Matthew (12:05)

You know, I have to say I thought maybe I was nuts. You know, maybe it was just me being alarmist or something that I was seeing trends in among in the virus world that looked distressing. And that because I was surrounded by the messaging that was the opposite. That, you know, it's all about cancer now. There's no reason to worry about these infectious diseases. But I had lived in Africa and had seen up close and personal on Multiple treks all over sub Saharan Africa, what measles was doing, all these things that we thought were no big deal back in the USA were ravaging populations, especially children, and that there was this whole background of mortality that was never diagnosed. You know, what was that virus? What was that bacterium? Nobody knew, nobody bothered to look, and nobody had the capacity and the laboratories to do the work because all the money was skewed to other parts of the planet.

Lori Garrett (13:10)

That part about not paying attention to infectious diseases, she's talking about her field work in the 1990s, does that ring a bell? Kennedy wants to stop or pause infectious disease research to focus on chronic diseases, never seeming to understand that sometimes infectious diseases become chronic diseases. That last part that Garrett was talking about, about the rich versus developing nations, that plays a big role when you think about health broadly, when you think about global health, especially because it's not like we live in silos, we interact with one another on a global level. And so if we're not taking care of the people most in need, that will come to affect us in some, some capacity. And that's our first warning sign. I'm going to talk about a few of the signs and talk about how they relate, although a bit obvious if you've been paying attention, what Maha's doing. But the widening health disparities and neglect is her first warning sign, and that is the widening gap between the health and well being between richer and poorer nations and the unequal distribution of public health benefits. They often signal a crises like Ebola, which she writes about in part of her first book, which became its own series for which she won a Pulitzer. I looked into the data comparing today to 1994, and some health disparities between richer and poor nations have actually narrowed, which is a good thing. Those two disparities are child child mortality and life expectancy. Significant gaps still persist and in many cases inequities within countries are widening. But what makes it worse is that global progress has not been sufficient enough to meet the targets for creating health equity. And in those, it seems to be getting worse. Even those two disparities that have gotten a bit better, they're not great. As of 2021, low income countries still face child mortality rates more than 10 times higher than higher income nations. And 94% of maternal deaths still occur in low and low middle income countries. And even within those countries, it's the disadvantaged groups that are at much higher risk. What has gotten worse? Well, in terms of life expectancy, people who are born in countries with the lowest life expectancy, even though it's narrowed a bit, they still live on average, 33 fewer years than the highest. So you have to remember when Kennedy comes on and says, America, life health expectancy, it's not great, it's dropped. And that is true. And it has corrected a bit since COVID he's comparing it only to developed nations. That's a caveat he never really likes to discuss because he doesn't discuss economics or finances or the social determinants ever at all. Healthy life expectancy rates. So that's how healthy are you? Throughout the range of expected rates that you have, they've also widened and the social determinants within countries are growing worse. And this very much includes America as well. Next up, she writes that a big warning sign is infrastructure collapse and deterioration. She points to the collapse of public health systems in former Soviet socialist republics. Tuberculosis came back and it was exasperate, exacerbated by economic instability and poor diet and alcohol consumption. She writes, and this is again back in 1994, that the American public health system struggles due to inadequate regulatory staff for food and water safety and public health programs, she writes, are, quote, allowed to wither in an age of anti governmentalism. Again, I can't express this is 1994 as I'm reading this book. It, it is today, but on steroids or I guess testosterone replacement therapy. Now, if you consider infrastructure collapse. Let's look at what's going on right now. So the 2026 budget request that Trump is trying to ram through Congress right now, I recently covered on my bonus episode Jay Bhattacharya and the way he tried to wiggle his way out of the proposed budget for the nih. Well, this is what's happening. The CDC is facing a proposed cut of 44% from 9.2 to $5.2 billion. The NIH would see a 40% reduction from 47 to 27 billion. Overall, the HHS would be cut by 34%. Now, direct federal support for public health has already been cut by $11 billion. There's been 20,000 jobs that have been lost because of Doge and because of Kennedy. Specifically, this budget proposes deep reductions or eliminations for a number of public health programs. Those that address HIV and aids, tuberculosis, malaria, maternal and child health, family planning, nutrition, that thing that, that's all they talk about. But they're actually cutting nutrition programs and global health security. Oh, back to nutrition for a moment. The food pyramid hasn't been around since 2011. You have Mackere going on TV talking about how they're going to get rid of the food pyramid when it's been gone for 14 years. Do they not think that people have Google or whatever chatbot you use for your search now to figure these things out? My plate has been in existence since then and, and what Kennedy is proposing is basically just my plate. So great job doing a lot of really good work here. This as bad as it is under Kennedy, it reflects a long term trend because over these past two decades, the CDC's budget has increased by only 6% when it's adjusted for inflation, which is