Stan, Clarence, Barry, and the Health Chatter team chat with Dr. Mike Osterholm about infectious diseases.Dr. Osterholm - a Regents Professor, McKnight Presidential Endowed Chair in Public Health, and the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota - has an extensive and distinguished career in infectious disease. Dr. Osterholm has also held numerous positions throughout state and local governments serving as the Science Envoy for Health Security on behalf of the U.S. Department of State, Special Advisor to the then Health and Human Services Secretary Tommy Thompson, and various roles at the Minnesota Department of Health. In addition to the countless published articles, Dr. Osterholm is the author of Deadliest Enemy: Our War Against Killer Germs.Listen along as Dr. Osterholm and the Health Chatter team chat about the effects of infectious disease and the importance of being prepared. As we learned with COVID, it is not a matter of if, but rather a matter of when.Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships.More about their work can be found at http://huemanpartnership.org/
Hello, everybody. Welcome to Health Chatters. Today's show, we've got a special guest with us that I'm sure many of you will recognize. We'll get to him in a second. It's on infectious disease, where we've been, where we are now, and where we're going, which we're going to be covering a lot. But we have a great guest. I'd like to recognize my crew. They're second to none, really.
Without their help, these shows would not be a success. Maddie Levine-Wolf, Aaron Collins, Deandra Howard, Matthew Campbell, Sheridan Nygaard. And of course, we have Dr. Barry Baines as our medical advisor. All the logistics are done by the crew in the background. They do the research and also get the shows out to you, the listening audience. Clarence Jones is my great colleague.
We do these shows together. We have a lot of good chats. And we've talked to a lot of great, great people on this show. So thank you, Clarence. It's a pleasure working with you. Also, our sponsor is Human Partnership. You can check them out. It's a great community health organization at humanpartnership.org. And check us out, healthshatterpodcast.com.
You will see all the research for all our shows, including this one. And you can also... put in questions or comments about the shows as you listened to them. So thanks to all of you. So today we have a great guest with us, Dr. Michael Osterholm. Mike and I go back a long way in the field of public health. We've done some great things together. I remember HIV training.
I remember also SARS and a whole bunch of different things. And Mike has served this community locally and also our country nationally on dealing with a lot of different things in the area of infectious disease. Mike is a Regents Professor and McKnight Presidential Endowed Chair in Public Health, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
Many of you might know that as CIDRAP. Excuse me, CIDRAP. He's also served as the science envoy for health security on behalf of the US Department of State. He's the author of a book back in 2017, Deadliest Enemy, Our War Against Killer Germs. I recommend that book.
From 2001 to 2005, Mike, in addition to his role in CIDDROP, served as special advisor to the HHS Secretary Tommy Thompson on issues related to bioterrorism in public health. And, and this is of course where I linked with Mike, was all the years that he served as the head of the Infectious Disease Department at the Minnesota Department of Health. Mike,
It's indeed a pleasure to have you on board with us today.
Well, thank you, Stan, both you and Clarence. It's a real honor to be here.
So all right, let's get this show on the road. It's like past, present, and future. All right, so let's just clear the airwaves a little bit. Let's just talk about COVID so we get that kind of out of the way a little bit, OK? And I'm going to start out this.
You were entrenched in dealing with this at the state level and at the national level, trying to get information out to the public as quickly and honestly as we possibly, possibly could. So, all right, now I really, at this point, at this juncture, what has Mike Osterholm learned from it? I mean, it's just like, it was such a complicated process
from a health perspective and a political perspective. What have you learned from it?
Well, first of all, let me just say that what has happened is still happening in the sense it's unfolding. I hope we can talk about that today because we're in another surge occurring right now. And the big question is, what do we do about it? How is it different or is it different than from before? And what does this mean about, are we in a pandemic or not? Are we over it? What's going on?
So I think there's a lot of there. But let me just start off by saying in the 2017 book that I wrote, Deadly Sinners, Organs, Killers, Germs, I devoted several chapters to what an influenza pandemic would look like in a more severe way. And what had unfolded was exactly that, but just a coronavirus.
And what was difficult for me was the surprise that I had about how we responded without really understanding what it meant to have a pandemic. What I mean by that, for example, is I was one of those lone voices early on in the pandemic. In fact, in early March of 2020, I wrote a piece in the Washington Post saying, do not do lockdowns. Do not do that. Do not try to take an aggressive approach.
And the reason why was because I too didn't want anyone to get infected, but I knew this was going to be a two or three year journey at the least. And you can tell people to do some extreme things for short periods of time. But over time, they won't maintain that. And then you kind of lose the credibility of, well, wait a minute, why did you recommend that?
And now why are you saying, ah, forget it, never mind. And so I think that we didn't really understand the implications of what a long-term podcast, or I mean, a long-term situation might look like. And on a podcast in early March, I predicted that we could easily see 800,000 deaths in the next 18 months. And it was interesting. You know who my most severe critics were?
