In conversation with ... Julio Frenk

In this episode of Not Alone: Leaders in Conversation, host Rafael Bras discusses higher education, public health, and leadership with Julio Frenk, the incoming chancellor of the University of California, Los Angeles. Frenk, a former president of the University of Miami, shares his rich background—from his family's escape from Nazi Germany to his groundbreaking reforms as Mexico's Minister of Health. He delves into his decision to shift from clinical medicine to public health, his influential role in creating Seguro Popular, and his perspectives on the impact of the COVID-19 pandemic. Frenk also discusses the challenges facing higher education today, and his unique contributions to children's education through his book series on human physiology. This episode offers valuable insights into how evidence-based policy, global cooperation, and enlightened leadership can shape better outcomes in health and education.

00:00 Introduction to Not Alone Leaders in Conversation
00:51 Meet Julio Frenk: From Mexico to Harvard
01:35 Family Background and Early Influences
06:18 A Diverse and Accomplished Family
09:59 Choosing Public Health Over Clinical Medicine
16:31 Navigating the Political Landscape as Minister of Health
25:41 Creating Seguro Popular and Its Impact
33:16 Massive Loss of Progress in Mexico
33:48 Impact of COVID-19 on Mexico
37:03 Leadership Styles and Pandemic Outcomes
40:02 Gender and Leadership During the Pandemic
41:47 Lessons from the Pandemic
50:11 Higher Education Challenges and Opportunities
01:01:38 Children's Books and Science Education
01:09:51 Concluding Thoughts and Reflections

Transcript

This transcript was generated automatically. It's accuracy may vary.

Welcome to Not Alone Leaders in Conversation, a bi monthly podcast where we delve into the minds and experiences of academic leaders who are shaping the future of higher education. Your host is Rafael Bras, professor at Georgia Institute of Technology and editor of Elsevier's Not Alone newsletter.

In each episode, he will explore the complex challenges, decisions, and opportunities facing academic institutions today. Whether you're an academic leader, work in academia, or simply want to learn about the latest topics that are top of mind for academic leaders, the series is designed to provide valuable insights and inspiration.

Please join us as we embark on this journey of conversation, discovery, and leadership.

We're honored today to have Julio Frenk visiting with us. Julio is the incoming chancellor of the University of California Los Angeles. He just completed nine years as president of the University of Miami. Frank is a physician and holds a PhD also in medical care organization and sociology. His early career in Mexico was in public service where he culminated that career as minister of health of Mexico.

And then came to Harvard, as we will explore later. Welcome, Julio, to Not Alone, Leaders in Conversation. It's really good to see you. 

Thank you, Rafael. Thank you for this invitation. 

Julio, let me begin a little bit with your background, because I'm a firm believer that we are all shaped by our history.

You're a first generation physician, clearly from a very well educated family. Can you tell us a little bit about them? 

Sure. In my, like every one of us, the background is, the sequence of contingent events that eventually lead to one's life. In my case that, the, crucial event was the rise of antisemitism and and hate.

in, in one of the most educated societies in the 20th century, the German society in the 1930s. And that led my my grandparents, with their son, my father, who was six years old, and his sister, my aunt, who was four years old, to decide to leave in the early thirties, as the climate was, deteriorating.

My paternal family was a typical urban, they were in Hamburg. professional, intellectual, middle class, Jewish, fully assimilated family. The, if there had been a place in, Europe where one would not have expected the type of antisemitism that took hold of that society, that would have been Germany, because Jews were very, highly assimilated, highly patriotic.

My grandfather, when he was studying medicine took a leave of absence to serve on the front as a medic in World War I. Was condecorated for that, and they led a, one would call a stable life where, we had these two children, but they decided early on and through a number of circumstances that I won't detail, they ended up going to Mexico.

Basically, my grandfather was a physician in the social insurance scheme. of Germany, which was the most advanced of its time. And Mexico was about to, develop a social insurance system. And they thought his expertise would be very helpful. But the fact of the matter is that even though my grandmother, who was a very intelligent woman and who lived to 106 years, although she had taught herself several languages, including Spanish, my grandparents came with these two young kids to a country that was very different from the country that we're coming from.

They took a ship, they landed in in, on the coast of the Gulf of Mexico, in the city of, on the port of Veracruz in the 1930s. And they looked very different. They spoke very differently, only my grandmother could speak Spanish and with a strong accent. They prayed differently. They were very, much strangers.

And Mexico did something that is very inspiring. They exhibited kindness to strangers, generosity to strangers. It is easy to be kind and generous to one's family and friends, to people that, that look like you and think like you. and pray like you and make love like you. It is hard to exhibit that kind of generosity to strangers.

And that is exactly what Mexico did. They took them in, they embraced them, they allowed them all kinds of opportunities that eventually allowed my father to have seven children. I'm one of those. And we were, and then my aunt to have another three. So there are ten grandchildren. We were all brought up.

With this idea of reciprocating the generosity that was exuded to our family by people who didn't have any obligation to them. And yet they did that, and by saving their lives, as they were fleeing an unsustainable situation in their home country, as they saved their lives, they made my own life possible.

So to me, that's It will be the defining episode of my life. 

It's a fantastic story and a lesson that we seem to have forgotten around the world. And needless to say, you are an example of what that type of generosity and kindness can result in. You mentioned you have seven siblings. And, I know you have a very famous sibling.