far below what experts believe is needed to keep pace with public health challenges. So we weren't investing in public health before and now we're barely investing in it. That is a huge warning sign that Garrett warned about. A few other warning signs Garrett warns about are lack of preparedness and expertise because officials often downplay outbreaks. When have we seen that happen? Recently, there's a lack of expertise at the agencies. Hello, there's an insufficient stockpile of vaccines. A major weakness she points to is the decline in commitment to tropical diseases research and control in North America and Europe. And guess what? Looking over the current proposed budget for 2026, the amount of tropical disease research continues to decline. Finally, Garrett talks about social and political factors and health and politics are always related, but it's never been as in our face as it is right now. She writes about the vague and often contradictory nature of information from overseas, which she says hinders effective responses. We did see some of that during COVID the lack of trust in government and health authorities, which she writes in 1994, that it fuels panic and conspiracy theories. You think so? Bigotry and community resistance, which blinds health leaders to the urgency of problems like perhaps measles. Garrett specifically writes about how homosexuals and drug users were demonized during the AIDS epidemic. We're seeing that sort of mindset happen with obesity and chronic disease sufferers from the wellness community. Now that link is pretty clear to me. And finally, she writes about how societies follow a pattern of denial, fear, and then repression when they're faced with epidemics. Going back a bit to the demonization aspect, I want to look into Garrett's keen observations about society at large, which she wrote about in the Coming Plague. With the initial emergence of the microbe, she found evidence of denial in all tiers of society and the tendency was to actually ignore the microbial threat, the disease, the virus, or only to assume that they, which she notes as some distinct sub population of the Society were really at risk. The microbes exploited such denial and it spread rapidly, while humans made no attempts through either their personal or collective behaviors, to block any of the avenues of transmission of the organisms. The second social epidemic, she notes, is fear. A biological epidemic suddenly shocks society out of its state of denial, and then that led to a state of group terror. She writes about this in 14th century Europe. And specifically, she notes that the time scale was very quick. Plague infested rats arrive on town on a Tuesday and then humans begin dying Thursday or Friday. And that led to a widespread panic by the middle of the following week. Now what's the biggest threat? She writes about the problems with microbial adaptation, specifically the number of drug resistant strains of viruses that our antibiotics can no longer counter. I started writing about this 15 years ago, and the fact that we're actually in worse shape now is even of greater concern. I don't have the exact numbers in front of me because as I'm reading through my notes for this episode, I just was reminded that in the 1960s and 70s there was a lot of public investment in antibiotics. So you would have multiples coming out every year to help to combat any sorts of diseases. Now, because there's not a lot of money in creating new antibiotics, pharmaceutical companies just don't do it anymore. Now, this could be solved if our government actually invested in and either had the scientists work on it themselves or paid pharmaceutical companies to develop antibiotics. For Garrett, this is one of the biggest problems. We have preventable diseases, but we're not going to be able to fight them anymore because we're not investing, because they're becoming drug resistant. I don't expect Kennedy's HHS to make these sorts of investments because they've been fomenting distrust in pharmaceuticals as it is. Except. Except, of course, when it suits them. So if it's ivermectin, if it's hydroxychloroquine, if it's testosterone replacement theory, if for some of them it's Botox, all those pharmaceuticals are completely fine. But when you have ones that actually address human needs, they seem to be a problem. All right, so how do nations prepare for plagues? As Garrett talked about in this week in virology, she was really hesitant to make predictions. But at some point she realized that people kept asking her to do it. And given her 30,000 foot view on the importance of public health, she started to. She thinks that being prepared first and foremost is achievable, but you need political will. And her recommendations for that are multifaceted so again, the global public health infrastructure, you have to work on global disease prevention. Prevention because it's necessary, cuz as I said, we live in a global, globalized society, but also because it's cost effective. It makes sense to try to get ahead of things now, considering Trump left the who, fuck all that cuz that ain't happening. But that is atop Garrett's prescriptive list. She also talks about a holistic approach. I mentioned this earlier. Health is not just about health. It's not just about exercise. It's not about, not just about the food you put into your body. You have to consider environmentalism, you have to consider ecology, you have to consider economic development, cultural anthropology, parasitology, virology. She includes a list of dozens of things that have to be considered under the broader rubric of public health. Next up, vigilance and surveillance. You have to pay attention on a global level. The better your disease surveillance is, the more effective the infrastructure will be. Rapid response and stockpiling. This includes antibiotics, vaccines and general medical supplies. Interagency coordination and trust us ain't doing too good on that with other countries right now. But that is still quite necessary. Here's one. She writes about public education and trust. Yeah, okay. And then she actually writes about addressing root causes. So prevention of diseases means confronting homelessness, confronting