Episode 1661 - Is It Possible To End Malaria?

[SPEAKER_01]: Our beloved 8% heart A.F. [SPEAKER_01]: Seltzer is now live in Florida, Georgia, Alabama, Texas, Ohio, Montana, Idaho, Oregon. [SPEAKER_01]: Mishiki, Pennsylvania, Illinois. [SPEAKER_01]: Go to hordaefselter.com to day click on the store locator and enter your city or zip to find the closest location near us you. [SPEAKER_02]: Welcome to drinking bros, folks, rosses and taxes. [SPEAKER_02]: I don't actually, what is he doing? [SPEAKER_02]: What's he doing out there?

[SPEAKER_01]: I think he went out there to do something with the old studio, or the police house, or something like that. [SPEAKER_02]: We've got new tenants out there, so maybe that's it. [SPEAKER_02]: Who knows, really? [SPEAKER_02]: He may be on the run. [SPEAKER_02]: That's on my money's on. [SPEAKER_02]: Yeah, if you guys tracked on his legal status now he keeps that to himself. [SPEAKER_02]: Yeah, well, we'll look into it.

[SPEAKER_02]: Today's guest is somebody we've been on citizen Bill Steiger from Malaria, no more. [SPEAKER_02]: There's going to be a really interesting conversation.

[SPEAKER_02]: We've talked a bit about all the work he's doing and some of the weirder stuff that goes on in American politics and science And now we've got some new information from Tulsi on some of these bio labs that I want to ask you about so anyways, how you doing today Appreciate that thanks so much for having it back of course. [SPEAKER_02]: Yeah, so let before we get into [SPEAKER_02]: all the stuff about Malaria no more.

[SPEAKER_02]: I assume you've looked into or heard about Tulsi Gabbards release on the bio labs all over the world. [SPEAKER_02]: What the hell's going on here? [SPEAKER_00]: I have seen that and it's an issue that we should all be concerned about. [SPEAKER_00]: No question about it.

[SPEAKER_00]: We as a country, and this is true on the civilian side and on the military side, have for a long time for a very good reasons, help to fund the development and the trading of a lot of laboratories around the world. [SPEAKER_00]: for both human health, animal health and agriculture, many of them what they call the biosecite-level three category. [SPEAKER_00]: That's a lab in which you can, if you have the right training and equipment, deal with very dangerous pathogens.

[SPEAKER_00]: And a number of these laboratories, especially as we kind of downsize our presence around the world, we don't have eyes on them anymore. [SPEAKER_00]: Well, that doesn't sound great. [SPEAKER_00]: Yeah. [SPEAKER_00]: It's a concern. [SPEAKER_00]: We're not always sure anymore in some places what is happening in those labs. [SPEAKER_00]: We know that there have been examples of dangerous pathogens being left behind in laboratories and conflict settings.

[SPEAKER_00]: And then somebody has to go back and retrieve them or destroy them. [SPEAKER_00]: We know that a lot of these technologies in the lab, the lab equipment can be dual-use, right? [SPEAKER_00]: You can do some very nice and very responsible civilian things with them, and then in the wrong hands, you can mix up some dangerous stuff.

[SPEAKER_02]: Yeah, I mean, we've had a number of, I think, six people over the last, maybe 10 months or so have been arrested for trying to smuggle biological material into the U.S. Mostly through universities, and I don't know if there's any reason to believe that's [SPEAKER_02]: bioterrorism or anything like that or if there's dipshits that are trying to skirt the loss to make it more convenient for themselves because they were all researchers and whatnot.

[SPEAKER_02]: But either way, that's not great. [SPEAKER_02]: Now an introduction to you, are you still at the Wilson Center? [SPEAKER_02]: No, not anymore. [SPEAKER_02]: I was for a while. [SPEAKER_02]: Okay. [SPEAKER_02]: So you were a public policy fall at the Wilson Center. [SPEAKER_02]: You've worked for USAID, not defrauding the government specifically, but working to actually do things. [SPEAKER_02]: You've worked on Avian Flu and Malaria, Malaria no more.

[SPEAKER_02]: We'll talk more about that later. [SPEAKER_02]: So you've got good street cred in this environment. [SPEAKER_02]: I'm curious, we were talking about this actually, and yesterday show, I'm very curious about this. [SPEAKER_02]: Because there's a debate over the efficacy versus the risk of gain-of-function research. [SPEAKER_02]: And to be honest, [SPEAKER_02]: I don't know enough about it.

[SPEAKER_02]: We're not scientists here, but it doesn't seem like gain of function is a good idea, really. [SPEAKER_02]: Especially not in places where you don't have complete control over it. [SPEAKER_02]: As you said, Ukraine turns into a conflict area. [SPEAKER_02]: There's like 20 bio labs there and what Russia can just come in and do with it. [SPEAKER_02]: Why? [SPEAKER_02]: That doesn't seem like a good idea.

[SPEAKER_00]: Yeah, I think gain of function is a bad idea that we ought to have both domestic and international standards and restrictions on doing that kind of research. [SPEAKER_00]: And at the moment, as you know, it's a gray area. [SPEAKER_00]: And this, there are different definitions of exactly what gain of function might be in some circumstances and scientists love to experiment. [SPEAKER_00]: That's what they do.

[SPEAKER_00]: That's what they grow up and dream of doing and that's what we train them to do. [SPEAKER_02]: Yeah, I wonder about tech, because we were reading some, I mean, it was just like, I don't know where our guy, our producer got it from, but there was kind of explaining the purpose of gain of function and it's like, well, we can tell the, [SPEAKER_02]: whatever the moment that some kind of infection or whatever it happens to be jumps from animals to human beings, right?

[SPEAKER_02]: But does that like what my question is always practicality, right? [SPEAKER_02]: Like I'm more of an engineer than a creator, I think, in that regard. [SPEAKER_02]: And it's like [SPEAKER_02]: What is the practical impact of having that information?

[SPEAKER_02]: For example, if we knew, just about COVID, if we knew that it was not that I believe it in this, but it was a bad virus that jumped to humans or panglons, it jumped to humans or whatever the hell, theory is, what are we going to do? [SPEAKER_02]: Kill all the bats or kill all the panglons or whatever?

[SPEAKER_02]: I mean, is there a practical step to be done [SPEAKER_02]: as a result of that research that will prevent it or do we just know something that's a curious thing to know and what the fuck is the point of that? [SPEAKER_02]: You know what I mean, especially with the rest that's involved. [SPEAKER_00]: Absolutely, I think what the scientists who are interested in this work will tell you is that it's the biological equivalent of white hat hacking, right?

[SPEAKER_00]: That you have software developers who are constantly trying to test the defenses of various information technology systems to find the vulnerabilities and then patch them or fix them. [SPEAKER_00]: And this is that, this is the natural equivalent of that is if we understand that a virus could evolve like this, perhaps to evade one of our defenses, can we come up with a countermeasure to account for that?

[SPEAKER_00]: But there's a stage there, obviously, if you make a virus more dangerous, and we don't have the countermeasure when it could turn into a pandemic. [SPEAKER_02]: You mean like what happened?

[SPEAKER_02]: by possibly okay so that seems real down to me again we're not scientists here but what the fuck man Jesus one thing I ask you on the other show before and this is more of like [SPEAKER_02]: because you work not only in research and prevention, but also in public policy to some degree, our relationship with the world health organization is at a beneficial one for the United States and should we continue it, or should we sever ties with them, should we try to stand up something new?

[SPEAKER_02]: That's better, you know what I mean? [SPEAKER_02]: Cause like this is one of the things that Trump likes to do is to, and this is true in his business and in his political life, is to identify modules inside of whatever organization [SPEAKER_02]: Let's figure out why it sucks and we either change it or replace it wholesale.

[SPEAKER_02]: And you can see the board of peace that he's trying to establish because the main problem center with geopolitics circles back to the Middle East pretty much consistently, right? [SPEAKER_02]: Which is why China and Russia both spend money there. [SPEAKER_02]: We think of China and Russia's our main geopolitical adversaries and they are to a large degree, but [SPEAKER_02]: They're spending as much money in the Middle East as we are, so that tells you something, right?

