← Bulwark Takes
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- [00:00]
A
Jay, let's just get started. Hey, guys, it's JVL from the Bulwark. And this week I am joined by Caitlin Jettalina, who runs the your local epidemiologist substack, which I started reading, I think, basically like two weeks after you stood it up. So it was your pandemic project, right?
- [00:22]
B
It was, yes.
- [00:23]
A
Yeah. So this is, you know, like my oldest son taught himself guitar. Other people baked bread. You decided to start a substack?
- [00:31]
B
Yeah, I mean, it was never planned. It was. You know, I distinctly remember telling my husband in the beginning, I'll only have to do this for six weeks max, because then surely someone's gonna pick up the baton and do something about it. And it still hasn't. And there's a lot of information voids to still help fill. And so, yeah, I'm here.
- [00:53]
A
Well, it's great. And I've loved it since then. I. I'm a little bit of an epidemiology nerd. I was pre med as an undergrad. I actually spent a summer working at Thomas Jefferson Medical School. They called it the Office of Outcomes Management, but it was just epidemiology that was there back before. Anyway, I found your stuff at the very, very beginning of COVID and it was fantastic. You probably started in March. Do I have that right?
- [01:23]
B
March 2020. Yeah. Actually, this week is the five year anniversary of my newsletter. So there we go.
- [01:30]
A
Oh, my gosh, I can't believe you're still doing this five years in anyway. It's fantastic. And I really can't recommend it highly enough to people who are interested in science and public health and all this stuff. Caitlin, you have a real gift for making all this stuff accessible, which is very helpful. So I want to start out today by talking a little bit about measles. So we have. Measles is in the news. You've been following the measles outbreak. There are some hotspots all over. West Texas is the big one. Can you just give people a quick update? Like, what. What does this look like right now? Put it in perspective. Tell people why we're concerned about measles. Measles is bad. Like, it's a very high R number, right?
- [02:15]
B
Yeah, it is. So measles is coming in hot this year, Right? So we've already had more than 300 cases, which means we've already passed the annual count of last year. And actually the past 12 years, 12 out of the last 15 years, it's coming in hot. And there's a few reasons for that. One is measles just flares up every five years. We don't really know why. And I think that this is just the five year mark of that. But also this is meeting a time where less and less people are getting vaccinated against mmr. And we're seeing a rise in mistrust in institutions. And so it's creating this really dark storm. Measles is usually the first block to go with vaccine coverage because it's so contagious, one person, if infected, can infect 18 other unvaccinated people. It is actually the most contagious virus there is known on Earth. And so if there's an unvaccinated pocket like we're seeing in West Texas right now, as well as all over the United States, it can spread like wildfire if that virus finds it. And so you're right, we have this really big West Texas, New Mexico, Oklahoma, now Kansas outbreak. But then also we're seeing sparks, I call them all across the country from international travel. And the problem is the more sparks we have, the more probability, again, it finds an unvaccinated pocket and spreads like wildfire. So we'll kind of see where this is going, but it's not necessarily fun to be talking about this virus that we eliminated back in 2000.
- [03:59]
A
Yeah. And can you just remind people that, like, measles isn't just a rash, Right. I mean, we've had a kid die already and hearing loss, I mean, you wind up with real problems, right?
- [04:13]
B
Yeah, it's a nasty virus. I mean, I'll say, like the majority of people, it is just a rash. The problem is you're playing Russian roulette here, right? Because it can cause way more severe disease like hearing loss, brain encephalitis, brain inflammation. A lot of people don't realize the, the thing measles does too, especially if you serve. Obviously, if you survive it, it actually wipes your immune memory of other viruses. So what we see is if you get an infection from measles, 10 years later, you may die from flu because you do not have the immune response. Measles is just not a fun thing. And like you said, one in every thousand people die. And we've already seen two deaths with this West Texas outbreak.
- [04:57]
A
And so second one now. Oh, God.
- [05:00]
B
Yeah, there's, there's an adult, an unvaccinated adult who was in New Mexico. And so, yeah, it's, it's, it's not something we want to play with. And compare that to the low, low, low risks of the vaccine. I mean, it's kind of a, it's not a hard decision for me as a parent. And we need to get people the trusted health information they need to make decisions.
- [05:25]
A
So you talked about how measles is often the first domino to fall when vaccine hesitancy takes hold. What does the progress of this look like? Because I'm struggling to come up with any other historical analog where a society just decides to mutilate itself and blow itself up over something like this. But what, I mean, are there other analogs? Have things like this happened in public health where society just decides that, yeah, you know, we're so decadent, we want to. I don't even know how to characterize it without sounding like incredibly angry. So I won't. But you know what I'm talking about, right?
