WEBVTT - Setbacks: Global Health Inequity is Solvable 0:00:15.076 --> 0:00:25.076 Pushkin, this is solvable. I'm Jacob Weisberg. In my lifetime too, 0:00:25.116 --> 0:00:28.956 and I'm sixty one. I have never seen this level 0:00:29.076 --> 0:00:35.356 of engagement in attention to the social pathologies that face 0:00:35.476 --> 0:00:38.556 us and also the pathogens that face us beyond the 0:00:38.596 --> 0:00:42.956 social pathologies. According to the UN, disruptions resulting from the 0:00:42.996 --> 0:00:47.716 global pandemic could push an estimated seventy one million people 0:00:48.036 --> 0:00:52.556 back into extreme poverty. That represents the first rise in 0:00:52.636 --> 0:00:56.556 extreme poverty since nineteen ninety eight. With every ounce of 0:00:56.596 --> 0:01:00.636 our energy, we need to direct ourselves to making this 0:01:00.756 --> 0:01:05.356 a temporary setback. Today we're bringing you the first episode 0:01:05.356 --> 0:01:09.156 in our Setback series, a collection of conversations about the 0:01:09.156 --> 0:01:13.196 pandemics impact on education, hunger, and of course global health. 0:01:13.916 --> 0:01:16.596 And it's fitting that we're starting today with one of 0:01:16.596 --> 0:01:20.396 my personal heroes, doctor Paul Farmer. As much as anyone 0:01:20.436 --> 0:01:22.796 I can think of, Farmer has changed the way the 0:01:22.836 --> 0:01:26.556 world looks at the unequal distribution of healthcare. He has 0:01:26.596 --> 0:01:29.836 spent the last forty years committed to improving health equity 0:01:29.876 --> 0:01:34.076 across the world, most notably establishing long running medical support 0:01:34.156 --> 0:01:38.476 services for communities in Haiti and Rwanda. He's the author 0:01:38.516 --> 0:01:41.236 of a fascinating new book that I'd call a medical 0:01:41.236 --> 0:01:46.316 and moral thriller. It's titled Fevers, Feuds, and Diamonds, about 0:01:46.316 --> 0:01:51.116 the twenty fourteen Ebola outbreak in West Africa. It's intensely 0:01:51.156 --> 0:01:55.556 relevant to understanding the global impact of COVID nineteen. Everyone 0:01:55.596 --> 0:01:59.796 knows that COVID vaccines are being distributed unequally. What's less 0:01:59.836 --> 0:02:04.556 appreciated is that disruptions from the pandemic are increasing inequality 0:02:04.596 --> 0:02:08.556 in the distribution of other health resources. This could ultimately 0:02:08.596 --> 0:02:11.556 lead to hundreds of thousands of additional deaths for children 0:02:11.636 --> 0:02:15.796 under five, and caused tens of thousands of additional maternal deaths. 0:02:15.996 --> 0:02:18.916 And I retain plenty of optimism. We have tools at 0:02:18.916 --> 0:02:22.396 our disposal that would have been unimaginable just a couple 0:02:22.436 --> 0:02:25.836 of decades ago, but the will to deploy them and 0:02:25.916 --> 0:02:30.676 deploy them justly still has to be summoned. In April 0:02:30.676 --> 0:02:34.396 twenty twenty, the World Health Organization, along with the European 0:02:34.396 --> 0:02:37.876 Commission and the Bill and Melinda Gates Foundation, launched a 0:02:37.916 --> 0:02:41.596 plan to get COVID vaccines to low income countries. It's 0:02:41.596 --> 0:02:45.156 referred to as covacs. There are many reasons to do 0:02:45.196 --> 0:02:48.396 this and The best ones, in my view are that 0:02:48.676 --> 0:02:51.156 science and the fruits of science ought to be evenly 0:02:51.196 --> 0:02:56.436 distributed like human capacity is. For all the devastation he seemed, 0:02:56.796 --> 0:03:00.996 Farmer remains hopeful that the setbacks from the pandemic don't 0:03:00.996 --> 0:03:04.556 have to mean a more unequal distribution of healthcare going forward. 