inadequate social services. And when I say confronting, I also mean working on them, spending money on them. Drug abuse is an issue. Anything that can help foster disease. She also notes that it means addressing human rights violation, poverty and general human behavior behavior. Because these all play a role in disease emergence. Last little story here. She specifically writes about the warning signs that she saw in US cities during the tuberculosis epidemic. I forgot about this because it was a long time ago, but in the late 80s, early 1990s, we had an epidemic of tuberculosis. The warning signs that she said were there for everyone to see included, included rising homelessness, fiscal reductions in social services, complacency in the public health sector, rampant drug abuse, and increases in a number of other infectious diseases. The emergence of novel strains of drug resistant tuberculosis was there for us to see. But as she writes, the warning fell on unhearing ears. Now, more recently, there was a notable tuberculosis outbreak in Kansas in 2024 with 67 active cases and 79 latent cases in the Kansas City area. Two people died from that. Now that is not a huge outbreak. But again, given all the pieces we've been talking about today, we we're seeing the warning signs shoved right in front of our face. Finally, in her work, she specifically writes about America's strength, strengths and weaknesses. Again, this is 30 years ago, but I want to give it some oxygen and then think about how that plays into how we're faring now. Strengths first, we have a history of public health pioneers, people who really change the course of history and understanding of science. That's a good thing. We have really strong, globally renowned institutions like the CDC and the US Army Medical Research Institute. Those are good things. We'll see how long they last. We have an ability to mobilize resources in times of emergency sometimes. She notes specifically how reluctant the Reagan administration was to move on the AIDS crisis once it did start to move. It can happen quickly. We do see this sometimes when emergencies happen. The US has demonstrated the capacity for rapid strategy development and implementation at local levels. She specifically notes that New York City had a response to the India plague scare that had preceded this book by a few years. And finally, the adoption of advanced scientific tools like PCR tests. Obviously PCR tests played a huge role in COVID 19. On the good side, we are capable of these things. We'll see how they go in this hhs. Now, the weaknesses, these will definitely ring a bell. The anti governmental sentiment and political interference. So you have the public perception of government and then you have the parties that are always fighting and refusing to work together. A lack of comprehensive national systems for disease detection and surveillance, which she me which she says makes us pretty defenseless against new threats. There's inadequate training for physicians in infectious diseases and in public health. I find this so telling because Kennedy is threatening to remove federal funding from the from universities that do not train doctors in nutrition. But physicians aren't being trained in things that are far more important. And it's not that nutrition training isn't important. And as a number of doctors that I follow said, their programs do have nutrition training already in them. But I don't know how strong their infectious diseases and public health training is. I'm guessing not that strong. Garrett writes about weak links between medicine and public health broadly, which I think is really, really important to understand as well. We have a vulnerability to external threats. We mentioned tropical diseases a little bit earlier. We don't pay enough attention to them, at least at this moment. The vaccine production system is limited and largely privatized. Yeah, you think so? For all the complaining that Maha does about the way that pharmaceutical companies operate and how they pay for clinical funding, which are then published in journals, yeah, it is a problem. The problem stems from the fact that the US government doesn't invest enough in that research and that we have a for profit health care system that's the fucking root cause. So if you start to solve that, all the problems you complain about, huh? They magically go away. Garrett notes that in terms of bioterrorism, the US is far, far short in detection and preparedness. That's not great. She writes about the risk of public health losing public trust. I'm just going to leave that right there. She admirably writes about the racial disparities in health outcomes because they've only gotten worse in the last 30 years. The aging scientific workforce and key public health labs. And that combined with budget freezes, is helping to take away our expertise. And finally, the overall healthcare financing system, which denies access to care for the vulnerable. And there's also often an over emphasis on curative medicine over preventative public health. Again, the very thing that Maha screams about all the time, but they don't actually invest in because they're so myopically focused on this inane, insane ideology, this culture of individualized health that is not how public health operates. If you want a robust, healthy nation, you start with public health and it trickles down. I'll use their term, to the individual. And if we don't focus our energies there, things are never going to get better and we are not going to get healthier again or ever. And when tragedy strikes, when the mass casualty horizon is here, you just know that RFK Jr and all his cronies and all those Maha wellness influencers, they're gonna find everything but themselves to blame.

Matthew (35:57)

We still really don't want to talk about modes of transmission of disease that make us uncomfortable and force us to think about larger social issues. Look at Covid, who really wants to get down and dirty about why African Americans are at special risk. Who really wants to go into the details of what it's like to live on an American Indian reservation in the current world and why that puts you at such extraordinary risk for Covid.