← A Shot in the Arm Podcast
A Shot in the Arm Podcast
Prescriptions for an American Public Health Revolution: Countering the Trump Administration’s Disastrous Assaults on our Health
01:15:24
Loading summary
Transcript60 lines
- [00:04]
A
Welcome to A Shot in the Arm podcast. I'm Ben Plumley and this is a podcast about innovation and equity in global health. Because let's face it, without equity, what is the bleeding point of innovation? Well, I'm delighted that we have a twofer today. And right up front, I'm joined by friend of the POD author and journalist Emily Bass. She has a most fantastic substack channel which I strongly urge everyone to visit and subscribe to. She's been breaking a lot of news around what's going on with these cuts and changes that are hitting us in global health and public health here in the United States as well. Emily, welcome back to the pod.
- [00:48]
B
Always happy to be here, Ben.
- [00:51]
A
So what a week we've had. We have the firing of Susan Moranes. We have the resignations of our friends Deborah Hoori, Dimitri Dusk. You tell me his name. I'm having a moment.
- [01:07]
B
He loved a time that an auto prompter auto transcription subtitle called him Dr. Disco Lights. So you can always call him Dr. Disco Lights, but if you want me to stick the landing, it's Daskalakis.
- [01:21]
A
Dr. Discolights, I think, is the one that's going to, he's going to kill me for that. And of course, he's one of us. He comes from the HIV field and of course you've worked with him closely in Mpoke. We've got Daniel Jernigan, who I had the pleasure of interacting with over the one health and zoonotic transmission work. And we have Jennifer Layden, who's gone. So we've also got the National Vaccine Injury Compensation Program, potential changes. We, we've got the Advisory Vaccination Committee agenda, which looks really dodgy now that RFK has filled it with friends and family. And we've also had some news on the legal front. And I don't know if you want to start with there, but what really sort of stands out to you in all of this?
- [02:09]
B
Well, look, last week was a hell of a week. It was a hell week. It was preceded, in fact, before we had the leadership leave cdc. Hundreds of CDC employees who'd been preserved, their roles have been preserved by an injunction. They lost their roles the prior week, really continuing to hollow out areas of expertise, maternal, child health, things that we all hold near and dear to our hearts. But last week took it to another level. And I think that one of the things that stands out for me is the ways that developments, these developments in our field, in the field of global health and public health have had tremendous ramifications and raised concerns for those of us in those fields, but are also really the signals to many, many other people who may not have thought about cdc, who may not have been following the foreign aid, the legal challenges to the cancellation of billions of dollars in foreign assistance, may not have been following those things in the context of caring about public health, but who care about democracy and care about the stability of our institutions and care about the separation of powers and congressional power of the purse that last week we saw a really complete alignment of public health concerns and concerns about the health of democracy. So it was, it was a powerful and very, very sobering week. And just on the legal front, what we're talking about is that our dear friends and comrades who have been leading a legal challenge starting in the very the unlawful cancellation of foreign aid resources that Congress had appropriated because here in the United States, our Congress has the power of the purse. And they had said the money should be spent on foreign assistance grants. And the Trump administration apparently didn't know or didn't care that that's how we do things here in America and canceled those grants unlawfully. And we had brave challenge mounted by AVAC Global Health Coalition saying this is in fact illegal. And in a series of of court court hearings, they got an injunction, there was some victory. And then they've had a couple of setbacks. And most recently last week after a circuit court had, had had vacated their, the previous ruling and said, you don't have the standing as civil society, you don't have the standing to bring this case. There's somebody who could. They're not saying the claim is wrong, they're saying you don't have the standing. That was a three panel, a three judge decision. They then said, well, can we have the entire panel of the circuit court hear it? It's what's known as an on bank hearing. And they declined. They declined to hear it. And again, the door is left open for a challenge. It is not saying your claim is wrong, but it's saying you yourselves through this particular case, you can't make it. It's the end of the road. You can go back and try something else. Essentially, the sun had not set, or perhaps it had set, but what we do in the shadows, that sun was barely down before the Trump administration had said to Congress, great. Now with that legal issue apparently out of the way, we're going to do what's called a pocket resc, which is saying we're going to claw back these funds. We have 45 days in which to do it. It's Only it's less than 45 days before the end of the fiscal year, which is September 30th. And so effectively, there's no. A pocket rescission is, is a done deal. It's a moot point. So it's essentially saying we're going to take back these resources, even though in a democracy in the United States of America, Congress appropriates, Congress holds the power of the purse. There are opinions that pocket rescissions are actually illegal once again. So we had a huge setback because those billions of dollars include resources for foreign aid. We have grief and thanks for our friends who brought the case forward, who've been doing their regular jobs as well as fighting these, fighting these court cases. And then we had our field actually bring a constitutional crisis into clarity, right, with the pocket rescission at the same time that we're seeing the destruction of an institution, the vacation of leadership of cdc. So it really was a week in which the events in a field that you and I have worked in for years, I think will be remembered for a long time as two watershed moments, two moments of red lines in terms of assaults on our democracy.
