Science Friday - Lucid Dreaming, Sex As A Biological Variable, Parachute Science, Global Vaccine Access. Feb 26, 2021, Part 2

Episode Date: February 26, 2021

Memory And The Dreaming Mind If you’ve ever stayed up too late studying for a test, you know that sleep impacts memory—you need that precious shut-eye in order to encode and recall all that information. But what is it about sleep that aids memory?  Researchers have pinpointed a specific stage of sleep, REM sleep, as an area of interest for studying memory consolidation. REM, or rapid eye movement sleep, is the same stage in which dreams occur. So researchers at Northwestern University devised a way to communicate with lucid dreamers—people who are aware of their dreams and can control what they do in them—as a way to study how memories get made. Science Friday producer Katie Feather talks with Ken Paller, professor of psychology at Northwestern University to discuss what lucid dream research has taught us about memory. Progress In Considering Sex As A Biological Variable Back in 2013, Charles Hoeffer from the University of Colorado Boulder was studying memory and learning in mice. He was looking at a specific protein in the brain called AKT1, which helps mice forget an old task and learn a new one. In humans, a mutation in that protein has been linked to disorders like schizophrenia, Alzheimer’s and depression.  But in a follow-up study, Hoeffer did something different. He included both male mice and female mice, and then tested them separately. As expected, he discovered that male mice had a much tougher time learning the task when AKT1 wasn’t working. But in female mice, he found the unexpected: It didn’t make any difference whether the protein was removed or not. In other words, the sex of the mouse became an important variable that affected the outcome of the research. Hoeffer’s study is one example of considering sex as a biological variable (SABV) in pre-clinical research. And in 2016, the National Institutes of Health’s Office of Research on Women’s Health made it an official policy for researchers applying for funding.  But that didn’t change things overnight. Five years later, the approach is still catching on in many areas of research. Chyren Hunter, from the Office of Research on Women’s Health, joins Ira to discuss the progress that’s been made, and what lies ahead for the effort to make pre-clinical research more inclusive. Further information on the NIH’s policy on sex as a biological variable is on its website. The Problem With ‘Parachute Science’ “Parachute science” is a term describing how researchers sometimes drop down from an ivory tower in the wealthy Western world into a foreign community for field work. They gather their data, and then zip off home without engaging with or acknowledging the contributions of the local researchers in that community. This week in the journal Current Biology, researchers tried to quantify just how widespread that tendency is in one area of study—coral reefs.Searching through fifty years of publications published on the topic of warm water coral reef biodiversity research, they found that in 22% of the studies on coral reef ecosystems in Australia, there were no Australian researchers included as authors on the publication. The effect was even more noticeable in lower-income countries, such as Indonesia and the Philippines—where 40% of the published studies on coral reefs included no local scientists.  Ira talks with two of the study’s authors, Paris Stefanoudis and Sheena Talma, about what they found, and how researchers can work to make science more inclusive. The Global COVID-19 Supply Problem  Of the more than 200 million COVID-19 vaccines that have made it to patients’ arms this winter, more than a quarter have gone to people in the United States—a country with 4 percent of the total world population. Just last week, UN Secretary-General Antonio Guterres said that 75% of the world’s vaccinations so far had been in just 10 countries—while 130 countries had not received a single dose.  Meanwhile, on Wednesday, the nation of Ghana was the first to receive vaccines—600,000 doses—shipped as part of COVAX, a multi-national program which aims to provide as many as two billion free vaccines to poor and middle-income countries by the end of the year. Ira talks to Yale global health expert Saad Omer about the international effort to move vaccines equitably around the world, and the remaining hurdles for poorer countries. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flato. Have you ever had a lucid dream? You know the kind where you know you're dreaming and can control what goes on in the dream. Researchers are studying how to communicate with lucid dreamers while they're sleeping. Yeah, as a way to study how memories get made. Sci-Fi producer Katie Feather shares more. If you've ever stayed up too late, studying for a test or cramming for a morning meeting, and let's face it, we all have. You know that sleep impacts memory. You need that valuable shut-eye in order to encode and recall all that information. But what is it about sleep that aids memory? Dr. Ken Pallor of Northwestern University is a memory researcher, but in his most recent study, he took a turn to study lucid dreaming. And he joins me now to talk about why.

