Nirav Shah is the director of the Maine Center for Disease Control and Prevention, and an alumnus of Sidley’s Chicago office. Partner Paul Kalb, M.D., sat down with Nirav to catch up on his current work related to the COVID-19 vaccine, lessons learned at Sidley, his transition from healthcare to law and back, and his growth as a senior government official.
If you would like to view Nirav’s interview with Paul, please click here to be taken to the video.
As the director of the Maine Center for Disease Control and Prevention, what can you tell us about your work related to the COVID-19 vaccine?
It’s an interesting time in the pandemic because all the things we’ve been doing for the past year are still in play, such as testing, contact tracing, and epidemiological investigations. That’s added on top of our new focus to coordinate a mass vaccination campaign across the state and country. The vaccination process is involved in a thicket of legal, clinical, and public health questions, and we haven’t really done anything like this. So in many senses, we are trying to figure things out as we go along.
One of the most interesting ethical questions that the country is facing relates to the tension between speed and fairness in vaccine distribution. How do you make judgments about that and other issues?
We have attempted to balance those principles by essentially running two mass vaccination systems in parallel within our state at the same time. One system focuses on very large-scale vaccination centers that are centralized, where a significant fraction of people in the state can access them. The other track brings the vaccine to the people. We ship vaccines to a network of Federally Qualified Health Centers and small community centers in rural places, recognizing that vaccination speed in these areas will not be anywhere near what it’s like in major metropolitan hubs.
There are instances at the margins where people simply cannot make the drive to one of our metropolitan centers, and we are not yet able to get the vaccine to them. We can’t get to everyone on the day that we would like — vaccine supply remains our biggest constraint. As the vaccine supply increases, we hope to get it out to more folks in remote parts of the state.
What’s your process for making these important decisions?
I start my week on Monday mornings by assembling a couple of data points in a spreadsheet and thinking through the issues of speed and equity we just discussed. For example, if Maine is getting 25,000 doses per week, what portion of that should we segment for the large-scale sites versus the smaller scale sites? I make these decisions by consulting with hospital CEOs and clinicians, before presenting them to our governor.
Almost every state is taking a different approach to which populations should be vaccinated first. If the goal is to reduce the number of cases, then you should vaccinate younger people, but if the goal is to reduce morbidity, then you’re vaccinating older people. I presented both options to the governor and she chose to focus on preservation of life. So that’s been driving our strategy ever since.
I think cases are dropping because we are vaccinating front-line workers, along with others who are more likely to contract the virus and also most likely to pass it on. Would you agree with this theory?
We convened with a group of infectious disease and vaccine epidemiology experts from the U.S. CDC to ask for their take on why cases are going down dramatically. The consensus was that we don’t really know, because there are so many factors happening at once. Some of it may be due to partial immunity that’s being conferred by first doses of the vaccine, or because many folks have already had COVID in certain communities. Then you layer on behavior change and the decrease in holiday travel, so we really don’t know why there’s been a decline.
What’s the most gratifying aspect of your role?
I’ll get an email from somebody who tells me, for example, that their partner visited one of our testing sites and received a negative result within 12 hours, or that their elderly mother visited a vaccination site and it only took them 15 minutes to get through. But I’m not the one doing the testing or vaccinating. I share these emails so everyone in the agency knows that their full year of hard work, countless hours, and late nights, has paid off. Being able to share that feedback with my team is the most gratifying part of my job.
What’s the most surprising part of your job?
The most surprising thing for me is the reception that the people of Maine have showed us. The work that we’re doing involves a lot of difficult tensions and emotions but, for the most part, people here have stood behind me and the entire administration. I’ve only been here a little more than a year and a half and I’ve got a funny name, but the people of Maine have come to see me as a trustworthy source of honest information.
For those who are unaware, you may be the only state health official with a candy bar named after him. How did your Sidley experience prepare you for this post?
The skills I learned at Sidley were instrumental during my prior job as director of the Illinois Department of Public Health and in my current role, in terms of technical legal analysis and how to be a professional when navigating difficult negotiations. Being able to communicate clearly while taking everyone’s views into account is critical to what I do. These are skills I gained from watching and learning from all the partners at Sidley. I owe everyone at Sidley a big debt of gratitude.
I was also never shy about my hopes and aspirations post-Sidley. Many people come to Sidley for part of their career, then move on to something else of interest. I would advise current associates to share their intentions to look for other positions with their colleagues. Being forthright about that was eye-opening and welcomed – if anything, it helped introduce me to interesting opportunities.
Tell us more about your transition from healthcare to law and back.
After medical school, I declined to do a residency and then went straight to Sidley after law school, so I never really had clinical experience. Thankfully, that wasn’t too stark of a transition, but transitioning from the legal world to government was different. My role in Illinois had some degree of medicine and clinical science underneath it, but it’s just as much about the law, finance, politics, and communications. Going from Sidley to taking over a team of 1,200 people in Illinois was tough, so I made sure I was asking questions. I never felt sheepish about being the dumbest guy in the room. There is a time in the history of every CEO where they were not a CEO, and I tried to keep that in mind.
Can you tell us more about that idea that every CEO is at first a new CEO?
The most important thing I learned and recognized is that I will never know as much about what’s going on in my agency as the people on the ground. When I make decisions, I do so with a high degree of humility. Another critical aspect, and something I also ascribe to my Sidley experience, is to stack your team with people who are totally comfortable in disagreeing with you. If a team is not one where negative viewpoints can be shared without fear of retribution, people won’t feel empowered to speak up against a bad idea. I’ve tried to create a culture where disagreement is not only welcome but expected, so we can ultimately make better decisions.
We appreciate your joining us today. Our listeners and readers will welcome the opportunity to hear from you.
It’s my pleasure. I’ve always tried to fly the Sidley Austin flag as high as I can, and I do so with pride.
Published March 2021
UPDATE: Nirav is now Principal Deputy Director, U.S. Center for Disease Control and Prevention
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