Were my colleagues for scaring the hell out of people needlessly because nobody could imagine that. Well, unfortunately, 18 months after I said that, we hit our 800,000th death in this country. And so I think it was a function of public health and clinical medicine, along with government leaders coming to understand what it meant to be in a truly significant pandemic.
And then accordingly from that, you know, make the decisions about what to do and how to do it. And, you know, my whole point was, you know, if whatever we do keeps you from dying in those first few months, that's great. But if you die in the second six months, you're dead. Or if it's the third six months, you're dead. Oh, by the way, if it's the fourth six months, you're still dead.
And so our goal is how do we in the long term minimize death? the potential impact that a pandemic has that's sustainable. And clearly the vaccine played a key role in coming on board. And yet we saw how that vaccine tore up the political, social, cultural issues of this country. And what has happened with that?
I mean, I think that people today have no real clue of the negative impact that that vaccine has had on the vaccine world. You know, we're now seeing remarkable drops in immunizations for kids. Even veterinarians are seeing it vaccinating their dogs and cats. And it's no longer a function about safety. It's about don't tell me what in the hell to do. And we're seeing that over and over again.
Did we understand when we mandated COVID vaccines that that could be a side effect of doing that, is that we would create more of a rebellion? Now, I'm not saying don't get your COVID vaccine. I'm up to date. I just got another one a couple weeks ago, okay?
But the bottom line is, is that we, I think, didn't realize that the implications of doing something may be one, two, three orders down the road. And so for me, that was the biggest surprise is people not appreciating that. And understanding we're in this for the long haul. And how do you get through a long haul is what this is really all about.
You know, the other thing I think is that, you know, how many of us have witnessed or been part of a public health emergency? I mean, and then all of a sudden it kind of hit. And it's like, you know, the response from many people is, okay, well, now what the hell do we do?
Yeah. And we surely did along the road have to learn. I mean, you know, if there was no other word that should have been a front and center guiding principle for public health, it should have been humility. Because in fact, there was a lot we had to learn.
For example, I oversaw an effort early in the pandemic, April, May of 2020, with some of the best and the brightest in both the modeling world, in the infectious disease world, experience with pandemics, John Barry from 1918 Flu, Mark Lipsitcher Group. And we put together a publication that's still on our website saying, how might this end?
Will this be a situation where finally there'll just be enough people who've been infected and immune that will hit this magical thing called herd immunity where transmission will no longer be sustained? Or will in fact that never occur and you just have these recurrent infections over and over again but maybe getting milder over time, is there some residual immunity that's so protective?
Because we know just like influenza viruses, the coronaviruses do not provide long lasting protection. And sure enough, we ended up realizing in the summer of 2020, oh my God, look at these new variants. These variants are, you know, derivations on a theme and they're more immune evasive. They're more infectious in some cases, et cetera.
And it creates a whole new risk picture that you were never out of risk of getting COVID beyond, once you got beyond four months or so of being vaccinated or having previously been infected. So that too, you know, led us to say, wait a minute, skip this herd immunity stuff. This isn't going to happen. Okay.
What can happen is we hopefully can see milder illness over time if we have some protection on board. But today we know, you know, the vaccines for COVID as well as for influenza are good vaccines, but they're not great. They're not great. They don't provide durable immunity.
The variants which occur with COVID, with coronaviruses, you know, are actually happening at an amazing pace, several a year, whereas flu, we might see one a year. And so I think that these all led us to also realize that This is something we're going to have to manage over the long haul. And right now we're sitting in a 10th surge of what you call, in this case, possibly the post-pandemic era.
But we're seeing transmission rates right now that rival many of the previous peaks we had in 2020, 21, 2022. The good news is less severe illness. We're not seeing 20,000 deaths a day as we did during Omicron. We're seeing 600 deaths. uh, we're seeing 650 deaths a week and 20,000 a week, I should say, or 200,000 a week back in the Omicron time.
So I think the bottom line message is expect the unexpected, be humble and just know that, uh, you know, it won't last forever in the way it started, but it's around now for good. It's
But
Long COVID is also a component of this going forward as well. So it's like you're dealing with actual COVID, then you're dealing with complications of that go with it as well. So I think, and you can respond to this as well, is this idea of people getting tired. Just tired.
Yeah, well, I think, again, we really haven't appreciated the mental impact that COVID's had. And, you know, I think that one of the lessons I've learned in my career was, you know, when I started at the University of Minnesota as a newly minted undergraduate, and then within days started at the Minnesota Department of Health,
in 1975, you know, I got asked many times, why are you going into infectious diseases? That's horse and buggy stuff. You know, this is done. We're over, man. I mean, we're going on to the next generation of public health challenges and we're going to fix them. Okay.
And no one really had a full understanding of just how complex this world is and why we would see the return of some of the infectious disease problems that we had not even imagined could be this bad. I mean, I go down a laundry list of issues. And so I think that one of the things we have today is what I call creative imagination. You know, what's happening.
I can remember very well, one of my mentors and who, someone who has had a dramatic impact on my career was the late D.A. Henderson, who was really the father of smallpox eradication in his office out of WHO. And D.A., was one of those brilliant minds that kind of thought about things, not just in the abstract, but, you know, creative imaginations I talked about.