- [07:07]
A
Do you know we've just done this interview with Eric Goosby, and normally I want to be very upbeat and positive about the interviews that we have. And of course, Eric is my co host on the global health diplomats. He and I have this wonderful patois in the way we engage and enthuse each other. But I feel we've reached yet another turning point. We've crossed yet another Rubicon. You talk about the constitutional crisis. It may well be that health, public health, is truly the first of these major crises to hit this administration and hit American society, because this is going to be Republican families in Republican districts that are going to have their children's access to vaccines severely curtailed. And I don't think anyone has thought through the ramifications of that. Not Republican political operators, not Democratic political operators. And my sense of this interview is that we really have a job now in front of us, and particularly it's on the shoulders of people like you and me, Emily, people with an outreach to a broader audience, not just a public health audience, to say this is what is happening precisely because Donald Trump's policies are impacting our health and because his appointments, particularly the appointment of RFK Jr someone completely unfit for purpose, they are damaging the health of your family, your children and your parents and your neighbors. And I think that this could potentially be a groundswell moment. So that's what I took from the conversation we had with Eric, what were your big takeaways?
- [09:15]
B
You know, I think that we are in a moment and I took this from the conversation, all three of us, who I would say are people who work within institutions for the most part with and for systems and institutions and that we were really digging into in a very detailed way. What do we do? What specifically are we going to do while we try to salvage the cdc? What is the workaround because the federal government is failing? That is a conversation that I think we have certainly haven't had on the pod. And if Ambassador Eric Goosby is going there and he went there, I hope everybody watches it. This is real. When the brainstorming is about how do we create a shadow public health system, not as a hypothetical but as a very that is where we are. I'm going to pose one thing and you can bat me back. I think we have a messaging issue with vaccines. And I think that what I want Republicans, I want everybody to understand you may or may not care about whether you get a vaccine. I'm going to set that aside. If you want to walk into your doctor's office with your child or your elderly parent and they are very sick and nobody knows what's wrong, if you want an accurate diagnosis, you need the CDC that's your child is suffering, your adult relative is suffering. You don't know whether it's the new outbreak of something you've never heard of or whether it's something predictable. Everything depends on diagnosis. That is where treatment flows from. You deploy vaccines to prevent those things from happening. You want the correct diagnosis. It's really that simple. We have turned off, we're turning off the lights on our surveillance systems. And I think that we need to communicators and vaccine advocates and I'm 100% pro vaccine. We need to start to figure out and test and understand the narratives that will bring this home. This is not necessarily about we're not going to win this with measles. Perhaps we might. But what we are really fundamentally talking about is can you find out what your loved one has before they die or before they experience excruciating suffering? And do you want to know? So it's an upper where it's one of our lighter podcasts.
- [11:58]
A
Well, let's get to it, shall we? Let's watch and hear our conversation with Eric.
- [12:03]
B
Oh, where we go.
- [12:06]
A
Well, Eric Goosby, we're back with a mashup of a Shot in the Arm podcast in the Global Health Diplomats and it's really terrific that we're back talking together and we've got author and journalist Emily Bass with us. How are you doing?
- [12:26]
C
I'm doing well, all things considered. I think we're all learning how to manage incoming fire better and process it and then still try to land on our feet and move, move forwards with it. So a confusing time.
- [12:42]
A
Do you know, I'm feeling that this is like a nightmare. Either a nightmare reality TV series or a nightmare 1980s soap opera. And I can't work out which it is. Or maybe it's a mixture of the two. But hey, it's been quite a week, right? We have the firing of the CDC director, Susan Monarz. We've got supposedly this new interim, Jim o' Neill, less said about that the better. We've got the resignations of friends of ours, people we've worked with Deborah Houry, Dimitri Daskalakis, Daniel Jernigan and Jennifer Layden. We've got the agenda for the VAX Advisory Committee to the cdc. That committee, of course, the members of that got fired and replaced with, how shall I put this? Friends of Bob, Friends of RFK and known vaccine skeptics. And they're going to address, it seems, a whole range of vaccines, including hepatitis B. And then of course we've got the possible changes to the National Vaccine Injury Compensation Program, the vicp, which could really have a chilling effect. But I guess, Eric, I think the question that maybe Emily and I would first want to get from you is just what's bothering you the most from this list.
- [14:20]
C
Well, thanks for convening a discussion reaction to this, Ben and Emily, it's great to see you. I think the thing that has bothered me the most is the abandonment of science as the basis for recommendations. The the admission or the willingness to even go into that space for the premier public health institution on the planet, the one that has had the most sustained recognition of its science driven recommendations, the importance and understanding of how surveillance of a disease process and how that disease moves through a population was defined and I would say made functional and more accurate with the center for Disease Controls implementation of these methodologies and strategies, making a surveillance system truly an instrument to understand where diseases are, how they move through populations once present and the individuals in those populations. So the center for Disease Control taking the population aspects of the natural history of a given disease through how it moves through communities where NIH really looked at the natural history of disease as it moves through and attacks an immune system, how the immune system responds or doesn't respond to that, and looking at the clinical manifestations of that. The CDC is the complement that brings in the public community response to that same disease process and makes it
- [16:05]
A
a,
- [16:06]
C
a national goal and agenda that brings, I say, the advances and individual disease advancement to benefit the whole population. And that gradient and relationship is being challenged and eliminated right now. And I think until we understand the specifics of it, we have to assume that it's an attempt to dismantle.
- [16:34]
B
Eric, can I, can I ask you to help out? Well, I'm not sure that it's the kind of help most folks want, but as I'm having conversations with people who don't think about the CDC as deeply or on a daily basis, first of all, because of the focus on vaccines, there's a real understanding that our access to vaccines is at risk. But what you're describing is, frankly what terrifies me the most as well, which is the lights going out on our surveillance. Can you, can you give us a specific example? Can you talk, you know, I mean, whether it's legionnaires or salmonella or lead poisoning. But just what does it mean? You just described it really beautifully. But if there's a way to sort of ground it for somebody who's trying to understand how does it affect me personally that the surveillance lights are dimming right now?