[SPEAKER_02]: So he sets up a board of peace to kind of do what the UN is incapable of doing, because there are a bunch of lazy bureaucrats in my opinion. [SPEAKER_02]: But Trump isn't the kind of guy that just throws out something wholesale, typically he would replace it. [SPEAKER_02]: So I think if we've got two more years to an half, more years of him left, is that a viable option, or what do you think we should be doing with regard to the WHO?

[SPEAKER_00]: You're asking all of the right questions. [SPEAKER_00]: Absolutely, the perspective of someone who may be as a takeover artist is the right one. [SPEAKER_00]: Is there anything worth saving at the World Health Organization? [SPEAKER_00]: I think there are a few aspects of it, as you say, a few modules of it that are worth saving. [SPEAKER_00]: Everything the WHO does is not worthwhile and not worth our investment.

[SPEAKER_00]: One of the places where the WHO does generally a good job, [SPEAKER_00]: governments share information with the WTO that they don't always share with us or with the private sector. [SPEAKER_00]: It's often very hard to gain the trust of governments to tell the world what's going on. [SPEAKER_00]: And it's not perfect. [SPEAKER_00]: This Ebola outbreak is another example of that where we have known about something too late. [SPEAKER_00]: And it's not been a perfect response.

[SPEAKER_00]: We can talk about that if you want. [SPEAKER_00]: the disease tracking or surveillance as they call it that the WHO has done over time is generally a module that I would want to keep among other things the WHO helps put together the science that tells us what components need to go into with the annual flu vaccine, which is really important to us.

[SPEAKER_00]: And the WHO has a series of regulatory or quasi-regulatory functions around vaccines, medical devices, medicines that have a great deal of impact about how and how quickly those tools get deployed around the world, because many governments deferred to the WHO's judgment on these what are called prequalification decisions. [SPEAKER_00]: quasi-regulatory, but that's a relatively small list I just gave you.

[SPEAKER_00]: So I think the President's instinct is right that look, this is a flawed institution needs major change, wasn't going to change without a shock to the system. [SPEAKER_00]: Another question is, what other pieces that can be either reformed and saved or replicated?

[SPEAKER_00]: What I'm hearing is that [SPEAKER_00]: what people inside the administration and outside are finding as they look for alternatives to the WHO is that rebuilding some of these capacities, like the disease surveillance and response piece, can be very expensive to do on their own. [SPEAKER_02]: Yeah, I would imagine so, and I mean, what are the chances that we're going to build something that's better?

[SPEAKER_02]: Because we have big-pray you mentioned in Ebola, we have big problems with both timeliness and accurate reporting coming from Africa. [SPEAKER_02]: But we also had that issue with China and the fall and whatever of 2019, right? [SPEAKER_02]: Correct.

[SPEAKER_02]: This could have been, had, had, [SPEAKER_02]: Regardless of what you think the origin of COVID was, had China done its job in the, let's say, September to November of 2019, that situation would have looked quite a bit different. [SPEAKER_02]: I mean, quite a bit different. [SPEAKER_00]: Yeah, no question about it, no question.

[SPEAKER_00]: And that's true of stars where the, [SPEAKER_00]: Johnny's eventually we're a little more transparent that's been this is in 2003 right the first then 2003 stars which was that the basically the the preview the dress rehearsal for for COVID It's true it's been true of almost every Ebola outbreak it's been true of outbreaks of a bunch of other dangerous fevers

[SPEAKER_00]: national governments for a lot of different reasons that are understandable are reluctant to admit that really bad things are happening inside their territories. [SPEAKER_00]: And so they're almost always going to be slower than we would like. [SPEAKER_00]: And one of the things we have to figure out, and this is something I know people in Washington are spending some time on is, are there alternative sources of information that are credible, alternative sources of truth?

[SPEAKER_00]: Especially given now, [SPEAKER_00]: the world of social media reporting, the way that people themselves are talking about their own experiences and their illnesses, their filming and uploading videos that you can get a pretty good sense of what's going on now sometimes, especially using artificial intelligence to sift through all of this information, of whether something is beginning to turn into a danger situation without having to rely on a government to tell you that.

[SPEAKER_02]: Yeah, sure. [SPEAKER_02]: I mean, I think it seems like a decent idea might be some kind of, um, whether it's through WHO or somebody else, a pact that supports this openly instead of isolates, because our tendency now is to isolate, right?

[SPEAKER_02]: And it's understandable why a country, especially one on the poor side, might be reluctant to share that information, because one it affects [SPEAKER_02]: them domestically, and so far as people get freaked out or whatever, and that affects commerce. [SPEAKER_02]: But it also, um, everybody's going to be like, well, you can't come here for now, not just forget about people traveling and talking about products going in, going out, right?

[SPEAKER_02]: So I think if there was, absolutely, if there was a better infrastructure and even MOUs that [SPEAKER_02]: when a, particularly a smaller country like that gets affected by, because this is usually where they are in high, well, small countries and then high low sanitary high density populations, I guess, like Indonesia, China, places like, well, parts of China.

[SPEAKER_02]: They're probably more susceptible to that kind of stuff, but just some kind of agreement that says instead of we're going to isolate you, but we're also going to help you get from point A to point B, right?

[SPEAKER_02]: I think that's probably a better way to handle things than what we're doing right now, because our instinct right now is just to cut off all travel, and there's not a formal plan [SPEAKER_02]: and Eastern Africa could look at and say, oh, we're going to be okay, even if we shut it down down for a little while. [SPEAKER_00]: Yeah, that's exactly right. [SPEAKER_00]: Now, that's the theory.

[SPEAKER_00]: And I think it's the right theory behind what the administration has done in its America First Global Health Strategy on this question of what they call global health security, where these memorandum are understanding that the U.S. government signing with a bunch of different governments, 32 of them at this point, mostly in Sub-Saharan Africa, but some other places too, part of the major component, one of the major components of these MOUs is, in fact, [SPEAKER_00]: outbreaks.

[SPEAKER_00]: And then there's a quick pro quo. [SPEAKER_00]: You share this information. [SPEAKER_00]: We're going to provide you with help. [SPEAKER_00]: Some of the details to be filled in later. [SPEAKER_00]: But it's exactly that kind of of an approach. [SPEAKER_00]: Instead of staying immediately, we're going to penalize you. [SPEAKER_00]: We're going to cut you off. [SPEAKER_00]: We're not going to let you in. [SPEAKER_00]: We're going to stop your products.

[SPEAKER_00]: Tell us what's going on. [SPEAKER_00]: And we're going to be able to help. [SPEAKER_00]: And maybe we can mitigate some of those second and third order consequences of a disease outbreak if we can snuff it out quicker. [SPEAKER_02]: Yeah, I don't know how much [SPEAKER_02]: Like we spent and lost quite a bit of money. [SPEAKER_02]: as a result of a global pandemic, but also we created inflation that's going to exist permanently.

[SPEAKER_02]: So it just seems to me like it would be quite a bit easier to have some even if it's a hefty reassurance for countries to report accurately. [SPEAKER_02]: Like, hey, no matter what happens, we're going to handle this.

[SPEAKER_02]: Rather than, you know, just hoping for the best, which [SPEAKER_02]: And most of the outbreaks happen in relatively low-trust societies too, so unless there's something hard and on paper, they're not really going to just, they're not going to report accurately. [SPEAKER_02]: That's just how it is, right? [SPEAKER_00]: Yeah, absolutely.

[SPEAKER_00]: And especially when you look at a disease that's as scary as Ebola, once people start to understand what happens to people when they go into the hospital, what the symptoms are, and they start seeing the people with the space suits on coming in and spraying down whole buildings and villages with bleach and trying to do disinfection.