Can you talk about your siblings? 

Yeah I have, six siblings. It's seven of us, but one of my siblings is a twin. I have a twin sister, which is an absolute blessing. Highly recommended if one can be a twin. And and then it's five sisters, five women. All of them very talented, very accomplished, and one brother.

My brother is very famous. He's a cosmologist. at the University of Durham, member of the Royal Society in London a very, prominent scientist one of the most cited cosmologists in the world today. I also have my, my, family was an interesting mix because my father was like his father and his grandfather, a physician like myself, and one of my sisters, by the way, is also a physician.

And, my mother was a piano, a classical piano concert player. At some point, she gave up her career to, raise this large family, but she made sure that, two of her daughters became professional musicians. So I have two sisters. One is also a piano. concertist. She just finished literally a few days ago her tenure as the dean of the music school at the National University of Mexico, which is the oldest university in Mexico and also the third oldest in the Americas after Santo Domingo.

I'm sorry, the second oldest after Santo Domingo came the University of Mexico and then came Lima. And one of my sisters lives in the UK, as does my brother she works at Oxford University. Another of my sisters, as I say, is a physician, a very skilled and beloved physician, and then my twin also got a lot of the musical talent.

So you have those two strands, a strong appreciation for art, specifically music, but art generally, and a very strong orientation to science. So we grew up in a very mystic household. My father, Jewish, although he was not practicing, his family was not practicing, as I already said, they were highly assimilated. 

My mother was also a nun, not very religious, but she was not Jewish. She was a Catholic in the country. Her father himself had migrated from Spain. So we had diversity in our household. Very complimentary. There are personalities between my dad and my mom, but very different.

One is scientist, the other a musician, one Jewish, one not Jewish. And we just grew feeling very comfortable in the midst of difference. And I think that's the other great lesson that that I was just fortunate to to be born in a household like that. 

Yeah. But what a joy to be in such a an environment, an accomplished set of siblings and parents.

So it must have been tremendous. Great opportunity for dinner conversations between music and science. That's the perfect combination 

and a lot of arguments, a 

lot of arguments. That's good. That's good. It's always good. As long as, they're well done is the way to go. You, did your medical degree at the Autonoma of Mexico Universidad Autonoma de Mexico.

And then you decided to go to the University of Michigan. Where you got three different degrees there. Why did you decide to go to Michigan? You already had your physician's degree. Why, didn't you just stay? 

I was saying that both my six siblings and myself and my three cousins who were the direct descendants of these migrants, these refugees from Germany, we, have all had a very strong sense that we need to give back because of that generosity to strangers that, that made our lives possible.

And in my case, I found medicine. A natural fit I was very close to my father and and in he was a great influence for me. And I was a very good medical student, eh, at the same time, I was living in a country with huge social inequalities. And as a young person, I was very impressed and, decided I needed to do something.

So when the time came, even though I had passed all the exams that would be required to do a, residency to become a specialist in one of the many clinical specialties of medicine. I decided I would like to do public health instead of clinical medicine. Some of my classmates asked me, oh, so that means you're no longer going to see patients.

And I said, no, the only, I am going to see patients. The only difference is that now society will be my patient. And that is my definition of public health. It's just like medicine. Instead of seeing one person at a time, society becomes your patient. And like in medicine, one part of public health is diagnosing.

What are the ills, the diseases of a, society? Not just what is the level of diseases, but how they are distributed among different social classes, geographic region, regions, racial or ethnic groups, how they are distributed, what are the inequalities that are present in a society. And then once you diagnose that, and that, by the way, is the science of the epidemiology that gives us that sort of understanding of the way, of the frequency, distribution, and determinants of diseases.

and risk factors in a society. But then you need to have a prescription, and that's the whole field of health policy. How do you design health systems so that they are accessible to everyone and they deliver high quality health care while protecting people from the financial consequences of disease or of taking care of disease?

There's a million families every year, according to the World Health Organization, that become impoverished because a member of that family gets sick and they need to pay for that care. That's not a good health system. So a good health system is one that is accessible to everyone, that provides high quality care, both technically and also in the way people are treated with respect to their, fundamental rights, to their confidentiality, et cetera.

And that protects those same families from the financial consequences of, losing health or taking care of your health. I decided that's what I was going to study. And it was also my good fortune that I met a brilliant researcher. His name was Avedis Donavidian, Armenian, also a a victim of the, Armenian Holocaust in the earlier part of the, in the 20th century, who had, whose family had to flee and lost many siblings in that process.

And eventually migrated to the United States, a physician who had specialized in public health and had made Okay. The study of the quality of care, his central focus of scholarship. And he was eventually recruited at, the University of Michigan. I met him at a conference. He was truly a scholar, the definition of a scholar, a person with very clear ways of thinking, of structuring his thoughts.

And then a superb writer, he, many books. And he became, he really founded the field of the study of the quality of health care. People speak to this day of the Donabedian paradigm of quality of care. So I decided that was the person I wanted to study with. I applied only to the University of Michigan.

Thankfully I was admitted, and I ended up spending four years as a first master's and then doctoral student. I, was also then offered and accepted a position, a tenure track position to stay there as an assistant professor. And ahead of me in life was a very clear academic pathway, when, and I think I became very close to Donabedian, to Professor Donabedian Avedis, as I call him, he became truly my mentor and, I was going to following his footsteps when Mexico appointed a very, enlightened person as the Minister of Health.

