Science Friday - US COVID Health Emergency Ends. May 12, 2023, Part 1

Episode Date: May 12, 2023

FDA Advisory Board Approves First Over-the-Counter Birth Control Pill This week an FDA advisory board paved the way for the first over the counter birth control pill, with an unanimous decision 17-0. The FDA must accept the recommendation before the pills are available for sale, which is expected in a few months time. If approved, the progestin-only pill would be manufactured by the company Perrigo, under the brand name Opill. Ira talks with Maggie Koerth, science journalist based in Minneapolis, Minnesota, about that and more including; Voyager spacecrafts get energy boosts, wild axolotls face extinction, testing airplane waste for COVID-19 and more.   US Declares An End To The COVID-19 Public Health Emergency Just over three years ago, Alex Azar, then the Secretary of Health and Human Services, issued a declaration of a national public health emergency as a result of the novel coronavirus, SARS-CoV-2. That declaration kicked off a cascade of nationwide funding, policies, and restrictions aimed at combating the spread of the COVID-19 pandemic. In the three years that followed, the Centers for Disease Control and Prevention estimates over a million people in the US have died from COVID-19. Yesterday, although the virus is still circulating and people are still getting sick, that emergency declaration finally came to an end, after being renewed over a dozen times. A statement released by the Department of Health and Human Services said “COVID-19 is no longer the disruptive force it once was. Since January 2021, COVID-19 deaths have declined by 95% and hospitalizations are down nearly 91%.” Dr. Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, joins Ira Flatow to talk about where we go from here. Is life back to normal—or is there a new normal? What have we learned from the past three years about responding to future outbreaks?   Transcripts for each segment will be available the week after the show airs on sciencefriday.com. 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 Iraflato later in the hour talking with Dr. Anthony Fauci about the government's calling an end to the COVID health emergency. And how prepared are we for the next pandemic? We're going to be taking your calls. You can talk to Dr. Fauci. Our number is 844-724-8255. 844-724-8255 or tweet us at SciFRI. But first, this week, an FDA advisory board paved the way. for the first over-the-counter birth control pill. It was a unanimous decision 17 to zero in favor. The FDA must accept the recommendations before the pills are available for sale, which is expected in a few months' time. Joining me now to talk more about this and other top science news of the week is my guest, Maggie Kerth, science journalist based in Minneapolis. Welcome back, Maggie.

Hi, thanks for having me. Nice to have you. Tell us more, how does it work? Tell us all the way you know about this pill. Yeah, so this is really something, this is a type of pill that's existed for a really long time since the late 60s or early 70s. It's called a mini pill, which is basically a type of birth control that only has one of the two hormones normally found in standard pills. In this case, progesterone only, no estrogen. And many pills have been shown to be highly effective, but they're effective in different ways than typical pills.

So pills with estrogen suppress ovulation. But that only happens for about half the people who take a mini pill. Instead, mini pills usually work by thickening cervical mucus and thinning the uterine lining. And that makes it harder for sperm to get to eggs and for fertilized eggs to implant. And what were some of the risks and benefits that panel weighed while making their decision? Yeah, so there are some ways that these are better than the standard birth control pills in some ways they aren't. On the downside to get to that 99% effectiveness that these pills can reach, you have to take the mini pills at not just every day, but the same time every single day. Otherwise, that effectiveness will drop to about 91%.

But the risk of blood clots is lower with mini pills, and you can also take them while you're breastfeeding. So the FDA's panel was really kind of bouncing around some of these things. you know, without a doctor's involvement, will people miss important information like the timing thing or the fact that you shouldn't take many pills if you've had breast cancer? But the people on the committee really ended up focusing in on the fact that this is going to be a lot more effective than any other over-the-counter contraceptive. And the benefits really outweigh the risks. So you'll just be able to walk into the pharmacy and buy the pill yourself without a prescription. Yeah.

If the FDA approves it, yeah. If they approve it. Interesting. This next story you brought us is about Energizer Bunnies of spacecraft. And I'm talking about Voyager 1 and Voyager 2. They were launched in 1977, and they're still going, right, in space.