[SPEAKER_00]: They also are not likely people who have fevers, for example, they might not know what it is, but they're probably unlikely to go into the hospital and hospitals get the reputation of places that people go to die. [SPEAKER_00]: So that lack of trust extends down to the community and family level in these situations that's not just that at the higher society or governmental level.

[SPEAKER_00]: And so [SPEAKER_00]: When you, the other factor here is that a disease like Ebola, as scary as it is, and as desperate as the situation can be, and as fatal as it is, and sad as the situation is, when you talk to people on the ground in places like Uganda and the Democratic Republic of Congo, they will say about Western assistance in an outbreak. [SPEAKER_00]: Why are you only here now, right? [SPEAKER_00]: We have malaria here every single day, killing thousands of people.

[SPEAKER_00]: We have TB, we have meningitis. [SPEAKER_00]: Ebola is not even in our top 10 of health concerns. [SPEAKER_00]: And you guys show up with the space to it's once every couple of years because it's scary to you. [SPEAKER_00]: But where are you helping us day to day to figure out how to differentiate between the fever that's malaria and the fever that might turn into Ebola? [SPEAKER_02]: Yeah, yeah, it's a good point.

[SPEAKER_02]: A big part of this, too, [SPEAKER_02]: just acceptance of two things, the germ theory of medicine and basic hygiene. [SPEAKER_02]: I mean, correct all the vaccines that have ever happened in human history, pale in comparison to the [SPEAKER_02]: life-saving capability of germ theory of medicine and basic hygiene. [SPEAKER_02]: I think my wife told me that infant deaths, or I'm sorry the deaths of the mother after giving birth.

[SPEAKER_02]: dropped by 90 percent in like the first 10 years after the germ theory medicine because doctors would go they would come from working on a dead body, come right over deliver a baby and go back it's like yeah running running water or some ability to clean yourself.

[SPEAKER_02]: right not just doctors but on a daily basis and understanding that germs are things right you don't have to be crazy about it but you do have to like you you don't want to slip trench over there on the south end of your camp running into your water supply running into the field but your food's growing right so this is this is stuff [SPEAKER_02]: You can say, people say this a lot. [SPEAKER_02]: It's time for that part of the world to grow the fuck up and start acting like adults.

[SPEAKER_02]: Okay, that's fine. [SPEAKER_02]: If somebody's got to do something, somebody's got to raise them at some point. [SPEAKER_02]: I guess because we are living in a flat world, both communication wise and transportation wise. [SPEAKER_02]: You can get literally anywhere on Earth in one day.

[SPEAKER_02]: that's never been true in all of human history right now you can get literally anywhere on earth in one day and imagine that I mean anybody that works any verologist looks at that statistic and is like fuck this is not great because it used to be three months six months whatever now very quickly so stuff can spread really quickly we don't have the luxury anymore of saying they're all the way over there because that's not it's [SPEAKER_00]: That's right.

[SPEAKER_00]: It's not a reality. [SPEAKER_00]: You have absolutely put your finger on it. [SPEAKER_00]: The scenario in movies like 12 monkeys, right? [SPEAKER_00]: That is not science fiction. [SPEAKER_00]: That's true. [SPEAKER_00]: There's somebody can get on a plane today in eastern Congo and be in Dallas. [SPEAKER_00]: tomorrow and have a bowl and not even know it. [SPEAKER_00]: We saw this in one of the outbreaks in West Africa, where somebody did show up in Dallas with Ebola.

[SPEAKER_00]: It is not a fantasy. [SPEAKER_00]: It's not a pipe dream. [SPEAKER_00]: This is the real and clear and present danger for us. [SPEAKER_00]: And you're right that that speaks to the [SPEAKER_00]: The legitimacy and the urgency and the sound investment that is trying to prevent these dangerous pathages from coming to us by looking for them and snuffling them out over there rather than waiting them for them to come to us.

[SPEAKER_00]: That kind of engagement on health and yeah, it's going to cost the money, but that's an insurance [SPEAKER_00]: policy for our security day to day here, even yes, as we're helping people overseas. [SPEAKER_00]: But in light and self interest, this is really trying to prevent these kinds of dangers, possibly pandemics, from coming to us, or at a minimum, buying ourselves enough time to be more ready than we have been in the past.

[SPEAKER_02]: Yeah. [SPEAKER_02]: And there's, you know, [SPEAKER_02]: Again, I consider this to be a national security thing at this point, right? [SPEAKER_02]: Yeah, the same food, or energy, or military security. [SPEAKER_02]: That's right. [SPEAKER_02]: And less, I mean, we can make the choice to shut ourselves off to the rest of the world. [SPEAKER_02]: But even then, there's still a chance somebody gets through the border with something.

[SPEAKER_02]: And so, so, it's a, [SPEAKER_02]: It's not a, it's not a no-fail mission, like you can have some uh, virality and still be able to control it, but it's certainly something that we have to be on top of. [SPEAKER_01]: All right, Dan, did we get some sponsors to put this shit, you know, on the air first and foremost, firstwarm.com forward slash drinking bros. You're still getting the five free meats toicks over there. [SPEAKER_01]: I don't know how they're able to do that.

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[SPEAKER_02]: Tell me about that organization and what you guys do. [SPEAKER_00]: So we're a pretty small non-governmental group based in the United States, but we work with partners all over the world. [SPEAKER_00]: And we have three basic missions. [SPEAKER_00]: We try and educate people in the United States, particularly policymakers and people who control the money about why malaria is important to us in the U.S. and why it's a good investment for us to work on eliminating it.

[SPEAKER_00]: We try and inspire people number two to consider that this is a cause that's worth [SPEAKER_00]: Joining might be with their own money, might be through their local faith-based organization through supporting another group that works overseas through advocating to their members of Congress and to the administration that this is something that we care about in the United States or should care about. [SPEAKER_00]: And then we tell stories.

[SPEAKER_00]: We're basically a storytelling organization foremost, I think, and that is to try and use examples overseas and in the U.S. of why [SPEAKER_00]: This is a disease, we can do something about, should do something about, and it's a fight we can win, and also why there are lots and lots of American institutions, companies, universities, NGOs, and community organizations who are engaged in the fight against malaria, in ways that benefit us here at home, too.

[SPEAKER_02]: And what is, is there like an invalued of global middle area that's a goal for you guys or what's your goal at the end of the day? [SPEAKER_02]: Like how do you judge success year to year? [SPEAKER_00]: The ultimate success is going to be elimination. [SPEAKER_00]: We do think this is the disease we can get rid of and get rid of in our lifetime. [SPEAKER_00]: The tools are there. [SPEAKER_00]: We know what works.

[SPEAKER_00]: There's some better tools that are coming down the pipe soon. [SPEAKER_00]: But we know we're not going to get there in the next year or two, or probably 10. [SPEAKER_00]: But probably in 2040, 2045, this is a realistic goal if I had to put a number on it.

[SPEAKER_00]: So our success is partially measured in [SPEAKER_00]: countries that begin to eliminate malaria every year and there are few of them every year that are doing that that there are some great stories out there and then reductions in the number of people who get sick and the number of people who die and ultimately we want to try and shrink the footprint of malaria down to something that's much more manageable so it's not as much of a threat.

[SPEAKER_02]: Yeah, I've got a question about the organization itself. [SPEAKER_02]: because the the acronym NGO isn't the most popular right now yes for obvious reasons you guys run yours a little bit different I've read an article I think you posted it on LinkedIn about five seas capital stack and it's a way to like [SPEAKER_02]: I mean, we think of NGOs as pork spending to some degree, right, because of how much fraud there's been.

[SPEAKER_02]: And you've got this theory on how to not just use the money that you're getting effectively but how to expand the offering to some degree. [SPEAKER_02]: Can you tell me more about that or my way off on that? [SPEAKER_02]: That's kind of the just I got. [SPEAKER_00]: Yeah, absolutely. [SPEAKER_00]: We're a public private partnership, and I'll tell you what exactly what that means in our case. [SPEAKER_00]: It means we don't receive federal money.

