Science Friday - State Of COVID And Antiviral Pill, Future Pandemics. Oct 8, 2021, Part 1

Episode Date: October 8, 2021

First Malaria Vaccine Is Approved by WHO The malaria parasite is one of the world’s deadliest infectious diseases, killing on average about 500,000 people per year—half of them children under the age of 5, nearly all of them in sub-Saharan Africa. Now, the World Health Organization has finally approved RTS,S or Mosquirix, the first vaccine against Plasmodium falciparum, which is the most deadly strain of the parasite. The vaccine has already been administered via a pilot program to 800,000 children in Kenya, Ghana, and Malawi, and in clinical trials showed an efficacy rate of about 50% against severe disease. WNYC’s Nsikan Akpan explains this and other stories, including a climate change-linked Nobel Prize in physics, controversy over the naming of the James Webb Space Telescope, and a new surveillance method that uses only the shadows you cast on a blank wall. Will Improved Testing And New Antivirals Change The Pandemic’s Path? Late last week, the pharmaceutical company Merck released data on a new antiviral medication called molnupiravir—a drug taken as a course of pills over five days that the company said was dramatically effective at keeping people with COVID-19 out of the hospital. In a press release, the company said that trial participants on the medication had a 50% lower risk of hospitalization or death compared to people getting the placebo. And while eight people in the placebo group died during the trial, none of the people getting the new drug did. However, the full data from the trial has yet to be released—and the medication must still go through the FDA approval process before it can be used. Matthew Herper, senior writer at STAT covering medicine, joins Ira to talk about the drug and what questions remain. Then, infectious disease specialist and epidemiologist Céline Gounder discusses other recent coronavirus news—from a government plan to spend a billion dollars on at-home testing to recent data on the Delta variant, including projections of what might happen next. Preparing For The Next Pandemic Needs To Start Now The United States has a long history of public health crises. For many, our first pandemic has been COVID-19. But long before the SARS-CoV-2 virus arrived, HIV, measles, and the flu all left a lasting impact. As a wealthy country, you may think the United States would be prepared to deal with public health crises, since they happen here with a degree of regularity. However, that’s not the case. The longstanding issues that left the country vulnerable to COVID-19 are explored in a recent article from The Atlantic, called “We’re Already Barreling Toward the Next Pandemic.” The piece was written by science writer Ed Yong, who won a Pulitzer Prize last year for his coverage of COVID-19. Ira speaks to Ed and Gregg Gonsalves, global health activist and epidemiologist at Yale, about the country’s history of public health unpreparedness, and what needs to happen to be ready for the next pandemic.   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. Later in the hour, a COVID update and what the U.S.'s response to this pandemic tells us about future ones. But first, another illness that has caused even more death around the world and for far longer, malaria, a parasite that every year kills hundreds of thousands of people, more than half of them children under the age of five. And nearly all of those deaths occur in sub-Saharan Africa. We've never had a vaccine approved to five. any parasite in humans, much less this one. But now the World Health Organization has granted a stamp of approval to a malaria vaccine made by pharma company Glaxo Smith-Kline. Here to talk more about the vaccine and other stories from the week is my guest, Sikan Akpan, Health and Science Editor at WNYC Radio in New York. Welcome back. Thanks for having me. All right, let's talk about how effective is this vaccine.

Yeah, you know, there's been some reporting on the RTSS malaria vaccine suggesting that its efficacy is around 50%, but that's actually not quite right. You know, so a clinical trial in 2015 showed an efficacy of 50% over the first year against malaria cases. But the longer term efficacy is probably closer to 20 to 30% against cases in severe disease. You know, 20 to 30% probably does it. sound that great next to the 90% that we've been seeing with the COVID-19 vaccines. But, you know, worldwide, if there are 200 million cases in about 400,000 deaths per year, you know, in the vaccines, the malaria vaccine's efficacy reduces the odds of those things happening by 30%. Then, you know, you'd be preventing about 60 million cases or 120,000 deaths in an ideal world where you can vaccinate

everyone who's at risk at the exact same time. But I think like a more realistic prediction for sub-Saharan Africa where we see, you know, 90% of these cases, when you account for logistics and the time it would take to put doses in people's arms, and we're talking about four doses for this particular vaccine, you know, you would see probably cases fall by like five million annually and deaths by 24,000 annually. But that's still a lot, right? That's a lot of people to save. People must be very excited about this. I mean, why has malaria taken so long to develop a vaccine for? Yeah, it's tough. You know, I think part of it comes down to economics.