- [17:21]
C
Right. I think we all understand the role of the physician in dealing with the complaints of a patient. The physician hears the complaints, understanding the pathophysiology and physiology of that patient. The physician tries to identify problems that can be diagnosed and treated most urgently. You're most interested in those disease processes that you have a diagnostic capability for and a treatment for. And the tragedy in our science and medicine is when we aren't able to hook up the science that we do know with the, with the patients that would benefit from that science. And the center for Disease Control with its surveillance instruments. And there's many aspects to the surveillance of it enabled us to understand where that disease threat was in a given population, how to identify, inner and retain that person in care for the duration of the need to treat that individual. For hiv, it's a lifetime. For tb, it's, you know, three months to six months to a year. For multidrug resistant tb, longer durations of interface with delivery systems are required. And the center for Disease Surveillance system was the part of that capability that identified and brought that individual in the crosshairs of the delivery system so they can benefit from the science. It's, it's simple. But it is critical for that machine to keep trudging down the road. When it's interrupted, the understanding stops completely. You don't sort of understand how the virus or individual disease is moving through a population. You have to constantly understand it, re evaluate, confirm as that individual is impacted by the disease process so your delivery system can diagnose and treat it when it emerges. So it's a delicate balance. Yeah.
- [19:36]
A
No, I'm struck by both of the comments that you're both making, and a question comes to mind, the abandonment of science and what that means. The CDC is one part of the equation.
- [19:52]
C
Right.
- [19:53]
A
We see the administration targeting grants from the NIH to academia, which is another part of the equation. But what about the NIH itself? Do you think we should expect the NIH to be put through the meat grinder in the way that the CDC is? Or is this not really a plan? It's just more a, you know, it's the revenge tour of, of, you know, for RFK Jr. It's the revenge tour against anything medical, and for Trump, it's something quite, quite different. Eric, I don't know if you'd take that first.
- [20:34]
C
Well, yeah, yeah, well, I, I guess I would say, Ben, that it has been very difficult to understand what the agenda or intent is. The cabinet leadership in the hhs, with Robert Kennedy's agenda around vaccine validation and the utility of vaccinations in general being kind of revisited. I think it's the idea of settled science being vulnerable to, to a reconsideration around whether or not there's a causal relationship or not is a oxymoron of ridiculous behavior, completely unscientific, not part of the way we have been trained to think about a problem. Or once a problem is understood, science still leaves the door open to reconsider it. But to reconsider it in light of the knowns and agreed upon assumptions as we move forward with it, not, not an abandonment of the accepted science. And the extraordinary approach that the Secretary of Health is presenting to HHS is to reopen what I would say were areas that were not controversial nor being considered by those who are expert in the field. Still unsettled and the disruption that that creates is what we're seeing now. It raises questions about issues that we have already made a decision on as a public health system and move forward with it. Taking and grabbing the benefits from those vaccines or those therapeutic interventions as truth. And when you identify a truth, it goes into a standard of care, becomes a standard, and that in our delivery systems in the United States, opens up insurance reimbursement systems that make it happen when you interrupt or question that continuum of care and services, you run the risk of interrupting the flow of services to those individuals who, as I say, need and deserve to benefit from the science we've already accepted and we know. And that interrupts that continuum of kind of cascade of events that have been going on for many, many years and in delivery systems that have interfaced with public and private for many years. It's an orchestration that is extraordinary when you dismantle all the component parts that need to contribute to develop and support a continuum of care and services for any given disease. That's based on the science that's known, understood, and as we implement these programs, as those understandings change, we are nimble enough and have figured out mechanisms to get the science in front of the recommendation quickly so experts in the field can incorporate into that continuum of care and services that's needed if there is a change needed. If there's not a change needed, we've got already existing platforms for the debate to occur, so we get to the truth quickly, safely, and then implement it so the population that needs to benefit from it can
- [24:15]
A
see. Emily, you and I have spoken about this in the past, but what's your take on what Eric just said? Because again, coming back to this abandonment of science, this feels actually much bigger than the cdc and your take on whether this is a Shakespearean revenge tragedy or I should say a Jacobean revenge tragedy, because they came after Shakespeare, but we don't need English drama history there, or are we talking about a scattergun approach or a deliberate strategy?
- [24:53]
B
So, you know, I think that. I think we're moving into a period where it's going to be increasingly difficult to believe the information that is coming to us from government agencies. And I think that actually where I want to reach right now is the removal of the leadership at the Bureau of Labor Statistics after a report that the president didn't like. You start to change the leadership and the expertise in neutral bodies, bodies that are collecting information that are telling you about the strength of the economy, that are telling you the right thing to do. Look at what's happening with the Fed. I think, and you and I have talked about this, that we're at this moment where there are real and specific issues that are coming up right now for public health in the US and global health writ large, and that there's a larger yet framework which is all of these different shifts are creating a climate have created. I think we're in the past tense in which the information coming out of agencies that we have relied on to give us the. Whether we agree or don't agree with their interpretation. It was there to be engaged with. We're not necessarily gonna be able to believe the information that's coming from because the people. And I wanna be clear, this is not about whether or not vaccines work. That's established. Many of the things we're talking about, you know, as Eric was saying, have already been litigated. Right. But we are getting into a position where the sources of information that are used to guide decisions and conversations, the sources are being compromised. You didn't ask for my movie reference, but it certainly isn't. I don't have the right accent to give you, to give back Jacobean, but. And I also am a person of a certain age, so I'm going to go Cloverfield, which was made by the people who also made Blair Witch Project, and it's a brilliant movie which has people using videotape. If you're watching this and you don't know what that is, welcome, and please go. Go review it. But it essentially means that you have. You have a recording happening over something else. And they're documenting the destruction of their. Their world by, I think, a giant angry lizard, if I remember it correctly. But every time they hit pause, the tape underneath it shows life before. And. And I've been thinking a lot, last week was. Last week was a horrifying week. And I. And what are we doing at this moment with these conversations, with everything that we're all doing? And some of it is documentation, for sure, and some of it is juxtaposing where we are now with life before. Right. And holding those things. And some of it saying is, wow, that's a really scary giant monster. Stepping on literally, institutions, literally the edifices. So I think we're in a moment, though, where both witness but also recall of what exists, what function it played is essential because we make the record and we keep what's there and we try to rebuild always.