[SPEAKER_00]: We're not in the business of taking money from USCID or the State Department as a traditional implementing organization as they're called. [SPEAKER_00]: We weren't running. [SPEAKER_00]: Have not been running for a long time programs on the ground.

[SPEAKER_00]: So [SPEAKER_00]: We have a neutral stance, maybe it's a less compromise stance in terms of working with the federal government, sometimes telling the federal government that they need to do things a different way, because we don't take their money. [SPEAKER_00]: And, however, what we do do is especially, as you noted, work with a number of private donors and funders. [SPEAKER_00]: Sometimes those are philanthropic foundations or family offices.

[SPEAKER_00]: Sometimes they're private companies. [SPEAKER_00]: Sometimes they're private individuals. [SPEAKER_00]: They're also institutions, development banks and others. [SPEAKER_00]: And we try and help show them ways that by combining money from various different sources and what's called a blended finance kind of deal, that there are some really good investments around malaria and other

[SPEAKER_00]: mosquito-borne diseases where you can do more with different kinds of money than you could with a single donor by itself and that the way that the private sector looks at the world results oriented, return on investment, time horizons that require milestones before payment, that that kind of [SPEAKER_00]: Lens of looking at a problem is not only the right way to do it, but also malaria lends itself to that kind of investment, too. [SPEAKER_02]: Yeah, for sure.

[SPEAKER_02]: I mean, there's, you know, not, it's not just a research thing. [SPEAKER_02]: There's, uh, there are, there's equipment, and I wouldn't not form a suitable sense of zero of a things that, uh, [SPEAKER_02]: can help, like, deep, that can help prevent it, and then delivery systems for those things. [SPEAKER_02]: That's a commercial activity, right?

[SPEAKER_02]: I mean, you're a public-private partnership, so the idea of commercial investment in something like this, where you [SPEAKER_02]: the, would you the expert on the ground with all the relationships are developing a product or products that can help assist with some of this stuff, right? [SPEAKER_02]: That helps then go back and fund more research or whatever other activities. [SPEAKER_02]: It makes a lot of sense to me.

[SPEAKER_02]: I don't know why more organizations don't do this. [SPEAKER_02]: I think there's, I don't know the people that the end up in NGOs often time are just, [SPEAKER_02]: not great. [SPEAKER_02]: Um, some of you asked me a question here in the chat. [SPEAKER_02]: I'm very curious about this because I've got a theory on it. [SPEAKER_02]: They say, why can't we just get rid of all the mosquitoes and my thinking on that is that.

[SPEAKER_02]: birds eat mosquitoes and if the birds don't have food they die and then rats show up or in the case of mow he kills all the sparrows and the locus come and wipe out the crops and that famine killed more people than he did right during the Revolution the cultural revolution so I think that's not an option right [SPEAKER_00]: Well, there are a lot of people working on this question.

[SPEAKER_00]: Can we either with parasites, in fact, mosquitoes in a way that make them either sterile or prevent them from transmitting a virus or a malaria parasite onto a person, or can we modify the mosquitoes in a genetic way with genetic gene editing to do the same things, make them sterile so that if they breathe, they can't reproduce or and or prevent them from transmitting. [SPEAKER_00]: something dangerous on to a person.

[SPEAKER_00]: So there's a lot of scientific work on both and as five or six different specific methodologies that are under a study. [SPEAKER_00]: And none of them is the ultimate end goal to eliminate all mosquitoes. [SPEAKER_00]: We're never going to be able to do that. [SPEAKER_00]: We're talking about a couple of species, a few species that specifically transmit malaria to people or in a couple cases, dengue or some other dangerous virus to people.

[SPEAKER_00]: We're not talking about the other thousands of species and mosquitoes that do lots of other things. [SPEAKER_00]: And the people who are doing this work are finding that even if we were to take, say, just one of the malaria species out of the picture entirely, which is unlikely, that there won't be other environmental consequences, because there's lots of other insects and even mosquitoes for the birds and the bats and the frogs and other things to eat.

[SPEAKER_00]: So there seems to be a pretty good [SPEAKER_00]: scenario under which in very careful ways with very careful targeting that we could reduce mosquito populations in a way that would allow, um, that would prevent the virus from being transferred in, in the case of dengue or the parasite in the case of malaria from being transmitted at the rate that it is today.

[SPEAKER_00]: So you don't need to get rid of all the mosquitoes everywhere in order to have some of these technologies work in making people less sick. [SPEAKER_02]: Right. [SPEAKER_02]: Bill Gates is trying to kill us all, right?

[SPEAKER_00]: That's what, yeah, that's one of those theories out there, no is the answer, but I think even without any of those technologies, there are a lot of other things, most of them made or invented in the United States that are going to have an incredible impact on malaria, probably before any of these technologies we're talking about with modifying mosquitoes, or ever really going to be deployed at scale. [SPEAKER_02]: I mean, he released, talking here as a way.

[SPEAKER_00]: Yeah, and there's an American company that's been releasing sterile mosquitoes in a couple of different places. [SPEAKER_00]: There's an American company that has been infecting mosquitoes with a particular parasite and releasing them in countries like Brazil to no ill effect at all. [SPEAKER_00]: And it's shown a lot of impact, actually, in relatively small trials. [SPEAKER_00]: So we're, [SPEAKER_00]: that that technology is very early on in its development.

[SPEAKER_00]: And I don't think we're going to see it at scale for a while, maybe even a decade researchers are telling me. [SPEAKER_00]: So we can't wait that long to do a lot of things now that are going to have an impact to save a lot of lives. [SPEAKER_02]: What's the idea behind releasing sterile ones? [SPEAKER_02]: Exactly. [SPEAKER_02]: Or maybe sterile's not the right word for it. [SPEAKER_02]: What's the... [SPEAKER_02]: Well, what would be the benefit of that?

[SPEAKER_02]: Or is it something else? [SPEAKER_02]: Are they releasing something that can't transmit a virus and then they breed with the ones that already exist and downstream? [SPEAKER_02]: We're hoping that becomes the case or what's that? [SPEAKER_00]: Yeah, yeah, both ways.

[SPEAKER_00]: So in some cases, it's either sterilizing the male or the female mosquito and two different approaches and over time with [SPEAKER_00]: interbreeding, you develop a population that starts to shrink because the mosquitoes aren't reproducing, because either side, male or female, right? [SPEAKER_00]: They can't produce offspring. [SPEAKER_00]: In the other case, they can produce the offspring.

[SPEAKER_00]: And when they do, they transmit what's usually a natural parasite from mother to larva, and then into an adult mosquito.

[SPEAKER_00]: And that, [SPEAKER_00]: Second parasite prevents a mosquito from transmitting either a dangerous virus or the malaria parasite to a person by blocking that transmission inside the mosquito doesn't kill it doesn't render it sterile just prevents the transmission of of what harm harms us yeah [SPEAKER_02]: have has is there any concern about breakthrough I mean nature is pretty good at telling us to get the fuck out of our get get the fuck out of its way.

[SPEAKER_02]: We try to do stuff I mean it's [SPEAKER_02]: Um, in the short term, we can make things happen, but, you know, nature's got no clock. [SPEAKER_02]: It just keeps going. [SPEAKER_02]: So, um, I wonder, especially with the rapidity that, that it's, uh, species like that breeds, um, we've seen it in some of the fruit fly experiments where they bred like thousands of generations worth of them, um, to see evolutionary changes and stuff.

[SPEAKER_02]: Um, yeah, we worried about something that becomes resistant, like a, a new version of malaria that becomes resistant to whatever technology we even have now. [SPEAKER_00]: So it's the right question to ask, also, absolutely. [SPEAKER_00]: And you're right to point to examples in the past where, yes, we've seen resistance. [SPEAKER_00]: And malaria itself is the classic example of resistance to everything that we've ever taught.

[SPEAKER_00]: It's a disease that basically is evolution on steroids. [SPEAKER_00]: And you're right, when we have developed a new insecticide, [SPEAKER_00]: mosquitoes have found ways to evade that. [SPEAKER_00]: A new test, the parasite is finding a way to hide from the test. [SPEAKER_00]: Drugs, the parasites are finding ways to resist developer resistance antimicrobial resistance to the drugs. [SPEAKER_00]: So it is a real concern.