You know, with the COVID-19 pandemic, the virus that is affecting the entire population of the planet, there's just going to be a lot more drive to develop that type of vaccine. When you look at malaria, you know, it is concentrated in sub-Saharan Africa. I think when it's concentrated in those places where you have a lot of low-income countries, there's just going to be less of an economic incentive for companies to produce a vaccine. I think the other part is that you're dealing with a parasite. And parasites are multicellular. They're just more complex organisms than a virus like the coronavirus.

And for that reason, parasites tend to be better at evading our immune system. so it can be tough. Let's move on to your next story. And of course, it deals with its Nobel Prize Week. There have been the usual early morning announcements coming from Sweden. But the one I want to talk about is the physics prize. It stands out a bit, namely because the Nobel folks singled out climate change, right, to give the prize for people working in climate change.

What's interesting about this year's Nobel Prize is that it reminds us that even with chaos, there can sometimes be order. So in the 1960s, Securo Manabe tamed some of this chaos and built what the Nobel Committee considered to be the first computer model to explore the connection between heat from the sun and the vertical movement of air through the atmosphere, which influences weather. So, you know, for example, when post-tropical storm Ida dumped all of that rain on New York in New Jersey, it was actually because a cold front in our region caused Ida's moist hot air to suddenly vault upward into the sky, and that caused like a ton of precipitation to just fall on us. Manabe's research also showed how increased levels of carbon dioxide in the atmosphere

can lead to increased temperatures at the surface of the earth, right, which is a cornerstone of confirming the greenhouse gas effect. His work set the table for future bottles, which included one by one of his co-winners, Klaus Hasselman, about 10 years later, that showed how climate connects to our chaotic weather patterns. So climate is what happens over months and years. Weather is the mess that we experience from day to day. Hasselman was able to formulate calculations that bridge the two things. Do you think that the Nobel Committee went out of its way to give the prize for climate change to give their seal of approval that climate change is a real thing and the science is real? I do. I mean, I think, you know, the Nobel Committee awards things for, awards prizes for basic

science. But in less than a month, the UN is going to be holding a climate conference in Glasgow, Scotland. And the timing is pretty interesting that, you know, that they would award this prize, like, ahead of that conference. You know, there's a lot of momentum right now around climate change, especially in terms of feelings among young adults. So Karen Kirk at Yale Climate Connections wrote an interesting story this week about a new study looking at climate anxiety in younger generations. And so in a nutshell, young people from 10 countries around the globe are mad as heck and

are not going to take it anymore. So worldwide, about 60% of these people, and they were like from 16 to 25. in terms of age. They feel betrayed by their government. You know, that's how they expressed it. And I think the pandemic comes into play there, too, in that the pandemic has actually ushered in this global transfer of wealth to younger generations or it's accelerated it. So, you know, baby boomers are starting to retire. The fact that COVID-19 hit that generation so hard, you know, a lot of baby boomers stopped working. You know, they just, they don't want to go to their jobs because it's a little more dangerous for them. And so you're seeing younger generations step into

these managerial roles at a faster rate. And so I think that transfer of wealth could be huge in the future in terms of addressing climate change because, you know, the people who will have the most money will also be the ones who are most concerned about the trajectory of the planet. All right. Let's go. Let's move on to something that may be finally happening. We're talking about the upcoming launch of NASA's James Webb Space Telescope. You know, it's been put off so many times. We talked about it a few weeks ago when it was in transit to the launch site. It might finally have a launch date, right? Right. The James Webb Telescope has been in planning and production since 1989. So for a very, very long time, it was originally scheduled to launch between 2007 and 2011,

but it got delayed over and over again due to technical issues with just sort of, you know, fine-tuning the instruments and getting it ready to take off and also like a series of budget crises. The project has been way over budget. It originally was only supposed to cost about $5.1 billion and now it's expected to be about $10 billion. And for anybody interested in this story, they should really check out Lisa Grossman's reporting at Science News magazine. She has a a great breakdown of how the James Webb Telescope can help us study really interesting phenomena in the universe such as dark energy, but it's also been hit with these massive setbacks. Yeah. When it gets launched, we'll probably do a really good in-depth coverage of what it's supposed to do,

but it is not going to be the same as the Hubble and look at different things. Let's talk about ironically that with all the controversy around the launch date, there's now controversy about the name of the telescope. James Webb is less popular than NASA would have hoped. Yeah, so he's come under fire for potentially targeting gay and lesbian people when he was NASA administrator back in the 1960s. And so NASA, when it sort of learned of a petition, which included scientists and collected hundreds of names,

it said, okay, we're going to conduct an investigation. and we're going to really look into what happened in this time period when James Webb was in charge of our agency. It then came out with a recent report in the past couple of weeks where it said, oh, we didn't find anything, but we're actually not going to release the full details of what we investigated and what we actually found. There's a really good story in nature news that people should look at that really runs through kind of the history of what happened. and what sort of the mystery around this investigation right now. You know, in truth, we're still in the midst of this social reckoning right now.