Oh, yeah. I mean, NASA's unmanned spacecraft have this history of being really long-lived, but these two are just crazy. I mean, you're probably most familiar with them from the photos that they took of Saturn and the pale blue dot shot of Earth. But these crafts,

hit interstellar space in 2012, and they are continuing to send back information about what space is like outside of our solar system. Things like magnetic fields and cosmic rays, they're taking measurements on this all the time. But to keep doing that, NASA's had to figure out how to keep these things alive. They run off of what are essentially nuclear batteries, little generators that turn plutonium 238 into electricity. And that power, runs all the instruments on board. But over time, NASA's had to turn off some of the working parts to keep others running. So in 2019, they turned off the heaters that were keeping some of the scientific instruments warm. And then in March, on Voyager 2, they turned off a safety mechanism

that was meant to protect the system from voltage spikes. Now, the good news with that is it's probably going to be enough to keep everything running on Voyager 2 until 2026, without shutting off any other scientific instruments. Wow. I love Voyager 1 and Voyager 2 because not people, many people don't know, they have a special 8-track recorder, the high technology of the day. There's an A-track on it. It's a little industrial design, but that's kind of fun. It's maybe the most famous for that brilliant picture they set back from Saturn and Jupiter. It's some great stuff. But as you say, they're way way out, way out past the solar system now, right?

Yeah, and the hope is that by kind of chopping off one little bit of their functionality at a time, they could maybe limp their way into 50 years of service. Wow, that's really amazing. All right, your next story is about an animal that unfortunately is facing extinction. Tell us about that. So, Oshelots, they are the cutest amphibians ever devised by nature. I'm not sure if you've seen them. They're kind of squishy looking, perpetually smiling little creatures.

They've got frills around their heads like they're off to a summer festival. Some of them are even pink. Unfortunately, as you say, they are also extremely endangered. They are native. I know it's the worst. They're so cute. They're native to lakes and marshlands and sewers, actually, around Mexico City. And Oshelot populations have fallen rapidly in recent.

decades. So there was a 1998 survey that found 6,000 per square kilometer, and by 2015, that was down to 36 per square kilometer. And so they have special things they can do, like they can regrow their limbs? They can. And as Richard Stone writes in science, one of the problems with causing them to be, you know, going extinct right now is actually part of what makes them special. So they're adapted specifically to what is now Mexico City, you know, nowhere else in the world. And they're related to these boring old normal tiger salamanders. But at some point about a million years ago, they just stopped going on land as adults. And they ended up remaining their whole lives in these plentiful, what were once predator-free waters.

And so they kept some of those juvenile features like limber growing. Wow, wow. So is it because that they've run out of their natural habitat that they're in danger now? Yeah, yeah. So that habitat has changed drastically around them. You know, from the time the Spanish colonists started draining many of the lakes after they invaded to the 1970s when the Mexican government started stalking these lakes with carp and tilapia, which is a delicious food that unfortunately also eats Oshelots. And now their remaining habitat is threatened further by gentrification as some of these canals and lakes get turned into restaurants. and soccer fields. And a lot of them, though, are existing mostly in labs, right, for research? Right, yeah, they're in labs for research. There's actually a growing pet industry around them.

So they're not going to die out completely, but their numbers in the wild are really not looking very good right now. Wow, sorry to hear that. Okay, let's move on to another animal that's in short supply in the lab, but not in nature. and I'm talking about monkeys. How did we get into a research monkey shortage? Oh, this is so interesting. So there's the National Academies report recently found that two-thirds of U.S. scientists are having trouble getting monkeys for their experiments.

And the U.S. uses about 70,000 monkeys a year, mostly for research on infectious diseases, neuroscience, and aging. But as David Grimm writes in science, the availability of these monkeys just plumb. limited after the COVID pandemic. Now, a big part of that is because we were getting 60% of our monkeys from China, and they basically cut off that supply at the beginning of COVID. Then we started getting them from Cambodia, but then the dealers in Cambodia got caught in a smuggling scandal where they were basically selling wild-caught monkeys and claiming they were

lab bred. Then all the major airlines have pretty much stopped agreeing to ship lab animals. And the monkey that's used most frequently was declared endangered. So now we have all of this growing amount of research on things like infectious diseases and neuroscience and aging. And demand is shot up, but supply is way, way, way down. So that means the price of a monkey has gone way up? The price of a monkey has gone up a lot. Researchers told science that they used to be able to get a monkey anytime they wanted one for $2,000.

and that process can now take months and cost upwards of $19,000. $19,000. This next story is some very good news. For people who hate to eat their veggies, scientists are working to make veggies taste better using gene editing technology. Now, this I have to hear. Well, if you're anything like me, Ira, you probably have memories of Brussels as a national punchline.

