Short Wave - Lessons From HIV On Ending The COVID Pandemic

Episode Date: May 6, 2022

The world has come a long way since the COVID-19 pandemic began. There are now vaccines, at-home tests, masks and treatments. With all of these tools available, why is COVID still here?Health policy correspondent Selena Simmons-Duffin talks to Scientist-In-Residence Regina Barber about what we can learn from the public health advocates working to end the HIV epidemic, how those lessons may translate to ending COVID and why having the scientific tools isn't enough.See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, shortwavers. It's Regina Barber here today with Selena Simmons-Duffin, health policy correspondent. Hey, Regina. So I am here because as the COVID-19 pandemic has worn on, I keep hearing a certain refrain. And I'm sure you've heard it too. We have the tools. We have the tools and protocols. We have the tools we need to protect you. We have the tools. And by tools, I'm assuming they mean there are vaccines, at-home tests.

And masks, treatment, all in ample supply. Right, exactly. So the funny thing is when I started hearing this refrain from the Biden administration, I thought, I have heard that before. And to be specific, I heard it in 2019. We have the tools. This is an historic opportunity. That is Alex Azar. He was then the health secretary in the Trump administration.

And the tools he's referring to are the ones that exist to end the HIV epidemic. Oh. So President Trump mentioned. mentioned this initiative to end the HIV epidemic in his 2019 State of the Union speech. And I got interested in what this was about and how it would work. And I started doing follow-up reporting. Wow. That's really interesting. Who'd you meet? Well, one of the people I met was Dr. Laura Cheever. She runs the National Ryan White program at the Federal Health Resources and Services Administration. And that program provides free HIV treatment to low-income people. Awesome. She is also an HIV doctor who's worked in

Baltimore for decades. And when I talked to her, she was really upbeat about this new funding. It's helped us with community. It's helped us with local government. It's helped us within the federal government to really come together differently. So it really, we do really do have different momentum here. So you can hear her optimism, right? Like, it seemed like the goal to end the HIV epidemic in the U.S. by 2030 could actually happen. That's so exciting. So what prompted this big announcement? Like, what changed? Yeah. The answer is not a whole lot actually had changed. Like there wasn't a new tool or a new something that made it suddenly possible.

These tools had existed for a while and the HIV epidemic hadn't gone anywhere. So it wasn't just that science needed to develop tools like fast and accurate HIV tests and effective treatments. It's that it takes a lot of organizing and momentum to marshal these tools to achieve something as challenging as halting the spread of a virus. So in other words, it sounds like having the tools isn't enough. Exactly. You also need the political will and funding and good strategies to reach the people who are hardest to reach. And that is a clear lesson for current federal officials who keep pointing out how we have the tools to end COVID-19. Today on the show, we bring you Selena's reporting. She talked to people whose lives and work have been connected to HIV for decades and how what they've learned can help end.

the COVID pandemic. You're listening to Shortwave, the Daily Science podcast from NPR. Stephanie Brooks Wiggins is 76 years old. She lives in Baltimore. She was diagnosed with HIV in 1986. Back then, there were no tools to help her. There was no treatment. There were no drugs. You'd go to the clinic and the psychiatrist would talk to you to keep you from going off the deep end. Over the decades, scientists developed many HIV treatments and they got better and easier to take, she says, but HIV has not ended in the U.S. as these tools became available. A stubbornly high number, more than 30,000 people are diagnosed with HIV every year. Only 25% of people who might be eligible actually take a preventive pill called prep.

And even with accurate and at-home options for testing, over 150,000 people in the U.S. are HIV positive, but don't know it. Scientific discoveries are a necessary but not sufficient factor to completely eradicate disease. That's Dr. Adora Ademora, a physician and professor at the University of North Carolina at Chapel Hill. She first started treating people with HIV in the 1980s. She says the tools to combat HIV have come a long way. There are now topical gels and easy to take pills and even injections. I don't know that I ever greeted. any of these new advances saying this is the thing that's going to end to HIV.

That's because she's seen the barriers to access and implementation, she says, barriers like the high cost of prescription drugs and the maddening patchwork health care system. The barriers to COVID's tools like tests and vaccines and therapeutics have been different. But A. Tony Young says there are parallels and common mistakes. She lives in West Virginia and runs the Community Education Group, which does public health outreach. We keep doing the same thing over and over and over again, saying it's over there, why you go get it?