And I think, you know, the energy around this petition and the energy around wanting to rename this telescope comes directly from that. And one last story. I don't know whether to say needo or oh no about this one. And this is a new way to figure out what people are doing based on their shadows. This is science fiction, it sounds like something out of Mission Impossible or something like that. Yeah, Sophie Bushwick at Scientific American spotted this really interesting study, a new piece of technology that is in the computer vision realm.

So essentially, this team developed algorithms that can track people's shadows against a blank wall and determine what activities they're doing based off of those shadows. Creepy would be one word for it. But I feel like computer vision is sort of doing this all the time. I remember one story I edited last year about how algorithms were being developed to determine whether or not a person was wearing a mask, which could be useful if you just have like CCTV footage of an office space and you want to know who's being compliant with wearing a mask.

mask indoors, especially if like a big outbreak happens there. But yeah, I think that the eerie, creepy part of this story is, okay, what's the application for this? Like, are you going to try to figure out what people are doing in a room by, I guess, like, discreetly having a camera in a corner that doesn't necessarily have to point directly at them, but can sort of figure out what they're doing by the shadows on the wall? Or is this an application that you could put in a car with smart technology that allows it to detect, you know, when a child might be riding a bicycle towards an intersection, you know, just sort of based off of the shadow and like prevent a potential accident from happening. So yeah, it's an interesting story. I think people should

check it out. But yeah, we'll make your skin crawl just a little bit. Well, it's just in time for Halloween. See, Khan. Good story to end with. Thank you for taking time to be with us today. Yeah, I appreciate it. Any time. Sikan, Akpan is Health and Science Editor at WNIC Radio in New York. We have to take a short break. When we come back, is a new antiviral pill against COVID, a game changer. We'll talk about it. This is Science Friday.

I'm Ira Flato. Last week, the pharmaceutical company Merck released data on a new antiviral medication. This one, a pill that it said was dramatically effective at keeping people with COVID out of the hospital. But just how good is it and will it change the equation for fighting the pandemic here in the U.S.? Joining me now is Matthew Herper, a senior writer at Statt covering medicine. Welcome to Science Friday. Thank you for having me. It's a thrill. You're welcome. Tell us about this new medication. Why are people so excited by it? Well, there's been a real hunger since the beginning of the pandemic to have a medicine that could keep people who get COVID out of the hospital and keep them from dying.

that's a pill. The real success we've had here has been with the monoclonal antibodies, which are great drugs, but they mostly need to be given via IV. The regeneron one can be given by injection, but it's a lot of injections. It's inconvenient to give them in logistically difficult. And so the idea is if you had a pill that you could give to people when they start to get sick that kept them from getting sick, it would make this whole pandemic a lot less bad. This is the first one to show efficacy. So although we don't have full data and there are a lot of questions, we know that this drug did in fact keep people out of the hospital. And there was even a difference in deaths.

There were eight deaths in the placebo group and none in the treatment group, which is an impressive result. You know, this pill reminds me of that other pill, that other antiviral Tamiflu, which people took. So that's the same idea. It's not a vaccine. It's a pill to fight the virus. Exactly. Now, Tamiflu has been a controversial drug because what it mostly seems to do is shorten illness. And so they're big believers and skeptics. The result here in COVID really does seem to be a reduction in hospitalization and in deaths. So that's important. And how do you take it? What's the course of treatment here? It's several pills a day, twice a day for five days, every 12 hours. What do we know about how safe the drug is and the cost of this drug?

if and when it does reach the market? Well, those are two very big questions. It hasn't even gone through the FDA yet, so usually you don't know. But what we do know is that on the kind of side effects that showed up in this drug study, there were actually more people who withdrew from the drug from what were thought to be adverse events due to the drug in the placebo group, who were actually probably, we assume, having effects from COVID than in the drug group. But this is also a drug that some experts have had questions about because of the way it works,

because it does work by affecting the virus's genetic material and what if it has long-term effects. And we really haven't seen with any granularity what the safety data look like, aside being told in a press release that the number of adverse events was the same between drug and placebo groups. So that's very much something I'd expect to hear a lot more of as we go through the normal FDA process, which could involve a public advisory committee where a lot of that data gets aired. You asked about cost, and that's a very good question. Right now, the U.S. government has bought a lot of this drug, 1.2 million courses, at $700 per course. We don't know whether that price, which is a pretty expensive price if you're going to stockpile a lot. of it, especially if you're going to use it all over the world. We don't know if that's going to hold up.

