A White House Veteran's Playbook for Crises That Start at Home

Dr. Raj Panjabi, a former White House health adviser, has published a book called Safer: A Playbook — and he means the word literally. "In the intensive care unit, we have a playbook when someone's heart stops beating," he told NPR in an interview at its headquarters on October 30. "In the Situation Room, we had a playbook for pandemic preparedness."

What he found missing was guidance for smaller, closer emergencies. "I was frustrated that we didn't have a playbook for crises that appear in our own living room," Panjabi said. The book grew out of his family's own ordeal: at age 1, his daughter was diagnosed with heart failure, a condition he and his wife initially missed. She is 9 now and has recovered.

What does the book actually offer?

Safer: A Playbook is three books in one, according to Panjabi: the story of how he and his wife confronted their daughter's condition; an examination of global public health problems; and direct advice for anyone facing a household crisis. The chapter titles state his method plainly: "Turn Denial Into Action," "Don't Go It Alone," "Get Ready to Pivot," "Embrace Uncertainty."

The author's credentials are not purely academic. Born to Indian parents in Liberia, Panjabi immigrated to the United States at 9. He became a physician and founded Last Mile Health, an award-winning humanitarian organization that sends community health workers into remote areas.

Why do capable people miss obvious warnings?

Panjabi is candid about his own failure. "I was wrought with the guilt of being a dad and missing this illness — and being a doctor and missing this illness in my own daughter," he said. "I thought it was a character flaw. What I learned is that it's not. Denial is the first stage of almost every crisis."

His research pointed to a known pattern. Psychologists call it normalcy bias: the assumption that tomorrow will resemble yesterday. "We have a hard time detecting slow moving threats until they reach a tipping point," he said. His countermeasure is concrete — set an if/then threshold in advance. If a warning sign appears, act in a specified way. In his daughter's case, a cardiologist performs a heart ultrasound every couple of years; the trigger they watch is whether the heart's ability to squeeze stays at a normal level. "Allowing a trigger to do the monitoring for you allows you to feel some agency," he said.

Can the same method work on vaccine hesitancy?

Panjabi applies the playbook to a societal crisis: measles, eradicated in the United States 36 years ago, has returned as some parents decline vaccination. His advice is to swap blame-oriented questions — "Why aren't you following the guidelines?" — for barrier-oriented ones asked face-to-face: "What's in the way of you following the guidelines?"

The barriers that surface are often practical: no time off from multiple work shifts, no bus fare to reach a clinic. Sometimes they are fears about side effects, or, in parts of the world where Panjabi has worked, assumptions that vaccines cause sterility. "You don't have to change someone's beliefs for their behaviors to be more protective," he said.

Trust, he argues, is local. "It's not in Washington. It comes from your local faith leader, your local physician, your local school." He cited polling showing 80 to 90% of Americans still trust their healthcare provider. "Our greatest protection is connection."

On artificial intelligence, which he uses in medical research, Panjabi acknowledged the same tools that help scientists design cancer medicines or vaccines could help a terrorist engineer a supervirus. His rule: draw a circle of what you can control, and act inside it. "AI has not yet been able to dissolve the barrier between the screen and the freezer," he noted — but he insists warning systems must be built now, before that barrier falls.

The personal thread runs through the professional one. Panjabi won over his wife, Amija Rai, after "about three or four" rejections, with peanut butter and jelly sandwiches — two-thirds strawberry jam, one-third peanut butter, layered — 25 years ago. The recipe, he admits, probably had little to do with her yes. The playbook, in his telling, is what remains when charm runs out.