0:03:05.276 --> 0:03:09.156 I'm Paul Farmer. The inadequate health resources of pork in 0:03:09.636 --> 0:03:13.396 a poor underserved people in affluent ones are a problem 0:03:13.436 --> 0:03:20.036 we can solve. Paul Farmer is a professor at Harvard 0:03:20.036 --> 0:03:23.756 Medical School, chief of Global health Equity at Brigham and 0:03:23.796 --> 0:03:26.876 Women's Hospital in Boston, and the co founder of the 0:03:26.996 --> 0:03:30.636 organization Partners in Health. I began by asking him to 0:03:30.676 --> 0:03:35.116 describe the global healthcare situation in his own words. Well, 0:03:35.156 --> 0:03:39.356 I mean, right now, we could focus almost entirely on 0:03:39.396 --> 0:03:42.596 the setbacks. You know, one of the biggest problems we've 0:03:42.596 --> 0:03:44.796 faced all over the world is that with a shutdown, 0:03:45.116 --> 0:03:50.876 obviously people aren't able to readily access their care. What 0:03:50.996 --> 0:03:52.916 if they have cancer, what if they have diabetes, what 0:03:52.996 --> 0:03:56.636 if they have severe hypertension. So you know, those are 0:03:57.276 --> 0:04:00.556 ranking problems I think to anybody who's involved in global health. 0:04:00.836 --> 0:04:03.796 But that's just the tip of the Iceberg. A lot 0:04:03.836 --> 0:04:07.476 of the efforts that we have engaged in to address 0:04:07.556 --> 0:04:12.916 social determinants of ill health are also being setback. Economic 0:04:13.116 --> 0:04:19.316 educational programs, cultural endeavors, employment opportunities. There's been a major 0:04:19.396 --> 0:04:22.916 contraction and anti poverty efforts overall. So it's going to 0:04:22.996 --> 0:04:27.316 be a troubling reflection on what's happened this past year 0:04:27.756 --> 0:04:30.676 and a last I'm worried it's going to be projected 0:04:30.676 --> 0:04:33.316 forward into a future as well. Paul. There are two 0:04:33.316 --> 0:04:35.916 different ways to think about the future in this setback. 0:04:36.516 --> 0:04:38.996 One is that it's just a temporary setback where we 0:04:39.116 --> 0:04:41.436 lose a year and quickly get back to where we were. 0:04:41.916 --> 0:04:44.516 The other is that it's a twenty year setback. How 0:04:44.516 --> 0:04:46.636 do you see it, well, I mean I see it 0:04:46.676 --> 0:04:52.756 as a struggle between those two options. With every ounce 0:04:52.836 --> 0:04:56.916 of our energy, we need to direct ourselves to making 0:04:56.916 --> 0:05:01.996 this a temporary setback. That's going to require rapid engagement 0:05:02.076 --> 0:05:05.036 in responding to some of these social problems and medical 0:05:05.036 --> 0:05:11.956 problems and health problems. But every week, month, season that 0:05:12.076 --> 0:05:15.476 goes by where we can't point to a resumption of 0:05:16.036 --> 0:05:18.396 some of these economic and social activities is going to 0:05:18.436 --> 0:05:23.956 mean more likelihood that the setback will endure, and so 0:05:24.036 --> 0:05:26.636 I mean, I retain plenty of optimism. We have tools 0:05:26.796 --> 0:05:30.516 at our disposal that would have been unimaginable just a 0:05:30.556 --> 0:05:34.836 couple of decades ago, but the will to deploy them 0:05:34.836 --> 0:05:39.436 and deploy them justly still has to be summoned. There's 0:05:39.476 --> 0:05:45.676 certainly more consciousness about healthcare disparities in this country on 0:05:45.716 --> 0:05:51.036 the basis of race and socioeconomic status. Then I remember 0:05:51.076 --> 0:05:54.596 in the conversation for a long time, do you see 0:05:54.636 --> 0:05:58.436 the pandemic as any kind of awakening, either in the 0:05:58.556 --> 0:06:03.196 United States or globally about the disparities between the global 0:06:03.276 --> 0:06:06.676 North and the global solve wealthier countries and poorer countries. 0:06:07.556 --> 0:06:10.676 For sure. I mean in my lifetime too, and I'm 0:06:10.796 --> 0:06:15.036 sixty one, I have never seen this level of engagement 0:06:15.676 --> 0:06:20.756 in attention to the social pathologies that face us, and 0:06:20.836 --> 0:06:24.676 also the pathogens that face us beyond the social pathologies. 