Dr. Ken Pallor, welcome to Science Friday. Thank you, Katie. So what's the working definition of a lucid dream? It's more than just a dream you remember, right? Right. A lucid dream is one step beyond that. It's during the dream, understanding that it's a dream that's happening at the moment. And the majority of dreams are ones where we think we're awake.

We think it's reality. We think things are going on as usual. Even though bizarre things might happen, we don't always have the realization that we're dreaming. We think we're awake. So the lucid dream is purely defined as saying, Well, if you understand that you're dreaming, that's a lucid dream. Sometimes I find myself towards the end of a dream after much has happened and there's no sense that I'm dreaming. Something will happen and I'll be like, wait a second, this would only really happen in a dream.

I think I'm dreaming. And then moments later, I'm awake. Is that a lucid dream? It sure is. It's just a very short one. So the lucid dreams get more interesting if you manage to stay in it and continue. and continue to explore what's going on because you can take another step, which is to try to influence what happens. You can decide where you want to go, who you want to meet. And sometimes

the dream goes along with your wishes, and it happens, though not necessarily. So as a memory researcher, how do you find yourself doing a study on lucid dreaming? Yes, my research is quite a different topic. I've been studying memory my whole career. And so I'm interested in how memory works, how do we remember things? And I've looked at what happens when you first learn something, what happens when you retrieve it later. And I also got interested in what happens in this intermediate time. So learning isn't something that just happens instantly the way you put a file on your computer. But often information doesn't stick in your head unless you practice it. And the interesting part now relating it to sleep is that some of the rehearsal that makes our memory work

happens when we don't realize it while we're sleeping. And information that we've recently learned comes up. It gets reactivated at night and therefore integrated better and more available when we wake up the next day and we need to remember things. But we don't realize we're revisiting information during our sleep because it's not necessarily part of dreaming. In fact, a lot of it happens during a stage of sleep called slow wave sleep, which is not during REM sleep when a lot of dreaming is happening, but it's a different stage of sleep.

And that seems to be a critical time for reactivating recently learned things. So what does this all have to do with lucid dreaming? Because it sounds like lucid dreaming is happening at a different stage of sleep than this consolidated memory portion of sleep. Yes. So we understand that deep sleep is very important for memory. REM sleep may also be important for memory, but it's been very mysterious. It's been hard to figure out what REM sleep is doing. And there are quite a few different theories.

and we need to do more work to try to figure out how REM is important. And related to that is, is dreaming important for our memory? Does dreaming somehow help our memory function better? Or does it more prepare us for future things that are going to happen? So to study REM sleep, we need to go in there and try to tinker with what's happening. And so one of our methods of tinkering with brain processing during sleep is to present sounds during sleep that remind people of what they learned earlier. And we've done that in deep sleep over the last 10 years or so. So now what we've done is asked, can we do the same thing during REM sleep and during the context of a dream where people are actually observing the information we're presenting and responding to it, understanding it, and having it even change their dream.

So it sounds almost like you need to study lucid dreaming as a tool because you needed to communicate with a person in a dream. Yes, our communicating with people during dreaming is part of the tools we have for trying to understand REM sleep and all phases of sleep. So in this study, you were able to communicate with a dreamer who is having a lucid dream. You said it was like trying to come up with a way to communicate with someone on another planet. Describe how you were doing that. So when people are in the midst of a dream, they're in a sense in another reality. they've manufactured this reality that they're wandering around in. And generally that means they're blocking out information from the outside,

which is one thing that we do during sleep is we're not necessarily attentive to what's happening in the world around us while we're sleeping. But we're not completely inattentive. So some information does get in. And that's been known since antiquity that sometimes sound from the outside world might change what you're dreaming about. And you would incorporate that into your sleep. You might hear the dripping of a water faucet and then have some dream about ocean waves or water or something like that.

But in our case, we wanted to see if the actual information we present could be understood correctly as it was presented. So the same words being understood. So we asked questions where we knew what the answer was, such as simple math problems. And people can't answer in the normal way because during REM sleep, the body is quite paralyzed, except your eyes aren't. And so people can move their eyes. That's why we call it rapid eye movement sleep. The eyes are still moving. So that's the method we used to have people communicate back to us by making a signal with their eyes that we then read out and understand whether they had understood our questions correctly.

Did you go through other possibilities of how to communicate with the sleeping person? Yes. One of our colleagues in Germany used eye movements with people talking in Morris Code. So that allowed them to actually speak in sentences, although laboriously. We've done other things where you can have people clench their fist in their dream, and we can see a small muscle twitch when that happens. So that's another method. And a newer method we've been using that we like a lot is sniffing.