- [28:13]
A
So question for you both, can we come back from this? Can the CDC come back from this? I mean, some folks are saying, assuming Trump doesn't prevent the midterms from happening, which is sort of way out of our bailiwick, although it's clearly very connected. But assuming those elections go ahead and a Democrat majority is returned in one or both houses, there's some way of putting the brakes on this. My question to you both, though, is, is it too late? Can CDC be repair?
- [28:55]
C
Well, I think that's. That's a tough question. CDC has been an agency that has been kind of at the crosshairs of a lot of controversy from family planning agendas that just dominated kind of the, the, I would say, kind of woke up political discussions came in there very early on in the late 60s and went international with where kind of family planning interventions really were most robustly implemented and deployed. But coming back into the United States, the Center for Disease Control has really been at the center of a lot of those types of social issues. And that has been a good thing because it has allowed for a convergence of a scientific discussion to dominate often what would and could be a politically dominated kind of social outcome, which I think is always a blending. But in this particular instance, the challenges that have come to the CDC span a 20 year kind of challenge that goes back to the, to the kind of family planning type agendas, to vaccines immunization recommendations. The advances that have occurred in both the ability to diagnose and treat in HIV and TB and in hepatitis have been breathtaking in these last 30 years. And CDC has quickly taken the science and incorporated into what should be the changes in the standard of care and then aggressively been the conduit through which that reaches academia and private sector insurance company reimbursement systems, which really is the resource motor that makes it get to the population. And understanding all of that is something CDC has become expert at. I think that in this period of, of reconsidering what I think is already cons, you know, accepted scientific data and accepted continuous, you know, continuum of care, putting it in the continuum of care and services for different age groups and genders is something that the CDC has excelled in. And their writing and defining of standards of care, especially in the infectious disease arena for vaccination, et cetera, has been the standard. I think with this moment, we now have to recognize that the challenges that have come to the CDC need to be accepted for what they are. And we need to look to professional societies to bridge this moment where cdc, I think, regroups in its leadership needs to come back as the premier public health institution in the United States, which there is still a need and a vacuum for that CDC is still the best candidate to fill it. And I think the medical community and the academic community cannot let this turf be lost. It needs to take on the challenges that have been put forward by the Secretary of Health. And he needs to be taken point by point and have his issues engaged and move through to this to revisit the standard of care that he has challenged now. But we need, with the methodology that we always use and the systems and convenings of both societal and federal expertise. We need to put those resources together to redefine a standard of care for the American people as we move forward that is based in the science that has continued to be informed by the science, but is validated by a surveillance system that continues to collect data. So if we are wrong, and that's the beauty of this system, we will find out the, we will see that divergent outcome and document it and make the appropriate change to prevent it. And we are an example of doing that over and over and over again in any disease you can name. But especially in the infectious diseases. That iterative nature of trial error based on the data that we collect and reflect back on the population outcome that we're after. We have gotten very good at aligning all of those and HIV and TB taught us how to do it internationally as well. And we have no excuse, we do know how to do that. And I believe that we need to depend right now on professional societies like, you know, the Infectious Disease Society of America is another entity that historically has always done standards of care, recommendations around vaccines, new treatments, etc. And they have always been part of the CDC process as well. And that needs to be kind of rejuvenated and rekindled.
- [34:44]
B
I mean, you know, I think that we, we, we have to work to preserve and, and save the CDC and we have to break it down a little bit and figure out how to make sure that core functions that the CDC was performing continue to happen. And that may look different in the short term. I'm thinking I have two children in the next room, they're 12 and 15, I have 82 year old parents, they're not in the next room. You know, when they, you know, if my, if my kid gets a rash, I want, and he walks into our pediatrician and there's an outbreak, let's have mpox. You know, maybe there's an mpox, which is, which is an excruciatingly painful virus in the smallpox family. It's killing children with a high case fatality rate in, in west and Central Africa right now. I want, you know, if it comes over and it's also an ongoing outbreak in, in the US and in Europe. But you know, I want, if my, the CDC historically is the reason why my kid could walk into a pediatrician and she would say, you know what? I've heard that there's a cluster of cases. I know something's going on here. I want to rule out this looks like chickenpox I want to rule out Mpoke. My mother has a fever. She walks into her doctor and they say, you know what, Legionnaires, we've seen a couple clusters. Have you been in these places recently? That is the difference between them getting care that could potentially save their life or prevent them excruciating pain and not. And that's what I feel like people need to start to understand when we lose the cdc. Whatever you think about vaccines, vaccines, you are losing the ability to have your loved ones and your most vulnerable loved ones have a diagnosis, including a differential, which means it could be this, it could be that, that brings in something that might be uncommon but could have been detected in your neighborhood, in your town. Because we have disease surveillance. And I when, when your, when your parent or your child is struggling to breathe or is in excruciating pain, you want the answer about what can help them. And we are shutting that down. So we need to preserve that. I'm interested, Eric. I don't know what you think about this, but I'm thinking a lot about municipal and jurisdictional state health departments, New York City's Department of Health. I've seen extraordinary pooling of resources and information both in Covid and in the MPOX outbreak. It was really at its height about three years ago. Waste. I'm thinking about wastewater surveillance. I'm thinking about different kinds of systems that we might be able to activate regionally, maybe with idsa, with consortia to keep some surveillance lights on, not to replace the cdc, but because we both have short term threats to our existence and a long term road to preserving institutions. So I'm really curious if any, if that sounds completely, you know, if the, if the dinosaur stomping on my building has gotten to my head.