Like, you know, people, the thing you're threatened, with as a child. And then it's kind of crazy when you turn around and see today they're this restaurant side dish everywhere. And it turns out that this is not just cultural gaslighting. Brussels sprouts actually did use to taste bad. And that changed in the late 1990s because these breeding programs figured out this bitter tasting chemical called glucosinolates could be actually removed from the plant's flavor profile by breeding sweeter tasting Brussels sprouts with Brussels sprouts that also produced a lot of sprouts.

And so now we have this really popular vegetable that was not really popular before. And Megan Bartels has a cool piece in Scientific American looking at efforts to do the same thing for other veggies, this time using DNA sequencing and CRISPR gene editing. Wow. Our last story, this week, the COVID public health emergency officially ended in the U.S. And we're going to be talking a bit about that with Dr. Anthony Fauci.

But I want to talk about a fascinating way researchers are still tracking COVID by monitoring human waste on airplanes. Airplane. Yes, it's so cool. So this is like an early warning system for new variants, basically. You know, there are a few people getting tested in any documentable way. So scientists are turning to toilets to understand what's going on. And this new program is testing wastewater from airplanes as they land in San Francisco. But the program is only looking at international flights.

This is from a story by Betsy Lauget's in Science News. And that's because, put it delicately, people are less likely to poop when they fly domestic. Aha. I get it. I get it. Yeah. So there's more samples on the international flights. And the scientists are hoping that this will give them a good idea. of what new strains are entering the country. And they hope that maybe this could be expanded

to track other diseases as well in the future. Great stuff, Maggie. Always a pleasure to have you. Thank you for taking time to be with us today. Thank you. Maggie Kerth, science journalist based in Minneapolis. We're going to take a break. And after the break, Dr. Anthony Fauci joins us

to talk about lessons learned from the COVID pandemic. Are we prepared for the next one? What should we be doing? And we'd love to hear from you, our number 844-724-8255. 844-7-24-8-255. You can also tweet us at SciFri. Stay with us.

We'll be right back after the short break. This is Science Friday. I'm Ira Flato just over three years ago. In late January 2020, the Secretary of Health and Human Services, Alex Azar, issued a declaration that a public health emergency existed nationwide as a result of the novel coronavirus SARS COVID-2 often called COVID-19. That declaration kicked off a cascade of funding policies and restrictions aimed at combating the spread of the pandemic. Over a million people died in the U.S. due to COVID-19 over these three years. And yesterday, that emergency declaration finally

came to an end. After being renewed over a dozen times, although the virus is still circulating, people are still getting sick and dying. A statement released by the Department of Health and Human Services said, quote, COVID-19 is no longer the destructive force it once was. Since January 2021, COVID-19 deaths have declined by 95% and hospitalizations are down nearly 91%. So where do we go from here? Is life back to normal? Is there a new normal?

What have we learned from the past three years? about responding to the future outbreaks. Joining me now is someone who became inextricably linked with the government COVID response, Dr. Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases at NIH. He stepped down from that role at the end of 2022. Welcome back to Science Friday. Thank you, Ari. Good to be with you.

Good to have you back. And our number, if you'd like to talk about this, I'll let our listeners know 844-724-8-255. 844 SciTalk or tweet us at SciFRI. It's nice to have you back. Just to begin, you're now a private citizen. What are you up to? Well, I'm up here talking to you on Science Friday. That's one thing.