And we talked at length about in the 1990s, what would happen when the population ages and we've not used any kind of smallpox vaccine, nor have had smallpox as a clinical illness in our communities for some decades. Today, the vast majority of the population in low-income countries are younger than 45 years.
Well, it was 45 years ago we stopped vaccinating for smallpox and we stopped, you know, basically clinical cases from occurring. Much of the world's population, particularly in low-income countries, have no protection against pox viruses today. Well, lo and behold, why should we not be surprised? Monkeypox is now returning in a big way because we now have this very vulnerable population. You know,
We have, for example, today a situation where the large urban areas of low and middle income countries, particularly low income countries, are nothing largely than, unfortunately, major garbage environments where there's all this discarded garbage, plastic, et cetera. And that is ideal habitat for breeding the 80s mosquito. because they want to live close to humans.
They want to live where there's this little bit of water in a plastic container or a piece of plastic or a piece of junk that water collects in. Very different than the mosquitoes that cause malaria that are much more open water mosquitoes, et cetera.
Well, when you look at what's happened with the urbanization of low-income countries in this world, you can see this dramatic explosive growth of 80s-related vector-borne diseases. Dengue, yellow fever, Chicken gun you. I can go down the list. And because of that now, we're seeing unprecedented occurrence of vector-borne diseases we'd never seen before like this.
And so I could go through a number of different issues today about why the world is different and why are we now seeing these diseases that make for a much greater challenge than it ever was in the earliest days of my career. A major challenge.
You know, also there's, you know, this constant balance between infectious diseases and chronic diseases, which we're dealing with. And I think that that also creates some angst for the public as well. It's like on one hand, I'm dealing with heart disease. And now all of a sudden you're telling me, oh, my God, we got to be careful about COVID.
You know, and Stan, I would even add an additional context to that. I personally am trying hard to get rid of the infectious disease, chronic disease nomenclature. Because today, so many infectious disease caused conditions are actually chronic manifestations of immune dysregulation. Yeah. And so long COVID is a good example of that.
I can go through, I mean, look at number one causes of cancer, hepatitis B, et cetera. So when you look at the tie, there's actually a lot of continuity between infectious diseases and what we call chronic diseases. And I mean, I think One day we will find that, you know, whether it's neurologic disease, whether it's immunologic disease, whatever, has in its origin an infectious disease trigger.
And I think so that's why, you know, we look at these. I look at the holistic, what is the whole picture? So a good example is just what you said with long COVID. You know, what's going on there? probably at least five or six different immunologic dysfunction issues that are occurring that you can't just treat one or the other. It may be this one you have, somebody else has another one.
Why do you have such fatigue? Why do you have the kind of conditions, that brain fog that we're talking about? And our studies today show that there's not a one or two diagnostic test approach here because it's really about major immunologic dysfunction in a number of different ways.
Yeah.
Clarence. I want to tell you, Dr. Michael, how much I appreciate your opening comments, first of all. And I really wish I would have been able to, I wish I would have read your 2017 book as we were going through this.
Well, you know, Clarence, I tell you what, I have a problem here that you might want to be aware of, okay? So in 2000, I wrote a book called Living Terrors, What American Needs to Notify the Coming Bioterrorist Catastrophe, 2000. I think I bought 14 of the 18 books sold in the next year. And then when 9-11 happened and anthrax became a New York Times bestseller.
OK, 2017, it got a little bit more circulation than me buying copies. But then when COVID hit, it became a New York Times bestseller. OK, now I have another book coming out this next year on the big one. You know what we need to do to prepare for the real pandemic of the future. And and I'm terribly afraid to put this out because I'm afraid I might predict we'll have it. Just bury that. Okay.
And then bring it out later. So yeah.
You have futurists in your titles.
I know, you know, you know, this is, this is where I think in public health, we need to offer more what I would call just plain common sense because all the things I've just talked about, why these diseases are increasing and, You know, it has nothing to do with some magical, mystical insight. It's just A plus B plus C. How do you get there? You know, what does it mean when we see all of this?
And so I think that, you know, it's an issue of, well, let's walk this through and see what this means. OK. And and, you know, for example, today, agriculture has changed dramatically. you know, with large animal production facilities, millions of birds, et cetera, that poses this whole new way of amplifying virus and mixing it up. I could go through a laundry list.
Look at antibiotic resistance today. I mean, we use antibiotics, unfortunately, like candy as the defensive drug of the century. Okay. If in doubt, Over Medicaid. Okay. And we're losing our antibiotics because you don't have to be a superstar to understand these kinds of things.
So I think it's more a matter of how do we bring reality to our educational experiences to those who are out there and understand what's going on. Let me just give you one other example. You know, I happen to spend some time in working on prairie restoration and burrilla forest restoration, etc.
People are all talking about climate change right now as being very critical as it relates to tick movement and so forth and potential Lyme disease. Well, ironically, it's not climate change. Climate change can play a role, ultimately. It's all about the fact that 120 years ago, we started stopping forest fires.
