Teaching Innovation Under Pressure: Three Months, Two Universities, One Pandemic
By Noah Pickus and Ben Anderson
One Pandemic, Two Universities
The arrival of Duke Kunshan University’s first class of undergraduate students in Kunshan, China, in August 2018 was the culmination of nearly a decade of work to develop a new model for international undergraduate education. One of us led the creation of the curriculum for Duke Kunshan (DKU) and hired the faculty who would bring it to life. And one of us, a Duke post-doc in global health, was part of the first cohort of twenty faculty who had come from around the world to prepare students to navigate a future none of us can predict.
Little did we know just how turbulent the world would become, and how quickly. By the early winter of 2020, as the Coronavirus spread, first DKU, and then Duke, closed their campuses. The first order of business was to find out whether these two universities could successfully collaborate in a crisis. Could the networks between the two schools enable faculty and students to respond quickly to a world-wide pandemic?
At the same time, we started to see that the pandemic could become the ultimate teaching tool for the very interdisciplinary approaches, critical thinking and global perspectives that we were aspiring to impart. After all, we had designed modular 7-week terms to provide greater flexibility and resilience — just the features that could enable us to pivot nimbly in the midst of a crisis.
But could we offer our students, now learning from home and spread out in 40+ home countries across the globe, a unique experience in real-time analysis of the medical, moral, political and other dimensions of a transnational emergency?
We quickly turned these real-time pedagogical and organizational questions into the platform for a new online course, “Epidemics in the Age of Interdependence,” for Duke Kunshan students. The course, which ran from March until May, focused on the causes and consequences of epidemics, and brought the students into contact with Duke and Duke Kunshan faculty members with expertise in a wide range of fields — from epidemiology and environmental biology to political science and public policy.
Near the end of the course, the 50 students enrolled learned that in lieu of a final exam, they would instead complete a final project. Assigned to a mock Task Force on Global Health and Education Policy, they were to design a university strategy for teaching and learning in Fall 2020, with the assumption that faculty and students would still be scattered around the globe because of the pandemic.
The students were asked to consider, given only what they knew at the end of April, should DKU plan to open its campus in the Fall and, if so, under what health and safety conditions?
How should DKU address the reality that some students and faculty would probably not be able to enter China in time for the Fall semester?
At a time when the rhetorical war between China and the U.S. over the pandemic was heating up, what set of principles and practices should guide a joint-venture’s strategy for on-campus or online education?
These were the questions students from DKU had to answer in April and May.
As the virus spread rapidly across the United States, we decided to offer the same course for Duke University students during Duke’s first summer session, in May and June. Though our Duke students faced many of the same topics and questions as their DKU peers, for their final project they ultimately had to address another set of difficult questions about re-opening the economy, navigating protests over racial injustice, and protecting lives.
This is the story of 20 faculty and 90 students traversing the perilous territory of global health during a pandemic. Over three months in the Spring of 2020, these faculty and students coordinated across multiple time zones, steered amidst contrasting national policies, and negotiated around cultural differences.
Global Health and Epidemiology
As our students grappled with the many intersecting questions posed by the course while simultaneously living through the evolving pandemic, we conducted weekly in-class interviews with faculty experts from Duke, DKU, and Wuhan University, the Chinese university Duke partnered with in the creation of DKU.
Each week, our Teaching Assistants — graduate students Yadurshini Raveendran, Annie Seaman, and Krista Odum and Duke senior Linda Zhang — prepped a student team to curate a set of questions that were specific to each interviewee.
In our first in-class interview in March, Chris Woods, Director of the Hubert-Yeargan Center of Global Health at Duke University and Chief of Infectious Diseases at the Durham VA Hospital, spoke to students while fielding texts from the front-line of the medical center. He highlighted how the enormous increase in global travel and the growing density of urban life have facilitated the movement of new pathogens. “Everyone is traveling,” he said, “and they’re going everywhere.”
Likewise, whether in downtown Durham or the outskirts of Mumbai, no one is really isolated from anyone else. As a result, Woods forecast, the business of the future will have to be healthy, urban development.
Large industrialized farms that feed growing populations have also contributed to the growth in novel pathogens. These farms’ proximity to metropolitan areas has increased the possibility for animal to human transmission, noted Greg Gray, an infectious disease epidemiologist at Duke, DKU, and Duke-NUS Medical School in Singapore. As humans and wildlife come into closer contact, he said, it is increasingly urgent that we develop early warning systems.
Charlie Nunn, a specialist in evolutionary anthropology, drew on his research in Madagascar to explain new ways of tracking human-animal interactions. His team of evolutionary biologists, ecologists, mathematicians, sociologists and environmental scientists uses GPS devices to map social networks. By showing how often humans, cows, dogs, and rodents are in close proximity they can test how these networks influence disease transmission.