0:06:25.036 --> 0:06:27.636 So you know they're they're from the very beginning, even 0:06:27.716 --> 0:06:31.516 before the murder of George Floyd, there was reason to 0:06:31.636 --> 0:06:34.996 think that, you know, such a catastrophic series of events 0:06:35.076 --> 0:06:37.876 could awaken a lot of people about the need for 0:06:38.876 --> 0:06:42.676 a better safety net, for example, health insurance, unemployment, insurance 0:06:43.196 --> 0:06:47.876 protection for vulnerable workers, prisoners, people who've been you know, 0:06:48.076 --> 0:06:53.236 shoved around onto reservations and meat packing plants. I think 0:06:53.276 --> 0:06:57.356 that sense of possibility is still very much alive, this 0:06:57.596 --> 0:07:02.036 heightened awareness of our vulnerability, of our collective vulnerability, but 0:07:02.156 --> 0:07:06.516 also our heightened awareness of the inequalities of vulnerability. So 0:07:06.956 --> 0:07:10.356 you know, I would proceed up domistically even if I 0:07:10.396 --> 0:07:14.796 weren't convinced, because that may be just psychologically necessary. But 0:07:14.876 --> 0:07:17.516 I think this is very real, and we have to 0:07:17.676 --> 0:07:20.596 act promptly while people are still alive to some of 0:07:20.636 --> 0:07:25.836 these challenges before they fade away. Your new book, Fevers, Feuds, 0:07:25.836 --> 0:07:28.876 and Diamonds is about the Ebola epidemic that broke out 0:07:28.916 --> 0:07:32.636 in West Africa in two fourteen, and one of my 0:07:33.116 --> 0:07:36.876 takeaways reading it was that a lot of the harms 0:07:36.996 --> 0:07:41.756 we think of as coming from the disease are really 0:07:41.796 --> 0:07:46.316 the harms coming from the underlying healthcare system, in place 0:07:46.396 --> 0:07:49.836 or not in place. What I mean is that, right 0:07:49.956 --> 0:07:52.636 that we are attributing things to the novelty of a 0:07:52.716 --> 0:07:58.076 virus that in many case just project reflections of what 0:07:58.156 --> 0:08:00.996 was there in terms of our capacity to deal with 0:08:01.236 --> 0:08:04.516 a healthcare crisis of any kind. You know every time 0:08:04.596 --> 0:08:08.836 there is a health crisis, and a pandemic is the 0:08:09.116 --> 0:08:13.396 classic example. Once you're sick, who lives and who dies? 0:08:13.516 --> 0:08:16.996 And on both scores, I think we're seeing, not just 0:08:17.076 --> 0:08:20.156 in the United States but across the world, a reflection 0:08:20.276 --> 0:08:24.876 not just of the novelty of the pathogen, but what's 0:08:24.916 --> 0:08:29.116 the opposite of novelty, the longstanding nature of our social pathologies. 0:08:29.676 --> 0:08:34.436 Social disparities are our social pathologies make things worse. The 0:08:34.476 --> 0:08:37.556 good news is that means we can alter that risk, 0:08:37.756 --> 0:08:40.836 because although we don't alter the shape of viruses, yet, 0:08:41.156 --> 0:08:44.356 we can't alter the shape of our social conditions. I 0:08:44.476 --> 0:08:46.876 think often about an article you wrote some years ago 0:08:46.916 --> 0:08:49.076 that I think might have had that title, who Lives 0:08:49.076 --> 0:08:53.156 and Who Dies? And you talked about, if I remember 0:08:53.156 --> 0:08:56.436 it right, what you called stupid death, and you told 0:08:56.476 --> 0:08:59.876 the story of a traffic accident you had I think 0:08:59.876 --> 0:09:02.276 maybe when you were still a medical student or many 0:09:02.356 --> 0:09:04.436 years ago, when you were hit by a car and 0:09:04.476 --> 0:09:08.196 it was theorious but because you've got high quality medical care, 0:09:09.316 --> 0:09:12.276 we lived, and probably it didn't it didn't do you 0:09:12.476 --> 0:09:15.236 the kind of permanent harm it would have somewhere else 0:09:15.236 --> 0:09:18.396 in the world. And then you talked about another accident 0:09:18.516 --> 0:09:21.236 to someone you knew, I think in Haiti. You know 0:09:21.356 --> 0:09:25.436 the term that I got, that expression stupid deaths from 0:09:25.996 --> 0:09:28.876 from Haiti. I heard it in my first years there, 0:09:28.916 --> 0:09:32.196 and I went there in nineteen eighty three for the 0:09:32.196 --> 0:09:34.276 first time, and I'm still working in the same parts 0:09:34.276 --> 0:09:38.596 of Haiti. And you know, in those early years, not 0:09:38.636 --> 0:09:41.116 only did I hear about stupid deaths, I saw some 0:09:41.196 --> 0:09:43.916 of them. And those happened to be the years in 0:09:43.956 --> 0:09:47.076 which I was hit by a car in Cambridge, Massachusetts, 0:09:47.396 --> 0:09:51.516 and knew right there lying in the street that you know, 0:09:51.676 --> 0:09:55.676 I would be okay, you know, And I was comparing 0:09:55.716 --> 0:09:58.836 that to the kind of circumstance that is faced by 0:09:58.876 --> 0:10:00.996 all too many to this day. You know. It's it's 