Because, of course, another thing that works during sleep is respiration. You're still breathing. And if you breathe through your nostril and just go sniff, sniff, sniff, you can get these three sniffes out and we can record that with just monitoring the air going out of the nostril. So from what I understand about lucid dreaming, some people can do it and some people can't. But is there a way to practice lucid dreaming if you are someone who can't always do it? Yeah, that's an important part of our research, that it's hard to study lucid dreaming because it's so rare and not many people can do it frequently.

And even those that do it frequently don't necessarily do it on the night they might need to it when they're in the laboratory for recordings. So we used methods to try to provoke lucid dreaming. And that makes it more easy to study this because we can study people that lucid dream a lot, but we can also study people that haven't lucid dream before, and we provoke them into a lucid dream. Wow. How did you provoke a lucid dream from someone? So some people learned a lucid dream because perhaps as a child they suffered from nightmares. And so lucid dreaming could be a strategy for dealing with nightmares. It could allow you to change what's happening in the dream or it could allow you to wake up because you realize you don't want to be in the dream anymore. So what we do is

have them first practice while they're awake, a strategy of trying to understand if you're having a dream at the moment of or if you're awake. And this has been called reality checking. So you can check, is your current reality a dreamed reality or is it a waking reality? And you have to think about that rather carefully. So what we do is train people to mindfully consider the present experience and decide whether they're awake or asleep. And importantly, we do that together with a special sound. So they hear the sound, perhaps the sound of a harp that cues them to make this check and decide mindfully, are they awake or asleep? And after practicing that for about 20 minutes before going to sleep, then we let them go to sleep. And they know, well, if I hear the

that harp sound, I'm supposed to think about whether I'm sleeping right now. And we're monitoring their brain activity. And when we see that they're in REM sleep, we again present that harp sound very softly so it doesn't wake them up. And it can sleep into their dream and then provoke them to make that check and ideally come to the realization that they're in the midst of a dream. Do you see different brain signals happening in the brains of people who are lucid dreaming versus people who aren't lucid dreaming? Well, that's been controversial. There is some evidence that fits with our thinking about brain function,

that the frontal lobe is less activated during a non-lucid dream. And the way that fits is that the frontal lobes help you think carefully about what's happening. And perhaps our ability to, or a tendency to just accept what's happening in a lucid dream is a reflection of the frontal lobe not being completely. completely online and not evaluating the bizarreness of things as carefully as it might otherwise. And so lucid dreamers perhaps have more of their frontal lobe online and functioning during the course of their dream. There's some evidence that fits with that.

It's still an ongoing question that's being investigated. I am reminded of the movie Inception, as I'm sure a lot of our listeners will be when it comes to this stuff. How close is all this to what is going on in that movie? because it seems eerily close. Well, the part that's not close is that as experimenters, we don't get to jump into people's dreams and experience them together. But in other sense, it's not so hard for us to influence the dream. For example, if a lucid dreamer wants to spend some time solving a particular problem

that's bugging them, very likely they might not remember that goal once they're in their lucid dream. And so the sounds from the outside can help them guide them to dream about what they prefer to dream about. This will be my last question, but can you lucid dream? I'm very interested in it, but I'm not a talented lucid dreamer. I've hardly had any lucid dreams. So I'm not speaking from direct experience when I talk about lucid dreaming. Well, this is really fascinating. Thank you so much for joining us.

Thank you, Katie. It's been great to talk. Dr. Ken Pallor is a professor of psychology and director of the Cognitive Neuroscience Program at Northwestern University. For Science Friday, I'm Katie Feather. After the break, an NIH policy that's making lab research more inclusive. This is Science Friday. I'm Ira Flato. Several years ago, Dr. Charles Hofer was studying memory and learning in mice. He was looking at a protein in the brain that helps mice forget an old task,

learn a new one. To be honest, I had pursued a lot of research prior to this only using male mice because it was more cost-effective. As expected, he found that male mice had a much tougher time learning a task when the protein wasn't working. But in a new experiment, he tried something different. He added female mice, tested them separately, and found the unexpected. In female mice, it did not make any difference whether the protein was removed or not. In other words, the sex of the mouse became an important variable. It affected the outcome of the research. Once we saw that, we couldn't let it go. In some ways, it would have been really easy to just pursue male data, but it was too promising a scientific avenue to pass up. A significant discovery,

and Dr. Hofer might not have caught it if it weren't for a new policy from the National Institute, of health requiring researchers to consider an animal sex in preclinical research. There isn't a lot of consideration for sex as a biological variable. So I really think it hasn't permeated research to the level that I think it should. I'm wondering, you know, how widespread this is, like how overlooked sex differences really are in research. My next guest is playing a critical role in implementing the policy first published five years ago. Dr. Sharon Hunter is Associate Director for Basic and Translational Research and the Office of Research on Women's Health at the National Institutes of Health in Bethesda, Maryland. Welcome to Science Friday. Thank you,

