so, part of the book talks about how to maneuver through those things. And, I guess, one thing that might be a good crossover lesson for business is that, you often hear that the head of the organization really has to be the face of the organization. And there’s a danger that, if people think that the head of the organization has to know everything, that the head of the organization is responsible for every up and down in a crisis response.
Josh Sharfstein: In the public sector analogy, this would be the governor. If the governor gets up there, goes, I’m in charge. We have whatever the crisis is, we have a hurricane coming, and I’m totally in charge. I’m going to be making all the decisions, everything. Now, anything goes wrong, it’s right on the governor. And that’s not a good situation for the governor, or for the state. It’d be better if the governor were there, I don’t want the governor not to be there.
Josh Sharfstein: But to say, I’ve set up a team to manage this. It’s general blank, who’s going to be the incident commander, and he going to be advised by the health commissioner and this person. And we are completely activating state government for this emergency. I’m going to turn things over to the general. And then, the general gets up, and explains what the plan is, and, if things work, or don’t, somebody who has a different kind of credibility can explain why, or why not, without making it all about the governor, and it creating openings for political opponents, and others, to just throw stuff on the governor, for no good reason.
Josh Sharfstein: If I make a decision for the health side, for example, that we’re going to not close a particular kind of facility, or we are going evacuate a hospital, say, and then someone gets injured during the evacuation, people can blame me for that decision, and I can explain, well, I understand that this is a terrible thing that happened, but here’s what we were thinking. And it doesn’t have to be the governor doing all that.
Josh Sharfstein: And I think it’s important in communications as you’re thinking about the politics of it, that you have really good spokespeople, but also, that it’s clear that there’s some degree of professional competence that’s been brought in to manage this, with people who know how to handle communications, rather than trying to do it all yourself as the leader.
Show Host: So, probably a lot of people have said this, it may have been Rahm Emanuel, but, to never waste a crisis. Talk a little bit about how, either in public health, or elsewhere, you can take advantage of a crisis to prevent the next, but also kind of make improvements in the system.
Josh Sharfstein: Sure. I mean, I think that crises are an opportunity for people to step back, and question their assumptions about how things should be structured. And it’s a like a huge blank slate sometimes, for people to ascribe meaning to what happened here, and what can we do so that this horrible thing doesn’t happen again. And I think it’s really important to have answers to those questions. My basic concept is, the most important thing an organization can do is, deal with the facts of the crisis well first.
Josh Sharfstein: Then you need to have a coherent explanation of what happened. And then you can talk about what it would really take to prevent a problem moving forward. And if you can really hit those three, it’s very, very strong. Because the first one, really responding to the crisis gives you credibility. And then, the explanation helps people understand.
Josh Sharfstein: So, an example from my own experience was we had a horrible outbreak at a plastic surgery center. Well, it wasn’t a plastic surgery center. It was a cosmetic surgery center. That’s probably better said. And, I think, one person died, and two people got seriously injured with the flesh eating infections. Very serious bacterial infections.
Josh Sharfstein: We heard about the problem, I think, through the news, and when we inspected, we found just a whole range of serious deficiencies. And so, the first thing that we did was, we shut down the facility. We explained our inspection, and we explained that this was inappropriate, we were going to use the authority that we had as the health department. And we really did a really solid press conference to explain that we were really on the side of safety for people.
Josh Sharfstein: At the same time, though, we planted a little seed, we said that these cosmetic surgery centers did not have to receive a state license. And we then opened a public comment period on, does anyone have any ideas for what could be done to prevent this from happening again? It turns out that these problems were happening in cosmetic surgery centers across the country. And we got people to write in and say, yeah, maybe they should have a license.
Josh Sharfstein: We worked with the media to tell the story about a family. And the media framed it around the idea of, you go to eat, and you assume the place is inspected. You go to the hospital, and you know that they have a license to operate. Why not a cosmetic surgery center? And the family was, like, we were shocked when we realized there had been no oversight. And all that led to the state legislature passing a law to allow us to do inspections ahead of time, and give licenses, which, I think, helps to screen out the really bad actors in that particular field.
Josh Sharfstein: And by going one step at a time, if you started out by saying, well, we’re not going to shut the place down until we have a new law, then people are, like, you’re not doing your job. But if you go one step at a time, I think it’s a great opportunity to do something that could never have been done otherwise. If we’d just shown up one day, and decided, hey, we just think cosmetic surgery centers need a license, then they would have objected, and nobody would have understood, and we never would have gotten it.
Show Host: So, you shared some amazing stories about, just, day one, and day two on the job, of crises coming up and kind of capturing your attention. What did you do as a leader to not completely drop kind of your priority areas that you wanted to accomplish, some of the more strategic things? Could you talk about any either daily routines, or weekly routines, or any kind of things that you did to deal with crises, but then, also, not forget about the other big things that you wanted to accomplish?
Josh Sharfstein: Sure. So, I was really fortunate, at the various jobs that I worked in, to work with some great people. And building a team, is, I’m sure, a topic of one your podcasts, somewhere out there, because it’s so important to management. And I felt, over time, I understood my own management style, I understood what I really needed from other people. And I sort of evolved to having regular meetings to really talk about our key priorities, and what we could do to keep them moving forward.
Josh Sharfstein: I really tried to surround myself who really understood what they were doing more than I did, and I really appreciated when people told me I was off on the wrong course. I was really wary of the feeling, or the sentiment, sometimes, which I used to describe as, someone shaking their head and going, I knew that wasn’t going to work. You know, that drove me crazy. I would have an idea, and people would be, like, great idea, great idea, great idea. And then it would not work, and people would then tell me all the reasons it was never going to work.