There isn't really any comment from Merck. You mentioned Tamiflu. Flu drugs like that cost a lot less, I think, around at 150. So how this drug is going to be bought, who is going to be able to get it, is a big question. Another thing that's important about this trial is that this trial only tested the drug in unvaccinated people. So one big question for regulators, is you'd like to be able to give a drug to people who are at high risk who have breakthrough infections, people on the vaccine who develop an infection. But your risk of being hospitalized or dying is already much lower if you're having a breakthrough infection. So how does one think about balancing the risks and benefits there for vaccinated people

should they have a breakthrough infection? That's going to be one of the important questions for this and other antiviral drugs. Can you give us an idea on what the likely timeline here on this Merck medication is? When might the FDA act on this data? Well, Merck has to finish filing. Then the FDA has been acting very quickly on some of these things. So normally this would take six months, but I would think a month to two months time frame would be realistic here. And are there other drugs like this on the horizon?

So to me, that's really one of the exciting things here. This is the first orro we've seen be effective. And on Wall Street, there's a debate of how much that first mover advantage matters. But the fact that one of them worked also raises the odds that the next ones will work. And there are, there is one from the drug giant Roche in a small company called Attea. There is one from Pfizer that works differently. The big news to me is that it looks much more likely that we're going to get an oral. And maybe this is it.

Maybe this is the drug. We need to see a lot more data before we know that for sure. Do these drugs target just the COVID, or could they be effective against other viral diseases? That's a good question. One of the things that was exciting about this drug initially was that it was expected to be more pan-viral. I mean, it's a tightrope that researchers walk in developing these drugs, because the more specific it is, the less likely you are to affect the host, which is us. But it would be great to have something that if there's a new coronavirus, this is the drug to use. And that also means you're less likely to get resistance because if it's killing all of them,

then you're less likely to have resistance strains emerged. Okay. So what's going to be taking up your attention? What will you be looking for in the coming week? What I'm really looking for on this drug, I really do want to see more safety data. One big question about this study is that if you look at the, the monoclonal antibody studies or you look at studies that were done, there was a positive study of remdesivir, which is another IV treatment in mild to moderate COVID, the rates of

hospitalization and death in those studies in the placebo groups are much lower than they were in this one. So we really are going to want to know why that is, why these patients were so at risk. It may have to do with the geography of where those patients were, but we need to see more clinical trial data to know that. I think that's one big question. The safety is certainly something that people are going to want to pick apart. I mean, if this is going to become a drug that is going to be given to lots of people as soon as they get COVID, it's a 1,500 patient study. We also haven't really even seen the full efficacy readout because this study was stopped early because the efficacy was so good, but that actually enrolled the whole study. So we've seen data from,

about 750 patients, we will probably be getting 1,400 in total. So that should be a lot more information on efficacy. So I'm watching for all of those to read out. These data have not been published. They have not been peer reviewed. They have not undergone reviewed by the FDA or public review by its experts. So, you know, the details matter. And I'm waiting to see the details. Well, Matthew, we will follow that along with you and talk about it later. Thank you for taking down to be with us. Thank you for having me. Matthew Herper is a senior writer at Statt covering medicine. You'll find links to his reporting on this medication on our website at science friday.com. Continuing our COVID conversation, it's been a busy week with data coming out

about the success of some of the vaccine mandates and new news from the FDA regarding at-home testing. me now to talk about that and other topics in the pandemic is Dr. Celine Gounder, an infectious disease specialist and epidemiologist at NYU and Bellevue Hospital. She's also the host of the Epidemic and American Diagnosis Podcasts and a member of the Biden-Harris transition COVID-19 advisory board. Welcome back to Science Friday, Dr. Gounder. It's great to be here, Ira. Nice to have you. Okay, we've been talking about the antiviral medication announced by Mark last week. What is your take on that? I think people need to think about this new drug, as well as other treatments for COVID as backup plans, not your first line option. It's a bit like you don't want to get in a car

accident, but if you do, you have your seatbelts, your airbags to protect you. I think similarly here, you don't want to get COVID, but if you do get COVID, it's great to have some new treatments available to us. And in other news this week, the FDA approved a new brand of at-home test for COVID. And news came out this week that the administration is planning to spend a billion dollars on the purchase of rapid at-home tests. How important is having access to this kind of testing? I think it's really important. And I'm really glad to see that they made this announcement before the winter holidays. The vaccines are wonderful, but they're not perfect. And as long as there's a significant amount of transmission in the community, even if you are vaccinated,

