Short Wave - NIH Director Talks The Pandemic, Vaccine Hesitancy And Americans' Health

Episode Date: December 15, 2021

Dr. Francis Collins talks with health correspondent Selena Simmons-Duffin about Americans' overall health, how tribalism in American culture has fueled vaccine hesitancy, and advises his successor on how to persevere on research of politically charged topics — like guns and obesity and maternal health. Selena talks with host Emily Kwong about the conversation. 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. We're going to take you back. Back to the summer of 2009. A lot happened then. The black-eyed peas boom-boom-boom pow was top of the charts. We were coming out of the recession. And in an office in Bethesda, Maryland, Francis Collins took office as head of the National Institutes of Health.

From high-throughput technologies such as nanotechnology, chemistry, imaging, And Collins has been there ever since as the NIH's longest serving director. And after 12 years, working under three presidents, he is stepping down at the end of this year. But not before reflecting on his tenure with my colleague Selena Simmons-Duffin. Hey, Selena. Hi, Emily. So you interviewed Francis Collins. Before we listened to that conversation, let's talk about the guy.

Tell me about him. Well, Collins is 71. He's a physician and a geneticist. And he's really known as a political bridge builder. He's really charismatic and likable. He famously rides Harleys. He's a Christian who's written about being a man of science and a man of faith. He has got a lot of fans.

Francis Collins is a true champion of science. This tribute was compiled by a coalition called United for Medical Research. It showed up in my inbox this week because it is his last week in the director's post. So there's been an outpouring of admoner. for him. I know that Francis Collins has a presence on the internet. He first came on my radar musically because I saw a video of him playing Here Comes the Sun on the NIH blog as like a morale booster.

Oh yeah. He's got the guitar skills. She's also got some political chops too. He's made friends in Congress. He's grown the agency's budget. it's now $41 billion, which is a lot of taxpayer dollars going to NIH research. And much of his has gone towards biomedical research. That is a lot of taxpayer dollars. Okay. Let's talk about some of the biggest achievements under his leadership. What's happened?

Well, before he was even director, he ran the Human Genome Project, which culminated in a complete sequence of the human genetic code in 2003. And he has been a champion of precision medicine, the idea that you can tailor treatments to people's unique genetic code along with their environments and lifestyle. And he also launched a huge effort to learn about the brain and the cancer moonshot to come up with new cancer treatments. It's a lot. He is a huge list of accomplishments. Yeah, it's impressive. And on his way out the door, what is the thing you wanted to ask him the most about? Well, the thing I just could not stop thinking about is that all these medical

advances are important and impressive. But Americans are still. still not as healthy as our counterparts in other countries. And this has been the case for years. So I wondered what Collins was thinking about that and why it is and what should be done about it. Selena, that's a really good question. And there's a lot of reasons for the disparity we see between the United States and other countries in terms of health. We have chronic diseases, poverty, and to some extent, really fragmented health care system, where do you think the NIH fits into all of that? Basically, by doing more research on it, there is a long list of of ideas in a report NIH requested and financed called Shorter Lives Poor Health. It is over 300 pages. It was done by a high-profile panel. And it enumerated all the ways Americans are behind. American kids are more likely to die before age five than people in other rich countries. And even wealthy, non-smoking people who are not overweight are also less healthy than their counterparts. It is across the board. But there hasn't been a lot of progress.

on that research ideas, the report recommended to address these problems. So I wanted to ask Collins about all of this and get his thoughts and his advice for his successor. So today on the show, we talk about the legacy of Francis Collins, how the NIH has fared under his leadership, and what the biggest biomedical research agency should tackle next. You're listening to Shortwave, the Daily Science Podcast from NPR. So, Selena, you and Dr. Collins covered a lot of ground in this conversation. Where did you start? Well, before we talked about the big picture, I asked Collins about what he has said is his chief regret as he steps down, persistent vaccine hesitancy during the COVID-19 pandemic. To have now 60 million people still holding off of taking advantage of

life-saving vaccines is pretty unexpected. And it does make me at least realize, boy, there are things about human behavior that I don't think we had invested enough into understanding because we basically have seen the accurate medical information overtaken all too often by the inaccurate conspiracies and false information that circulates so rapidly on social media. It's a whole other world out there. Yeah. We used to think that if knowledge was made available from credible sources,

it would win the day. That's not happening now. You mentioned the idea of investing more in the behavioral research side of things. Do you think that could happen, should happen? We're having serious conversations right now about whether this ought to be a special initiative at NIH is to put more research into health communications and how best to frame those so that they reach people who may otherwise be influenced by information

that's simply not based on evidence. Because I don't think you could look at the current circumstance now and say it's gone very well. Yeah. So looking at how America has fared in the pandemic, more broadly, it really, it really is astoundingly bad. I mean, the cases and deaths are just so high. What do you think? What do you think about the toll the pandemic has taken, even as it's clearly not over? It's a terrible toll. We've lost almost 800,000 lives to this coronavirus. pandemic. In 2020, before we had vaccines, there was not a really good strategy to protect people other than social distancing and mask wearing, which were important, but certainly not guarantees of safety. But in 2021, we should have been better off. We had vaccines that were safe, that were available for free to all Americans, and where the ability to get immunized really went up very

steeply in March and April. And yet, it all kind of petered out by about May or June, and the resistant group of 60 million people remains, for the most part, still resistant. And that's where we really missed our chance to pull out of what had been a devastating 18 months or so into a better place. And unfortunately, now with Delta having come along as a very contagious variant, and with Omicron now appearing, we have. missed the chance to put ourselves in a much better place.