[SPEAKER_00]: And in this case, so far, in all the studies, I've never seen anything to indicate that that's happening or imminent. [SPEAKER_00]: But it's one of the major things that everyone's going to have to watch, including from a regulatory perspective, as these new mosquito technologies can introduce, is after a number of generations after they're released in the wild, do we see anything that suggests that either the mosquito or the parasite is in some way adapting.

[SPEAKER_00]: And so far so good in the test that are there, but absolutely it's something everybody needs to be vigilant about. [SPEAKER_02]: It turns out that sickle cell was a reaction to malaria, and it's just the shape of the cell creates a hostile environment basically for malaria. [SPEAKER_02]: That's an interesting little battle.

[SPEAKER_00]: Yes, absolutely, and it plays out mostly in West Africa, but then of course now in the United States and in Brazil and lots of places where their large populations descended from Africa, where that genetic mutation is no longer useful in our context. [SPEAKER_00]: It's dangerous, right?

[SPEAKER_00]: So it is an example of the human mosquito [SPEAKER_00]: parasite interaction that's been going on for thousands of years, and an adaptation that now in our Mart world, unfortunately for a lot of people is now life-threatening rather than being potentially life-saving. [SPEAKER_02]: What do you know about this Lyme disease conspiracy that ticks or making people allergic to meat? [SPEAKER_02]: Because I keep hearing about this.

[SPEAKER_02]: And being a carnivore myself, a lot of [SPEAKER_02]: refuses to move to the east coast where he wants to live specifically because he's worried about that. [SPEAKER_00]: I have a friend who is absolutely convinced that in middle age he developed an allergy to red meat because of the tick bite. [SPEAKER_00]: Now, I don't think he can prove that.

[SPEAKER_00]: And there are some indications that among a very small percentage of people that this reaction and it's some kind of an allergic reaction basically happens after an infection from a tick. [SPEAKER_00]: I don't think it's anything people the vast majority of people have to worry about, but I have read literature and it does suggest that it does happen in a very small number of people. [SPEAKER_02]: Hmm. [SPEAKER_02]: Yeah, I don't know. [SPEAKER_02]: I mean, I've.

[SPEAKER_02]: I feel like I've been exposed to a lot of ticks. [SPEAKER_02]: And I've never had any issues with that, but who knows? [SPEAKER_02]: Hopefully. [SPEAKER_00]: Yeah, I think you've got to have a very specific genetic make-up that makes use susceptible to that already. [SPEAKER_00]: And maybe some underlying other challenges with meat or animal fat that then this triggers, basically.

[SPEAKER_02]: You've been pretty supportive of the, you mentioned it earlier, the America First Global Health Strategy, give us an idea of what that is. [SPEAKER_02]: I mean, I know Bobby Kennedy's trying, he's flipped the food pyramid, which is nice.

[SPEAKER_02]: We're moving into, [SPEAKER_02]: some more cutting edge science, like they want peptides to be regulated obviously, but they want it to be available to people and because of people will just buy them from China and who knows what's in that. [SPEAKER_02]: And just, you know, some of the the sillier things we've done, [SPEAKER_02]: from a public health perspective are going away.

[SPEAKER_02]: What is it about the America First Global Health Strategy that's one that's different and two that really appeals to you as some of the works in this industry? [SPEAKER_00]: I think it's great because it's a new paradigm for how we would engage in international cooperation.

[SPEAKER_00]: So we're not saying any more that we in the United States are going to be responsible for delivering health care, taking care of people, [SPEAKER_00]: forever, or on an open-ended basis, we're saying we're going to develop time-bound milestone based arrangements written down, compacts you could call them, memorandum understanding that suggests that we're going to make some investments together with the National Government and others.

[SPEAKER_00]: co-finance over a defined period of time against defined outcomes, and at the end, the goal is self-reliance independence, that at the end of it, national government and other funders are going to take over what we've been helping to fund for a long time. [SPEAKER_00]: As long as we're all meeting goals and that we're funding what works, [SPEAKER_00]: that it's reducing long-term dependency and that it's moving both people and coal governments or nations towards self-reliance.

[SPEAKER_00]: And that's the deal in the strategy is. [SPEAKER_00]: We're going to do some things for a while now to help you stand on your feet. [SPEAKER_00]: We're going to help you get there, but we expect you, national governments, others, to begin to pick up more of the tab and tell ultimately you are responsible for managing and funding these health programs yourselves.

[SPEAKER_02]: There's a lot of safetyism and there's a lot of this is how it's always been done, which is the word, I mean, when you're talking about fighting against nature, which is sort of what you're doing in this field, you gotta be a bit more nimble than that. [SPEAKER_02]: You can't, like, it's any of the military people out there, you know exactly what it looked like to have cold war, ground combat ideology put into an urban environment in the Middle East. [SPEAKER_02]: It did not work.

[SPEAKER_02]: it was it was very poor and especially at the outset of the global war on terror because most of our field grade officers the last time if they had ever seen combat it was a very briefly in in goal for one and it was primarily your education was in Vietnam style combat right which is not what we did over there now map that on to public health and science and stuff like that

[SPEAKER_02]: combat changes with new technology for the most part, but science changes with new new information, just new information, a one piece of new information can change the entire landscape of something, and this [SPEAKER_02]: this tendency we have to just like have institutions that know this is how this works versus we better we better revisit every six months now in the technological age, especially with AI to see what new stuff we can do.

[SPEAKER_02]: How do you, what would you say one has been the hardest adjustment [SPEAKER_02]: to our moving to the nonprofit, excuse me, where you can't really direct resources by mandate inside of executive branch. [SPEAKER_02]: Now you've got a board, you've got all this other stuff, and you've got to report to what's tell me about that. [SPEAKER_00]: Yeah, absolutely, you put your finger on it again. [SPEAKER_00]: It's that we don't have an ability to direct anybody to do anything, right?

[SPEAKER_00]: We are in the business of persuading of bringing data and science and evidence and arguments. [SPEAKER_00]: based on what we have seen in the field, what we understand of what's developing in science and when new technologies and going to the government and others, including the private funders, people like the WHO, national governments, and saying, it's time to change, right?

[SPEAKER_00]: We know we've always done some things a certain way, and everybody's very comfortable with that way, but actually we're seeing that it's time to do things a little bit differently. [SPEAKER_00]: And all of these institutions are very small sea conservative.

[SPEAKER_00]: They're incredibly risk-averse, [SPEAKER_00]: They lock up resources for long periods of time because it's safer to do that with organizations that they know that have plans that sound very familiar and we're always fighting the last war.

[SPEAKER_00]: So this is at a point, particularly on malaria where all of the new science and tools and technologies are here that suggest that there's a totally different way to do things and it's really hard to convince people to try something new. [SPEAKER_02]: Well, that's a good, that's goes to my next question. [SPEAKER_02]: I guess.

[SPEAKER_02]: over the next, well, I don't know how you guys plan out your timelines, but over the next ex years, two years, who do you most need in your corner? [SPEAKER_02]: And then who have you found are, I guess, willing to operate with you and who has been the most difficult to win over, I guess. [SPEAKER_00]: Oh that's a great question. [SPEAKER_00]: So who do we need in our corner? [SPEAKER_00]: I think more than anything, we need the American people in our corner.

[SPEAKER_00]: We need Americans to believe that this cause is one that's worth their resources, worth thinking about, worth telling their government is [SPEAKER_00]: something that they're comfortable having tax dollars spent on and that they understand we all understand that this is an investment that's going to pay off because we can win if we do things the right way. [SPEAKER_00]: So the support of the American people's number one.

[SPEAKER_00]: Number two, of course, translates into people in Congress and people of the administration. [SPEAKER_00]: We're making sure, giving them advice. [SPEAKER_00]: Can't tell them what to do, but trying to get them to spend the money that we do have on malaria, on the right things in the right place, in the right way, in the right time.