And as a result of that, we've seen the successional forests in the east, the middle east. We used to be prairie oak savannas in the upper Midwest, right up towards the boundary waters. And today, because there's stop fires, we've seen the white-footed mollusk in a whole totally different environment emerge. And at the same time, we've seen population centers develop in those areas.
And so, you know, we should not be surprised that we're seeing this whole new effort or involvement of ticks and so forth because they're now living in forests that never existed before because every 50 to 100 years they burnt. I mean, it's just something that's simple. It's just that simple.
Yeah. So let me do a follow-up question with you. With all the things that you said, how do we create trusted sources? Because I think that there are so many different things that are happening. Where do you go? What tips do you have for us as a community to create more trusted sources?
Well, you know, Clarence, you hit on the question of the century for public health, I think. You said it so well. this is a huge challenge. And one of the reasons that in my new book coming out, I say we're less prepared for a future pandemic than we were before is because of the loss of trust. And I think that that is a huge issue. You know, my own personal approach to it is, first of all,
Humility, humility, humility. Say when you know, and if you say you know it, why do you know it? How do you know it? Can't be personal opinion. It can't be. If you don't know, say that. But then tell people what you're going to do to try to find out. And tell them, I'll let you know when we find something new. It may not answer the whole question, but the bottom line is, this is why we're at.
And so I think we need a major new understanding of how do we do public health communication. I think it's one that we're desperately needing much more work in. And so, you know, we won't gain back the trust as long as people perceive that we think we know everything. We're going to tell them exactly what to do. And oh, by the way, that didn't work.
Yeah.
You know, there was a recent article, actually very recent, I think it was yesterday. What's today? Yeah, it was yesterday in the New Yorker. There's an article that came out. The veterinarians preventing the next pandemic.
And it was really an interesting article in the sense that what it does is it really focused on animals overall and their linkage to us as humans as far as pandemics are concerned.
Well, you know, at the risk of being, raining on a parade here, I think that article was in some ways misdirected. And what I mean by that is that clearly the zoonotic issues of animals and humans is very important. And the next pandemic will have at its root cause an animal reservoir of some kind that spills over into humans. So that's not even a question.
But the challenge is there really are only two infectious agents today that has the potential to cause a pandemic. influenza and coronaviruses. And because for a virus to cause a pandemic, it's got to be able to be what I call a virus with wings. In other words, it will move quickly around the world. It will be one that respiratory transmission will play the most critical role.
And I'm talking about effective respiratory transmission. And we will not have seen it before in a way that immunologically
some of us might be protected by having previous experience so the article did a great job of laying out these events that occurred i mean i think the group for example in the zoos in new york were absolutely essential in identifying what happened with west nile they really oh god they were very important but west nile has never posed a challenge with a worldwide pandemic
You know, it's going to cause problems. It's going to continue to cause problems, but that's not where it's at. Mpox, you know, unless Mpox takes on a virus with wings-like issue where it's respiratorily transmitted, you know, contact, particularly sexual contact, will not be a reason for a worldwide pandemic.
So I think that one of the things that we need to understand is, you know, what are the diseases that kill us? What are the diseases that hurt us? What are the diseases that concern us? What are the diseases that scare us? And how do we distinguish between them all? And so I would say right now, we need to focus heavily on coronavirus and influenza.
And today I have the lead article out in Foreign Affairs. on our lack of preparedness for influenza or coronavirus pandemics of the future, and really goes into what we need to do. You know, our influenza and coronavirus vaccines are good vaccines, but they're not great. They lack long-term durability, easily evaded with new variants or new strains, and We don't really understand that yet.
We're still using, for influenza, largely 1940s technology. We make it in chicken eggs. I mean, it's crazy. So we can do a lot better. And so I think that's what we want to focus on. So taking pandemics off the table would mean having... coronavirus and influenza vaccines that could be pre-delivered, meaning that, you know, they cover such a broad brush.
If I got vaccinated today, no matter what Mother Nature threw at us tomorrow, we'd have some pretty good protection. And I actually believe that's possible. Our center at the University of Sidra actually leads the world in that we are responsible for the overall influenza vaccine roadmap work, as well as the coronavirus vaccine roadmap. So WHO, NIH, All these use our materials.
And we have seen real advancements made in these vaccines, but we're still a decade or more away from really having game-changing flu vaccines at the rate of we're supporting it right now.
So I think that article was helpful in illustrating how, in the meantime, we're still going to have a lot of these skirmishes that show up that still are challenges, and they're still very important, but they're not pandemic-causing. And, you know, one day maybe there'll be a new virus class that will come into play that will be a pandemic virus.
You know, if Ebola ever becomes airborne, if, in fact, MPOX becomes much more efficient at airborne transmission, then I might be saying there's a third category. But right now it's flu and coronaviruses.