0:10:01.036 --> 0:10:03.476 as if, you know, someone would say to you after 0:10:03.516 --> 0:10:05.436 you've been hit by a car, well, you should have 0:10:05.476 --> 0:10:08.476 looked both ways before you crossed the street, right, And 0:10:08.516 --> 0:10:12.556 it's not very helpful to look back and explain away 0:10:12.716 --> 0:10:16.476 these disparities of risk and outcome without making an intervention 0:10:16.676 --> 0:10:20.836 to lessen that risk. Here we're facing a respiratory pathogen 0:10:21.756 --> 0:10:24.836 and it's a different set of needs, but I think 0:10:24.836 --> 0:10:29.196 the needs are nonetheless material as well as social meaning, 0:10:29.676 --> 0:10:32.356 you know, do we have the staff, the stuff, the space, 0:10:32.396 --> 0:10:34.916 and the systems to respond to our health crisis. So 0:10:35.036 --> 0:10:37.356 right now we're talking about COVID, but we could be 0:10:37.356 --> 0:10:43.516 talking about surgical trauma, or AIDS, or ebola or any 0:10:43.516 --> 0:10:46.836 one of a series of maternal mortality and Sierra leone. 0:10:47.036 --> 0:10:51.716 Each of those problems requires and always has a set 0:10:51.756 --> 0:10:56.756 of material responses, which you know, I've just summarized as staff, stuff, space, systems, 0:10:56.756 --> 0:10:59.956 and support. And I got all that, you know, as 0:10:59.956 --> 0:11:03.876 a medical student transferred from one hospital to another and 0:11:04.316 --> 0:11:07.956 then to rehab and then to having surgical care that 0:11:07.996 --> 0:11:13.316 I needed, except I knew I would those disparities staff stuff, systems. 0:11:13.316 --> 0:11:14.556 It's a bit of a tongue twister. I think I 0:11:14.596 --> 0:11:18.356 got it right. Are not exactly reflected with COVID nineteen 0:11:18.476 --> 0:11:22.076 the way you might expect. There's an article in The 0:11:22.076 --> 0:11:26.356 New Yorker that Sanartha Mukherjee wrote that looks into that 0:11:26.476 --> 0:11:29.876 a little bit. Nigeria, for example, one of the countries 0:11:29.916 --> 0:11:32.796 you talk about in your book in relation to ebola, 0:11:33.276 --> 0:11:36.316 doesn't seem to be getting hit at hard. United States, 0:11:36.396 --> 0:11:40.596 obviously wealthiest country, you know, most expensive systems, has gotten 0:11:40.676 --> 0:11:43.236 hit very hard, but focusing particularly on the question that 0:11:43.316 --> 0:11:46.956 why some poorer countries, some countries in the developing world, 0:11:47.596 --> 0:11:51.436 are not having the experience of the pandemic that's a 0:11:51.556 --> 0:11:54.076 severe Why do you think that is? Well, you know, 0:11:54.116 --> 0:11:59.156 I'm going to try and resist the conventional explanations. I 0:11:59.196 --> 0:12:02.956 will mention them. They include the age structure of the population. 0:12:03.756 --> 0:12:11.876 There's less obesity, there's asthma, diabetes, hybrid tension, there's perhaps 0:12:11.956 --> 0:12:16.356 less of it in a largely younger population. But instead 0:12:16.356 --> 0:12:20.396 of focusing on the susceptibility or the nature of the 0:12:20.516 --> 0:12:22.916 virus alone, it's also a risk to focus on the 0:12:22.996 --> 0:12:27.356 nature of the individual and the physiology of an individual alone, 0:12:28.076 --> 0:12:31.116 and instead we have to also bring into other questions 0:12:31.156 --> 0:12:35.556 like it's not unthinkable, of course, that some of these 0:12:35.596 --> 0:12:39.836 places have had very robust public health responses to COVID, 0:12:40.836 --> 0:12:43.316 and that they deserve some of the credits, the credit 0:12:43.356 --> 0:12:46.556 the humans deserves some of the credits for having been 0:12:46.556 --> 0:12:49.516 the architects of this response. Let me just take Rwanda, 0:12:49.916 --> 0:12:52.676 a country where I lived on and off for a decade. 