It was a crisis of legitimacy. They were looking for prestigious people. And the person who was the president of the National University when I was a medical student and who I met like that, became minister. He had a very ambitious reform agenda, and he asked me to come back and set up a research component so that reform effort would be informed by scientifically derived evidence.

And at that point I spoke with my mentor, I know he wanted me to stay, but he understood that this was a unique opportunity to go back to my country, serve my country. And that's when I came back to Mexico. But, that episode was driven by this search for, knowledge and learning from truly a, masterful mentor that was very, fortunate to, get to know.

You, you ultimately went back to Mexico, as you said. Got into public service and became the Minister of Health. In the eyes of many, and certainly mine, ministers are political figures they're appointed by the president, they're members of the cabinet. How did you navigate that political environment?

I was appointed in a very special historic moment. And first of all, let me tell you, when I came back after my studies My focus was in providing rigorous research to inform policy. So I started interacting, there was this enlightened minister of health who had been, as I said, president of the National University, a very famous scientist, biochemist, originally.

And, I developed also a very, close relationship. I have had very important mentors in my life, starting with my dad, then professors on obedience, then Dr. Guillermo Soberon, who was a minister at that point, they, really gave me incredible opportunities. And so I was on, on these on the, side of a dialogue, which I think is essential between policymakers and academics who produce very rigorous research.

And immediately translate that research so that it's relevant for policymaking. One of my basic ideas and values is that excellence and relevance are not opposed objectives. They actually reinforce each other. So eventually my service in that research position led to the creation of the National Institute of Public Health.

I was the founding director general, I developed the project, I oversaw the building of its headquarters in a city 50 miles south of Mexico City. It has become, it's still there 40 years later, and it has become the, I think, most, distinguished center of higher education and advanced research in public health in any developing country in the world, recognized by objective indicator.

I was, always in that interface between research, the academic work, and education, educating also leaders for the health system, and policymaking. That led me to constant contact with the policymakers. At some point when I finished my eight years as the founding director of this institute I, took a sabbatical at Harvard.

Because we had a very strong, collaboration with Harvard. They, we sent many, people to get their PhD so that they would come back and be the staff of this institute, the faculty of this institute. And and that led me to a position at the World Health Organization where there were the first two.

Again, an enlightened leader that opened incredible doors. Her name was Gro Brunsland. She was, she is, she's still thankfully very much alive. She, the first woman Prime Minister of Norway. Yes. And also the youngest Prime Minister of Norway. 

Very well known. 

Very well known, The Brundtland Report coined the term sustainable development, which now is in place use.

So, when she finished her second period as Prime Minister of Norway, she was elected Director General of the World Health Organization in Geneva. And because of the work I had been doing at that interface between evidence and policy, she recruited me to be a member of her cabinet and to establish a new unit within WHO called Evidence and Information for Policy.

That was exactly the title. I was there when Mexico in the year 2000. I joined WO in 98 and I was gonna stay there for her term of five years. But in, in 2002 and a half years of me serving at WHO Mexico had a historic election. It was the first fully democratic election, a party different than the one that had ruled for 72 years.

For 72 years, they had won every single election, and if they hadn't won, they, they claimed they wanted, so they had held the presidency for 72 years. But through a series of reforms that colleagues from my generation pushed over 30 years, Mexico fought to have democracy. Eventually, we had a very a clean election and a member of the opposition won.

His name is Vicente Fox. He was looking for new faces for his cabinet. And interestingly, he thought he didn't want to have conventional politicians, but he didn't think about inviting billionaires or things like that. You don't have any experts today. It sounds like a crazy idea. Why not have some experts in the cabinet?

Not in every position. Most of the cabinet is intrinsically political. That's what government is about. But there are some cabinet positions that have a technical core. Education, environment, health, treasury. You need to actually understand the economy if you are to be a treasury secretary. Treasury always had a technocrat, so that was not new.

What was new was in, in ministries or departments like health and education and environment, they actually recruited experts. I was in Geneva working on the World Health Organization. I didn't campaign for the president. I didn't even vote for him because I couldn't vote since I was not in Mexico. But I was, rooting for him because I wanted democracy in my country.

So the. Contacted me I, had an interview, very positive, immediately connected with, the President elect at that point. And he invited me to, to be the, Minister of Health. And when I accepted, and I was obviously very honored, I did ask for one thing, I said the reason I am coming is I need some assurance that when there are controversial policy issues, you will support a position based on evidence, not ideology.

Because he was from a center right party, and I'm a little bit, I'm also a very moderate person, but not on the right, definitely. And I knew that especially with reproductive health. I was likely to run into some issues with members of his party. And the president elect looked at me and said, Julio, that is why I'm appointing you.

Okay. And, that was tested at some point. We, approved emergency contraception. There was a big backlash from multiple conservative forces. And when I offered to resign because I wasn't going to, back down because of ideological pressures, Because the evidence that there was some concerns, there was some confusion that this emergency contraception was was the, pill that produced abortions.

It was not that. It was, the day after pill that you use as emergency and there's abundant evidence that is one of the most effective. measures to reduce abortions, because you reduce unwanted pregnancies. Unplanned pregnancies or unwanted pregnancies, that result from rape you, take, you avoid conception and In the exceptional emergency way, you avoid unwanted pregnancies.

you, avoid abortions. so I was able to explain that to religious leaders who were opposed to members of the president's party. I was not, I have never been a member of a political party. The answer to your question, Rafael, is I always said I am a health professional in a political job, not a professional politician in a health job.