Gayani Tillekeratne, a faculty member in Medicine and Global Health, underscored the imperfections of our current diagnostic measures of respiratory infections. Doctors over-prescribe anti-biotics, she said, because they don’t know if the cause of an infection is viral or not — a particularly strong tendency with COVID-19.
Broader environmental conditions are also associated with the transmission of the virus, according to Bill Pan, a professor in the Nicholas School of the Environment. In weekly meetings with NASA and the World Health Organization, Pan and an array of analysts pore over satellite and remote sensing data while others track sewage and water pathways. They can see correlations between factors like UV exposure and pathogen spread. While the lack of historical data for a new virus limits the accuracy of their findings, there is a high likelihood that the COVID-19 virus originated in wet markets.
Drawing on his experience in Peru, Pan emphasized that social factors are often the most powerful forces in spreading a disease. Peru did everything right from a policy perspective, he said, but social life there is organized around daily visits to densely packed public markets. As a result, “Peru had the policies but not the social means to enforce them.”
At this point in the course, students had to synthesize the ecological factors associated with the emergence and transmission of new pathogens and consider what policies were best suited to minimize future harm. We asked our students: If the entire world implemented a global ban on wildlife trade and consumption and on wet markets, would that eliminate the risk of another future pandemic of zoonotic origin?
To answer this question, students had to balance the calls for a permanent ban against several competing cultural, economic and health factors. Live animal markets have an important cultural significance in many countries, including China. They have also become integral parts of the economy in China, especially for small, independent farmers. And some worry that a ban would lead to an explosion of an unregulated black market, which is what happened in 2003 and 2013 when such bans were implemented for a period of time.
In short, what at first appears to students to be a straightforward public health measure soon emerges as a complex web of social, financial, and regulatory factors. One of the great advantages of the global student body at DKU is that it brings together a much greater degree of diversity in viewpoints than in a traditional U.S. or Chinese classroom. Students from urban and rural China and from countries as different as Ethiopia, Kazakhstan and Japan all bring unique experiences of the cultural dynamics involved with wet markets, as well as contrasting views of the relative balance of economic and health concerns.
History and Media
From the epidemiology of the present, the DKU and Duke courses took a step back to think about lessons from past outbreaks.
European historian Tom Robisheaux spoke to the students about the Great Plague of the 14th century. He described a world in which the loss of life happened on an unimaginable scale. The plague undermined both scientific and religious authority, as neither could adequately explain it. For doctors, the plague transformed the practice of medicine as it led to more evidence-based practices and the evolution of measures like quarantines.
There were also many ideas about the cause of the calamity. Some emphasized divine providence against sinful Christians; others spoke of astrological forces. In parts of Germany and Austria, the theory took hold that Jews were behind the devastation. City councils rounded up Jews and burned them alive in the town square. “It was a search for a human scapegoat,” Robisheaux said.
Eileen Chow, a Fellow of Asian and Middle Eastern Studies at Duke, said that Chinese people have often been portrayed as scapegoats for disease — as foreign pathogens infecting other societies. In the late 19th century, Chinese immigrants were barred from the U.S. and Chinatowns were burned down as public sanitation measures. “Fear amplifies and clarifies,” Chow said. “Existing social problems suddenly come into high relief.”
She pointed to the term “Wuhan virus” as a contemporary version of scapegoating — both by the U.S. media and the Trump administration and across Asia as a way of blaming the Chinese government for concealing information.
History professor Nicole Barnes offered a historical comparison that focused on the treatment of women in health emergencies. In the 1930s and 1940s, she said, female health workers were honored for their war-time resistance to Japan. Yet today in China, where many health workers are female, their contribution is down-played. One prominent news story about women on the front lines focused on the difficulties their husbands were facing raising children at home without them.
From March through June, students struggled with how to interpret the welter of information about the virus.
Priscilla Wald, a professor of English, focused their attention on the broader stories being told about the disease. Outbreak narratives help make the immediate experiences more coherent, she said. But they also distract attention from broader causes. An outbreak narrative “happens in the middle of a crisis, [and] the obvious solutions are quarantine, pharmaceuticals, and vaccines; but it obscures the larger scale of the problem which is the day to day practices of human beings that are irresponsible in the world.”
Social media has given individuals more of a voice, Sanford School Professor Ken Rogerson acknowledged. But he pointed out that so many voices make it harder to assess what’s really going on. And despite local media outlets doing some of the best reporting on the pandemic, the desire for free news has further eroded their business model.