0:12:53.236 --> 0:12:56.316 The quality of their response to COVID, both in terms 0:12:56.356 --> 0:13:00.796 of prevention and in care, has been pretty pretty damn good. 0:13:01.196 --> 0:13:03.876 So all this to say, Jacob, I think that when 0:13:03.916 --> 0:13:06.796 we go back, or when we start to explore this 0:13:06.916 --> 0:13:10.476 even now, we're going to be called to come up 0:13:10.516 --> 0:13:14.836 with lists of factors that could explain these disparities and 0:13:14.996 --> 0:13:17.876 also sort them out and put them in order. I 0:13:17.876 --> 0:13:22.036 imagine that folks in Singapore and China and Taiwan are 0:13:22.076 --> 0:13:27.196 justifiably proud of their ability to bring this their fraction 0:13:27.196 --> 0:13:31.756 of the pandemic under control. We could be justifiably proud, 0:13:31.796 --> 0:13:34.556 for example, in the United States, of our ability to 0:13:35.476 --> 0:13:38.476 martial scientific research to come up with vaccines in such 0:13:38.516 --> 0:13:41.556 short order. But we're probably not called to be proud 0:13:42.036 --> 0:13:45.756 of our public health delivery system, which is very patchwork 0:13:45.956 --> 0:13:49.436 and it's also underfunded massively. If you were to compare 0:13:49.996 --> 0:13:52.676 Rwanda to the United States, not just in terms of 0:13:52.716 --> 0:13:56.716 their programmatic response to the pandemic, but the fraction of 0:13:56.756 --> 0:14:00.556 their public treasury that they put into public health and healthcare, 0:14:00.796 --> 0:14:05.396 it's much much larger than the United States the public treasury. 0:14:05.436 --> 0:14:10.716 So they're also prioritizing public health very high up on 0:14:10.756 --> 0:14:13.516 their agenda. It's not some black box mystery where we 0:14:13.516 --> 0:14:16.676 have to say, well, what is it about Rwandans that 0:14:16.796 --> 0:14:20.076 makes them so invulnerable to disease. It's not the case 0:14:20.156 --> 0:14:22.996 at all. It's rather, what is it about their response 0:14:22.996 --> 0:14:25.476 that has made them able to do a better job 0:14:25.476 --> 0:14:27.716 than we have here in the United States. The reason 0:14:27.756 --> 0:14:30.356 to ask that is not to win an argument, but 0:14:30.596 --> 0:14:35.516 rather to learn from our colleagues and the experience of Rwanda. Paul, 0:14:35.516 --> 0:14:38.076 you've talked about a kind of nihilistic thinking which can 0:14:38.116 --> 0:14:43.836 take effect in relation to public health problems that seem insoluble. Recently, 0:14:43.836 --> 0:14:47.516 I've seen you use this term containment nihilism to talk 0:14:47.556 --> 0:14:50.716 about what we can't do in relation to the pandemic. 0:14:50.756 --> 0:14:53.116 Can you explain a little more what you mean about that. 0:14:53.676 --> 0:14:56.636 You know, one of the things that I've seen again 0:14:56.716 --> 0:14:59.196 and again in my clinical practice over the years is 0:14:59.676 --> 0:15:02.636 clinical nihilism. You know, the argument that, oh, we can't 0:15:02.676 --> 0:15:05.876 do anything for these people, they're too poor. It's not 0:15:05.956 --> 0:15:09.796 cost effective, not feasible, not sustainable, not even prudent. Now, 0:15:09.836 --> 0:15:13.196 of course, those are also predominantly black and brown people, right, 0:15:13.916 --> 0:15:17.036 So that's clinical nihilism, and it's a very hard sell 0:15:17.076 --> 0:15:20.236 in the United States, you know, I mean, would you 0:15:20.476 --> 0:15:24.156 openly argue for a different standard of care for the 0:15:24.156 --> 0:15:27.636 bronx than Manhattan. It would be a very difficult sell politically. 0:15:28.076 --> 0:15:30.676 It's the functional equivalent of Jim Crowe. But it's just 0:15:30.916 --> 0:15:34.356 not something that you can sell. But we do see 0:15:34.356 --> 0:15:36.396 a different kind of nihilism in the United States, and 0:15:36.396 --> 0:15:39.196 that's containment nihilism. And it was so striking, you know, 0:15:39.596 --> 0:15:42.356 every time we made a suggestion like we should do 0:15:42.396 --> 0:15:47.596 more contact tracing, we'd find takers, even governors of entire 0:15:47.676 --> 0:15:51.516 states like Massachusetts. Right, But it's not anything that ever 0:15:51.596 --> 0:15:57.516 became a national program yet. That's containment nihilism, right. And 0:15:57.556 --> 0:16:01.556 then after the really dramatic moment of having the President 0:16:01.596 --> 0:16:03.956 of the Republic gets sick, you remember the next day 0:16:03.996 --> 0:16:07.916 after his hospitalization, his chief of staff said, we are 0:16:07.956 --> 0:16:10.436 not going to contain the