- [37:51]
A
But that's, well, I think it's, it's also a question of a coalition of the willing of states. And I want to come back to that. But, but my take on this question about whether the CDC can be salvaged happens in September. And I was struck by the comment that RFK Jr made in the Trump Cabinet meeting at the start of the week. And I use cabinet meeting in a very light description, but he said he promised that there would be an answer to whether vaccines, childhood vaccines, cause autism by September. And he said we're finding interventions, certain interventions now that are clearly almost certainly causing autism and we're going to be able to address those in September. So for me, if he comes back in September with some sort of, pardon my French, bullshit piece of crypto analysis rooted in skepticism and then requires the CDC to adopt ADAPT guidance, then for me, that's a real line in the sand. And so, Eric, just picking up on what Emily asked you, your sense of where these coalitions of willings. I mean, we're seeing it sort of kind of in the northeast of the United States, the New England states, but we're also potentially seeing it out west here with California, Oregon and Washington, along with the academic institutions and the professional bodies. Do you think we have a mechanism to tide us over or are we screwed?
- [39:46]
C
No, I think that we are smart enough to bridge this and should not give that up. The knowledge to continue a surveillance effort, to choose what should be the targets of that surveillance effort. Should we do impacts or, you know, should. We would not have known Covid was the culprit had we not had the surveillance system that we have, that would have. That would have gone through our population and we would have. When they started hitting the emergency rooms and ICUs, we would have taken note and then we would have scrambled. If I'm for trying to figure out what is causing it. But with our surveillance system, we saw it coming, you know, weeks before it actually got to the point where it was saturating our hospitals. We had a couple of weeks to position ourselves, and it made a huge difference in those places that were able to do that, which are many of your urban settings in the United States, many on the. On the west coast. But you've got departments of health in states that are strong, some stronger than others, but all strong enough to play this role. If there's an orchestrating convener, and that traditionally has been a federal entity that convenes that, I think we've had a question and a corruption of the credibility of that federal entity. And I think we're going to have to have a period where we create a process that's acceptable and trusted by those in and outside of the government enough that it's allowed to play the role. We got to agree that we're going to give it that license to play the role, but to bridge into a rejuvenation and strengthening exercise for cdc. All of those elements and systems can be rejuvenated. We do not have to reinvent them. They were correct to begin with. But I think you put a naysayer or someone who challenges a system, and it's easy to challenge and to raise enough question that people quickly go to dismiss the findings of it. And we in the academic arena need to be vigilant about validating a process that moves forward with this. So we on the front end are dealing with those concerns. There will still be people who call foul and raise questions about validity, but we need to outweigh their cries with credible, knowledgeable responses. And I think that's going to be tricky. And I think, Ben, you and this type of a skill set are often the conduit through which that is bridged.
- [42:41]
A
So I'll hand over to you, em, in just a second. And I know this is a really dreadfully serious issue. And of course, the way that I deal with dreadfully serious issues is with humor. But, Eric, when you said about a convener, we need a convener. Yeah, Boy, am I thinking of Gavin Newsom and his tweets and his bleeds. And anyway, moment of humor done, Em, over to you.
- [43:08]
B
You know, I go lighter, I go dark. And I feel like part of what I'm doing with the big picture here is saying, yes, 100%. And the other piece of the context, the undermining of our faith of trusted information, is, quite frankly, an attack on cities. You know, and so I'm thinking, and unfortunately, I do think we need to start to think about all of the risks and liabilities, but really thinking about the extent to which this government seems to want to put the military into cities. I live in New York. They're, you know, they've. We're on the list. That that means that autonomous work of any sort is going to be in the crosshairs. And so as we think about public health work, I'm thinking, well, at what point does that become insubordination? So there's the darkness. But I am curious, and this is a question I should know the answer for coming onto the podcast. But in terms of resources, Eric, maybe just to think about that, urban city resources, state resources, you know, losing the funding, you know, how much do we have to be thinking about who's going to pay for the coalition of the women? Are the spigots? Are the resource spigots going to be turned off? Is RFK's hand on the tap? Do we not want to talk about it right now? But can we get the coalition together with the funding? Do we have what we need?