[SPEAKER_00]: And we also then working with lots of our partners, because we don't have offices around the world, have to persuade national governments in a lot of cases that things that they might have done in the old way, maybe we can do a different way, with a new technology, a new approach.

[SPEAKER_00]: And we also need to make sure that we've got innovators and the private sector on our side too, that they believe that this cause is also something that it's worth their time and their investments, that their boards believe it's worth their money to continue to invest in. [SPEAKER_00]: Because let's face it. [SPEAKER_00]: We believe in free enterprise. [SPEAKER_00]: We're all about investment and innovation from American companies.

[SPEAKER_00]: But there are very few people who are going to [SPEAKER_00]: become millionaires off malaria, right? [SPEAKER_00]: This is, in many cases, for companies, this is something interesting that they might make a little bit of money off of, but they're doing it because they're good corporate citizens and they're good scientists and they care about this. [SPEAKER_00]: And they also care about us in the United States, protecting us, but this is not, there's no malaria, ozampic, right?

[SPEAKER_00]: There's no blam. [SPEAKER_00]: Ockbuster jokes from Larry that's going to be then, something that makes a bazillion dollars for some company. [SPEAKER_00]: Companies have to believe in the cause in order to continue to invest. [SPEAKER_00]: and they want to believe that other people are willing to co-invest with them, whether that's government or private philanthropy, or even private individuals. [SPEAKER_02]: Yeah, I mean, it's a good point.

[SPEAKER_02]: Global health is historically been one of the very few things in American politics that has bipartisan support, like a PMI, the presidential malaria thing, and then pep far as another one. [SPEAKER_02]: I can think of several more. [SPEAKER_02]: I could probably look up rather, [SPEAKER_02]: I would say the last 40 years have been pretty tumultuous in American politics, but those global health initiatives have been ever received pretty decent bipartisan support.

[SPEAKER_02]: Is that consensus do you think still intact because it doesn't sound like it is necessarily? [SPEAKER_02]: I mean, I feel, we're just overall we're kind of trending towards more low trust in government over the past couple of decades, but is that consensus still intact or is that something you guys work to rebuild now? [SPEAKER_00]: We're working every day to keep that consensus going.

[SPEAKER_00]: I think it's still there of all of the subjects of all of the fields where you could, the exception of, I think, national defense, where you could think about American investment in engagement overseas. [SPEAKER_00]: Health is the one place left where you've got Republican and Democrats, conservatives and liberals agreeing that this is a good thing to do. [SPEAKER_00]: Not necessarily because it's the right humanitarian thing to do, but it's in our own self interest to do it.

[SPEAKER_00]: And that's what's keeping that consensus together.

[SPEAKER_00]: During the first conversations around Pepphar, Bono, the activist who was involved behind the scenes and publicly trying to rally support for the idea, he used to say that it was the coalition of very strange bedfellows that [SPEAKER_00]: made pet far in PMI politically possible that it wasn't just because you had the faith-based organizations or the private sector or liberal activists all talking about HIV and malaria.

[SPEAKER_00]: It was when you had the church ladies and the generals and the scientists all coming in together that people started to pay attention. [SPEAKER_00]: And that coalition is still there. [SPEAKER_00]: We might not spend as much money as we used to, and that's probably okay. [SPEAKER_00]: We can spend it wiser, we can spend it in new ways more efficiently, we can take advantage of the new tools.

[SPEAKER_00]: But at least in DC, and I think this is the case out in the rest of the country, according to the polling I see, people still believe that international health done the right way is a good thing for us to do. [SPEAKER_02]: Yeah, yeah, I mean, well, [SPEAKER_02]: Excuse me, malaria progress specifically is kind of stalled globally in the last few years.

[SPEAKER_02]: even before the funding shift started to happen before like this is something that's been going on for a number of years now.

[SPEAKER_02]: I'm curious about that because I was reading some stats earlier how much of that is funding and how much is just biology and operations because like 1905 Einstein writes his miracle year papers and [SPEAKER_02]: reforms, gravity, hence, at quantum field theory, can't really figure it out in his lifetime, we still haven't figured we still haven't married the big world with the small world.

[SPEAKER_02]: And that's been the biggest hang up in physics, right, for the last 100 years, while 100 [SPEAKER_02]: what year is this? [SPEAKER_02]: 111 years. [SPEAKER_02]: That's been the most, the biggest hang-up in all of physics for the last century. [SPEAKER_02]: So, you know, some of this isn't about money because we spent plenty of money on it. [SPEAKER_02]: Some of them, that's right.

[SPEAKER_02]: We have also figured out a number of new things we still just haven't reached the one goal that we're kind of looking at. [SPEAKER_02]: So, it isn't always about money. [SPEAKER_02]: Sometimes it's just like [SPEAKER_02]: we're waiting on that one event or that one person to think it have a revelatory moment or whatever it is. [SPEAKER_02]: What do you think it is? [SPEAKER_02]: Is it, is it, is it, in this case, is it funding or are we just waiting on a breakthrough?

[SPEAKER_00]: it's not always fun. [SPEAKER_00]: There are undoubtedly some cases where maybe if we spend a little bit more money, more money we might have done something better, but it's true that beginning in 2015 to now, progress has stalled in a lot in some places, particularly in sub-Saharan Africa, even though we've seen great deal of progress in Latin American Southeast Asia. [SPEAKER_00]: So there is good news out there.

[SPEAKER_00]: That plateauing coincides with increased this every year in budgets. [SPEAKER_00]: So there wasn't necessarily correlation between spending more money and getting better outcomes, mostly because of biology. [SPEAKER_00]: So what are we talking about? [SPEAKER_00]: The mosquito itself, mosquitoes, became resistant to a number of the insecticides that we use. [SPEAKER_00]: So they just weren't as efficient anymore.

[SPEAKER_00]: The bed nets that was one of the great revolutions [SPEAKER_00]: They weren't as effective anymore. [SPEAKER_00]: So we've had to invent new pesticides with new kinds of nuts. [SPEAKER_00]: The parasite that causes malaria has become resistant to the major drug family that's used against it that was incredibly effective for a long long time.

[SPEAKER_00]: There are new species of mosquitoes, or there is a new species of mosquito and Sub-Saharan Africa that came from Southeast Asian, the Arabian Peninsula that bites during the day, for example, lives in urban areas, whereas the regular traditional species of mosquito that causes malaria bites at night tends to be more prevalent in rural areas. [SPEAKER_00]: But even that mosquito is now starting to bite during the day.

[SPEAKER_00]: So you have this almost perfect storm of biological changes where this is very widely enemy of ours or enemies, the mosquito in the parasite are in this incredibly complex choreography between human [SPEAKER_00]: mosquito and parasite. [SPEAKER_00]: And for a while, let's look like the enemy was winning. [SPEAKER_00]: We think the breakthroughs are here now or about to be here that are going to change that scenario for the better.

[SPEAKER_02]: Okay, so what are the tool or breakthrough? [SPEAKER_02]: What's the tool or breakthrough you think? [SPEAKER_02]: Is it a vaccine or a gene drive or an emanator or is it something else that's really going to change the math over the next 10 years? [SPEAKER_02]: Because we're talking about some, [SPEAKER_02]: yourself, Bill Gates, a number of other people, said, we could really end the malaria effectively in. [SPEAKER_02]: You can never get rid of anything entirely, maybe.

[SPEAKER_02]: But you can effectively end it where it's not spreading nearly as rapidly or if it's become low grade and demicrist something like that. [SPEAKER_02]: So what is the tool of breakthrough that you think is going to be the one? [SPEAKER_02]: I mean, I know that's speculative, but I'm curious what you think.

[SPEAKER_00]: Yeah, there's no silver bullet, but you've already mentioned, I'll touch on them briefly, there are going to be breakthroughs or our breakthroughs in every one of those areas. [SPEAKER_00]: So, what we call vector control that is trying to eliminate or control the mosquitoes, you've got new nets with different insecticides that are much more effective, 40% 50% more effective than the ones that are out there in many places. [SPEAKER_00]: That's great news.