I'm doing fine. I'm giving a bunch of lectures still writing opinion pieces. And probably going to be starting soon on a memoir to sort of document my experiences over the last you know, I was at the NIH for 54 years, and I was the director of the Institute for 38 years. Wow. And we had a number of experiences that I think might be instructive for younger people interested in going into science, or those who were already in science, starting way back, you know, more than 40 years ago with HIV,

and then a number of other challenges, Ebola, Zika, pandemic flu, the anthrax attacks. And now, as you mentioned, over the last three plus years with COVID-19. So there's a lot of public health science and medicine in there. Let's talk about the results of this declaration ending their emergency state. Are there any practical differences that people are going to see? Well, yeah, the practical differences are that the accessibility, ultimately, to vaccines and therapeutics, particularly for people who don't have health insurance, could be an issue. Right now, when you call off the emergency nature, there are a number of advantages in the sense of accessibility of interventions for everybody that's free.

The vaccines, the therapeutics, even some of the diagnostics that we know of. There are still a supply. It's going to run out before it ultimately becomes privatized where you'll have to buy the vaccines if you want it. we're not there yet, even with the discontinuation of the emergency, there are still a supply of vaccines that have not yet been used that could be available to be free. But when they run out, if you have insurance, then you could obviously charge that to the insurance. But if you don't, then there's going to have to be some programs to provide somewhat of a safety net for those who need the vaccines, but who don't have the financial accessibility towards them. And that's one of the things that needs to be worked out. Yeah. Yeah, I'm sure you're right about that.

Let's talk a bit about your experience with COVID-19, and you were the central figure in this. If you had to give the government an overall grade on how it handled the pandemic, what would you give it? You know, I'd have to break it up into two separate categories because they really are distinct. If you talk about preparedness and response, I tend to break it down into two general buckets. One is the scientific response and the other is the classical public health response. From the scientific response, I would give it an A and maybe even for the vaccine component of that, an A plus, because as you will know, and you mentioned it earlier, in January of 2020, actually on January 10th of 2020, we got the genomic sequence of,

of the new novel coronavirus, which we called SARS-CoV-2. And then in a completely unprecedented manner, 11 months later and tens of thousands of people in a clinical trial, that vaccine was shown to be safe and more than 90% effective in preventing clinical disease. We've never had anything that needed to approach that in the field of vaccinology. So that was, you know, judged by Science Magazine as the science breakthrough of the year. And I think appropriately so. And that was the result of literally dozens of years of investment and basic and clinical biomedical research.

When you go to the other bucket, the public health bucket, you know, I don't think we did very well. I mean, you could go maybe generously a B minus and possibly a C or C plus for the simple reason that the local public health and the interaction between the federal and the local public health, I think reflected the discontinuation or the disconnection is a better word between individual health and public health at the individual level and public health at the broad national level. For example, and the CDC has made it very clear and admitted that this is something that they're working on improving right now is the lack of a complete accessibility in real time of data from the local public health infrastructure, namely the local public health departments, which it isn't

required that they give the information to the CDC in a certain amount of time. The CDC has to ask for it, and then they may or may not get it to them in an expeditious manner. That really has to change, whereas in many other countries, the connection between the individual health and the delivery of health care and the accessibility of data is almost in real time, which is the reason why we got a lot of our real-time information by collaboration and coordination and communication with countries like Israel and South Africa and the UK. So those are the things that we really need to do better on is the general public health approach. And as I mentioned, the scientific approach did very well. Do you think then because of this, the public has lost

faith in the public health system? Well, I think that might be too strong a word to say the public, like everybody. I think there are certain segments of the population, understandably, when they saw some of the inconsistencies and the communication issues felt that we could do better. I mean, losing faith is a pretty dramatic endpoint to get to. I think everybody realizes that we have lessons to be learned, and that's one of the lessons that we have to learn. We have to really bolster up our local public health capabilities and the connection between the federal and the local.

public health. We need to do better. I wouldn't say lost faith, but had some concern about the performance. Okay, we have so many calls, so many interesting calls. Let's go to the phones. Let's go to Catherine in Minneapolis. Hi, Catherine. Hi, thank you for taking my call. Just to piggyback on Dr. Fauci's comments there, and that was most useful. It helped my question. How prepared are we to, first of all, discover any new virus coming along and deal with the next pandemic because certainly COVID will not be the last pandemic we see in light of the fact that the Trump administration cut the funding and eliminated the science teams out in the other countries that were doing this work. And I will listen on the air. Thank you. Thanks for your call. Well, that's a great