Students asked: How can we figure out what’s really true? “Cultivate multiples sources of information,” Rogerson advised. Professor Wald urged students to constantly toggle between personal narratives — the ones that humanize a situation and forge connections — and broader social and structural assessments.
Li Ji, a professor at Wuhan University, pointed to the Chinese writer Fang Fang as an example of the value of conveying everyday life in cities like Wuhan. Her published diaries expressed wide-spread criticisms of the government’s initial responses to the virus. But the larger context also mattered. Many in China attacked the writer for lending support to foreign governments threatening to sue China.
Tom Rankin, from Duke’s Center for Documentary Studies, urged the students to tell their own stories. “In the history of photography and documentaries, some of the best work has been done closest to home. Everyone thinks they are one [plane] ticket away [from the action,] when in fact it’s probably right around the corner.”
To find their way through this thicket of perspectives, we asked the students to analyze either the influence on current decision-making of historical narratives or modern social media. In the first case, we asked them to wrestle with a specific tension: on the one hand, pandemics have led to greater governmental authority and to the persecution of minorities and, on the other, to resistance to government authority. What lessons can they draw from this complex and often contradictory history? In the second case, they had to explore how political narratives represent the particular goals or viewpoints of their creators.
Politics and Governance
In the final section of the DKU and Duke courses, faculty spoke to the students about political factors.
In the face of a global pandemic, many students saw the need for a global response. At the same time, other students wondered about the plausibility and even the desirability of a global response, especially given concerns about the loss of national sovereignty and the absence of shared universal values.
Gavin Yamey, from Duke’s Global Health Institute, underscored the ethical perils in the scramble to monopolize the system of vaccine development. “Never before has there been a more important time for global cooperation,” he said, while acknowledging that such a likelihood was far off. As a first step, there had to be agreement that health workers would receive the vaccine first. Otherwise, he stressed, “the world is over.”
Students also wrestled with the differences among different countries’ responses to the virus. How, they asked, can a country follow “best practices” when each nation’s form of government, social trust, and institutional capabilities differ so much? Does what works in South Korea apply to England?
Within China, DKU’s Annemieke van den Dool observed, the experience with SARS in 2003 led to greater government transparency in the sharing of information. But after the 2013 H7N9 Avian influenza outbreak, laws were amended to criminalize sharing rumors about outbreaks, which then contributed to the slow response in Wuhan in 2019.
Likewise, political scientist Melanie Manion discussed how an excellent technical system for sharing information after SARS was embedded in a political system where information is controlled. The Wuhan authorities did not want to share information upwards. Once officials in Beijing learned about the outbreak — from social media, ironically — they then moved fast to establish a strict quarantine.
DKU’s Nellie Chu focused on the human cost of the quarantine. She noted that the lock-down of Wuhan solved one problem, a public health crisis, but inadvertently created a desperate situation for migrant workers who could no longer move.
To grapple with these complexities, the DKU students undertook a Task Force Simulation on Global Health and Education Policy. On Monday, April 27th, the Task Force assignment read, Xi Jinping and Donald Trump announced that they would join forces and merge into one country: Chimerica. “We are facing a world-wide crisis,” the two leaders wrote, “and we must take this radical step to fight the virus and to usher in a new era of global cooperation. We are therefore establishing several task forces, including one to determine how and under what conditions universities should proceed in Fall 2020.”
They directed the Task Force to focus on one single Sino-U.S. joint venture, Duke Kunshan University. This example, they said, would serve as a test-bed for identifying and resolving different values and approaches and its policies would guide all other universities in the previously sovereign nations of the PRC and the USA. Any recommendations should address three questions and account for both Chinese and American values and views on social and governmental trust:
· Should DKU open its campus for the Fall and, if so, under what health and safety conditions?
· How should DKU address the reality that some students and faculty will not be able to enter China in time for the Fall semester?
· How might students actively partner with their faculty to use the crisis to develop new forms of teaching and learning?
To answer these questions, students had to wrestle with broad epidemiological, political and cultural issues. They also had to grapple with tensions between their own desires to return to campus or stay at home and with fairness toward students inside and outside of China. As the Task Force began its deliberations, the students found themselves debating the same questions that DKU, Duke and all of higher education was debating: Should they open campus and provide in-person education for those present, while offering online education to everyone else? Or should they keep the campus shut and focus attention on providing the best form of online education for all students?
Race, Liberty and Economics
While in April the DKU class debated the lockdown of 11 million people in Wuhan, in the Duke class attention shifted in June to stay-at-home orders, masks, and protests over racial injustice in North Carolina and across the U.S.
As the number of COVID-19 cases began to increase in the U.S. in late February and early March, students tracked how states implemented different measures to mitigate the spread of the virus. They analyzed the pushbacks against these public health policies for reasons ranging from individual and religious liberty to mental health and from economic well-being to opposition to police brutality and institutionalized racism.