[SPEAKER_00]: You have something that, [SPEAKER_00]: has just been rolled out called guardian that's produced by. [SPEAKER_00]: Great Wisconsin company called Essie Johnson and son that's a new tool to ward off mosquitoes, especially in areas where maybe the net's aren't as useful or effective or in combination with nets where you could take the effectiveness of the insecticides up to a whole new level. [SPEAKER_00]: on treatment. [SPEAKER_00]: There's a new treatment coming.

[SPEAKER_00]: It's called Gan Lume that is specifically designed to get around the drug resistance because it doesn't use the ingredient that the harrothite has become resistant to. [SPEAKER_00]: There's also a new treatment called Coartum Baby, which is specifically formulated for very, very small inference.

[SPEAKER_00]: for whom we had no treatment before, as any parent would know, sometimes if you don't have the right treatment, you're using an adult drug and trying to figure out how to break it up into smaller pieces or smaller amounts of syrup or something and that's what doctors and nurses were doing to treat very young infants. [SPEAKER_00]: It didn't work all the time. [SPEAKER_00]: The drug was formulated for little babies.

[SPEAKER_00]: So now we have one that is, that's going to save a lot of lives for sure. [SPEAKER_00]: There are two malaria vaccines in the field, which are pretty good. [SPEAKER_00]: They're not perfect, but in combination with other things, they're definitely starting to bring down hospitalizations and deaths. [SPEAKER_00]: And they're better vaccines in the pipeline that are coming in the next couple of years that might even be able to stop. [SPEAKER_00]: transmission.

[SPEAKER_00]: And then for tests, they're better diagnostics that are also now accounting for this amazing ability of the parasite to evade detection by some of the tests that we have. [SPEAKER_00]: So on every aspect of fighting malaria, there's a new technology.

[SPEAKER_00]: Many of them invented or produced or both here in the United States that are either right in the field today or about to be ready to go into the field that will provide answers to some of these challenges that we were just [SPEAKER_02]: S.E. [SPEAKER_02]: Johnson's making two, one of them is called Mosquito Shield as well, and they're both, I don't know, they're not in trials, but they're in, what do they call it, prequalification stage with WHO for global use?

[SPEAKER_00]: I think is what they got, they got the prequalification. [SPEAKER_00]: That's that's set. [SPEAKER_00]: They got regulatory approval, licensing in a bunch of countries in Africa, and in the United States by the way earlier in the year. [SPEAKER_00]: So, [SPEAKER_00]: We, I keep hoping Johnson is going to sell me one because I'm one one for my back yard.

[SPEAKER_00]: No, no, no, no, no, no, no. [SPEAKER_00]: So those those technologies are here, the State Department just announced a big deal with S.E. [SPEAKER_00]: Johnson and an organization called the Global Fund to fight AIDS malaria and tuberculosis to roll out 30 million of those units in Sub-Saharan Africa over the next couple of years. [SPEAKER_00]: So that's here and ready and licensed and [SPEAKER_00]: We're going to say, then, use this here.

[SPEAKER_02]: I mean, we've used for those who are curious what we're talking about, um, these emanators, I think are just like a bag on the wall or something like that. [SPEAKER_02]: But you've seen some of the ones like thermoscell that have, you know, active, uh, repellents. [SPEAKER_02]: They're not, they don't do anything to the misguida. [SPEAKER_02]: They drive them away, basically, right? [SPEAKER_02]: Correct.

[SPEAKER_02]: And they heat up and they put out some kind of, [SPEAKER_02]: I guess I don't know if it's an odor or if it's a tannin in the air, what it is exactly actually, I have no idea, but emanators have been pretty, well they come and go, right? [SPEAKER_02]: I think that's a good anecdotal example to let the average person know how the fight goes back and forth because, yeah, while

[SPEAKER_02]: they sell the eminator bracelets that give off something I found those to be pretty effective for a very short amount of time now they don't work at all the thermos cells are hit or miss it depends on what kind of mosquito you're dealing with I think that's right but yeah this is like a constant back and forth with these things and we never really know when something's going to stop working to be honest.

[SPEAKER_00]: It's true, and that means luckily, though, that the scientists and even community members, because a lot of this depends on people in communities helping out with this work, are tracking what's happening with mosquitoes all of the time. [SPEAKER_00]: They're checking for resistance, that checking for... [SPEAKER_00]: new developments through the mosquito, whether the insecticides are still working, whether the drugs are still working, where the new species is starting to spread.

[SPEAKER_00]: So it's not perfect, but we have a pretty good idea of where the most vulnerable places are, and that's where I think these new tools are going to have an impact right away. [SPEAKER_02]: We've got some questions in the chat here. [SPEAKER_02]: One of them is just kind of in line with what you just said.

[SPEAKER_02]: How is humver controls the delivery mechanism, getting whatever it is, the emanators of vaccine, two people in these affected countries, Africa wherever it happens to be. [SPEAKER_02]: A lot of them are in Africa, some of them are elsewhere, but a lot in Africa, Brazil, you mentioned Brazil as well. [SPEAKER_02]: Who's is it like the local governments or is it state governments or who is it that you're dealing with?

[SPEAKER_00]: So it depends of course country by country and in most places the general answer It's a national government through what they call a national malaria control program that's working Through public hospitals and clinics sometimes public schools to do the distribution of things like Bednets and we we think eminators coming here shortly for example vaccines where they're available

[SPEAKER_00]: In some places where the government structure looks a lot more like ours, and they're the equivalent of states that have a lot to say about the delivery of healthcare and control money, places like Kenya and Nigeria, the picture is complicated because ultimately it's the state responsibility for doing this, so the federal government can set like ours does can. [SPEAKER_00]: grant money to a state, but the state has to implement.

[SPEAKER_00]: In all of those cases, though, you also have two other actors who are indispensable, faith-based organizations, particularly crew run mission hospitals and clinics way out in the bush, in the field, sometimes in urban areas as well. [SPEAKER_00]: About 40 to 50% of healthcare and most of the sub-Span Africa comes through those kinds of religious organizations, Catholic Protestant, other. [SPEAKER_00]: And they do a lot of the frontline treatment, prevention and treatment.

[SPEAKER_00]: And the final factor, final player in all of this is the private sector. [SPEAKER_00]: Because in the case of malaria, many people around the world, when they have a fever, they presume that it's malaria. [SPEAKER_00]: And the first thing they do is go to a local pharmacy or drug shop, and they'll try and get drugs over the counter. [SPEAKER_00]: immediately rather than weight alignments in some public clinic, right?

[SPEAKER_00]: Pharmacies know a lot about what's happening in malaria and one of the key delivery points for people, because it's just where people are used to turning to first. [SPEAKER_00]: So there's no one answer as to who's responsible, it's all those actors working together that make the coverage as robust as it needs to be. [SPEAKER_02]: Yeah, one of the issues as well with this is that most of these countries have security issues.

[SPEAKER_02]: they have kind of rolled over from Alshabab from North East Africa, a little bit of ISIS, and then Nigeria, Bogob famously Bogob Ram operates in Nigeria and a couple of their offsuits in the Islamic State as well. [SPEAKER_02]: That's got to present some pretty interesting challenges as well. [SPEAKER_02]: I know most of the faith-based organizations from the U.S. that are going over there, are Christian and nature, I'm not sure how.

[SPEAKER_02]: There's a lot of Christians in both Kenya and Nigeria, [SPEAKER_02]: Islamic terrorists, right? [SPEAKER_02]: So it's present some pretty interesting challenges, I would imagine. [SPEAKER_00]: But sure, if you were to map conflict in Africa over the last say five years and the highest prevalence of malaria, you're going to get an exact match.