Ira. Happy to be here with you today. If this policy was enacted five years ago, why do so few researchers know about it? Well, I would say that like an ocean liner turning, getting individuals aware of the policy takes time and effort. Researchers are busy. But they do know now that if they're going to apply for an NIH grant, they must address SABV. Let's talk about SABV, sex as a biological variable. What does that mean in the context of this NIH policy? Great question.

Thank you. I always like to first start with definitions. And as you said, SABV is an abbreviation for sex as a biological variable. We know that every cell has a sex, and so do the cells that make up our tissues, and so do the tissues that make up our organs, and the organs that make up our cardiovascular and other systems. So consideration of sex is a constant in our biological makeup, and therefore it's very important to consider how sex is involved in health and disease.

So the policy primarily talks about pre-clinical research, but we're we also talk about how SABV is related to gender. And so as we get more information about sex and gender, perhaps there will be progress that can be made along the consideration of sex and knowledge about how to improve treatments for all of us. And the history of research, why wasn't this something that was, you know, known about years ago or taken for granted that we need to include sex and when we talk about research? Yes, that's a question I get a lot. So I will say, however, that there are a cadre of investigators that always have considered the sex differences or the influence of sex in their research fields.

But I'll say that for a number of reasons, researchers maybe for convenience, they predominantly use male subjects or when they were using female and male subjects, they didn't, analyze the data by sex. So that's a problem. And so researchers are now aware that not including sex, we actually lose lots of information. And this policy helps to get that word out and make scientists aware that the study of SABV is important and it improves rigor and transparency of research. And the more we study SABV, the better the science and the better the health. for all of us. If researchers were not including female, let's say, lab rats in their studies, was that showing up when you went to create a medicine or a technique that both men and women were using? That it'd say, hey, look, there's a difference in men and women here. Absolutely. So, for

instance, between 1997 and 2000, eight of the 10 drugs that were pulled from the market were drugs that had more adverse side effects in women. So perhaps what's happening is that because the pre-clinical studies did not use both males and females, the studies in humans did not have enough information to create a treatment that would not have adverse effects in women. When this requirement was first proposed and published by the NIH, what kind of response did you get from the scientific community? in the few short years since the policy has been implemented, that have been positive changes.

For instance, there was a very large study that was funded by NIH called the G-Tech study. And that study recently found that there are over 13,000 genes that are expressed differently between the sexes. Now, this G-tech study has been going for some time, and now, recently, they have looked at the differences between the sexes. And so they found over 13,000 genes that are expressed differently, differently, between the sexes. And moreover, there are sex bias patterns on how these genes are regulated in over 50 bodily functions. So these findings are exciting, and they may be seen as a foundational starting point to pursue personalized medicine. Well, it looks like the policy is working then, wouldn't you say? Absolutely, the policy is working.

I will say that we do not have full implementation, and we do know that we do need to do more, and I can't do it alone. We need other funders, because after all, this is an NIH policy. So there are other funders of biomedical research that do not have this policy. Also, closing the loop on SABV is the engagement of journal editors, because journal editors publish the data of scientists. And we hope that these journal editors would require researchers also to consider SABV before their information is published. Because, again, the more we know about SABV, the better the science, the more rigorous the science, and the big of the knowledge base.