pandemic. We're going to only 0:16:10.476 --> 0:16:14.396 do this through vaccination. So again, that's about as eloquent 0:16:14.436 --> 0:16:18.876 a statement of containment nihilism as you can get. It's 0:16:18.916 --> 0:16:24.356 a great phrase for surrender. It's a great it's a surrender. Right. Unfortunately, 0:16:24.396 --> 0:16:28.716 even with great vaccines, we have to do contact tracing, 0:16:28.796 --> 0:16:32.196 we have to observe social distancing, we have to mask 0:16:32.676 --> 0:16:37.156 all of the conventional public health demands really are still 0:16:37.196 --> 0:16:39.236 out there and we'll be around for a while. But 0:16:39.476 --> 0:16:43.636 containment nihilism is not what we saw in the Ebola 0:16:43.716 --> 0:16:47.236 epidemic and West Africa. There was clinical nihilism, and I 0:16:47.276 --> 0:16:48.996 think here in the States we're seeing a lot more 0:16:49.036 --> 0:16:54.156 containment nihilism. Paul, How does the roll out of vaccination 0:16:55.036 --> 0:16:59.836 globally look to you in terms of equity? I mean, 0:17:00.116 --> 0:17:03.436 there are many developing countries where essentially no one has 0:17:03.476 --> 0:17:06.716 been vaccinated. As you said, the vaccination seems to be 0:17:06.796 --> 0:17:09.996 part of the success story. That say, it's both in 0:17:10.076 --> 0:17:13.636 terms of the development and the rollout. I don't know. Overall, 0:17:13.636 --> 0:17:16.876 it's not going badly. The numbers that are accelerating, you know, 0:17:16.956 --> 0:17:20.076 things seem pretty good. But we just see this vast gap. 0:17:20.156 --> 0:17:22.356 You know, it seems that our whole country is going 0:17:22.396 --> 0:17:25.556 to be vaccinated before a lot of poor countries are 0:17:25.596 --> 0:17:29.636 vaccinated at all. Yeah, I mean, this is the great worry. 0:17:29.676 --> 0:17:33.316 I will say that there's a fairly massive coalition of 0:17:33.356 --> 0:17:38.716 people coming together to try and diminish vaccine inequality or 0:17:38.796 --> 0:17:41.916 vaccine apartheid, or wherever we call it. I mean, supply 0:17:42.116 --> 0:17:45.356 is the problem. There will be other problems with distribution, 0:17:45.396 --> 0:17:47.556 but you can't have the distribution challenges if you don't 0:17:47.556 --> 0:17:50.916 have the supply the mechanisms that have been pulled together 0:17:50.996 --> 0:17:53.316 to address this, and you've probably already heard of or 0:17:53.396 --> 0:17:58.156 spoken about covacs, but the targets are still not high enough. 0:17:58.156 --> 0:17:59.916 They're not as high as the R oneans want them 0:17:59.916 --> 0:18:03.036 to be. It's something like countries with barely more than 0:18:03.236 --> 0:18:07.316 ten percent of the world's population have already cornered the market, 0:18:07.316 --> 0:18:10.796 have already bought actually about half of all the doses. 0:18:11.916 --> 0:18:13.876 And you know there are going to be lots of 0:18:14.516 --> 0:18:18.716 complaints about that, of course, and legitimate complaints, so we're 0:18:18.716 --> 0:18:21.396 really going to have to again redouble our efforts to 0:18:21.436 --> 0:18:26.876 address this. The timeline of implementation, if you want to 0:18:26.876 --> 0:18:30.156 call it that, the time between the development of an 0:18:30.156 --> 0:18:33.956 effective technology that could be a medicine or a vaccine 0:18:34.436 --> 0:18:38.836 and its widespread distribution is usually measured in decades. But 0:18:38.956 --> 0:18:41.276 as people now know in the United States as well, 0:18:42.076 --> 0:18:47.596 if there's ongoing community transmission of the coronavirus, the novel coronavirus, 0:18:48.436 --> 0:18:51.596 then there's going to be ongoing mutation and the emergence 0:18:51.596 --> 0:18:56.036 of new and more troubling variants, which is already occurring, 0:18:56.476 --> 0:19:00.276 is sure to increase so that's one of the you know, 0:19:00.316 --> 0:19:03.996 one of the reasons that I'm not suggesting we use 0:19:04.076 --> 0:19:08.636 fear to stimulate more investment in vaccine equity. I'm just 0:19:08.676 --> 0:19:12.396 saying people should know that there is a There are 0:19:12.436 --> 0:19:15.636 many reasons to do this, and the best ones, in 