Barry. I have one that's more of a statement than the other is an opinion, asking for your comments. One of them is with the H word, humility. And I think that's also very important. And one of the issues that, and I don't know how you get around this, is that in science, you come up with a hypothesis or a theory, and it seems to bounce along, holding up pretty well.
But there's always the expectation that something is going to sidetrack it, and you need a different theory or a different hypothesis. As we learn more and more, that's what happens. That's what happens. Unfortunately, I think the public in general thinks that if you say something and then you change your mind and say something else that you lose trust.
Well, but wait a minute, you told us this and now you're telling us that. How could that possibly be? And you sort of discount that we have new information now that there's really so much more that we don't know than we know. And we have to reformulate, you know, things with them, I think.
So it becomes an educational communication challenge to the general public to understand that we sort of expect things to evolve, hopefully not quite as rapidly as coronavirus variants that seem to, you know, come upon us. So if you wanted to comment about that. And then the other piece was about COVID.
You know, if you watch TV at all, it seems that 90% of the commercials are about these new biologicals for just about every ailment, which are types of immunotherapy. And they always have, you know, in the. small print at the bottom about how you can be more prone, particularly to tuberculosis, but also a number of other diseases.
And I was wondering what your thought was on the advent of all these biologicals and how potentially that might impact infectious disease spread as more and more people seem to migrate to those type of medications.
Well, thank you both for your point and your question. To the point, I have always put forward that science is not about facts. Science is about learning. And you lay out the process of science is basically do this, doesn't work, you try that. You do this, you do that. Okay, and you learn from that. And then over time, facts will change as you learn more.
But you prepare the public in advance for that and tell them, you know, this is what I'm going to do to learn more about that. And I think that for me, that has never felt uncomfortable or as if somehow I'm failing. And therefore, I don't get defensive. I say, I don't know. This is what I do know, though. This is how I know it.
And I think that too many of us feel obligated to be right and have the facts. that then locks us into, oh, wait a minute, that's not what really happened. And so I think that people understand what is happening. And let me give you, I think, an example of where we can learn. If you look at the US Weather Service and you look at the Hurricane Center, they have all these different models.
They always tell you what the different models show, but this is what it could be. And You never hear people saying, they misled me. They told me I was supposed to do this and that because they gave me the variability. But you know what? They're pretty often right on the mark or close to it. But sometimes a curveball gets thrown in and suddenly it shears off to the right or to the left.
And I think that we in science and medicine need to do much more of that kind of scoping to say, This is what we know. This is what we don't know. This is what we're finding out and go from there. So this is part of the communication issue I was talking about for public health.
We need to better understand how to communicate with the public in a way that they can understand where we're coming from.
I think it's true in medicine, too.
Yeah, well, it's true. At the same time, some of the biggest challenges I've had is with my own colleagues. It's not the public. And the colleagues get out there and say things, okay? I mean, for example, there was a lot of BS put forward by some groups during the COVID about what masking could do or not do.
And what I mean by that is, is that, you know, N95 respirators are highly effective in reducing the likelihood of becoming infected. But they equated anything you put in front of your face. And even if it was down below your nose, OK, well, that's not masking from a protection standpoint. Yet I heard people and saw people promoting all those things.
And the public said, wait a minute, why are you telling me this now? You said I could do this. It was not said with credibility. And everybody has an opportunity to have a voice. Everybody can say this is what, you know, it is. And they become believable. And, you know, TV producers and oftentimes reporters don't know the difference.
And so they get reported and then they become officially, officially the official, you know, and that's the challenge we have today. So, you know, all you can do, I think, is just stick with the track record and, you know, acknowledge what you know and what you don't know. So I think that's it.
The question you raised about the biologics, the irony about this is it's not in many cases a big challenge. And why? Because the kinds of immune compromising conditions that these drugs cause, like enhancing TB or things like that, are frankly diseases of low and middle income countries, not high income countries. And they're only selling these drugs in high income countries.
So if you were to take the same drug and deliver it to Gaza right now, you would have a very different side effect, you know, the implications for, you know, any kind of adverse event, very different than if you gave it to the people who attend the University of Minnesota, you know, cancer clinics. And so that's the biggest issue we have today is that
And for most of these drugs, they're not going to be a problem for us other than, you know, the other immunologic issues it might cause. But this is why these drugs are never meant for the low and middle income countries. They couldn't afford them to begin with. And second of all, that's where the real challenges are with the diseases.
Yeah. You know, you mentioned before, Mike, the idea of diseases with wings, per se, which brings up an idea in my mind. It's like, OK, many of the epidemics that we saw historically, you know, to a certain extent, they were self-contained within major regions of a continent. Now, you know, we're dealing with airplane travel. We're dealing with technology.
And so I wonder if you might be able to talk about that a little bit. It's like, OK, all of a sudden you've got, you know, COVID in China and the next thing you know, it's on a cruise ship. The next thing you know, it's on, you know, in the United States.
Well, you know, this is an interesting one, because this is another one where I got crosswise with some people. You know, I have served in every presidential administration since Ronald Reagan, some official role. During the Trump administration, I was actually the science envoy for the State Department and pandemic preparedness for the world, ironically.