And that goes to creating better health for all of us. Well, as you gather more information about SABV, do you think there might be any revisions or tweaks to the policy? Well, right now, I think that, as I said, as we go along, the policy has been and was enacted a few short years ago. And right now we're really focusing on getting the word out. And what we're hoping is that when we get the word out, we won't see publications that talk. about the gender of mice because I do see those publications. So first we really need to get the word out. And I'm happy to say that one of the ways that we're doing that is we have created a free online course called the SAPV primer. And it talks about why we needed a policy,

the background to the policy, and importantly what the policy does not do. So the ORWH and the NIH is making every effort along many lines to make sure that the policy, sure that investigators consider sex as a biological variable. Well, we know we have many scientists who are in their labs listening to Science Friday when they're doing their work, the radio's in the background or they're listening on podcasts. So maybe the word will get out. Well, you know, and I would ask that investigators, when they're considering a research project, when you don't consider sex as a biological variable, you might have data that's

hiding in plain sight. Thank you very much, Dr. Hunter, for taking time to be with us today. All right. Take care. Dr. Sharon Hunter is Associate Director for Basic and Translational Research. That's in the Office of Research at Women's Health at the National Institutes of Health in Bethesda, Maryland. Turning now to what is sometimes called parachute science, and I don't mean the physics of how the rover got down to Mars. Parachute science is a term describing how sometimes researchers drop down from their ivory tower, often located in the wealthy Western world, drop into a foreign community for fieldwork. They gather their data and then zip off home without engaging with or acknowledging the contributions of the local researchers in that community.

This week in the journal Current Biology, researchers tried to quantify just how widespread that tendency is in one area of study coral reefs. me now are two of the authors of that report. Dr. Paris, Stephanutus, postdoctoral researcher in zoology at Oxford, and Sheena Talma, the science program manager at Nectin Foundation in the UK. That's an ocean conservation-focused nonprofit. She's from the Seychelles. Welcome to both of you. Hello. Hi, and thank you for having us. You're welcome. Paris, you studied this effect in coral reef research in places like Indonesia and Australia, give us an idea of what you found? So we chose this focus on those specific countries just because they were the most

call reach in terms of the available habitat that they have in their waters. So what we did find is by looking at papers that have been published over the last 50 years, that a lot of the papers did not include any local scientists as co-authors. Now, this is one form of parish. science, so excluding scientists from the publication process. And we did see that when we were comparing Indonesia and Philippines to low to middle income countries, compared to Australia, a high-income country, the rate of excluding scientists for publications for Australia was twice as low compared to the other countries. So this is a classic phenomenon whereby rich universities and the researchers try and exclude scientists from lower-income countries.

When you say they try to exclude them, is this really something that they tried to knowingly try to do? Maybe trying was not the right word. What I meant was, is that they don't necessarily think it's important to include scientists from those nations in the publication process. And this could be because it's something that always happened and scientists didn't necessarily think about it as an immoral or wrong thing to do. And it also stems from the wrong belief that local scientists do not. necessarily have good skills that are violator to the science that they are conducting, which is a very wrong view to have. Sheena, I gave a try at defining parachute science before. How well did I do that? So my take on parachute science is that it's complex, it's multi-layered. It's not just

including more scientists in publications. It's about actively building partnerships and relationships with host country nation scientists. It's about enabling skills sharing and investing in up-and-coming talents. And it's ensuring that once you leave that country where you do your field work, there are other people there that are as invested and ready to take up the work in true partnership. So you're not saying that researchers from places with more money and more resources shouldn't be coming in there at all. Oh, not at all. I mean, if you look at a lot of countries, especially, I'm going to use, say, Shells, because that's what I'm used to. We don't necessarily, have the resources that we can use towards doing high-tech science, such as, you know, deep sea science or

genetics, you know. So we need those collaborations. We need the money that comes with institutions that do have a better financing or better technology. What we're saying is that how those relationships need to be built is that, for example, if you're writing a proposal to try and find out what coral lives at 30 meters in the Seychelles waters, then that proposal should be written both by a local scientist and the scientists in the higher income countries, for example, so that the investment is done locally. Because if you don't invest in the host nation scientists, essentially once you leave, the local population doesn't have the investment in the research that is being conducted. I'm Ira Flato, and this is Science Friday from WNYC Studios.

Paris, I can see where this is a problem in fields like coral reefs, where the study area is in one specific place in one specific country, but is parachute science a problem in other fields too? Yes, it's not only confined to fieldwork-based studies in environments that are far away from typically sort of Western countries, so it can affect other research fields as well. from biomedicine or other fields. So it's not unique for us marine scientists.

And, Sheena, how do you fix this? What's the solution that you're advocating? And I'll ask both of you. Sheena, you can start first. First and foremost, it's, you know, ensuring that you look up scientists in your field where you want to go and work. For example, if you decided to come and work in the Seychelles and you have funding, look up the scientists that already work there that are based there.