Does that frustrate you? I mean, I'm just like, how do you think about that? It must be, I imagine it would be maddening. It's disheartening. You know, when history is written about the COVID-19 pandemic, I think they will marvel at the way which the scientific community rose to this challenge, building on decades of basic science research, developing vaccines and getting them tested and approved in 11 months, at least five times faster than has ever happened before. I think they will marvel at the

development of monoclonal antibodies and now antivirals. I think they'll marvel at what was possible to do after a bumpy start with diagnostics. But then on the other side of that, We have the fact that we still have a thousand people dying every day, most of whom are unvaccinated, because somehow all of these scientific triumphs did not reach vulnerable people in a way that they trusted them. Let's step back from the pandemic. I mean, you have served as director for 12 years. You have a lot to be proud of, and even before director running the Human Genome Project. But, you know, in that time, Americans haven't, on the broader scale, gotten healthier.

I mean, they're sicker than people in other countries across the board. All races and incomes, we don't live as long. I just checked that when you were sworn in in 2009, life expectancy was 78.4 years. And it's been essentially stuck there. So does it bother you that there haven't been more gains that Americans haven't kept up with other countries? and what role should NIH play in trying to understand what's to blame for these trends and what should be done to turn them around? Well, sure, it does bother me because in many ways, the 28 years I have been at NIH,

have just been an amazing ride of discoveries upon discoveries. But you're right. We haven't seen that translate necessarily into advances. Let's be clear, there are some things that have happened that are pretty exciting. Cancer deaths are dropping every year by one or two percent when you add that up over 20 years, cancer deaths are down by almost 25%. And that's a consequence of all the hard work that's gone into developing therapeutics based on genomics as well as immunotherapy that's come along and made a big dent in an otherwise terrible disease. But we've lost ground in other areas,

and a lot of them are in fact a function of the fact that we don't have a very healthy lifestyle in our nation and particularly with obesity and diabetes. those risk factors have been getting worse instead of better. The other main reason for seeing a drop in life expectancy other than obesity and COVID is the opioid crisis. We at NIH are working as fast and as hard as we can to address that one as well. In all of these instances, as a research enterprise, because that's our mandate, it feels like we're making great progress, but the implementation of those findings,

runs up against a whole lot of obstacles in terms of the way in which our society operates, in terms of the fact that our health care system is clearly not even handed. It's full of disparities, full of racial inequities. We're not at NIH able to reach out and fix that, but we can sure shine a bright light on it. Some of the reasons why Americans tend to be less healthy than people in other countries do get political pretty quickly, like healthy environments. gun injuries and drug overdoses and suicide and maternal health. I mean, all of that is quite charged. But the research is important. So, you know, you're stepping away from the director role.

Do you have any guidance or thoughts for your successor on how to get that research done? The research that's not universally, potentially embraced on both sides of the aisle? I think the guidance is you have to look at all the reasons why people are not. not having a full life experience of health and figure out what we, as the largest supporter of medical research in the world, should be doing to try to understand and change those circumstances. A lot of this falls into the category of health disparities. It is shameful that your particular likelihood of having a certain lifespan depends heavily on the zip code where you were born.

And that is a reflection of all the inequities that exist in our society in terms of environmental exposures, socioeconomic, social determinants of health, et cetera. We actually want to try pilot interventions to see if some of those things can be changed. But that's about as far as we can go. Again, if there's a major societal illness right now of tribalism and over-polarization and hyper-partisanship about every issue, probably the NIH is not well-positioned all by ourselves to fix that. We have an urgent need, I think, across the society.

to recognize that we may have lost something here, our anchor to a shared sense of vision and a shared sense of agreement about what is truth. That is the outgoing director of the NIH, Dr. Francis Collins. Selena, let's talk a little bit about this conversation it published last week. And what do people think about this idea that Americans are not very healthy? Yeah, the reaction has been really interesting. You know, some people responded, oh, It's all about the fragmented dysfunctional for-profit health care system, which, of course, I know a lot about because my beat is health policy. Other people said, you know, it's all about food.

We're eating too much meat and too much soda. And, you know, seeing those reactions, I kept thinking, I don't really think it's either of those things like by itself. It's so much more complicated, right? Like, the health care system is not great, but I don't think it explains it because, we just have so much more disease in America than other countries do. And that is upstream from the medical system. Like, why are we getting so sick? And then the food thing is interesting too because, of course, in other countries,

they also have junk food and soda and meat available. So, you know, what are the systems and policies and cultural beliefs here that nudge Americans to eat that stuff so much more often? And where does the NIH fit into all of this? Like, what kind of research? would you like to see them do once a new person takes over as director? Yeah, I mean, if the new director comes in and has this, you know, really strong desire to tackle these trends and turn them around, there's a whole list of ideas in that report that I mentioned, the Shorter Lives, Poor Health Report. And a big thrust of that is doing more comparative research with other countries. So we don't have to go to Mars here.

We can, like, look at other places. We can look across the ocean. Yeah, that are having success and say, like, well, what can we borrow from them, right? But I think that one of the things that makes these problems difficult is you're coming up against people's behavior, right? And that's just, it just is messy. It's complicated. But I feel like the vaccine hesitancy really encapsulates why it's so important because you have this breakthrough discovery of a COVID-19 MRI vaccination vaccine. vaccine in record time, and then you have it come up against people's distrust and their hesitancy.

And, you know, that's why understanding why people act the way they do is as important to human health as understanding their genetics. Well, Selena, thank you so much for asking these questions to the outgoing NIH director. I hope you bring us an interview with the new one whenever that person's in place. Thanks for coming on the show. Thanks for having me. This story was produced by Eva Tess Fy. and edited by Giselle Grayson.

Rasha Aridi and Margaret Serino checked the facts. The audio engineer was Patrick Murray. I'm Emily Kwong. Thanks for listening to Shorewave, the Daily Science podcast from NPR.