And so I had a very, clear guidelines. You can only serve in government if you're willing, you're not willing. If you have decided that you will step down, you will resign if some of your fundamental values are. are challenged. And I had a litmus test and thankfully I was able to do a lot of things that were very satisfying to me.

And I think positive for the country because I had That identity as a health professional in a political job, it actually makes you a better politician because people, the politicians trust you. I, they knew I didn't have any personal agenda. I didn't want to become governor or senator or anything. I was just interested in advancing health.

That's a, great, statement, a great advice again, one that, that is very apropos to the times. As part of your period as minister, you created the, what was called the Seguro Popular which as I understand that was effectively a single payer. program that went on for several decades successfully, but then it failed.

Can you talk a little bit about that? 

Sure. So the, yeah, the most important accomplishment was a comprehensive reform. It included a number of elements. For example, we established a a science based Modern regulatory agency, people don't think of ministries of health as regulatory. They think it's it's the doctors and the nurses taking care of six people.

Maybe you know, the vaccines and the public health side. But actually in governments, everywhere in the world, health departments are among the most regulatory intense, think of the us. The Food and Drug Administration, just think of, that. The, Occupational Safety and Health Agency, OSHA.

The Environmental Protection Agency, that although it's not administratively part of the Department of Health, it is, most of its regulations are based on, on, on the health effects of pollution. And lead to regulation. So the, elements, the criteria for, the regulatory actions of agencies like that are based on on a health concern.

So we created a modern regulatory agency both to protect the health of people and also to make sure that, Mexico had a strong science based element to oppose, health related, barriers to trade. The most common non tariff barriers to trade are health or environmentally related for example, with food and other things.

By then, Mexico was in the NAFTA with the U. S. And Canada, and, Mexico needed a, very strong agency to be able to counter any such thing. So it was. Fundamentally, to protect the health of people, but also to protect the economy. That was, that's been established. It's still there.

I think it's been a very, powerful agency. The other element that, that was the health protection agency. But there was another part of protection that was needed, which was the financial protections of people who get sick. And Mexico in the year 2000 was about a hundred million people. Half of them had some form of insurance, mostly employment based, but not through private insurance, but through a social insurance mechanism.

It was the institution that was created when my grandfather moved to Mexico that he helped create. That insurers. And I'm going to talk about a very important field which is the health and well being of And I'm going to tell you how I came to this idea. And you have to think about it. I don't mean to be too radical.

I'm not

saying that this is a bad idea. beacons. This was a reform that was going to cost money and to the Congress that in a democracy, you couldn't have first class and second class citizens on any dimension based on the type of job they have. I said this is like if, to vote. You could only vote if you held certain jobs.

That was the origins of the right to vote. Only landed people, with above a certain income level, only men could vote. But it became a universal right. As in any democracy, you need to apply the same standard to social rights, not just to political rights like the right to vote. Prominent, or the most prominent of those Rights are the right to education and the right to health.

And therefore, we had to have a universal system, meaning that everyone could exercise that right equally. Irrespective of whether you had a job or not, that should not be the criterion. Because a child with leukemia, it's not his or her fault that the dad is a, person working in in, is a peasant working in his fields or her fields, and therefore doesn't have insurance.

Thank you very much. So I argued on that principle and so we did was create Yes, a single payer, a public insurance scheme for the 50 percent of people who were not covered by the employment based insurance. And those were the poorest people. The largest group were peasants, people working in, in, in agriculture but they were also self employed small merchants in the cities, self employed professionals the lawyer or the accountant who, who works on his or her own.

It was very successful, it allowed the investment in health to quadruple in real terms, adjusting for inflation between 2000 and 2050. So in, in the, program was not perfect, had a lot of things that needed to be improved but it, it, was passed in my, the administration I served under. The following two administrations expanded coverage, so that it was now covering everyone, Mexico had near universal.

A health coverage in 2018, though, Mexico fell prey to the wave of populism that started around the world, it was not just Mexico, it was all over the world, populist leaders whose basic premise is to divide people, and they have a divisive policy and sometimes and create enemies. And, they typically have a very narcissistic style of leadership that says that everything that came before was wrong, but they are going to save the country.

So Mexico had such a president elected in 2018, and he decided that everything, not just in health, that had been achieved. In what he called the neoliberal period, which is really a total misuse of the term. This was not neoliberal. This was based on the opposite of neoliberalism. This was based on social rights.

But anyway, he decided that everything that had come before him was wrong. He was going to save it. He was going to launch this big transformation of the country. And he started a process of institutional destruction. One of those was Seguro Popular, which was this insurance scheme. Interestingly, because that president presented himself as a left wing populist.

And what I learned was when I compared him pressing Bolsonaro in Brazil, it was, they were indistinguishable. Bolsonaro said he was a right wing populist. López Obrador was the name, is the name of the Mexican one, said he was a left wing populist. They were indistinguishable. Everything is wrong, I'm going to save the day.

And, then start destroying things, not just that a very thorough education reform, a reform of telecommunications and energy reform to, to make a transition toward green, and, sustainable energy sources. During that period, there was a massive, a massive loss of of progress.