question, Catherine. And right now, even in the midst of the height of the pandemic, we in the government, when I was the director of NIAID, we at NIH and the CDC and HHS, particularly BADA, put together a pandemic preparedness program and request of being able to do many of the things that Catherine was alluding to, to be able to rapidly identify and go from the identification of a pathogen to the point where we have countermeasures in a very expeditious period of time. that G7 has endorsed and put together what we call the 100 days mission, which is the aspirational hope that we can go from the identification of a new pathogen to actually have interventions starting to be distributed, certainly not to everyone, but at least starting to be distributed within 100 days. And we have a program at the NIH, which we started, which is we call the prototype high pathogen approach where you anticipate within the categories of the various families of viruses to do seed work in immunology, virology, and vaccinology already within that category so that we'll be

able to literally hit the ground running when the next outbreak occurs, whenever that will be, which of course is entirely unpredictable. Speaking about the next virus and the next vaccine, one highlight of the response was the rapid development of a vaccine using this MRI technology. It certainly worked in a crisis, but this technology means that we have to make another version for each new variant for the spike proteins, does it not? I mean, we have talked with researchers who say we should and we could be putting more effort, and by that, I mean, the drug companies into making vaccines the old-fashioned way, using parts of the actual virus that don't change from one variant to another, but these critics say that drug companies don't

want to do that because they don't make as much money on this. What's your take on this? No, no, that's nonsense. Ira, really, that's nonsense. We would love to be able to get a good, durable immune response to the invariable or the unchanging component of the virus. But there's a lot of technical and scientific stumbling blocks there, particularly the immunogenicity of it, and whether or not you can induce broadly neutralizing antibodies from those particular epitopes. It is a scientific challenge. It's not something that you don't want to do because you want to be able to make a lot of different versions of the vaccines, certainly from the standpoint of the scientists at the NIH and the thousands of scientists that we fund.

throughout the country, we're all trying to get, you know, we use the terminology, a universal coronavirus vaccine, namely one that would be effective against any variant of a coronavirus. But you want to start off first with getting a universal SARS-CoV-2 vaccine or a universal beta-coronavirus vaccine and then ultimately, aspirationally, to get a universal true coronavirus vaccine. There's a lot of work going into that. We refer to it as next generation vaccines. And recently, you may recall, Ira, that the department, the government, has put in $5 billion for that goal to be able to get next generation vaccines.

This is Science Friday from WNIC Studios talking with Dr. Anthony Fouchy. The first time we've ever talked to him as a civilian, if I might, terminated that way. because you've been coming on this show for 30 years. Here's an interesting tweet from Ken from Baltimore who says he's a teacher. He's exposed to the virus a lot. What's going to happen as he gets exposed to the virus repeatedly over time? Is it going to happen? What's going to happen to him or other teachers?

Well, again, it gets to the different types of immunity, Ira. I mean, for example, my case, I was double-eastern. vaccinated with the original regimen of Moderna, and then I had two boosts, and then I got infected, and then I got the bivalent boost. So I have a lot of hybrid immunity. I mean, that doesn't mean I'm not going to get infected when I get exposed again, and I probably will, because there still SARS-CoB-2 out there, but it is unlikely, knock on wood, unlikely, that if I do, do and when I do get exposed, that I'm not going to get severe disease if I do get infected. So the person who just called in or tweeted in, that person likely was already vaccinated and maybe even was infected,

which means that subsequent exposures to the virus, so long as the virus doesn't change dramatically, like we saw when we had the Omicron. Amicron variant was a very profound change from the initial alpha, beta, and delta variants that we had earlier on in the outbreak. If we don't have another really truly dramatic change, subsequent exposures for those who have been vaccinated and maybe hybrid immunity because they've also been infected, doesn't mean you're not going to get a mild infection, but it's a very, very small chance that you'll get a severe outcome. Let's go to Will in Chicago. Hi, Will. Hi, how are you? Fine. Go ahead. Just a quick question. I've been reading a little bit about the issue of nucosal vaccination, and I'm wondering what Dr. Fauci thinks about the future of nasal vaccines, especially with respect to COVID.