- [06:04]
B
Yeah. I mean, this is very new territory for public health. Right. And we're seeing this, I mean, if we take a step back, we're seeing this clash between individualism and collective good. And this is a really big problem for public health because the DNA is making the assumption that we're all taking care of each other as neighbors and there's a collective action there like vaccination and herd immunity. And that value system has been, been decreasing among a particular set of people in the United States. And it's incredibly challenging. And I'll say, like, I don't know if public health really has an answer right now of like, what do we do other than reach people where they're at, approach it in a place of empathy, debunk, debunk and try to equip people with evidence based information. And so it's a really, really tough landscape right now.
- [07:08]
A
The empathy is the hard part, isn't it? Well, I mean, for me, just speaking for myself, the empathy is the hard part because like there's, I joke around that like, you know, inside of all of us there are two wolves. Right. And so, you know, there's good JVL and bad jvl and good JVL is like, we don't want people to die. And bad JVL is like, let me out of the box. Right?
- [07:27]
B
Yeah, I mean, I guess it's.
- [07:28]
A
You clearly succeed in this. You're a very empathetic person. What is your secret?
- [07:33]
B
I'm a mom. Right. I have a four and five year old. There is so much crap on social media, sent to parents and all we're trying to do is do the best we can do for our darn kids. And I actually have a lot of empathy for Parents who are trying to wade through all of this information to just make the right decision for their kid. And so I do approach it in an empathetic way. I think that is one approach. Others approach it more in a bullish manner. And maybe both are needed, I'm not sure. But as a parent, I just get it that there's just so much out there, and I don't think people necessarily listen when you start screaming at them. And so I'm trying the other approach. We'll see.
- [08:25]
A
That's great. I'm just. It is almost impossible for you to monitor the comments as we talk, but two things. First of all, I just saw an old friend of mine from high school, Dr. Ryan McCormick, logging on. Hey, Ryan. But secondly, I've seen a whole bunch of people asking questions about the vaccine, which are basically boiled down to. These seem to be older people who are like, do I need a measles booster? Is it fire and forget? Once you're vaccinated, you never have to worry about it. So there is a complicated version of this answer which you've gone into, which is like, you know, I think what was there was a band of vaccine vaccinations from like 1967 to 1970 or something. Can you just do very quickly for people what they need to know?
- [09:07]
B
Yeah. Bottom line, if you're born after 1957 and you've had at least one MMR vaccine, you are incredibly well protected. There are nuances there, but just know that if you've had at least one vaccine, you're very well protected. Kids need about two because they're so susceptible to measles, but. And that's the bottom line.
- [09:29]
A
Right? Okay, perfect. So I want to talk about something else then, which is not. I mean, it's kind of of the news, but it's much more of a bigger picture thing. So you wrote a fantastic piece about the idea of efficiency in public health, which is. So I wrote something sort of similar about government more broadly. And my argument was that government is by nature inefficient. It is built. Slack is built into the system for all sorts of reasons. And efficiency is another way of saying we take slack out of the system so things can't absorb unusual stresses. And I think the metaphor you used was, if you want to lose weight, cutting off your own legs is not an answer. Yes, you lose weight, but that doesn't really do anything. And. And so much of public health is like that. Like, well, you know, we spend so much money on all of this preventive stuff. And it's like, well, yeah, but you think preventive medicine is expensive. You should see how much it is when, when people are sick. Right. So can you talk a little bit about what's going on? This is, this is all part and parcel of the Doge stuff that I don't think anybody in America thought they were voting for. I don't think a lot of people thought they were voting for the dismantling of medical research and the NIH and the cdc. Maybe some of them work. But can you talk a little bit about this?
- [10:57]
B
Yeah. I mean, this is one of the biggest nemesis of public health is that when it works, it's invisible. Right. Like, when was the last time you thought that remembered that your seatbelt saved your life? Right. Like, that's just not something we think about. Or like indoor air filtration. Right. Stopping infectious diseases. It's invisible. And so one, we just have to get a. Public health needs to get a whole lot better at explaining what we do as prevention and that it saves a ton of money. The article you're talking about was making the case that there's a huge return on investment with a lot of these public health problems like vaccines or even mental health programs, et cetera, and we just need to get better at talking about that. I will say, you know, I think that I agree with you that government is meant to be slow so we prevent these whiplashes. With that said, there's definitely places that it could be improved, especially at. Where I was at for the last three years was cdc. And I was brought in to help fix and make CDC more efficient, but it requires a scalpel instead of this axe approach. And one of the biggest things I'm worried about is workforce stamina. Like, is there going to be a public health workforce here in three years? I don't know, because one, we're getting burned. Two, we're already burned out from COVID And if, if you're not appreciative, I mean, I don't know. And you're not paid well. Right. We're in this for the mission. We're in it to be public servants. And it's. It's really hard to watch being dismantled. And I don't. I don't know how else to. To explain it, but it's hard to watch.
- [12:48]
A
Can you explain what you're seeing at cdc? So, like, what is, what is happening there over the last few months?