you're still at risk for a breakthrough infection. And so one of the most important things we can do other than getting vaccinated over the holidays is to test ourselves at home every morning, every other morning. And that's the best way to keep ourselves and our families and friends safe and to prevent transmission of COVID when we're gathering together over the holidays. The fact that the administration is sinking a billion bucks, and to the purchase of the at-home tests, does that mean they will be free to us or do we still have to buy them? Well, the administration is aiming to increase free testing through the pharmacy program that provides free testing.

Whether at-home tests will be available for free, I'm not entirely sure yet. Other countries certainly have gone that route where in some countries, they're mailed to people at home to use and they're free. And so I think if we eventually got to that point, I think that would be a wonderful development. Are they reliable? Do we think home tests are as reliable as we would like them to be? They are pretty good. They're not perfect either. But they are quite good at detecting people who are infectious, who are at risk for transmitting the infection onward to others. It is important to remember that just because you test negative on one day doesn't mean you'll test negative the following day. do need to be testing pretty frequently to make best use of ease. Yeah. There's been a lot of talk in recent weeks about vaccine mandates. And now it looks like as they are starting to go into effect, that they're working. They're effective in pushing

folks to take the shot. They've been remarkably effective. In New York City, where I live, we've seen the impact on nursing home staff, on health care staff, where we've seen vaccination rates jump up into the mid to high 90s. And we've seen this impact in other industries, too. Tyson Foods, for example, which is a meat and food processor. We've seen vaccination rates jump. And so I think for a couple of reasons this works. I think people in the United States are more receptive to something coming down from their employer from the private sector than from the government necessarily. And it also provides a kind of cover. You know, I'm getting vaccinated because I have to to keep my job, as opposed to I'm getting vaccinated

because that's what public health officials have told me to do. And I think it gives people sort of that cover socially to do this. I would imagine with the success of this, we would see it showing up the mandate, showing up in more than just the workplace. We may. We may see other mandates. And in New York, again, where I live, we are seeing mandates to go to restaurants indoors, to go to gyms indoors and the like. And so you may see more and more places adopting those kinds of mandates. This is Science Friday from WNYC Studios. Moving on to the data, some of the data seems to suggest

that the latest surge from the Delta variant may be on the decline. What should we make of those numbers? Well, you know, we've seen an interesting pattern over the course of the pandemic, and we still don't entirely understand this. But the virus does seem to occur with these two-month cycles of waves of infection. And we seem to be at the tail end of that now. I do think things are improving dramatically across the country, although some parts of the country are still very hard hit, parts of Alaska, Appalachia, parts of the Northwest, for example.

But I do think big picture things do seem to be improving. I don't know that this is going to be our last wave. I think that's highly unlikely. And I think there's a very good chance that we'll see a resurgence, not as bad as last year, but a resurgence over Thanksgiving, Christmas and New Year's when people travel, when they let down their guard, when they hang out with family and friends. This week, New Zealand, which had been famously trying a policy of reducing cases to zero, basically changed tactics.

What happened there? Well, I think there's been the realization that with the Delta variant, which is more infectious, significantly more infectious than the early strains of the virus, that a elimination strategy or COVID-0 strategy is just near impossible. And so understanding that, how do you reallocate your resources while minimizing impact on society and the economy? And I think that's what they're recalibrating right now. Whatever happened to that Mew variant people were worried about just a few weeks ago? Well, it really hasn't turned out to be a problem. so far, I think you have to think of these variants as being in competition with one another.

And the Delta variant is so good. It is so infectious. You can think of it as being that much faster in a race that it has really outrun all the other variants so far and so continues to be the dominant variant. Do we have any idea when the Moderna booster may be coming out? Because I know I'm certainly waiting for it. I know a lot of other people are. What is holding that up? So, Moderna, as you'll remember, was rolled out after the Pfizer vaccine. And so they're just a little bit farther behind and also gathering data on questions like boosters. The FDA and the CDC are going to be reviewing that data. I will say that the Moderna vaccine does seem to be holding up better than the Pfizer vaccine. So I would not be surprised if recommendations from Moderna recipients to be boosted

are a bit narrower than what they were for Pfizer. And there are a piece. And there are a piece of People who are going to say, you know, I don't want to wait for that merderna. I'm going to go get the Pfizer and mix and match them. Anything wrong with that? Well, you know, that may not be the best mix and match option. What we've seen with other mix and matching, in particular, the AstraZeneca vaccine, which is an adenovirus vector vaccine, not unlike the J&J vaccine. What we've seen is that when you mix and match that vaccine with MRNA vaccines like