We went, Mexico went backwards. Now, It was pervasive. The only thing that made health more painful was that while that process of destroying what was there before without having a clear idea of what was going to replace it, the world experienced its most severe health crisis in a century in the form of the COVID 19 pandemic.

So it is not a surprise that Mexico literally had, is among the five worst performers. If you take indicators like excess mortality, the, percentage of health workers who died of COVID because they were unprotected, the number of COVID orphans, kids who lost their parents or grandparents, which in the case of Mexico, it's almost a quarter of a million.

The loss of life expectancy, Mexico has the first generalized loss of life expectancy in a century. It went back 30 years. It went in 2021 in the middle of the pandemic. to the level that of life expectancy of 1991, 30 years. Now, many countries lost life expectancy, including the U. S. and many other countries.

But that 30 year, movement backwards, backward movement, was one of the highest in the world. And, so forth. Yeah, that program was discontinued. The replacement was a disaster. And now there's a new government. And everyone is trying to It is very clear that one of the priorities is to reconstruct, repair, not go back to what there was before, not at all.

Take the next step. Because what I have found is that in contrast to this narcissistic style of leadership that says that everything was wrong, typically, except under extreme circumstances, not everything is wrong. Actually, one receives a legacy that has been built by those who came before us. And our fundamental duty as leaders is to hand that legacy and reach to those who will come after us.

It's understanding that there were some before you and there will be some after you, that you're not the center of the universe. And having that fundamental duty. 

Beautifully said.

Let me pick up on the pandemic, because you touched on it and the impact it had in Mexico, because it was not prepared. You would argue then the United States, we did better, but in fact, I don't think we were quite prepared if anybody is, can talk about this issue is you, were at that point, the president of the University of Miami, you also are an expert in the field.

Tell me what, what went on, arguably, and many have said that science was not the driver of many of the pandemic decisions here in the United States. How do you see it? How did we do? 

I, would say, and there's been now some papers published that there was a high level of association, not a cause and effect relationship.

Between the style of leadership and the outcomes. And, I saw two patterns if you look across countries. Typically, among the worst performers in the world were countries with populist leaders. And that's because the essence of populism is this division between the good people that the leader says he, and these are all men, by the way, he represents, and the elites, the corrupt elites, and scientists and experts are part of the elites.

That is a big component of the populist discourse. It goes back to Mussolini. This is not a recent, the playbook was written by Mussolini. Typically, populists, not all populists are fascists. In fact, I would say most populists are not fascists. Populists in general are anti intellectuals, are against science in general.

It's not surprising that you saw some of the work performers, according to outcomes, In the United States had a populist leader, Mexico had a populist leader, Brazil had a populist leader, India had and still has a populist leader, Turkey, Russia you Britain at that point with in the early stages of the, pandemic, the you, go around the world and as I say, an association because the mindset that the people that informs the populist style of leadership is divisive and it places expertise, devalues expertise because it's centered around an idea of concentration of power in a charismatic leader and obviously experts chip away, not the power, but certainly the authority.

So one of the things you saw in every country like of this type. is that the political leaders were contradicting the experts, their own experts. So you would see, in, the United States, this became materialized in cultural wars because the populist leader did not, they refused to wear a mask. Because they thought that they looked weak.

It's not weak. The reason to wear a mask is to show you care for others because the mask not only protects you, which it does, it also protects the others in case you you happen to, be affected with the virus. You look around the world and you had those contradictory messages. The other part are interesting, again, it's an association, I'm not claiming any cause or effect, but among the top performers, the best performers, you have an over representation of governments led by women.

Okay, and whether, the president in, in, in Taiwan, obviously in New Zealand, which became almost a foster child, In Europe, Angela Merkel and the, Prime Minister of Norway and country, in many of the countries across the world, you had an over representation. There were also countries led by men that did well but, you did, you do have that over representation.

So one of the things that I, one of the positive consequences of the pandemic, I hope, is that the myth that women cannot be good political leaders is. gone with the pandemic because they actually showed the opposite. And some of these leaders, women or men, they were the opposite. They didn't divide their citizens in the middle of an emergency.

They brought them together because it was a common thread for everyone. They relied on the science. They relied on the opinion of experts. They had a clear communication strategy that wasn't. Putting people in front of the experts saying wear a mask. The politicians say don't wear a mask. They didn't create that conflict that then evolved into culture wars and people being aggressive with the other side because they wore a mask.

That then transpired into vaccines as well. People refusing a vaccine even though the evidence was clear and you had it here in the United States. Counties with a majority of Republicans had higher mortality rates because people were refusing the vaccine. And we got caught in, in, this politicization.

Yuval Harari, I think, summarized the pandemic. He said, and I'm paraphrasing, the pandemic was a triumph of science and the failure of political leadership. The big triumph was the fact that the world was able, through an incredible level of global cooperation, to develop safe and effective vaccines in a record time in less than a year, since the sequencing of the genome of the virus.

But the failure was the way that so many politicians were unable to lead with that kind of enlightened style of leadership that, that so, many of the women leaders exhibited. And in this case, it cost lives. The estimate is about 20 million excess deaths in the world. You could say it's less than in the 1918 pandemic.

of influenza, which was about 50 million, it's estimated. But if you make, if you count the excess mortality relative to the state of science and technology, this was probably the deadliest pandemic relative to what it could have been. And, if, we hadn't had that, that, that conflict among the populist in countries led by populist leaders.