0:19:15.676 --> 0:19:18.676 my view, are that science and the fruits of science 0:19:18.716 --> 0:19:23.076 ought to be evenly distributed, like human capacity is. We 0:19:23.196 --> 0:19:26.716 got the COVID nineteen vaccine really fast. The system worked 0:19:26.956 --> 0:19:30.876 in that case, but for other diseases that primarily affect 0:19:31.356 --> 0:19:35.756 the global South, we don't have vaccines, or at the 0:19:35.836 --> 0:19:39.316 very least, vaccine development can take a very long time. 0:19:39.716 --> 0:19:41.356 So how can we have a system that does a 0:19:41.396 --> 0:19:47.236 better job of eradicating diseases that primarily affect the developing 0:19:47.276 --> 0:19:50.876 world and not the rich countries. Sometimes we talk about 0:19:50.956 --> 0:19:56.516 the discovery science, right, the basic science, discoveries, the development 0:19:56.516 --> 0:19:58.036 of the new tools, A lot of that is done 0:19:58.036 --> 0:20:01.436 by pharma and biotech, right, and then finally the delivery. 0:20:01.996 --> 0:20:05.276 So getting from the first day of discovery to the 0:20:05.356 --> 0:20:09.236 third day of delivery requires the assistance. I'm sure a 0:20:09.236 --> 0:20:11.916 lot of these companies that you know are know how 0:20:11.956 --> 0:20:16.276 to make tools, whether those be medical treatments, or vaccines, 0:20:16.716 --> 0:20:18.956 So we just need to bring everybody on board. I 0:20:18.956 --> 0:20:22.316 don't want to sound like I'm singing kumbaya, but again, 0:20:22.476 --> 0:20:27.196 there's even a cold headed logic would say, well, if 0:20:27.356 --> 0:20:32.756 there's already COVID vaccine in rural Rwanda, that means that 0:20:33.596 --> 0:20:37.076 you could move quickly. It's possible to see vaccine in 0:20:37.116 --> 0:20:39.836 the field in the arms of people who in the 0:20:39.836 --> 0:20:42.516 past have been shut out of medical modernity. But they 0:20:42.556 --> 0:20:44.836 don't need to be. And that's one reason that my 0:20:44.916 --> 0:20:50.636 solvable problem is to argue that these are not insurmountable problems, 0:20:50.796 --> 0:20:53.516 none of them. Yeah, that's really interesting. I mean you've 0:20:53.596 --> 0:20:56.316 changed the terms of the debate from how do you 0:20:56.396 --> 0:20:59.836 do it? Instead of whether it can be done? You've 0:20:59.876 --> 0:21:03.916 made it. Yeah, I hope that. I hope. I mean 0:21:03.956 --> 0:21:07.356 I would love to claim that I put that on 0:21:07.396 --> 0:21:12.476 my tombstone, know because you know, how are you going 0:21:12.516 --> 0:21:15.716 to put a man on the moon with that kind 0:21:15.756 --> 0:21:18.036 of logic? You know, can we do this? It had 0:21:18.116 --> 0:21:20.836 to be how do we do this? I assume, I 0:21:20.876 --> 0:21:25.196 mean I wasn't there, but that's when you didn't take on. Yeah, 0:21:25.436 --> 0:21:28.876 in medicine and public health, it's hard to point to 0:21:28.996 --> 0:21:33.836 any example of sustained attention to a health problem that 0:21:33.956 --> 0:21:39.156 resulted in failure because you know, implementation was impossible. It's 0:21:39.236 --> 0:21:41.196 it wants you to say, how do we do this? 0:21:41.356 --> 0:21:44.276 Rather than should we do this? I mean part of 0:21:44.316 --> 0:21:47.716 me wanted to say, you're halfway there. Bill Gates and 0:21:47.756 --> 0:21:50.196 the Gates Foundation, who played a very big role in 0:21:50.236 --> 0:21:54.756 the Kovac's program, he have thought a lot about this problem. 0:21:54.876 --> 0:21:58.836 He takes the position very explicitly all lives have equal value. 0:21:58.836 --> 0:22:00.876 I mean, he says something, you know, very similar to 0:22:00.916 --> 0:22:03.596 the kind of thing you say. But he also takes 0:22:03.596 --> 0:22:07.476 the view around vaccines that you need the profit motive 0:22:08.116 --> 0:22:12.276 and the private sector to drive the innovation and development 0:22:12.316 --> 0:22:16.676 around vaccines, and that they need patent protections, and often 0:22:16.756 --> 0:22:20.276 you hear criticism of that that the patent protections in 0:22:20.316 --> 0:22:23.916 particular keep vaccine prices high and keep vaccines out of 0:22:23.956 --> 0:22:27.036 the out of reach for