the Pfizer and Moderna vaccine. So really crossing different technologies, that's when you get the best combination. The NIH is currently studying every possible combination of Pfizer, Moderna, and JNJ, which you know, which one did you get first and which you get a booster to see what combo is the best. And we should have data on all of those mix and match regimens by mid to late October. So at least personally, I'd rather wait and see what that data shows. And, you know, if I do need a booster, I would go based on that. Okay, Doc, you're the doctor. I'll take your advice. Dr. Saline Gounder, thank you for taking time to be with us. My pleasure. Dr. Gounder is an infectious disease specialist and epidemiologist at NYU and Bellevue Hospital. Also, the host of the Epidemic and American Diagnosis Podcasts and a member of the Biden-Harris transition COVID-19 advisory board.

We have to take a break. When we come back, we'll talk about. about how history tends to repeat itself when it comes to the U.S. and pandemics, certainly. Stay with us. This is Science Friday. I'm Ira Flato. For many of us, our first pandemic has been this COVID-19 one. But the U.S. has a long history of public health crises. AIDS, measles, the flu, they're all illnesses that left lasting impacts on the country.

You would think, then, that the country would be better prepared to deal with public health crises since they happen not infrequently. Well, you would be wrong. A new article in the Atlantic explores the country's gaps in public health prepared this and why many experts saw the country's mishandling of the pandemic coming a mile away. The article is called We're Already Barreling Toward the Next Pandemic. It was written by my guest, Ed Young, science reporter for the Atlantic based in Washington. Ed won a Pulitzer Prize last year for his coverage of the COVID-19 pandemic.

Also joining me is Dr. Greg Gonzalez, Global Health Activist and Epidemiologist at Yale in New Haven, Connecticut. Welcome to the show. My pleasure. Thanks for having me. Ed, let me give you the first question here. A lot of people are going to be wondering why we're already talking about the next pandemic when this one isn't even over yet. Why did you decide to write about this now?

Well, I sympathize with those people. I'm sure we all want to just never. have to think about this again, and I certainly don't. But I think that history tells us that if we take that attitude, we are doomed to making the same mistakes. For a very long time now, the US and the world at large has been trapped in the cycle of panic and neglect, where a new epidemic hits, everyone pays attention, investments flow in, the right moves are made to make us a little better prepared the next time, but those moves eventually get eroded. People forget complacency settled in. And we enter these Sisyphian cycles where we never get any better at

dealing with the next crisis. And the next crisis is surely upon us. More epidemics are imminent. And there's no guarantee that we'll have the luxury of facing just one at a time. So sadly, we have to walk and chew gum at the same time. We have to control this current pandemic while also trying to prepare ourselves for whatever is to come next. Can you give me an example of what you're calling a Sisyphian cycle of panic and neglect? Sure. So if you look at just the recent history of the last decade and so, after the Ebola outbreak in West Africa, people paid huge attention to this idea of emerging diseases that could threaten us. A lot of investments were made. That money eventually,

was eroded. When Zika emerged and started causing problems, a lot of money that was devoted to Ebola was cannibalized for dealing with Zika. And, you know, we don't even have to think about past epidemics. We can look at what's happened just this year. After the surge of the previous winter started abating and when cases started falling in the spring, America and many other parts of the world dropped to their guard, testing scaled back. The CDC announced that indoor masking was no longer necessary for vaccinated people, in many ways, hitting two of our most effective defenses against each other. President Biden on several occasions gave what were pretty close to victory speeches.

And then the Delta variant came out of other parts of the world and completely pummeled this. We didn't even get out of this current pandemic before we entered into the neglect stage. And I think that, again, is why we need to start thinking about preparedness now. This cycle of panic and neglect spins so quickly that we are already heading towards the neglect phase, even in the midst of this generation-defining disaster. Greg, as an epidemiologist living through a global pandemic, when did you start thinking about the next public health crisis? So, I've been living with another pandemic for 30 to 40 years, which is the AIDS epidemic.