You can do that on Google Scholar. There's so many different ways you can do that. You can also do it through governments. And try and collaborate with those scientists to come up with research plans that will not just benefit the science, but also the country in which you desire to work in. I think one of the bigger conversations to have is the fact that it's very institutional. the way that science, especially within the publishing world, the way it's built is that you're rewarded on publishing and perhaps high-end papers.

You're not rewarded for your abilities to create those relationships on the ground, which are really important to ensure that long-term conservation work and investment from both the higher and lower-income worlds are done in a long-term process. So I think it's really important for, first of all, from my perspective, so from researchers who go into other countries and conduct research, it's really important to consider sort of the ethical considerations of your work. So you have to work together with people that live in the environments you want to study. It's just not right to only focusing on trying to build your academic career and get all the resources, write papers and have a very successful career in academia without necessarily trying to help the people that actually live there. So I think there are a lot of skills and practical knowledge from people who live in those environments, which shouldn't be considered as of lesser value. They're very important. It will actually make the science that you're conducting much, much better.

So I think ultimately what we should be trying and doing is engaging before, during, and after fieldwork with those scientists as equals, because that's going to benefit them as well as us. Well, unfortunately, we have run out of time. I'd like to thank both of you, Dr. Paris Stephanutus, postdoctoral researcher in zoology at Oxford, Sheena Talma, who is the science program manager at Nectin Foundation in the UK. Thank you both for being with us today. Thank you so much for having us. Thank you for having us.

You're welcome. After the break, vaccine distribution. If you're in most African countries and parts of the Americas, signs of a vaccine are still far off. There is frustration. with their own governments as well as the global system. But also, there is resignation. That's the sad part of it. I've heard more than once, like, what did you expect?

A look at global vaccine access and distribution. Stay with us. We'll be right back. This is Science Friday. I'm Ira Plato. All winter, vaccines for COVID-19 have been rolling out to the arms of health care workers and other high-risk populations around the globe. More than a quarter, though,

of the 200 million vaccine doses worldwide have been given in the U.S., home to only 4% of the global population. Meanwhile, poorer countries are lagging far behind, unable to compete with the rich nations that paid high premiums to reserve doses early. World Health Organization Director General Tejos Adonam Gabriasis has advocated for vaccinations to begin in all countries within the first hundred days of this year. I need to be blunt. The world is on the brink of a catastrophic moral failure. And the price of this failure will be paid with lives and livelihoods in the world's poorest countries.

Covaks, a project that includes the WHO, has set a goal of providing two billion vaccines for priority populations in poor countries. Just this week, Ghana became the first country to receive a shipment of vaccine via COVAX, and President Biden last week pledged $4 billion to that effort. But what will it take to ensure equitable vaccine distribution around the world? Here to talk about this is Dr. Saad Omer, Director of the Institute for Global Health, Yale University, in New Haven, Connecticut. Welcome to Science Friday.

It's my pleasure. Saad, first of all, let's talk more about this. gap in vaccine access. The U.S. and the U.K. have some of the highest per capita vaccine rates right now. Israel is posting very high good numbers. Tell us what's happening everywhere else. It's very patchy. In a few countries, in the Middle East, for example, there's more access. But beyond that, especially in low and middle income countries, particularly in low-income countries, the access is very patchy. Some countries have received from other places already or have purchased outside the Kovacs facility.

Right now, this week, the good news is that the Kovacs vaccines have started arriving. In Africa, there's a dual system. There is the Kovacs agreements, but also the African Union has purchased or in the process of acquiring its own doses. In addition to that, and there are specific country-level agreements as well. The vaccination access is very modest in low and middle-income countries as of now. Can you tell us what's happening outside of COVAX in terms of other countries working to address inequities? A lot of countries, and not just high-income countries, but low- and middle-income countries, have these individual bilateral deals with companies and other countries to get their own vaccine.

And you can't blame them for that because if you don't have a global system for that, then that's, you know, each country for itself kind of a scenario. So that's what is happening. There are bilateral deals with companies. There are bilateral deals with sort of group purchasing mechanisms, etc. In Europe, European Union countries are acting as individuals, but also as EU. In countries like India, there is domestic production, since they are a major producer of vaccines. For example, the Oxford vaccine. vaccine is produced by AstraZeneca as well as the Serum Institute of India, which has a license from EstraZeneca to produce this vaccine, and they have their own indigenously developed

product as well. So they have a share mark for their domestic market as well. Pakistan has obtained, for example, vaccines from China directly, but they are also part of COVAX, so they're getting those vaccines as well. So it's a mishmash of things that is going on, and various countries are trying their best to obtain vaccines under difficult circumstances. You have research connections in many countries around the world. Do you have a sense of how people are feeling to see rich nations already well along in vaccination?