the poorest countries. Do you 0:22:27.116 --> 0:22:31.716 think his approach is right or the best available solution 0:22:32.036 --> 0:22:35.916 or neither, Well, you know, I think, And first of all, 0:22:35.916 --> 0:22:39.836 I don't doubt that his work and the world I'm 0:22:39.836 --> 0:22:42.716 talking about the work of the foundation is premised on 0:22:42.756 --> 0:22:46.356 this notion that all lives have equal value, don't doubt it, 0:22:46.756 --> 0:22:51.636 and have some experience discussing these matters with him. I 0:22:51.676 --> 0:22:56.556 also don't doubt that a great titan of industry knows 0:22:56.716 --> 0:22:59.596 things that I would never know about things like patents. 0:23:00.196 --> 0:23:03.556 But I also I further believe that people like me 0:23:03.676 --> 0:23:05.836 have something to add even if we don't know a 0:23:05.836 --> 0:23:08.636 lot about trade agreements. When I say people, I mean 0:23:08.676 --> 0:23:12.556 I mean clinicians, nurses, doctors, community health workers. You know, 0:23:12.636 --> 0:23:16.916 we have responsibilities as well to communities that we're serving, 0:23:17.276 --> 0:23:20.156 and if those communities are not well served by current 0:23:20.196 --> 0:23:23.756 trade arrangements, including patent law, then we should suspend or 0:23:23.796 --> 0:23:26.156 wave them in the middle of crises like this. This 0:23:26.236 --> 0:23:29.196 is a global health emergency the likes of which we've 0:23:29.196 --> 0:23:32.316 not seen in our lifetime. I would imagine that many 0:23:32.356 --> 0:23:35.636 people in industry, and including in the farm industry, could 0:23:35.676 --> 0:23:40.156 agree there are moments when you would wave intellectual property 0:23:40.236 --> 0:23:43.756 rights in order to increase production. And you know, right 0:23:43.796 --> 0:23:46.516 now we're in a situation, as you know, where a 0:23:46.556 --> 0:23:49.716 production is, the chain is the chief barrier. It's supply 0:23:49.836 --> 0:23:52.876 as a chief barrier. And so if a country like 0:23:52.996 --> 0:23:56.996 Rwanda can convince those who do hold patent rights over 0:23:57.116 --> 0:24:01.556 new technologies like mrina vaccines, that they too could participate 0:24:01.676 --> 0:24:05.316 in the production of vaccines and in their distribution elsewhere 0:24:05.356 --> 0:24:07.076 in the world. I think that would be a good 0:24:07.116 --> 0:24:10.756 thing for the species. Meaning our spec Paul, I wanted 0:24:10.796 --> 0:24:13.316 to step back and ask you a more personal question. 0:24:13.356 --> 0:24:16.236 It's a question I'd like to ask all our guests, Unsolvable, 0:24:16.476 --> 0:24:21.276 which is essentially, how did this become your life's work? 0:24:21.916 --> 0:24:27.116 How did you end up devoting yourself to global health equity? 0:24:27.196 --> 0:24:30.036 I can answer in one word, which is uncharacteristic of 0:24:30.076 --> 0:24:36.636 me Haiti, meaning the brevity part is uncharacteristic. I went 0:24:37.356 --> 0:24:41.996 almost by accident to Haiti between college and medical school 0:24:42.716 --> 0:24:46.996 and learn things there in one year that I think 0:24:47.876 --> 0:24:50.876 it would have taken me many years to absorb in 0:24:50.996 --> 0:24:54.876 a classroom, for example. And that's where I learned both 0:24:54.916 --> 0:24:58.356 the devastating toll of not having a safety net, but 0:24:58.476 --> 0:25:02.996 also the almost shameful facility with which one could be 0:25:03.036 --> 0:25:06.076 put in place. The other regular question we like to 0:25:06.116 --> 0:25:10.316 ask Unsolvable Paul is what can listener do? And in 0:25:10.356 --> 0:25:14.076 this case, it's to make up for the setbacks brought 0:25:14.076 --> 0:25:17.276 by the pandemic. I might divide it into two separate answers. 0:25:17.356 --> 0:25:21.796 One is, you know, talking about those increased and highlighted 0:25:21.796 --> 0:25:26.236 disparities in the United States, but then in terms of 0:25:26.276 --> 0:25:29.756 the global gap, in the global shortfalls. You know, I 0:25:30.436 --> 0:25:33.716 would love to see people the age of my students 0:25:35.676 --> 0:25:39.596 grasp on to this as they're you know, a hankering 0:25:39.676 --> 0:25:43.236