So I was always waiting for the shoe to drop with this one, and it finally arrived in 2020. And so it was clear early on, as you watched the United States try to respond in its dishevelled chaotic incumbent way last year, that we were singularly unprepared. for what was happening and that the next pandemic was not going to treat us as kindly as even this one has, even with its sort of devastation and its cause so far. We're weaker than we've ever been. So you're saying basically the COVID pandemic and how it was treated is a sort of a reflection on the total health, if I could put it that way, of the American healthcare system. Well, the health care system writ large, which includes public health, which is sort of the

appendix of the body of American health care. We speak. pennies, three cents on every dollar on public health in the United States. So yes, and Ed talks about this in his piece at length. And, you know, if you look at the history of science and medicine, people like Elizabeth Fee, the late historian of science and medicine, you know, she discusses this at length. This is a century in the making. There's a book on Katrina that came out a few years ago.

It was called Katrina, his history, 1915 to 2015. The idea here is that the catastrophe of Hurricane Katrina, was avoidable as well, but the policy decisions that were made over the course of a century in that city that led to the devastation and the lack of preparedness for that natural disaster. And the same thing has happened here. We've seen millions of infections in the U.S. by public policy, by choices we made last year and into the years before that. You know, this pandemic began during the Trump presidency, and a lot of people put the blame on that administration's flaw handling of it

for how bad things went in the early days. but you say things would have still have been bad even without Trump. Is that your reflection again on the whole state of health care? Trump made things in arguably worse, right? It was just a fiasco of incompetence, malfeasance, and I think a little bit of malign intent. And so, yes, last year could have been better. But I think we should temper our expectations about what we could have achieved last year, even with President Biden at the helm of the country.

You know, the point is you get what you pay for. And we have a crumbling public health infrastructure. You know, look at the maps of COVID-19 right now or three weeks ago, and then superimpose it with diabetes, maternal health, infant mortality, life expectancy. And you start seeing maps that look eerily familiar, right? The catastrophe of COVID-19 in our towns and seized across the U.S., was we capitulated in a smaller form by chronic infectious diseases going back generations. Ed, looking forward, what types of mechanisms do you think we need to put in place to make sure the

U.S. is better equipped to deal with public health crises? So I think there's a couple of things. Greg and others have spoken about the need for a high sustained level of public health funding that crucially cannot be eroded for other purposes. That pot of money needs to be immune to the vagaries of electoral cycles and whatever Congress decides to do in each round of appropriation. Public health departments need to be able to rely on a stable and substantial amount of funding if they are to actually rebuild. There's so much to do in terms of basic infrastructure and debating for hiring people. There's no use giving a department.

emergency funds to hire someone who might then lose their job in two years. And I would also argue that aside from that, aside from shoring up the public health departments, I think the US really needs to think about shoring up all of society and especially its most vulnerable sectors. The country has shredded its social safety net for many decades now, from the Reagan administration to the ones that came after, the country is. therefore weak. Those weaknesses affect everything from maternal and infant mortality to the opioid crisis and they've manifested over the course of the COVID pandemic. And those weaknesses are

fundamental. It means that many people are living on the edge. They struggle to provide enough food for their families. They struggle to earn a living wage. And when you have a novel virus that hits such a society, you get very predictable inequities and very predictable losses of health and lives. It's completely predictable that a lot of essential workers couldn't take actions to protect themselves, couldn't isolate or take the time off to get vaccines or tests because they work low-income, hourly wage jobs without any paid sickly. We have a system where millions and millions of people have no access to healthcare, have no access to a trusted primary health provider, have no access to trusted sources of health information. It's no wonder that even if you release incredibly efficient

vaccine into that population, that you'll get uptake plateauing very quickly. In the US, it was 38, in the world in terms of vaccination rates, which is ridiculous, given how much of a central role the country played in development of those vaccines. But vaccines are great, but vaccinations are what matters, and you don't get vaccinations if you have a society that is so vulnerable and so important. Do you have confidence, though, that the U.S. government will be better prepared from now on to deal with the next pandemic? In part, Eric Lander, who's the president of science advisor, is created a whole sort of new pandemic preparedness plan. But again, it's really focused on big science and the shiny toys.

And there's not very much mention of the sort of basic public health, which Ed talks about in his article in the Atlantic, and that we've been talking about here. We need a massive investment in public health in the United States. You don't build a castle on a weak foundation. And so the big science, the big technology approach to protecting us against our next pandemic, it's all well and good. But if we don't have a local infrastructure from small cities and towns in the U.S. to big metropolises, we're in trouble, right? We fight diseases community by community block by block.

And we can see that when you look at zip code maps or census track maps of how COVID is, we take havoc in our communities. And so I don't think President Biden, and to be fair, presidents before him, really understand the fundamental problems in American public health and that is what has been sort of a catastrophic. failure to invest in public health. Remember, when public health succeeds, you don't see it. When you say invest in public health, are you talking about first responders, having enough hospitals ready? I mean, you know, like gearing up for a war where you keep stuff stockpiled until you need it?