Yeah, that's, recently I did a similar interview with Bob Langer, who, as you probably know, is a scientist at MIT and one of the founders of Moderna, and the story of the development of the pandemic vaccine, the COVID vaccine, It's just such an unbelievable triumph of science, where after the decoding of the genome in a matter of days, the vaccine was ready and the rest of the time was just testing it for safety.

How, can we use that example to really and truly make, improve health around the world in a, faster, better way? 

I think that's one of the big lessons of the pandemic. And honestly, we owe it just to the 20 million people who died, all who didn't die, but are experiencing The sequelae, all this, those billions of, orphans who lost parents and grandparents from the pandemic.

All the people who lost their, they didn't lose their lives, but they lost their livelihoods. We owe it to learn the lessons. And that's one of them. And one of the big lessons is the reason in Moderna and Pfizer, the mRNA vaccines were able to were, developed so quickly is that behind them, there were decades of basic research.

And, so when one hears some of the politicians say no, why do we need basic research? It's, the ivory tower. It has no practical application. That is a recipe for disaster down the line. Because curiosity driven research is the fundamental basis through which applications can come.

And everything that makes our life longer and more comfortable today, including the internet including, obviously, everything that related to drugs and vaccines, everything starts with basic understanding of nature. It starts with basic research. So one of the lessons is we need to invest more on basic research so that we can be ready.

It's again the idea that excellence and relevance are actually connected. You can advance the frontier of knowledge while at the same time deriving useful solutions to the world's most difficult problems. And, that's to me, the pandemic illustrated that it would have been impossible to develop those vaccines In one year, less than one year, had it not been for the decades of basic research that have been carried out before.

Now, obviously, you, when did it fail? Because once the technology is out there, based on that fundamental research, we also need societal institutions that are based on some ideas of fairness. We had this paradox. Of seeing rich countries like the United States discarding vaccines because they want to expire because it became so politicized that some people were not taking the vaccines and at the same time, poor countries.

where people were dying because they didn't have the vaccines. I think we need rules that when it comes to global emergence, we need global rules so that the advances of science can, be distributed in an equitable manner and reach the people who need those life saving measures in time.

That, that was another lesson of the vaccine I mean of the pandemic. We, it's as I would say, we not just need the science, we need also the political leadership. That's up to the level of up to the demands of facing successfully a catastrophe and there will be future catastrophes. We need better, science, better technology and better leadership.

Absolutely. Said. I'm always struck that over probably about 1. 5 million, you probably have the correct number, people in the United States have died of COVID. It was a million years ago, so I don't know how much it is now, but it's probably about 1. 5. Yet in the collective memory of the nation, it's That seems to be discarded, forgotten, not given importance.

I think it's a post traumatic response. The pandemic was a huge trauma. And I think a defense mechanism is you forget about it. It's, a well known reaction to stress, to, to, to trauma. For, everyone everyone who had a family member or someone they But yeah, to have a million excess AIDS in in, in, the country.

it's, it's, it should be a big deal and we should continue to honor the memory of those who, who lost their lives and their livelihoods. And everything that's happened afterwards we know historically that after every major pandemic there've been huge social and economic and political transformations.

I don't think, for example, that the invasion of Ukraine, the timing of the invasion was, a, random choice by, Putin. I think he was calculating that the world was weakened by the exhaustion from the pandemic and then the economic crisis that it unleashed, and and that was the world was distracted, was divided, and that was a good moment to, strike.

But at some, sometimes the changes have been positive. After the, the large loss of life in, during some of the Black Death, the bubonic plague, one of the big pandemics, so many young people died that it led to some of the to a rising of the big standards for peasants cultivating the field because there was a shortage of labor.

You don't want to pay that price for that benefit. But also some very negative things have come, and and I'm afraid we're seeing some of the Aftermath, the aftershocks of the pandemic extend way after the, emergency has has, passed. So we, ignore the lessons at our peril because one thing we know is there will be future pandemics.

We need to learn the lessons, and as I say, we need to honor the memory of everyone who suffered so much.

Julio, let me take you back, from Mexico to Harvard, where you were dean of the public school, then to the University of Miami, that you're about to leave, I believe, today, to go to UCLA. It's, an interesting trajectory, but one that puts you at the heart of, top universities in the United States, research universities.

We know that higher education has been losing popular support. It is perceived as elitist, something that you said earlier, and unaffordable. What can be done? You're going to be going to a public university where the pressures are different. than a private university like Miami, where affordability and accessibility are crucial.

What are your thoughts? 

I think higher education in the United States and around the world, but let's focus on the United States it, has a it's, at a critical point. A few years ago, higher education started being part of the, cultural wars. And, Part of that was with the rise of populism.

Yeah many of the people in academia are exactly, demonized by populist leaders as, part of the elite, of the perverse elites that are, that, that become the enemy. And, viruses were caught in that crossfire. Also, one of the characteristics of the rise of populism has been the disregard for standards of truth.

And that. affects one of the core values of universities, which is the pursuit of truth, understanding that truth is never eternal. On the contrary, it's dynamic. It's contradictory sometimes, but it's the commitment to the pursuit of truth that matters and that has been at the core of what universities are all about.