All citizens are getting their doses while these countries can't get vaccines from their, for even their health care workers? So there is actually a lot of heterogeneity in responses. The first, there is frustration. but the frustration is with their own governments as well as the global system. But also there is resignation, and that's sad. That's the sad part of it. I've heard more than once, like, what did you expect, Saad?

Like, what did you expect, Dr. Omar? We knew this was going to happen. On the other hand, the fact that Kovacs has done a remarkable job of bringing these vaccines, even if it's not, doesn't meet the complete demand that you have in these countries, does give people hope. So it's a mix of frustration, resignation, and hope that I hear from, that I see in my colleagues in various parts of the world. I said in my introduction that Kovacs has set its goal of buying and distributing two billion doses

by the end of 2021, enough to vaccinate all the health care, workers and vulnerable populations, is that ambitious enough? As I said, I think if they had more doses and if they had a real possibility and if they had early money, if they had their request fulfilled in March, for example, because we knew that this was bad, like this was a bad pandemic, like soon after the pandemic was declared, if they weren't starved for money, you know, without projecting any decisions that would have happened, I think they would, it's safe to say they would have had a lot more options. You know, the doses will cover all healthcare workers and some of the highest risk groups.

Not all high risk groups, but some of the highest risk groups like the elderly, etc., and like will cover even certain teachers, like a good chunk of teachers so that schools can open up safely. But even with this facility, there will not be enough vaccines to reach the so-called herd immunity threshold in these countries for sustainable control of these outbreaks. So the real problem was that because these are poor countries, they could not get in early, forbidding for the early doses, the high prices, early doses of those early vaccines. So they're way behind now. Is that a fair way of looking at it? That's part of it. And then the other part of it, that the global mechanism that were created to address that gap were also starved of resources.

So it's not just the country level, but Kovacs level. The third thing is, look, even if there were resources, there would have been some limitations. But I believe we would have had more options. Look what putting money on the table did for the U.S. domestic market. If there were similar higher incentives, you know, these are Moderna and Pfizer and Novovacs are not the only players in the world. If there was more serious money on the table in March, I'd like to think there would have been even more players farther along.

I'll give you an example of Chinese vaccines. Some of them have decent emerging data, but they don't have 30,000 people large trials. And it takes resources to do trials. It takes infrastructure to do these trials. If CEPI or COVAX had money earlier on, you could have seen much larger trials, globally for these kinds of vaccines and trials of more vaccines out there.

You know, we wouldn't have gotten into the zero-sum game or would have gotten into it a little less. The size of the pie would have been or could have been bigger itself. And where would that money have come from or where should it have come from? I think it should have come from U.S. taxpayers. We have $2 billion. It's been non-controversial now. the $4 billion offered $2 billion now and $2 billion later, that could have come from the U.S. in June. And that money has attracted even more money from Europe and other players

now, you know, after the president announced this investment. So that money plus that leadership could have sped up that process. So you're saying it was a failure of the Trump administration to get in early with the money? Partially. Partially it was the Trump administration. but I do think the Europeans should have put in more money than they did. But you can't blame them for putting less money when the US put zero money for this kind of enterprise.

So there's plenty of blame to go around. There's another nuance. The entity that I talked about, CEPI, that was created very recently. The whole idea was to have a lot of candidate vaccines in advanced stages for these global health emergencies. It had funding before this pandemic, it had funding from countries ranging from Norway to Ethiopia, or the UK to Ethiopia, although not sort of universal funding, but one country that was conspicuous by its absence was the US. And we could have and should have invested in this endeavor before the pandemic so that there

more candidates available for the whole world, including ourselves, including ourselves, because it's not a zero-sum game. If technology moves forward, everyone wins in this game. And just to say that it's not that the U.S. is not a major player in global health funding. So I'm not saying that universally the U.S. hasn't invested in global health. The U.S. is a huge supporter of Gavi, and there's bipartisan support for that. It's a huge supporter for the global fund for AIDSDB and malaria, and so and so forth. But I wish we had made some strategic investments even before the pandemic in the last three, four years

and should have made more investments in the early part of the pandemic. And that goes to the U.S., Europe, and certain other countries as well. People have been talking about this for years, about once you get from one virus to the next, right? From Ebola to whatever, we're never ready for the next one, are we?