- [12:53]
B
I mean, there's definitely lists of names of employees that are planning to get cut. There's already been 10% of the workforce already cut, I mean in morale is really shot right now. People are very scared, people are uncertain. There's no transparency, there's no communication. You get an email and then they change their mind and get an another email. And all of this while we're trying to still protect the health of Americans. Right. We have this masses measles outbreak, we have H5N1 bird flu happening. We have just off of a huge flu year, we still have Covid going around. So like we also have day jobs too. And so a lot of this noise, it's just not, it's not a useful source of resources, which is kind of ironic given that this is trying to make people more efficient.
- [13:52]
A
Yeah, it's these, I mean, I don't know CDC in general, but I do know institutions, institutional muscle and institutional memory are hard to rebuild. Like it's really easy to break them apart. But it does take like 30 years, 40 years to build up all of that stuff. And when you lose the personnel, you lose the institutional memory, you can't build those things back up overnight. Right. And a lot of times, as we've seen in America, public health, it goes to crisis real fast. Right. I mean this is, you know, you don't get the benefit of like a 10 year lead up to the problem where you can decide like, well we can see we're going to have a pandemic in 10 years. So now we'll spend our time directing resources in that way.
- [14:37]
B
Yeah, it's challenging. Right. Because we live in a very reactive society. But public health is all about being proactive and like anticip and getting a reactive society to appreciate proactiveness is the challenge of the day, I will say.
- [14:53]
A
Yeah. The problem is that that's like a human nature challenge as much as anything. It's one of our cognitive biases. We're risk averse. But there's a classic fallacy about this. People are much more worried about, you know, losing $2 and winning $10 or something like this.
- [15:14]
B
Yes.
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A
And so it's hard to, hard to get people to appreciate the stuff that that happens to them invisibly. The other part of this, which is not quite epidemia, it's sort of more forward looking just what's going to happen on the research end. Right. You know, with the advances that, you know, a lot of public health relies on advances. And looking at what's happening with nih, what's happening with research grants, is this something you guys are worried about as well also, like not just like what's happening with the technology and the pharmaceuticals that we have now. But what does the development of this stuff looking forward look like going forward?
- [15:56]
B
Yeah. And you're talking mostly about nih. And for those listening, NIH is National Institutes of Health, and it's basically what funds the research machines in the United States. Most of this research has been put on hold, which means that today we're about answering about 2,000 less research questions than we were last year to the average American today. It won't necessarily impact them unless they're employed by these research grants or academic institutions. What it will impact is years down the road. Right. We won't have an answer if you get some rare cancer. We won't have a clinical trial that is trying to help solve Alzheimer's. Right. And so again, I think it comes down to this theme that you and I keep bringing up. It's like anticipation. The other thing that losing a lot of these research grants do is one, it impacts local economies. So for example, in Alabama, the biggest employer is the university, Right. So that, I mean, it impacts local economic development. And then also like on, if you step back on a broader scale, it is being the global leader in biomedicine. And if we're not that, guess who is ready to just jump in. And that is going to be China. And we will have a whole lot less control on the ethics of that. We will have less control, no control on what research questions are being asked and if and how they impact Americans. And so there's huge ripple effects that are happening. And it's not just cutting research. There are, there's downstream impact that I fear is not being considered very seriously by the current administration.
- [18:00]
A
It's all great. It's all great. It's as if society said, well, we haven't had any fires lately in any of our buildings, so we're just going to pull out all the sprinkler systems. It's this insane thing.
- [18:16]
B
And who will hurt is Americans. Right. It's going to impact those on the ground, whether it's right now or in 10 years. And if we're thinking in this America first framework, we really have to take that into consideration, too. And I've been surprised as well as I think a lot of people how much that's been more of just a tagline than like the implementation and keeping it central.
- [18:45]
A
Yeah. Well, listen, Kaylin, I just want to thank you for all the work. Again, I've been just consuming your content for a good five years now and you don't charge for it. You do it all as a public service, and it's incredibly valuable. Everybody here should sign up for it. And I want to echo what some of the commenters said. Thank you just for the work you do in public health. It's so important and it is invisible to so many people. And I'm sorry that your profession is being sort of targeted and pushed aside right now. It's deeply frustrating and it's deeply unfair.
- [19:24]
B
It is. But you know what? Like I said in the beginning, we're here for the mission. And the mission is to keep Americans safe and healthy. And whether we're pushed aside or not, I mean, I'm still gonna be here, so we'll see how this all plays out. But I appreciate that a lot. Thanks so much for having me, Jonathan.
- [19:42]
A
Thanks a lot, guys. Go hit. Subscribe to your local epidemiologist. It's not even like a one man band anymore. You've got a whole bunch of people doing the newsletter with you. It's a really, really good newsletter. The most digestible public health periodical you'll be able to get. So go get on it, Caitlin. Again, thank you so much. Take care. Don't get measles, everybody.
- [20:06]
B
Okay, bye.
- [20:07]
A
See you next week. Bye.