Harvard's motto is Veritas, truth, just the word, because it encapsulates it. What universities are about, it's the pursuit of truth. So when you go into an era of post truth politics, a phrase that was coined a few years ago, of alternative truths, of activeness and disinformation, which was deadly in the case of the pandemic, literally cost people their lives.

You understand that in itself is a challenge to the fundamental value that underpins higher education. Now, if you add to that, in the case of the United States, rising costs and the crisis of affordability and especially an increasing burden of debt. Higher education related debt is now the second highest item of consumer debt.

It is. And, you want and, one understands that there's a, growing demand for higher education despite the demographic changes because the hard, the high school population is, has peaked in the United States. But despite that, the United States does have the most admired system of, universities in the world.

So people come from all over the world to study here. I'm talking especially of the top echelon of the Comprehensive Research University case. When, families face a financial barrier for something that's highly valued in society, what you get is a backlash of frustration. So it is true, as you say, that many surveys show a loss of, trust, of public trust in universities.

I think we need, as university leaders, to face that reality and work proactively to earn again that trust. Because universities used to be among the most trusted. I have to say that lack of trust is very centered on the educational mission of universities. But let's not forget that many universities, a subset of the top universities, also have a research mission.

We don't see yet, but we need to be careful. That erosion of trust on the research, I think people generally still value, despite the attacks on science that we saw during the pandemic, people do understand that science is the fundamental basis for material progress. And then there's another subset of universities that run comprehensive health systems, providing the most, the highest level, the most complex health care to the communities.

And that, again, that is not the case. Subject to the same laws of trust. But if you look at, those three missions, I would even add a fourth mission, which is the athletic mission, where universities are part of creating a sense of community and identity. This is stronger in some universities than other that also, is, there.

It's the first mission, the, which is a core mission of education that I think is the one where we, see that the problem, and it is driven by both the emergence of this attack on the pursuit of truth. But also by the real affordability crisis. And then for the first time, what people have seen, substantial members of the public questioning the value proposition, whether it's worth the investment of time and money.

Until now, people understood that higher education was an avenue for upward social mobility. There's abundant, overwhelming evidence that people with a college degree, their lifetime earnings are several times higher than people without a college degree. So it was seeing, yes, it was costly, but it was an investment.

The problem now is not just that it continues to be costly. But that, that the perception of value for the money is also going down. We need to be clear about that and make a deliberate effort to revert that perception by taking real action. Sometimes we are actually doing things like that. Most people do not, are not aware that, the publicly advertised tuition is seldom the tuition that most students pay.

We do a bad job at informing. We there's, to me, the real tragedy in terms of access to higher education is the fact that there are tens of thousands of very talented young people from underprivileged homes who would be admitted to the top universities, to selective universities.

But I'm would, I would qualify for very substantial financial aid. Often they don't even apply to those universities, A, because they think they're not going to be admitted, which is wrong, and B, because they think that even if they are admitted, they won't be able to afford it, which is also wrong.

That's why there's a very valuable initiative called the American Talent Initiative, which you know well run by the Aspen Institute with, funding from the Bloomberg Philanthropies. Which is a group of universities, I was proud to have the University of Miami join that group, who have made collected commitments to, through proactive recruitment, reach out to those tens of thousands of talented young people who never realize their full potential because of lack of information about the opportunities.

They're typically the only ones in their families who, thinking of going to college, they go to public high schools where there's one advisor. College advisor for thousands of students. They just don't have the access to the information networks that would allow them to successfully apply and thrive in a selected university and then change their life trajectory.

That's the kind of thing we have to do. I am very proud as I am approaching the day when I will become Chancellor of the University of California, Los Angeles. The UCLA has, very, thoughtfully over the last several years, decades, been very focused on improving access and and you now have a university with one of the light, a comprehensive research university.

Still very selective, Actually, it's the most applied to university in the United States. The number one public the number one ranked public universities for eight years running. And part of those metrics that are used to rank universities is questions of access and affordability. It has made a real effort to improve access and affordability.

First first generation students a very diverse student body. It's a proof, in this culture wars, we have pitted Excellence against diversity. That's a false dilemma. You can actually cultivate excellence. Excellence comes in many different shapes. And the more you can have different life perspectives.

Coexisting in a framework of respect and mutual enrichment in a campus, the better for everyone. And and UCLA is an example of that, a very diverse, student body with, one of the highest standards of performance anywhere in the world. There's still a lot of work to do. And I think we need to, especially for the, educational part of our mission.

We need to make a better job of of increasing access, affordability and of publicizing what we're already doing, not for self congratulation or for complacency, but just to make it clear that progress is possible and that the solution doesn't lie in dismissing. A college education based on a fall for in on a flawed calculation of value for investment, but actually in there's still a huge value to be realized, not just in terms of lifetime earnings, but also in terms of finding the meaning and purpose of your own life.

Leading a meaningful life, and I have a lot of ideas of how we can take a university that's, among the top in this arena's ticket to even higher levels of performance. 

Wonderful. I, think UCLA will do very well with you. As the leader, let me end with a question that I'm very curious.

I, you've written several books, but some of the books you have written are children's books. And you develop a, character, which I believe is called triptophanito, that, around whom all you develop the book themes. So why that name? What are you trying to accomplish? What, made you do this?