- [44:50]
C
No. I think, Emily, that the funding is going to be something that we need to struggle to identify and then hold accountable once the flow is started, because there'll be agitation around it to stop it. I think what the truth shall set you free. The ability to understand and have the issues and questions that people are struggling with on the plate and indeed become the questions that we engage and answer is part of that transparency. But I believe a benevolent benefactor is the most rapid way to get this done. And that would be somebody who is not connected to the billionaire thought process as intimately as so many of our foundations are. And I don't mean that overly critical. I just mean we've already been burned by allowing the belief that a foundation actually has ever had the bandwidth to be able to do what a government should be doing to respond to the unmet needs of its population. That's a government's job to do. Those are numbers and resources that exceed any foundation's ability to put a dollar amount on it. And it was unrealistic for us to think that foundations were the answer for these big global problems. We should never have allowed governments to get out of the crosshairs and be held responsible and accountable for the services they are not delivering to their own populations. Just the healthcare that's not delivered in San Francisco or Los Angeles or New York that should be. Is pathetic and completely indefensible to argue that no, we shouldn't, we should have an understanding of how to diagnose and treat something, but we shouldn't make it available to the people with that diagnosis or in need of those treatments unless they can pay for it. And that for some reason has won the discourse. And we all nod our heads and look at it and say of course. And it's because people have bought in to the resource expansion. It's meant for their personal lives by being the doctor that becomes part of the system that is corrupt in the way it takes or limits access to health care delivery for the population. They say they're concerned about the political connection to that need, that unmet need we abandon and don't hold the politician accountable to deliver it when it's not delivered. We just go, well whatever, you know, you're not responsible anymore for that. And we don't continue to hold that individual and that political system accountable for the delivery of that service. And that alignment needs to come back into how we design our systems of care. So all that being said, I think we need a benefactor for that can bring.
- [48:00]
B
I mean that might have been the benefactor calling. Do we want to just. That might have been the benefactor on the phone. So that, that, that, that, that incoming call. Just be sure we didn't miss the benefactor. So we, we need a benefactor. We need a coalition of the willing and we need a leader of the coalition of the willing. I'm trying to keep. Is that, is that the to do list we have right now.
- [48:23]
A
Well, let me, let me step in here because do we need, do we need a champion, a philanthropist? Because look, there's one immediate elephant in the room when you say we need a philanthropist to step in and support us. And that, of course, is the bill of the Gates Foundation. And I have to say, I think the CEO, Mark Suzman and obviously the leadership of the board have been very smart in steering the foundation away from trying to do that. They've been burnt in the past and I know that's what you're referring to, to Eric, as they've taken on more and more financial responsibility and indeed content responsibility. But that's just not going to work in this environment. The other part of philanthropy which speaks to us on the west coast, of course, is this dark enlightenment, the Peter Thiels, the Palantirs, the Elon Musk's of the world that have a very different view of the role of the billionaire in driving change. And that is completely counter to the kind of citizen led public health approach. It is ideological, it is purely opinion driven and it will destroy us. I mean, I frankly, listening to the both of you talk, and I don't want to talk civil war here, and I'm not talking about the movie either, but I'm thinking that states themselves, who are, let's face it, net providers of funding to the federal government, well, they're going to have to rethink how they do things in this environment because if the needs of their citizens are not being met in the context of public health, in the context of public safety and the expression of autonomy, as you were describing, Emily, in cities, then they have a really tough question to answer about whether they should be providing the federal government with resources to do that. So whichever way you look at it, we're sort of heading towards a crunch. And that gets me to, I think, one of the penultimate questions that I wanted to raise with you both. And again, Emily, you and I have spoken a lot about this, the political ramifications of this, because there are so many opinion polls showing that, okay, put Covid to one side, but that over 90% of the population is in support of vaccines that protect their children, that protect their parents. And how is it possible that a Republican party and let's just go right there. How is it possible that that kind of political institution can get away with supporting an ideological skeptic agenda that goes completely counter to the needs and wishes of their citizens, whether it's Alabama or it's Georgia or wherever? And I guess the Question is, do you both have hope that perhaps we can reel some of this in as people think, well, you know, maybe we're going a bit, we're going steps way, way too far here.
- [51:56]
C
Well, you highlight to me Ben, how far away from a rational linear thought process our society has gotten. We are not trying to figure out what our population wants. Indeed, when we believe we understand what they want in a poll or whatever, we don't honor it. And we don't expect a politician to understand what the population wants and deliver it, give it to them. That expectation has been dismantled, eroded and diluted. So much so that the causal linear connectivity to a causal effect with that is no longer seen as that results in an outcome that we could have predicted. We no longer do that or want that to be done. We have abandoned what was a rational, I think justifiable and defensible system that allowed for continued feedback as it moved towards implementation. We continue to know if it's aligned or not aligned with the outcomes we're trying to create. And public health struggles with all of its methodologic interventions to get delivery systems that have surveillance systems that inform it in real time and allows feedback loops that allow for correction in real time as much as possible. So it's not a three year wait to change the out to change the outcome in the population. We try to reintroduce that in that same year and get that outcome changed in that year. And when you have surveillance systems that are robust, you can do that. When you don't, you cannot possibly do that. So not letting it unravel to the point where we have to build it again is the, is the hope and I think we're smart enough to do that, but we have to be charged to do it. And getting the charge from the federal government seems to be a, a more difficult thing to secure. And I and a foundation or something saying that is not good enough quite frankly. So I really do hear returning to a more local delivery system, supporting and strengthening those delivery systems are something that we, we've always needed to do. But now maybe more than in the past, waiting for a top down answer is not going to happen quickly and we need to kind of do both at the same time. But I do believe we have the knowledge to build it, but we don't have the resources aligned in such a way that, that, that they will generate the outcome that we're trying to build. And I think rethinking on a societal level how our resources support and expand political systems that result in the outcomes that we're talking about is the realignment that we've lost. It was never perfect, but it was certainly a lot better than it is now. And I think crises like HIV caused us to develop these systems in a robust way. And so I believe that we need to recall the utility of that. And I think monkeypox or any current threat, the COVID threat, when unpacked, took us through the exact same challenges that we now need to strengthen. So I don't think we need to act like we don't know what to do. We do.