That attitude hasn't worked to fight HIV or COVID, Young says. It doesn't work for people who don't have access to health care, who don't trust the medical system, or who don't think they're at risk. As she sees it, when it comes to the COVID-19 pandemic, the country has missed out on the chance to make the most of the vaccine by failing to understand and work with people in all their complexity. It was an all-or-nothing approach. You're either with me on this vaccine or you're not. You're either on my side or you're my enemy when it comes to the vaccine. You're either a vaccine denier or you're a vaccine getter. And there's a whole lot of room between those two. The frame of us versus them is implicit in a lot of the rhetoric these days about getting back to normal. It's in terms like pandemic of the unvaccinated and telling people, they've done the right thing by getting vaccinated and should therefore have special privileges, like not being punished with things like indoor masking and testing requirements.

That way of talking about public health, says Stephen Thrasher, creates the conditions for pandemics to last longer. Thrasher is a professor of journalism at Northwestern and author of the forthcoming book, The Viral Underclass, with HIV in the mid-1990s, when treatments became much more effective. People who got access to the drugs began to pull away and take their political capital and go home because they didn't need to be in the fight anymore. And the virus continued to pool in what I call a viral underclass in the United States. This was a sad and lethal mistake in the fight against HIV, he says, and now it's happening again.

The lack of political will in Congress to pass more COVID-19 funding is a perfect example, he says. And those still at particular risk are those who are warehoused away out of sight. People who are in nursing homes as elderly people or who are in convalescent centers as disabled people. And of course, people who are incarcerated, they're already out of public view. And people are not listening to them. Those settings can act as epidemic engines, he explains. People visit their loved ones in these places. Staff come and go back into the community.

And so the pandemic drags on and lives are needlessly lost. He is disappointed that policymakers seem to be centering the people who have the most access to tools to protect themselves, not the least. I really hoped that that would be different this time. This is not to say no one is trying to get the available tools out to people who don't have as much power in access. A Tony Young in West Virginia has one idea for how to do it. We want to hit people in the face with the COVID vaccination because we're in the middle of the pandemic. but maybe I've got a slow walk you to that COVID vaccination. Here's how that might go.

If you got five kids and y'all are hungry, you need to figure out where you're going to get food from. You don't care about my vaccine. Let me help you. What do you need from me if I can get you the food that you need? When we do the follow-up, hey, do the food voucher work out for you? Great. Can we talk to you now about, again, about the COVID vaccine?

Her organization has a $3.5 million cooperative agreement with CDC to use this approach to vaccinate people against COVID-19 and influenza in West Virginia. Young hopes CDC will continue funding this for three years so they can expand. She also hopes to spread one of the lessons from HIV, that people and their relationship to health is complicated, and the public health response needs to be ready to meet them where they are. Selena, thank you so much for that reporting. So we just heard about the effort in West Virginia hoping for more money. Where are things with the bigger picture of pandemic funding? I know Congress got close to a deal back in April.

Yeah, exactly. Well, we're recording this on Tuesday, May 3rd, and currently there is not a whole lot going on. The White House has been asking for more than $20 billion of pandemic funding. When Congress got close to a funding deal back in April, it was for less than half. of that. And what that means is that uninsured people currently do not have free access to testing or vaccines or treatment. The funding for that program has run out, and it's not clear if it would even start up again if the congressional funding did come through. And that's why so many people are pointing out that there are now these new kinds of haves and have-nots in terms of access to

protection from this pandemic. And that's concerning. And Regina, before we go, I want to return back to Dr. Laura Cheever, the HIV doctor who runs the National Ryan White program. Yeah, the official who was so optimistic about the initiative to end the HIV epidemic. Yeah, exactly. I'm guessing a lot of that got thrown off since COVID. Right. Yes, well, there was a new infectious virus in town that sapped a lot of the expertise and staff in funding from the HIV effort. But as I was finishing up the story, I called her up again and I asked her if she's still optimistic about the effort.

I'm actually very encouraged. Our programs were incredibly effective. Even during COVID, I was incredibly shocked what happened in 2020 in that program. So that's been amazing. That's uplifting. That's great news. Yeah, it is. But then I asked her, what about efforts to end COVID-19?

And on that, she was a lot less upbeat. Oh, no. She said she thinks a lot of Americans at this point are just not willing to get boosters, let alone do the lower threshold things like wear masks and social distance. And she said this. Much more broadly, unless we can really get the world vaccinated, I am not very optimistic. Another parallel with HIV. To stop a pandemic, you have to think beyond just stopping the spread within one country's borders.

Selena, thank you so much for bringing this story to us today. You're welcome. This story was edited for radio by Joe Neal, and for shortwave by Giselle Grayson, who is also our senior supervising editor. Burley McCoy was our producer and the marvelous Margaret Serino Check the Facts. The audio engineer for this episode was Josh Newell. Andrea Kisick is the head of the science desk.

Edith Chapin and Terence Samuel are the executive editors and vice presidents of news. And Nancy Barnes is our senior vice president of news. I'm Regina Barber. And I'm Selena Simmons-Duffin. Thank you for listening to Shortwave from NPR.