So and I was on the Biden-Harris transition team for COVID. So that, you know, no one, I think, hopefully would accuse me of being politically motivated. You know, my job has always just been a private in the public health army and report to duty and do what I can to help. Okay.
So I think from that standpoint, that's really an important point is, you know, just basically put it out there as you do. But again, the challenges that I saw often were coming from my own colleagues in public health who were had points of view that, you know, differed and therefore they, they, they, that became the battleground and the public is sitting there listening to this. Okay.
You know, what, what does it mean? Not mean. And I think that that's the challenge that we had was there's not a way to come up with a single public health voice. I understand that. I agree with that. Um, And there's not a way to understand outreach.
A good example in Clarence, I know that you're probably likely very aware of this, but one of the most wonderful, absolutely incredible activities that took place during the pandemic was the Black Barbers and Black Hairstylists programs, where the group out of the University of Maryland in particular were working on Black Barbers. And I got very involved with this.
I even had my own name, Big Mike, okay, in this program. I mean, I love these guys. And their outreach was remarkable because they knew how to outreach. And when they were sitting in that barber chair and they had their trusted barber who now, because they had taken courses and they were being educated on the current issues, they became trusted voices in the community.
And they did more good, and they still are doing more good than a whole lot of us with all kinds of academic degrees. And, you know, and so I think part of it also is how do you find the trusted voices in your community in that community. And, you know, I would just say, again, one of the greatest successes in the whole pandemic if there were any was the black barbers and hairstylist program.
And I think that's what we're looking for today is how do we find those kinds of trusted voices that can be informed, that can run the day, okay?
And when you were getting your news and your updates from that barber chair versus some far right or far left cable TV show, I bet you you're getting a heck of a lot better information in the barber chair than having some talking head on one of those talk shows. I don't know, Clarence, if you want to add to that, but I think that's... Well, no, no, no.
I agree with you that barbers are, and barbers and beauticians are really effective in certain communities. I always talk about barbers are, is the one group of people that allow a man to touch him intimately in public. Yeah. And they'll tell... They'll tell things that they won't tell their partners. You know what I mean? So I agree with you.
And if you know that and you know how to work with that, then you're able to really make a difference in terms of, as you just talked about, the trusted messengers. So, yeah, I agree with you. And thank you for doing that shout-out to Barbers.
Yeah. Clarence and I work together on getting people in Barbershops, teaching them how to take their blood pressure.
Yeah. Yeah.
Same concept, you know, same idea. So, you know, to your point though, Mike, it's the idea of how do you effectively communicate? Well, number one is within your community and with people who you really trust. Right. Who you can have the conversation with and know that you can get good information that way. So let's talk, you know, obviously what's hit the scene today
Actually, it's been around, but all of a sudden it's hit the scene just yesterday was Mpox. You and I and, you know, some of us with a little bit of gray hair or no hair called it monkeypox. But there are some reasons not calling it that. All right. So what just so, you know, for our listening audience going forward now with something else that's hitting the scene, what do we need to know?
Well, as I alluded to earlier in our discussion and talking about my conversation with the late D.A. Henderson and the fact that global population immunity to the pox virus has largely evaporated with the aging population and the fact that we had our last case of smallpox in 1978 and the vaccine ended in 1979. Right.
And so imagine that everyone literally born over the last 45 years has never been exposed to either smallpox or to the vaccine. And it turned out that as we realized that once you had protection against smallpox, whether vaccine or clinical illness, you basically had quite good protection against all the other orthopoxviruses, monkeypox, buffalopox, horsepox, et cetera, okay?
All these are viruses that can infect humans. And there was very few diseases in the world where there was more widespread immunity in the population because either you got smallpox or you got vaccinated up until 1979, okay? Well, now today we look at the low-income countries and the median age in many of these countries is in the 30s and young 40s.
because that is the population pyramid is there, okay? And, you know, I mean, I can tell you just Kinshasa, for example, you know, which is now at the heart and the DRC of some of these really severe health challenges, you know, working in HIV there in 1985, there were 3 million people living in Kinshasa. Today, Kinshasa has 24 million people and with almost no urban planning going into it at all.
And if you've ever been there, it's like, oh my God, And so now once that virus starts spreading either by droplet or by contact, it really moves. And as you pointed out, the idea of borders, let me just give you another example of, you know, I came out strongly opposing border closings for the whole COVID situation saying, you know, it was useless.
It's like taking a garden hose to a, you know, 5,000 acre forest fire, okay? And people said, oh, you don't care. You just, you know, well, we tried to arm ourselves with all this testing on planes coming in on the West Coast. OK, by God, we're going to keep that out.
Never thinking about what some of us did think about it, but the hires up didn't, is that that same virus is going to go from China to Europe, to Europe, to the United States. And the whole East Coast was totally left uncovered in terms of that.
And again, and so what happened, we saw these huge outbreaks that occurred in Italy and places like that, that had come from China and then to New York City. Why was New York City light up like a light early on? Because they didn't come in the West Coast, came in the East Coast. You cannot effectively basically protect a border. You have to assume that this is going to move. And they move quickly.