Many of the protests drew large crowds and raised concerns that they would spread the virus. At the same time, some members of the public health community issued a public letter in support of the protests. In class, students tried to work through the risks associating with protesting and the benefits some saw in the current movement to bring about fundamental changes.
Deondra Rose, a political scientist, focused the students’ attention on opportunities for building long-term systemic change. Declaring her faith in government to do great things, she urged the students to “pay attention not only to shorter-term gains but also how to sustain institutional change.”
Both the DKU and the Duke courses adapted weekly as the students and instructors took in new data and new and often conflicting recommendations for managing risk. This real-time analysis underscored the underlying uncertainty about which policies were best to follow. Our students could feel this uncertainty in their own lives. And they learned directly from their peers how different parts of the country and the world responded to new developments. In the Duke course, students especially confronted the difficult issues about how to respond to the growing lack of adherence to some or all of the initial public health measures to prevent the spread of the virus.
A particularly vexatious issue in North Carolina and in the U.S. focused on the impact that lockdowns have on the economy. In class, the students debated whether the intervention could be worse than the disease itself and whether the lives saved in the short-term could be balanced against the livelihoods lost in the long-term.
John Hood, chairman of the John Locke Foundation and an adjunct instructor at Duke’s Sanford School of Public Policy, spoke to students about how values like freedom, authority and caring shape the vociferous, and in some ways uniquely American, debates over masks. He also pointed out that there are enormous partisan differences in whether someone is comfortable going to a restaurant or a movie theater during the pandemic: noting that “there is a lot of ‘my team is supposed to think it’s bad to go or it’s OK to go.’”
The Duke course culminated in a North Carolina Task Force Simulation on Public Health and Policy. Governor Roy Cooper, the students were told, appointed this Task Force to guide his decision-making and his response to individuals and organizations resisting his orders.
The students received the following assignment in a mock directive to the Task Force from the governor:
In a large and heterogeneous country such as the United States, one in which many citizens indicate low levels of trust in government authority, I seek your guidance on two specific questions:
· Should public health measures to prevent the spread of COVID-19 maximize public safety or should they make trade-offs demanded by moral concerns such as personal liberty, economic well-being, or social injustice?
· How should public health officials respond to the reality of individual and communal opposition to public health policies or to lack of adherence to them?
The student leaders of the task force appointed two sub-teams to provide the best arguments in response to each prompt and then to answer questions from the larger committee. The first team argued that public health measures should maximize public safety and prioritize ameliorating immediate harms. By contrast, the second team contended that public health measures should give more weight to the economic impact of lockdowns and to moral values of personal liberty. In their final papers, students had to sort through these positions and provide recommendations to the governor.
Three Months, Two Universities, One Lesson
In both the DKU and the Duke courses, students experienced a real-time lesson in the unwieldy intersection of science, politics, and culture. They analyzed issues as they lived them. For the DKU course, the global diversity of the student body — and the many time zones from which students participated — underscored the range of perspectives that we saw playing out cross-nationally. This diversity made it harder for any one set of intellectual or ideological viewpoints to dominate and was an education in itself for students and faculty.
For the Duke students, the timing of the course in May and June meant that they brought to the class the urgent moral and practical concerns they felt in their homes and communities. These concerns, and the deep and difficult tensions they engendered within and among students, made the readings for class come alive. At the same time, students learned the most from the Task Force debates in which they were often assigned to represent positions that did not align with their views. This gave them a chance to step back from the issues of immediate urgency and, at least for a moment, imagine how to defend a different world view.
In short, we never lacked for student interest. As teachers, we were constantly challenged to balance setting an academic context while taking on the political and ethical conflicts at the heart of the course. What made this especially doable were the dialogues the students held with our Duke, DKU, and Wuhan colleagues. Over a three-month period, students from both universities heard from over 20 faculty members in fields as distinct as medicine and documentary studies. As crises often do, this one provided an opportunity to build something unique from their exchanges. These faculty showed how collaborations between the two schools could offer students a timely and exceptionally powerful educational experience.
Noah Pickus is Associate Provost and Senior Advisor to the Provost at Duke University, Dean of Undergraduate Curricular Affairs and Faculty Development at Duke Kunshan University, and Professor of the Practice at the Sanford School of Public Policy. He co-directs the Arizona State University-Georgetown University Academy for Innovation in Higher Education Leadership Intensive Program.
Ben Anderson is an Assistant Professor of Science and Global Health at Duke Kunshan University. He has an MPH and PhD in Public Health concentrating in One Health, with research interests in emerging infectious diseases, zoonotic diseases, and viral respiratory pathogens.