Well, certainly it's something we're striving for, Will. It's one of those things where it would be, if you get a successful, mucosal vaccine, you would build up mucosal immunity at the surface where the virus enters into the body, namely the mucosal surface of the nose, of the upper airway. That would be very good against protection, against infection itself,

whereas some of the systemic vaccines don't protect, at least for a long period of time, very well against protection, but they protect very well against severe disease. there's a lot of activity right now working on a mucosal vaccine. No guarantee we're going to get a really good one, but you know, you try and you try and hopefully with a good input from a number of good investigators, we'll get there. That's a goal that we certainly are striving for. Yeah, makes a lot of sense, doesn't it? Hit it where enters your body? Right, exactly. And so how much

more difficult is that to do? You know, we have an example of that with the flu-mist, of influenza. That has been partially successful, not necessarily as successful in adults as in children, but it isn't, you know, a home run in the sense of that is the answer to preventing infections at a very high level with influenza. It's worked reasonably well, but it hasn't been a home run.

I got it. So although conceptually it could work and it could work well, we don't have the answer to that immediately right now. Yeah, we've got to wait to hit one out of the ballpark. Stay with us. We're going to take a break and when we come back. Lots more to talk about with Dr. Anthony Fauci, so don't go away. This is Science Friday.

I'm Ira Plato. We're talking this hour about the COVID pandemic, the end of the National Public Health Emergency Declaration, and the future. What's in store? Looking through our crystal ball with us is Dr. Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases. at NIH. If you'd like to get in on the conversation, our number 844-8255. You can also tweet us at a sigh fry. Would you agree, Dr. Fauci, that the poor nations got a short shrift on the vaccines

that rich countries got, and do we have to do better on that? Yeah, Ira, they did. I mean, obviously, if you're talking about true equity, there was not true equity. And the developed nations certainly were able to get as much or even more vaccine than they really even needed in several of the countries, you know, in the relatively less affluent South, countries in Southern Africa and other areas of the world, other regions of the world, who do not have as good access to kind of health care interventions, didn't do as well. We tried. The United States really went a long way in donating a considerable amount of doses to the developing world and contributing a substantial amount to COVAX, which was the UN-based organization or enterprise that try to get vaccine to the developing world. Having said that, we still have to do much better because there still is a disparity in this arena of equity for things like vaccines and therapeutics.

for those in the developing world. You're absolutely correct. Let's go, let's go to the phones. Let's go to Brandy in Portland, Oregon. Hi, Brandy. Hi. Hi there. Go ahead. Hi, yeah. My name is Brandy Herrera, and I've been living with long COVID now for three years after a mild acute infection in early 2020. And I'm wondering if Dr. Fauci can speak not only to where we are with solving for severe out. comes when it comes to an acute infection, but also long-term impacts of the virus, like long-COVID. I think it's unfortunately a little bit more common than we once thought. And so I'm wondering what the outlook looks like for long-COVID diagnostics and approved treatments, which we still

don't have after three years. Good question. Yeah, Brandy, it's a good question, and it's a very perplexing problem. First of all, long COVID is a real phenomenon. There are varying levels of severity of long COVID. And long COVID can actually occur in people who have not only severe COVID disease, but even those who have mild to moderate degree of severity of disease. And it's the either persistence of or the acquisition of new symptoms that you may not have had with the COVID that lasts for very old periods of time. There's a lot of effort going on that the NIH has a $1.15 billion effort called recover, which is looking at both the cohorts to determine some common denominators, what the pathogenic mechanisms are of it, and it's still unclear.

There are some hints, some suggestions that it may be persistence of response to viral antigens that hasn't been definitively proven yet, but it looks like the body tends to be in overestined. drive a bit even after you get through the acute phase of COVID, and it manifests itself in different ways in different people. It could be profound fatigue, particularly induced by exercise in individuals who otherwise were pretty good from an athletic standpoint. It could be sleep disturbances. It could be autonomic dysfunctions, namely an unexplained rapid heart rate called tachycardia and any of a number of things, tingling, neurological abnormalities, things like that. It's very difficult to prescribe or develop a therapeutic approach when you don't fully understand

what the underlying pathogenic mechanism. And that's where a lot of effort is going on right now to try and understand what are the mechanisms of this syndrome, which is a real syndrome, that a significant proportion of people have. People are taking researchers and the government are taking it seriously, Dr. Fauci, I guess, is what. You're darn right. I mean, it's a real phenomenon. It's not something that you want to blow off because if you look at the volume, the just sheer numbers of people who have been infected with SARS-CoV-2,

even if a very, very small fraction of those get long COVID, you have a lot of people who have prolonged suffering due to a viral infection that you would have hoped would have cleared completely. Yeah. Brandy, does that answer your question? Yeah, I think it does. I mean, I think more than anything, I just appreciate the response and also driving awareness, I think, because not a lot of people really understand what long COVID is, and so many people have it. So, yeah. Good luck to you.