Virus with wings move fast. And so I think that that's one of the things, again, that in our new book, we go into some extent about border issues and say, don't waste your time on it. It's still going to happen. No matter what you do, even if you slow it down a little bit, it won't materially change where you're at three months or five months or six months. Instead, plan for it.
Plan is going to come in. Plan that New York City could get hit hard. Plan that that's going to happen as opposed to thinking, you know, and unfortunately, you Say, oh, we're under control. We got it under control because they weren't sending on the West Coast coming in. OK. Meanwhile, the East Coast was on fire.
Right.
So I think that's the kind of thing that, again, we can anticipate. Hopefully next time we won't count on the geographical or, you know, country borders as such serving as an efficient wall against a virus. It will not. It will not.
What about contact tracing?
You know. To me, contact tracing is... And we wrote several papers on this and regarding this. And we found that there was no value squeezed for the juice once it took off because it was so extensive. It was so out there. And contact tracing was what we were trying to accomplish. Well... We wanted to let people know that they might have been exposed.
And then, therefore, what are you going to do if they're exposed? Well, tell them not to go anywhere, particularly if they get sick. Well, testing was such a problem. And following up all these people was such a problem. You know, at one time in Minnesota, we had over 250 people doing contact tracing. I mean, I couldn't imagine that in public health. I couldn't imagine that. And you know what?
We likely had very limited impact at all. And so I think that's why by the end of the first year, all government bodies stopped doing contact tracing. It just wasn't effective. It was like, again, taking that garden hose to the 5,000 acre forest fire.
Right, right. And I wonder if it was almost dictating to the public a false sense of security. It's just like, hey, we've identified somebody at your place of work that came down with COVID, so now we're telling you to do X, Y, and Z. Well, You know, if you're not feeling well, you should stay home anyway, no matter what the hell it is.
Yeah. And I think that's the challenge. I mean, you know, I mentioned earlier about lockdowns. So he wasn't supportive of lockdowns. The vast majority of lockdowns that actually took place were really not lockdowns. They were an illusion. Take, for example, Minnesota. You know, the government, the governor put in place, you know, stay at home order basically from work, except for essential workers.
Now that clause was important. Do you know it turned out that about 83% of the Minnesota's workforce is considered a central worker? Now tell me, is that a lockdown? So I mean, part of it was, and the poor governor got hung then with that issue of, oh, look, you shut down the economy. It wasn't they shut down the economy. It was the fact that people were too afraid, period.
It didn't matter what the political leader said, okay? They just didn't want to go into public spaces out of fear for getting infected, okay? So to me, that again is just trying to set the facts straight and say, oh, so what makes a difference? What doesn't, okay? And I think you're going to see
even through this election cycle, more and more discussions about, oh, you destroy the economy by doing these lockdowns, when you really realize what happened. You know, to call them lockdowns was to say, I'm smart. And we all know that's not true.
All right. So, you know, one thing that I became really sensitive to is proper funding for So that, you know, you and I could talk about public health in general, which is a whole other story. But going forward, if indeed the nation is going to be proactive based on what we've gone through, give me your sense about, you know, what would be appropriate funding and the focus for the funding.
Well, first of all, everyone will always acknowledge there's never enough funding, okay? But what does that mean? Well, today, as I mentioned earlier, the lead article in Foreign Affairs is my piece on that very issue as it relates to influenza and coronavirus vaccine preparedness, okay? And the lack of funding. So we are and have had a model for public health funding that is based on a biennium.
Every 2 years it's based on very limited foresight into really the future. Now take the Defense Department funding when they decide to build a new aircraft carrier from start to finish is 14 years. They basically fund it for the whole 14 years. Okay, fast forward funding.
They take into account all the different issues that could come up and the cost overruns that might happen, et cetera, et cetera. Nobody, nobody complains about that. That's the approach that we find necessary. If you look at our influenza vaccine work right now, I mean, the vast majority is being funded by the US government, which is fortunate, but it's less than a billion dollars.
And there is no long-term future planning for funding. It's biennium to biennium. And talk about if you wanted to find a magic bullet that could take off the table one of the very worst wars of all against another pandemic virus, you'd think we'd be investing in this like the defense. We're not.
And I go into that in some detail in this piece today about why we need a new mindset to deal with what is our current cost of investing versus the cost of not investing. What's the potential return on investment? And I do believe we can get much, much better flu vaccines and much better COVID vaccines or coronavirus vaccines in general.
And that could fundamentally change the game on when the next pandemic emerges, what that's all about then. But we don't do that. We're back. We're still making in this country the vast majority of our flu vaccine in chicken eggs. Yeah, this is 1940s technology, guys. Yeah. I mean, what's wrong with us?
You know, these are vaccines that when you give them and the fact, you know, I'm again, a counter voice right now. I'm urging people do not get your flu vaccine right now. Do not. get it when it's closer to the actual advent of flu season and let the public know when that's starting. So if we start to see activity in Minnesota in November, let the public know. Why?