- [56:00]
B
You know, Grace Paley wrote once, the only recognizable feature of hope is action. And there are still actions to take then. So I'm not going to say is there hope? There's certainly action that we can take. And I think that's what we have to focus on. Eric covered a lot of it. I think. The thing I am also thinking about is that vaccineness and disinformation, distrust in vaccine, fear of vaccines, and has been with us for a really long time and that all of the science and all of the inquiries into that tell us that talking to people about what's going on with them and for them is really, really important. And that at this moment, right, and we've been in this, this moment is now an extended period to the extent that we can continue, that is evidence. Also, the vaccines are evidence. So is the evidence that if we're trying to build trust in science and Eric, I'm not saying nobody here is doing this, but you do see it in, in the kinds of media and the kinds of posts I, I consume. You know, how could you be so stupid as to think X? You know, there's a, you know, little thing, you know, about RFK and the brain worm and the, and the bear and the shark. I mean, there's, there's some craziness there, but how can he, you know, fix mental health? And there's also people who are like, well, he said he was going to take high fructose corn syrup out of food. And I really care about that. And so I, I am not making a claim for, for his sanity, but I am saying that the evidence behind what we need to do to continue to have people want and trust science also tells us we've got to continue to find ways to have conversations and deliver information that isn't in the context of, of if you don't believe this, you're stupid. If you think some of what he's saying right is right, you're stupid. And I feel myself at this Point sort of moving away from that and so continuing to be curious at this moment about what else can we do to bring things back together when there's such an impulse to destroy is I think that curiosity is where there's hope for me as well.
- [58:19]
C
Yeah.
- [58:19]
A
I think that really one putting the
- [58:21]
C
Emily, I was just going to say, Ben, that to me it is important right now to be very clear about calling foul with, with what the secretary is proposing. The, the, the authority and the scientific credible authority needs to say you are stepping away from a scientifically based recommendation not in the interest of our patients or the population that you're responsible for. You're irresponsible in that charge. Stop it. That needs to be that clear. It needs to be instead of couch, it needs to be a clear statement of you crossed the line as the Secretary of Health and Human Services. You really can't be that irresponsible in what you say because people give you more credibility than you've earned. And that is just the truth. That's the position you're in. And what people are going to do and the community and the scientific community and the clinicians in the world need to call foul with this and watch and pull the boat back into the current because he has allowed it to go out. And it's not clear to people that he's out of the current, but it's clear to us and that needs to be communicated better.
- [59:45]
B
Well, he can't. I mean, are we going up to the line or not stepping over it? You know, someone will tell me we have to edit this out, but he, he's not fit for the job. I think is what is, is part of what we're saying. You know, if your, if your job is to, is to review evidence, deliver guidance, support institutions that do those things, those are just job qualifications, as I understand it, for the role that he's in.
- [60:12]
A
Well, which is why both Cassidy and his ranking Democrat, Bernie Sanders, are being drawn inexorably to some kind of Senate hearing around what is happening here. What advice would we give them? Should Trump fire Kennedy? Should Kennedy resign? Are we at that point? I ask that because I truly believe we are. And I'm going to say right up front he must resign. But I welcome your thoughts.
- [60:46]
C
I think he's crossed the line and is no longer looking out after the interests of the population he has charged to Shepherd. And when you have somebody who's making, who has stepped outside of that kind of bubble, I think the profession of public health and scientific profession and clinicians especially people who care for other people off of these standards of care and recommendations, need to hold this equivocation accountable and call it for what it is. It raises questions when it shouldn't and you risk lives when you do that. And that is irresponsible. So on that level, I think his tenure as Secretary of Health is challenged on a fundamental level and I believe should be visited that way and he should have that kind of inquiry aggressively now and would take him back up for what is it you think you're doing if there's not an adequate response, I would say that this needs to. We need to have a Secretary of Health who has the interests of the population at core central and demonstrates that in every decision they make when they don't demonstrate that we and the President need to call him on what are you doing? If the answer is not acceptable, it needs to be acted on, period. This is not a game. This isn't some kind of a pretend operation. This is the real deal. And he doesn't realize maybe this is real life and we need to hold him accountable as such. It's not rocket science
- [62:35]
B
where, where. Dedicated public servants are being fired for, for spurious allegations or seeking to remove one of the governors of the Federal Reserve. What is happening here is not spurious. I mean, I think that's really. And I would encourage Cassidy and Sanders Congress. This is not their oversight. Yes, but really move into a mode of looking at the job, looking at the job description it and it is not being executed. And to be just really specific, you know, as the heroes who have recently left CDC. Dr. Daskalakis, you know, talking about how he tried to keep an open mind when he was told they were changing COVID vaccine recommendations. And he said, great, let me see the evidence. Let me see what you're working with. Right. He didn't say, you know, that's crazy, it's settled. He said, let me see what you're working with. And they refused. So let's just step back from ideology and go, you know what? This. Your role, if you are leading this institution, is to assemble the evidence, share it with your experts, let them debate it. You know, you know, where it's settled. Science have it stand, but not executing those steps, you're not doing your job.
- [63:56]
A
Yeah, right.
- [63:57]
C
Is is what I'd call him on in that he did not create a process that got to the truth and he knew he didn't. And we are observing him not doing it. It is on us to say, you need to have a process. It finds the truth. You haven't done that. If you don't do that, you're the wrong person in the job.