Thanks for calling. Thank you. I have a few tweets about this and actually a personal experience I want to share with you, Dr. Fauci. I went into my local pharmacy to get a second booster shot, and the pharmacist told me that he would give it to me if I wanted one, but he advised me to wait because the drug companies will be coming out shortly with a more new effective vaccine, one that defends against the newer variants than the current booster does. but if I decided to go ahead and get the current booster, I wouldn't be eligible for the newer one because it would be too soon. Is that right? No.

Okay, so let's unpack that for a second. Please. I've got to lose three tweets on that one also. Okay, so here's the situation. Somewhere around the end of August, the beginning of September, the bivalent BA-4-5, which was more matched to the circulating Omicron sub-lineage viruses that were circulating, was available. And people got it then. What the FDA and the CDC are saying right now is that right now, if you've had several months, like if you got a vaccine in September, which is what, seven, eight months earlier,

right now, if you are an elderly individual and or a person with an underlying, immune compromised condition, you can get and should get the booster, the bivalent booster that's available now. Come to fall, likely in the end of September, the beginning of October, you're going to have the big push for people to get the flu vaccine. And they're hoping to be able to give an updated version, the most recent updated version of what is circulating with regard to SARS-CoV-2, at that time in the fall of 2023. So if you go in now, Ira, and let's assume you're not, but let's assume that you're an elderly person and you have somebody and you have an underlying condition

and you get vaccinated now in the first week, a week and a half of May, if you look at May, June, July, August, September, October, that would be six months from now if you had the availability of the most, recent one, you can get a vaccine now to get your defenses up, and you could also then appropriately get it six or seven months later in the fall. So remember, we're talking about now vaccines for people who might be immune compromised or elderly. If you are a healthy person and you've been fully vaccinated, then you can wait until the early fall when the newer, more updated version of a

vaccine will be available, and then they'll be pushing to have people get it at the same time as you get your flu vaccine. So get that second booster now and get the later one in the fall. Okay. Right. Okay. Free advice. I didn't know.

Pay for that one. Let's go to Joe in Virginia Beach. Hi, Joe. Hey, thank you so much for taking my call. Thank you, Ira, and Dr. Fauci, appreciate your leadership. 80 billion animals are slaughtered every year, and these animals are kept crammed in cages in filthy condition. Antibiotic resistance, bird flu are spreading like wildfire? Are we brewing our next pandemic by keeping billions of animals in cages and slaughtering them for food?

Should we go vegan for health and justice? Thank you. Okay, thanks for that call. Dr. Fauci? Are we are going to, are these captive animals? breeding grounds? Well, you know, it's more of a breeding ground for the next outbreak, Ira, is encroaching on the animal-human interface. And by that I mean, you know, going into rainforests and putting

humans in contact with animals that they never would have otherwise been in close contact with. In addition, what we saw, for example, with SARS-CoV-1 and very likely, Also, with the ideology of SARS-CoV-2, where you have wet markets where animals from the wild are brought in to markets for people to shop, we know that SARS-CoV-1 went from a bat to a civet cat to a human. We know that when you have bird flu, you have birds, as the caller was mentioning, that are packed together in flocks, sometimes in association with pigs and other animals. that can harbor influenza, that's a perfect breeding ground for a new type of influenza.

And that's the reason why we're really keeping our eye out now on the H5N1 bird flu, which is starting to infect mammals, which makes it more adaptable that it might jump into humans. So it's the animal-human interface that we have to be paying a lot of attention to when you're talking about the possibility of outbreaks because, as you know, I were 75% or more of all of the new emerging infections are zoonotic in that they come from an animal reservoir, jump species, and infect a human. If they adapt themselves well to human, you could have an outbreak. If not, you may have a one-off infection or a two-off infection. But that's really the issue, the animal-human interface.