Josh Sharfstein: And so-
Show Host: Why didn’t you tell me then? Back at that meeting.
Josh Sharfstein: … Right. Exactly. Oh, yeah, I mean, and so, I could tell you a very funny story about that. But I think, in general, really having good people reviewing your plans, talking over problems, listening to different concerns that people have, and then adjusting, is really important. And sometimes it gets really hard, and you have to reach outside your organization for different kinds of perspective on what would be needed to get things back on track.
Show Host: And on the personal side, do you have any daily routines, or morning routines, maybe things in the morning that you do regularly to start your day, or throughout, that you’ve found that really work for you?
Josh Sharfstein: No, I was usually pretty happy just to get into the office with all kids successfully in school, and fed, and everything like that. The days that I would have a big day at work, and I would get to the office, and it’d be, like, one of your children forgot their lunch at home. And then, I would be, like, oh, how did that happen?
Josh Sharfstein: So, I would say we were a little bit more in survival mode at home. Probably we could have been a little bit more efficient in different ways. But, I think … I know that there are definitely sort of, like, books, like the 10 secrets to success, how to organize your life for greater efficiency and mastery and dominate the world, and all that. I think I’ve been in these environments where there are just so many different things happening at all the time, it’s really hard to do the same thing all the time. And I’ve had to evolve perspectives, even as I’ve gone from different levels of government to the other, let alone other kinds of transitions.
Josh Sharfstein: And so, I think building a good team, being able to talk to people. Obviously, I have friends, and others who I would call in really difficult situations. Those have been kind of the most important things to me.
Show Host: You mentioned different levels of government, and you have leadership experience at city, state, and federal. What differences would you say that you’ve seen between those levels of government?
Josh Sharfstein: Sure. The city is really cash-strapped. Most cities are. There’s not a lot of flexibility in organizations. There’s huge, intense pressure to deliver. I had great mayors that I worked for, and they were very demanding of results. Anyone feels like they can call you up, at any time, and they do, and I enjoyed that. So, it’s really a frontline kind of job. I describe my job as city health commissioner as, more pounds per square inch of pressure than anything else that I’ve ever done.
Show Host: Wow.
Josh Sharfstein: It’s just people really expect you to be there all the time. And to be ready to respond to anything. Then I went from there to the federal government. And the federal government has a different vibe, in part because it’s so big. There’s certainly more money, and the federal government has so many great people working on different problems, but not quite always the same sense of urgency.
Josh Sharfstein: And an example of that would be very early on at my time at the FDA, some people there brought me a problem that some face paints had been contaminated with mold, and I think a girl scout troop that put them on got painful facial rashes, which eventually resolved, so it was not a permanent scarring, but it was uncomfortable, right? You put on face paints, and you get a horrible rash.
Josh Sharfstein: They knew I was a pediatrician, and they wanted me to know. They thought I would give them points, because they identified something that I was interested in. And I said, wow, that’s great. What’s the plan? And they said, well, the company has two weeks under our policies to announce a recall. And I was like, say that again? And they said, two weeks to announce a recall. That’s our policy. It’s not a life-threatening problem, so we let the company say that they’re doing the recall. We don’t come out and say that they’re doing the recall.
Josh Sharfstein: And I said, how about they do it this afternoon? And everybody was like, well, that’s not our policy. I’m, like, well, how about we change the policy? If it were your daughter who wanted to put on the face paints, wouldn’t you want to know? What is the possible justification for two weeks in that situation. And they kind of looked at me, and I said, let me put it to you another way. If I’m the health commissioner of Baltimore City, and the mayor calls, or not even the mayor calls, somebody calls, and says, there’s a group of girl scouts somewhere in West Baltimore, and they’re about to put on face paints that’s going to give them horrible rashes, I can’t say, it’s okay, we’ll deal with it in two weeks. I’ve got to drop what I’m doing, and stop those kids from putting that on their face.
Josh Sharfstein: And if I don’t do that, and it comes out that I knew that that was going to happen, I would get fired. And I should get fired. And, just, the federal employees just looked at me like I was crazy. But we did make an announcement that day. And so, I think there’s just a little bit of a different vibe, but they have a different scale. They’re dealing with things across the whole country. They have to make sure that everybody is treated fairly.
Josh Sharfstein: And so, I really appreciated the commitment that people at FDA have, and I saw that they can really respond. We actually set up incident command at the FDA for the first time. I think. And I saw that the FDA really can be quite responsive to public health crises as they’re happening.
Josh Sharfstein: The state is sort of a bit of a mix. In some places it acts like a local health department, in some places it acts like a federal agency. And so, it’s a little bit of both. I was very involved in healthcare financing at the state, and I found that very rewarding. It doesn’t have a lot of money, state government, so it’s more like the city in that regard. But it’s not necessarily pressed up against the problems like the city is, and so you have to overcome, I think, some of the, like, this, we’ve got plenty of time to work this out kind of feeling that sometimes you get in the federal level.
Show Host: Josh, I’m going to remember this next time I see one of my daughters at a birthday party, about to get some face paint. I want to thank you for being on the show today. This was an awesome discussion, and really love your book, Public Health Crisis Survival Guide. Strongly recommend it, and it was great to catch up and hear these stories from you.
Josh Sharfstein: Oh, yeah. It’s wonderful. And keep in touch.

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