- [64:17]
B
Yeah.
- [64:18]
A
Okay, so. And a couple of quick fire questions before we. Yeah, no, go ahead, Eric.
- [64:24]
C
Okay, I'm good, I'm good, I'm good, I'm good.
- [64:29]
A
So look, a couple of quick fire sessions before. Sorry. So a couple of quick fire questions before we close. We've got a couple of new COVID variants doing the round nimbus and stratus, or stratus depending on which part of the world, which form of English you speak. How worried should we be about them? And to what extent are we even capturing how much of a renewed degree of infection they are causing? I don't know, Eric, what your thoughts are on that.
- [65:10]
C
So when you have a, a mutation that occurs that changes the surface proteins on the virus itself, your immune system's ability to identify it quickly with antibodies that it's already made from past vaccinations or past primary infection with the organism are not as effective or not effective at all. It's. They are less effective or not effective if it's a large change from the prior spike protein dominance for antibody production that has nothing to do with those antibodies. You've got to create an entirely new immune response to identify and remove that virus from your blood. And that, that takes about three days to two weeks to do in a primary new infection after a mutation. So to not get the vaccination would be a mistake for that reason. For if you're. They're saying for people over 65, they are recommending the vaccination, but for younger people they're saying no. And I believe that they should be for everybody. Just as it always was up until this recommendation for, for Covid. For the reasons that I just said, none of that's changed. So now we're acting like something's different. No, this is a new mutation. You could assume that you've got some immunity for it from vaccination, better immunity from a primary, from a. From a real infection, you get a better portfolio of antibodies waiting for that new virus to present itself. But the revaccination and continued vaccination would be my recommendation to any patient I've got anybody with an immuno incompetent disease underlying, definitely. But anybody who's over 60, I would give it to my kids and everybody else with it. As this new variant emerges, for the reasons that I've said, none of that's changed. So to say we now need to come up with a New thought process on this really is infuriating. But that's what these little hiccups do. Every time someone raises a question, smart good people go back to the beginning and re. Engage as if we need to start from, you know, the, the first thought of, of a COVID pandemic. But we're further down the road than that. But the, but it does show the stutter start cadence that somebody who's the Secretary of Health can create, you know, a stagnant pond with pebbles thrown in it. All of those pebbles hit the water and ripple out with, with a wave that reaches the edge of that lake eventually. And that's just how it works. So I think we're once again in that, in that, in that moment. So I would say professional societies need to step up to the plate. I think a process needs to be thought about and created either with a multilateral, which was, which would be shunned by this administration. So thinking through how to include the United States in this, which continues to be the largest motor of resource on the planet for public health initiatives. And we don't want to exclude the United States. We need to kind of shame them into why are you not part of this effort? And you leaving this effort makes no sense.
- [68:50]
A
Talking about leadership at the top. Question for both of you, our final quick fire. Can we talk about mitochondrial challenges that can be seen in the faces of children by Secretaries of state. Sorry, Secretaries of Health and Human Services. Did you ever expect such a secretary to ever make a statement like that? How did you respond to it? Em, do you want to go first?
- [69:22]
B
I missed this one. What happened?
- [69:25]
A
Oh, bless him. He explained in some. And I don't know where it was. Perhaps it was on Fox News, maybe it wasn't. But he described how walking through an airport, he was looking at children, seeing how weak and measly they were. And he put it down to mitochondrial challenges that were impacting their health and the entire world, both the medical and scientific community and the public health commentary societies said. What the bloody buggery bollocks is he talking about?
- [70:07]
B
I mean, I think mitochondria everywhere are feeling very upset right now, is what I would say are feeling upset, offended and maligned. And I stand with the mitochondria in saying they have never challenged anybody in their face. That that is my response.
- [70:24]
A
Eric. Yeah, you get the final word.
- [70:27]
C
I'll just say that I think our Secretary of health is a, is a person who's been trained in law and not medicine, not physiology, not immunology. And it is it is really infuriating to hear someone just throw something out and expect us to place it in a rational sentence thought that makes sense. And I I just think it's an example of the gentleman that we have in this role is really out of his areas of expertise and it's obvious to those of us who are looking at it more from inside the tent and it was a bad choice for a person to be over health and human services to not have any kind of medical public health context or background in which to put it except a his a long history of anti vaccine really chicanery and that's the way I would put it. So this has been a frustration.
- [71:40]
A
Well we've reached the top of the hour and I guess Eric, we should let you go. We didn't cover the international ramifications of any of this which I was thinking could be a quick fire question but that would be like 1980s breakfast television. You've got between 8:27 and 8:30 to sort out global public health. But maybe we could come back in a different podcast to cover what this all means. So Eric, Emily, thank you both very much indeed.
- [72:14]
B
Thank you, Ben. Thank you, Eric.
- [72:16]
C
Thanks Ben. Thanks, Emily. Great to see both of you.
- [72:19]
A
Well, that's it for this episode. Thank you to my new partner in crime, Emily Bass, joining Eric Goosby, ambassador and Professor Eric Goosby of ucsf, co host with me on the Global Health Diplomats podcast. Thank you also to our director and producer Eric Aspera of A Shot in the ARM Media. And finally, a big thanks to to you. You can of course find us, download us and subscribe to us wherever you download your audio podcasts. And we urge you nay, we encourage you to visit our YouTube channel at www.YouTube.com hotarmpodcast. Subscribe. Hit that notification button because we'll be back with equally upbeat beat and optimistic podcast episodes of the Public Health Revolution. And in the meantime, have a great week and a safe week, everyone.