I get it. Let's go to another phone call this one. Jeff in Sacramento. Hi, Jeff. Let me get your punched up here. Welcome to Science Friday. Hi, Jeff. Hello. Hello. Thank you. I'm doing fine. How are you? Fine. Go ahead. Thank you, Dr. Fauci for taking my call. I have a two-part question. What is your understanding on the original? of COVID. And my second part is having COVID start and originate from a phorology lab in Wuhan. Is that a reasonable hypothesis? And I heard some of what you said from the previous caller. Okay. Those are my questions.

Okay. Okay. Well, first of all, with regard to the origin of COVID, we don't know definitively. where it came from, for sure. And until we get a definitive determination, which, you know, unfortunately, I remember, we might not ever get there. But when you are in a situation where you don't have a definitive determination, you have to keep an open mind as to the various possibilities. And two possibilities that are discussed very actively are, one, a lab leak origin, like the Chinese somehow or other were working on a virus in the lab that escaped and was able to infect humans,

or they brought a virus in from the wild, worked on it, and it infected humans and began to spread. There's no real evidence at all for that, but it certainly is a possibility. And the other possibility, which many, many of the experienced evolutionary virologists think it's the most likely, but again, not definitively shown, is that it was a natural occurrence jumping species from an animal reservoir into a human. Again, to underscore, we don't know definitively what it is, so we have to keep an open mind. This is Science Friday from WNIC Studios. Talking with Dr. Anthony Fauci.

Okay, in a few moments I have left, Dr. Falci, I have a big task for you. I want you to lay out for me a program that will keep us, what do we have to do? What kinds of money do we have to spend to be prepared? for the next big one? Well, we have to spend a fair amount of money, Ira, and that's one of the things that I mentioned earlier on in our interview is that we put together a program right in the early year, a year and a half of the outbreak,

which was a pandemic preparedness program to not only help us respond better to the ongoing outbreak, but to be prepared for the inevitability of a pandemic again. We don't know when that will be. be. And that is a combination of what I answered to one of the other callers questions is both a scientific approach as well as a public health approach to continue the sustained investment and basic and clinical biomedical research that allowed us to come up with the vaccine, but also to put a substantial upgrading of our public health process, both locally at the

government level and in our international collaboration because pandemics are global, Ira. I guess what I'm driving at is where's the money going to come from? Because Congress doesn't want to spend money on this now, does it? Well, they don't. That's understandable. I don't think it's advisable not to spend money. I think we need to put a lot more money into pandemic preparedness. and hopefully that we will have the Congress appreciate soon. They have put a lot of money in. And fairness to them, they have put a lot of money into this outbreak. But that doesn't mean that because we put a lot of money in,

that we don't have to put even more money to help prepare us for the possibility of another outbreak. And that's what I hope we see happen over the next year or so. Are you going to be doing any lobbying for this kind of outcome that you hope for? Well, lobby is a charged word. I don't mean a registered lobbyist. You're right. Yeah, I am going to continue to speak out as I have when I was in the government. I spoke out very actively, you know that. And I will continue to speak out for the support of both in money and resources for both biomedical research as well as for public health infrastructure and capability.

Yes, I will continue to advocate for that. Well, we hope you come back and talk a lot's more with us on Science Friday, and thank you very much for taking time. My pleasure, Ira. Good to be with you. Dr. Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases at NIH. We had help from lots of people in putting this week's show together, including manager of impact strategy, Nahima Ahmed, office manager, Valissa Mayors, and individual giving manager, Annie Nero.

B.J. Leatherman composed our theme music, and we had wonderful help this hour from audio engineers, Lisa Gosselin, and Kevin Wolfe. Of course, if you missed any part of the program, or you'd like to hear it again, and why not? Subscribe to our podcasts, or ask your smart speaker to play

Science Friday. We are active all week on every kind of social media you can think of, and ones we haven't thought about yet, we will be there, too. when it happens. Or you can email us, our address SciFri at ScienceFriadie.com. Have a great weekend. I'm Ira Flato.