Because we have clear data today that anywhere from 3% to 12% per month reduction in protection occurs after vaccination. So it's just waning immunity. So if I get my dose now and it's not till four or five months from now, flu season really starts, I may have lost 50% of the protection of that vaccine just as I'm getting into the flu season.
Yeah.
So, I mean, I think that's the kind of thing. What if we had a vaccine that could give us long-term protection against a variety of different strains? Shouldn't we be funding that like we fund the Defense Department? So that's my mindset. I don't try to say, well, the Defense Department gets lots of money. I'm talking about cost investment related to return on investment.
And I think that's what we're missing.
So, you know, we're very, you know, I guess the best way to describe it, we aren't very strategic overall. We're, we only, react to kind of what's right in front of our face.
Yeah.
And, and that's, that can be dangerous as we found out, you know, certainly with, with, with, with COVID and it will happen again. I mean, history bears that out that we will have something again.
You know, C.S. Lewis once said, if you don't know where you're going, any road will get you there. And, and, and, We do that really well. Yeah, no kidding. So I think that's the challenge we have today. You know, we're all going to die. All of us on this screen are going to die someday. And whoever's the last one here, shut out the lights and wish you best. Party's over, right? Yeah.
So we're not trying to avoid death. So if we're not trying to do that, which is often the way people measure what we do or don't do, what is it? We're trying to have healthy lives for as long as we can of sound mind and body. free of pain, cognitive function, positive, et cetera. Okay. So what do we do to help accomplish that?
And, you know, realizing that as we age and we're now the aging population where we understand, oh, you know, we didn't realize falls were really all that hard on people, but you know, they are kind of tough on older people, et cetera. So I think it's more investing in what is the return we want. What do we want? Kids should not be dying from vaccine preventable diseases. They should not.
That should be a clarion call. OK, so I think it's things like that that we need to put in order to say this is what we should be doing.
You know, certainly during this during COVID, the pandemic is where. you know, I, you know, when I was dealing with, you know, the cardiovascular stuff and contact tracing at the time, I couldn't help but get wrapped up in, in how the politics of it all became a negative factor, you know? And it just, it, it, it obviously it bothered me.
You know, it's like, I remember my dad always used to say, when you have your health, you have everything. well, excuse me, the politics was getting in the way of your health at the time, just for, you know, if for nothing else, accurate information. Mike, this has been great. Last thoughts.
Well, first of all, it's a real honor to be with you. Thank you. I'm very, very honored to be here. You know, I think it's fair to say that if you are a student of public health or considering to be a student of public health, this is a great time to get involved because we've got lots of challenges. We need you. I am encouraged by that.
I have a set of graduate students right now that are as good as any I've had in all my 50 years in the business. And I have a hope. I have hope. And I hope it's not a strategy. It doesn't hurt to have it. Okay. And I think that that's really where we're at right now.
And again, I hope that our conversation today helps give people a sense of where we're at, what we need to do, and hopefully engages them in the critical, critical area of public health.
Yeah, I underscore that a lot. Clarence, I know you have to leave. Last comments from you.
This has been phenomenal. It's been a pleasure to finally put a name and a face together. And definitely as a health leader, you definitely are setting the standard. At least for me as a community member, I love hearing from people like you who can break down these complicated issues in, in, in a, in a simple, understandable, and also doable way.
And so, uh, again, I want to just thank you very much.
Thanks Clarence. It's a real honor to be with you here today too.
Very, very last thoughts.
Yeah. Also, this is a wonderful, uh, the ground we covered was, was fantastic. Um, I also wait until November to get my influenza vaccine for the reasons you stated. You're a smart man, Barry, a smart man. Yeah, every one of my family medicine communications is talking about the surge in COVID right now.
And, you know, I think from a total confusion standpoint, on the one hand, yeah, we'll get your immunization now. But then they come up and they say, well, if you wait a few months, we're going to have the multivalent that's going to be better. So I think, you know, again, even with something that's very much in front of us, there's, you know, how do you make the right equation the right guess?
But again, thank you so much for being on this program. It was just wonderful to have the conversation and to listen to all the things that you've done and great things that you've done. And please continue. Thank you so much.
You know, if Stan asked me to walk over broken glass barefoot, I would. He's a good man.
So, you know, uh, one thing I want to do is, uh, you have your own podcast, the Austin home update.
Yeah.
And I encourage our listeners to, to check that out. Comes out every other week. Correct.
Mike Thursdays every other week.
All right. And, and also, um, Feel free to link this particular podcast with your podcast as one of your shows. Feel free. I mean, you know, it would be absolutely, absolutely great. We also reserve the right to get back to you if, you know, God forbid something else happens. Oh, my God, I got to call Mike.
It's an honor. Thank you.
Hey, thanks so much for being with us. To our listening audience, keep health chatting away. Our next show will be on health. and traveling, which kind of links to the thought of, you know, putting wings to everything here. We'll talk about that for sure. Keep health chatting away.