Sure, yeah, this is another unexpected twist in my, life, but so I went to medical school in Mexico and in the first year in the curriculum back when I was studying, one of the basic subject matters you took on the first year was physiology. Physiology is the science that explains the functioning, and human physiology is the science that explains the functioning of the human body.

I was fascinated by, physiology. You also had to take anatomy. That was memorizing a lot of the structures. And you had to do that, but physiology was understanding how those structures function in a systemic way, how they interrelated, how the, body in all its complexity, how it managed to keep this very delicate equilibria that we see every day that allow us to, live and grow and develop.

and adapt to changing circumstances. So I was fascinated by physiology. I had a very good teacher. I, he invited me to, to work in his lab. Obviously, I was a student. I was an unpaid part of the labor force in the lab, but because it was a learning experience for me. And one day I had the following reflection.

I said, gee how can it be that it took me all those years of going through elementary and high school all the way to studying medic, into entering a medical school, so that finally I could understand how my own body functions. Obviously, I had a few courses that gave me some idea of human biology in high school, especially in high school, but that kind of comprehensive awe that one experiences when you finally understand You know, how the heart beats and how the immune system works, et cetera.

That kind I said, does everyone need to study medicine? No, we need to democratize this knowledge. It is essential for our so called self knowledge and for the knowledge of our fellow human beings. I, had a girlfriend then, who eventually became my wife, who had a very, a younger sister, she was 10 years old, and once stuck on a highway driving with, her parents, there was a terrible traffic jam, and the little girl, the sister of my girlfriend, was bored, really bored.

So I started telling her a story of, to keep her interested, that I had been thinking about, but I, started telling it to her. It's a, family called the protein family who lives in an egg in a farm. 

Wow, that's great. The 

farmer eats the egg, and once inside the body, the amino acids, the constituent molecules of the protein, start traveling through the human body, And then they face a number of adventures, they face a parasite in the gut and things like that.

And everyone said, why don't you write this? So every weekend during my first year in medical school, I sat down there were no computers there. Then I wrote, I just found now that I'm packing the manuscript of that book. Anyway, that book, eventually I was 19, I put it to rest for three years before I, I mustered the, courage to take it to a publisher.

And the first one rejected it. The second one accepted it. I got a very close friend of mine to do the drawings. It was illustrated book for, older kids and young teens. But it's turned out that many kids, Older persons, including adults, have read the book. The book was initially published in 1979.

It's been in print ever since. And because I don't do this for a living, I haven't actually promoted it very much, just sell some. It came to fill a vacuum. And the word of the main character, I was discussing with my father. My father was a pediatrician who specialized in endocrinology and nutrition. I have learned a lot about my basic biochemistry from him.

So I was telling him this whole story and he said one of the essential amino acids, is tryptophan. So you could, in Spanish, it's easy to make a diminutive by adding the suffix ITO. So rif toto is little trytophan. And then we, needed a female hero as well. And so we took , which is the name of another.

And then there was glutamide, became glutamito, and aspartite became aspartito. And I had four or five characters, it's not too complicated, there's 20 essential amino acids, but only four characters. And then they encounter other characters, they interact, they talk to the, cells. There's a chapter on human reproduction that I think is what's, what made it a bestseller.

It explains this is a very. Tough topic, even to this day, when parents finally have to explain to kids where they came from. And I think it managed to create a very loving, respectful conversation between Tito Fanito and Missina Alvisai, the male and the female character. And that, people tell me, is why a lot of parents, and now grandparents, buy the book.

It's still in print, 45 years after I bought it. I decided to publish it, and then I partnered with a younger colleague of mine to, develop a series which just published literally this last week, came the latest in the series. Now six books in total. And this is something about the physiology of daily life.

And he said, Here's the thing, you just gotta do, you gotta do all the calculations Why do we sneeze? Why do we cough? Why do we blow our noses? What happens with our gut? The, daily reactions of our body, which are a form of, understanding, but we take them for granted, it's the physiology of daily life, that would be the subtitle.

And again, very much illustrated, very much aiming at that. It's not for really young kids, it's for, kids, let's say, about 10 and up. But it's, fun. It's, and, it's been there. So that that, that's the story of Tritofanito. I, it, it doesn't take much to realize that in the sense I identify myself with my character.

I wish I was Tritofanito, because he's always, all the time doing something good. For humankind, he does that in a way that's much, much better than the author. So he's like a model for me. 

That's wonderful. I, promise I'm going to buy the book and read it. I I'll send you a copy. Maybe, it'll inspire me to do the same.

That's fantastic. And I certainly admire that, you did it. Let me end by saying, You, are truly an inspiring leader. You, this conversation has been great. I'm sure the audience is going to love it. Your insights are really valuable. You've given us a history a, lesson in history and politics in the, in this last hour, that is very timely and very important for people to listen, particularly when It relates to science and medicine, human health, and the well being of people.

Let me end by, quoting some words that you said that I really like. Politics is the art and science of reaching agreement. on values shared goals and politics become corrupted when power becomes the end game. They are powerful words and I really thank you for them. Thank you so much, Julio. It's really, truly been a pleasure and good luck in UCLA.

Thank you very much. I really appreciate this opportunity.

Thank you for tuning in to this episode of Not Alone, Leaders in Conversation. We hope this discussion today sparked new ideas and left you with plenty to think about as you continue to lead in your own institution. If you found this conversation interesting, insightful, or thought provoking, please share this episode with your colleagues, peers, and friends.

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