Look, let's think about maternal mortality in Georgia, the state of Georgia. Terrible, right? Is that about the wonderful obstetric care you might get at any of Emory's hospitals? No. It's about what we've done in communities around Georgia to ensure that women are healthy before pregnancy, during pregnancy and after pregnancy. So we need to build up frontline public health, right, to make people less vulnerable communities less vulnerable. Yes, we should have more force responders. We should have better sort of protocols and hospitals.

We should figure out how to deal with the sort of shortages of key commodities. But keep going backwards to the very place where health happens in homes, in communities, on blocks, and realize that a lot of risk happens there. This is Science Friday from WNYC Studios. And to mitigate that risk, we should be doing what? Look, since 2008, we lost 50 to 60,000 frontline public health care workers. They never came back. You know, and the public health associations around the country

suggest the deficit in frontline public health care workers is in the hundreds of thousands, right? Again, we spend three cents on every dollar on public health care. in comparison to healthcare. I talk to health departments around the country. You know, they're doing vaccines now. They can't do testing in vaccines. So this week, it's vaccines, right? The understaffing is incredible.

Also, the physical infrastructure of some of these public health departments, the data systems of some of these public health departments. You know, we do not have a robust, strong 21st century public health infrastructure in the US from physical infrastructure, data infrastructure, and human resources. And you're saying this is not by accident.

It's not by accident. You know, we make choices about about what we think is important in our society. And, you know, as Ed said in his article, one quoting Elizabeth free, public health always gets the short end of the stick when it comes to making public policy decisions. Greg touched on this earlier. About last month, the Biden administration released a $65 billion pandemic prepared this plan. Is this plan going to address the deficiencies that you talk about, Ed? I don't think it is for two reasons. 65 billion sounds like a lot, but it's actually much less than what others have suggested

is necessary to truly bolster the country against pandemics. And at least two-thirds of that pop goes towards things like vaccines, therapeutics, diagnostics, the kind of biomedical countermeasures that we think of as being crucial to pandemic preparedness. Now, I'm not saying that we don't need vaccines, obviously those are great, good to have, they're important. But if you devote two-thirds of a preparedness plan to them now, like after everything we've learned over the last two years, that suggests to me that we've not actually learned the right lessons. You know, like I said, we developed vaccines at incredible pace, and we now are 38th in the world in vaccination rates. The deaths per capita from COVID are higher in the US after the point

when all adults became eligible for vaccines, then in 100 plus other countries, before vaccines were available. That's a shocking statistic which will make us think hard about what actually it means to be ready or to be strong against an infectious disease. I do think that if people are looking at the last two years and thinking, well, what we really need is just to do the same thing but harder, you know,

to get a vaccine but faster, I just think that's, the wrong lesson. Like, if anything, it might be counterproductive. Like, a lot of vaccine hesitancy stems from this idea that the vaccine development process was rushed, that corners were cut, and it's, you know, adequate safety tests weren't done. I don't think that that rationale is correct, but it does exist and it does explain why a lot of people have been reluctant to get vaccinations. Now, you know, you look at that situation and you think, well, we'll just make vaccines quicker. I just don't think that's the right strategy. We need to start coming to grips with actually how vulnerable and weak a lot of sectors

of American society were and how those weaknesses cannot simply be addressed by throwing more biomedical countermeasures more quickly at the problem. You need to sort of fix the weak foundations rather than just layering more technological faster on hoverman. We have run out of time, gentlemen. So much to talk about such interesting stuff you have to say. I want to thank both of you for taking time to be with us today. Ed Young, science reporter for the Atlantic based in Washington,

Edwin-Napolitzer Prize last year for his coverage of the COVID-19 pandemic, and Dr. Greg Gonzalez, Global Health Activist and Epidemiologist at Yale, based in New Haven, Connecticut. Thank you both for taking time to be with us today. Thanks, sir. Thanks for having me. One last thing before we go. Back on November 8, 1991, I hosted the very first Science Friday, and I remember we spoke

with Frank Sherwood Rowland, better known as Sherry Rowland, about his research on the ozone hole, for which he would later receive a Nobel Prize in Chemistry. Over the years, we have spoken to thousands of incredible guests, and you, our listeners, have always participated. So this November, we're celebrating 30 years of Science Friday, and again, we want to hear your favorite or most memorable moments on Science Friday. You can tell us about a memorable story or a person you heard on the show on our SciFri Vox Pop app. Download it wherever you get your apps. Have a great weekend.

I'm I Refleto.