Yeah, and in the pandemic world, there's a term that is used and without even thinking a lot of times. So you have the pandemic, and then you have the inter-pandemic period. So we will enter an inter-pandemic period, meaning we assume that there will be another pandemic. And so when the field has internalized,

when a certain group of people have internalized, that there will always be a threat of pandemics, It is even more frustrating when the key, other key players who are responsible for our collective well-being, national governments, global mechanisms, etc., they do not put in the right amount of resources in the inter-pandemic period. Is there any reason to believe when this pandemic is over, that anything is going to work any differently in the next inter-pandemic? So, yes. Look, I'm in global health, and you have to be an optimist to remain in global health. And I often say that the glasses always at least 10% full, never 90% empty.

So you have to hope that there will be a change. And there were positive things that were put in place. Even before the pandemic, I'm just saying there wasn't enough. I'll give you an example. after the H5N1 threat that was in 2005, 2006, the Bush administration made a major investment in preparing CDC and, through CDC, another mechanism, the global community, and invested in certain technologies, created Barda or supported an expanded Barda's role, and that happened in the Obama administration as well. Barda is an entity within the Department of Human Health

and human services to create and prepare the US and then as a secondary mission, the rest of the world, with technologies like platform technologies, like manufacturing technologies. And so a lot of investments that went into viral vectors, and some investments in terms of MRNA vaccines, came through those, that work that happened during that inter-pandemic period.

It wasn't, in certain parts, it really worked. The investment in MRNA technology, both within NIH and outside, paid off. The fact that there was investment in viral vectors, which is the basis of the J&J vaccine and the AstraZeneca Oxford vaccine and the Russian vaccine and so and so forth, that also happened in that period. But, you know, so I think there will be a change in how we look at pandemics, how we invest in pandemics as a global community. after this, whether that is enough that remains to be seen. Quick reminder, this is Science Friday from WNYC Studios. Before we go, I want to talk about the impact of vaccine inequity on the entire planet. Here's Dr. Ahmed Agwell, Deputy Director of the Africa Centers for Disease Control,

at a recent Duke Global Health Institute panel. So for us, it makes absolutely no sense for a very healthy, relatively young, individual in one part of the world to be getting vaccinated, while a health worker in the front lines in another part of the world is not getting vaccinated. For us, South Africa, CDC and the Africa Union, there is really no option, but equitable distribution of vaccines. If we don't do that, then the virus will never go away. Saad, this is especially true, given the variants rising up in different countries, isn't it? Absolutely. Absolutely. So in global health, more often than not, a good thing is a good thing for everyone. These are not zero-sum games. And being our self-interest has to be enlightened self-interest in the sense that we sink or swim together. And I'm not just saying that because it sounds warm and fuzzy. It has been shown from economic models as well as we did, we have a

preprint out and we're hoping to sort of get it out in peer reviewed literature that shows that there's a strong case once any country reaches herd immunity the next best use of that doses in that country is to vaccinate other populations rather than continue to increase coverage that also means so in a practical level that may mean that it makes the case of pretty substantial investment in the global vaccine supply. And so we have shown it from an epidemiological perspective. Economists have shown it from an economic perspective that it's in our shared interest to ensure equity in vaccine distribution. So besides being the right thing to do, ensuring equity is the smart

thing to do for us as well. Thank you very much. Very interesting. Dr. Saad Omer, director of the Institute for Global Health at Yale University in New Haven, Connecticut. Thanks for joining us today. My pleasure. And that's about all the time we have. I want to thank our guest, Dr. Sot Omer, Director of the Institute for Global Health at Yale University in New Haven, Connecticut. If you missed any part of this program, you'd like to hear it again. Share it with your friends. Yeah, subscribe to our podcasts or ask your smart speaker to play Science Friday. And while your podcast hunting, our nerdy, wordy podcast Science Diction, hosted by Johanna Mayer, is back for a third season. And this new season, it's all about mind control. The latest episode is about

the word robot. You can catch that wherever you get your podcasts. And of course, you can say hi to us on social media, Facebook, Twitter, Instagram, or email us the classic way, SciFri at Science Friday.com. Send your feedback. We're always interested in what you'd like us to cover. Have a great weekend. We'll see you Next week, I'm Ira Flato.