[SPEAKER_00]: You're going to get Sudan, South Sudan, northern Nigeria, the Democratic Republic of Congo, northern Mozambique, [SPEAKER_00]: This is malaria thrives in conflict, thrives in chaos. [SPEAKER_00]: As systems get disrupted, patients can't go to clinics, drugs aren't getting delivered or bedmats aren't getting delivered. [SPEAKER_00]: People are on the move, interacting with each other, more chances to get bitten. [SPEAKER_00]: That's.

[SPEAKER_00]: a lot of standing water because as you and your listeners know better than anybody, military maneuvers produce a lot of trenches, a lot of ditches, a lot of earth movements that then when it rains collect water, these are the perfect environments for for outbreak some malaria. [SPEAKER_00]: So you'll see an exact match between violence and conflict in Africa and malaria. [SPEAKER_02]: Hmm, interesting. [SPEAKER_02]: We had one other question here and it's not about malaria.

[SPEAKER_02]: It's whether [SPEAKER_02]: as it seems to be or is that media? [SPEAKER_02]: And is it, is it plateaued or going down? [SPEAKER_02]: Because we hear about it along. [SPEAKER_02]: Yeah. [SPEAKER_00]: So I can't tell you exact numbers today. [SPEAKER_00]: I didn't look that up. [SPEAKER_00]: I should have. [SPEAKER_00]: But here's what I can tell you. [SPEAKER_00]: Big picture.

[SPEAKER_00]: of all of the dangers in the world, the biological dangers in the world, the one we should all be most concerned about is influenza.

[SPEAKER_00]: Historically this, more than anything else, is what that virus, is what produces really serious pandemics and the threat of amutation with whether it's a strain of birds flu or something we don't know about yet, turning into something that can be transmitted around the world really quickly from person to person, flu's at the top of the list. [SPEAKER_00]: Well, it's a couple of things.

[SPEAKER_00]: I mean, it's been, whether this as long as malaria has, so it's exquisitely adapted to us as people. [SPEAKER_00]: It mutates really fast, and it's very easily transmitted from person to person. [SPEAKER_00]: So compare it to Ebola, right? [SPEAKER_00]: To get Ebola, you have to have pretty, [SPEAKER_00]: serious sustained contact with somebody who's sick and who's already symptomatic and their bodily fluids flu, you don't need that, right?

[SPEAKER_00]: It's airborne, it lives on surfaces, it's easily transmitted [SPEAKER_00]: multiple times from one person to other people. [SPEAKER_00]: So you have a much, think of it like the measles, which is the most transmissible of any of these diseases that what they call the R number, the R number for measles is the highest. [SPEAKER_00]: But flu is right close to it in the number of people that one person can infect.

[SPEAKER_00]: It's potential for mushrooming, from a relatively small outbreak and going around the globe, is bigger than anything else. [SPEAKER_02]: Interesting. [SPEAKER_02]: All right, well, that's, that's not great. [SPEAKER_00]: The good news is we have vaccines against flu, right? [SPEAKER_00]: We have drugs that work against flu. [SPEAKER_00]: If we know in time that something's happening, it's about back to the beginning of the conversation.

[SPEAKER_00]: If we have transparent reporting, if we can have a trust-based relationship with governments and communities where these things are likely to come from, [SPEAKER_00]: then we're going to have more early warning to develop protective measures for our people sooner and for the rest of the world. [SPEAKER_00]: Flu like most of these diseases, this is something that flourishes where there's a lot of contact every day between people and animals, right?

[SPEAKER_00]: We know where those places are in the world, where there's just [SPEAKER_00]: cultures of animal husbandry and settlement that increase the interactions between, say, ducks and chickens and pigs and people in the case of flu, that's Southeast Asia, that's some parts of Latin America, that's a lot of potentially sub-sarened African India. [SPEAKER_00]: Their places, we have to be watching all the time, and those are the places I'd argue, we need some forward deployment, right?

[SPEAKER_00]: We need some people beyond the wire who can help us figure out what's going on so that we get information fast enough to protect ourselves. [SPEAKER_02]: Sure, I mean, that's an interesting public policy point, but what can the average person listen to this show due to kind of insulate themselves or protect themselves? [SPEAKER_00]: Well, I think the most important point is something that you talked about, which is basically hygiene, right?

[SPEAKER_00]: The rules of protection around most of these things are exactly the same as we've been hearing about since we were little kids. [SPEAKER_00]: We got to wash our hands, right? [SPEAKER_00]: We got to cover our nose when we sneeze. [SPEAKER_00]: We got to be cautious about going out when we're sick, be conscious of how these diseases spread and how they don't spread.

[SPEAKER_00]: because one of the worst parts of any of these outbreaks is the disinformation that can crop up, to prevent people from taking the steps that really protecting themselves versus some other things that maybe aren't doing any good. [SPEAKER_00]: And the other is without being paranoid about it, just keep an eye on things, right?

[SPEAKER_00]: These are the kind of things that it's worth following, what's happening in the rest of the world because of that because we're, as you said, they're close to these outbreaks that are way closer to us than we think they are sometimes. [SPEAKER_02]: Sure, yeah. [SPEAKER_02]: Well, that's good information, and yeah, there is a lot of bad information. [SPEAKER_02]: There's a lot of hysteria and a lie travels the world twice before the truth gets out the front door half the time.

[SPEAKER_02]: So you are in the business of storytelling, as you said, where could people go read, listen to it, et cetera, your story, so they know what's actually going on? [SPEAKER_00]: Yeah, we've got a lot of great stories in material at malariano more.org and we'll have some more. [SPEAKER_00]: We've got a series, for example, that is up in multiple parts about what people on the front lines and in communities are doing about malaria community health workers and families.

[SPEAKER_00]: We've got a number of stories about what your and my tax dollars have done over the last 20 years on malaria through PMI through the President's malaria initiative. [SPEAKER_00]: and we've got a lot of great stories about the science and the new technologies that are either with us or about to be with us. [SPEAKER_00]: Great. [SPEAKER_02]: Well, it's all good public health information.

[SPEAKER_02]: There's one more public health question I have for you, but when we get out of here and it's that, are you aware that McDonald's is bringing back the fried apple pie? [SPEAKER_00]: I heard about that and I had there are a number of members of my family who are extremely excited about this and we are trying to plan for what it is that we can go and we got to find the outlet that has one. [SPEAKER_02]: Well I think it's is a July 26 or June 26 excuse me look it up asshole.

[SPEAKER_02]: What are you shaking your head for? [SPEAKER_02]: type it on the keyboard in front of you. [SPEAKER_02]: This guy over here doesn't know what's John. [SPEAKER_02]: I think it's June 23rd. [SPEAKER_02]: It's when it launches. [SPEAKER_02]: But I don't know if it's in select stores ever. [SPEAKER_02]: It's got to be right where you got it right. [SPEAKER_02]: June 23rd. [SPEAKER_02]: Yeah, don't, don't fuck with me on McDonald's.

[SPEAKER_02]: Um, does it say how long it's going to be available? [SPEAKER_02]: Is it short term or is it just back? [SPEAKER_02]: Cause I, I'm, I'm my understanding is it was just through the mirror two weeks and it's going to be available everywhere or is it, yeah, we got to know. [SPEAKER_01]: It says menus nationwide, but there we go. [SPEAKER_02]: All right, there we go. [SPEAKER_00]: That's still a tight window.

[SPEAKER_00]: I got to get people planning in my family is a difficult subject. [SPEAKER_00]: So we're going to have to do some some chalk talks on this. [SPEAKER_02]: Yeah, I would imagine so. [SPEAKER_02]: And fortunately, it's not going to be ready for Father's Day, which is this Friday or wait. [SPEAKER_02]: This Sunday, excuse me, right, 19, 2021, 21st is Father's Day. [SPEAKER_02]: What the hell, McDonald's? [SPEAKER_02]: That's that planning.

[SPEAKER_02]: McDonald's doesn't care about American families. [SPEAKER_02]: You heard it here first, folks. [SPEAKER_02]: No, yeah, I'm definitely going to have one too. [SPEAKER_02]: For sure, right? [SPEAKER_02]: We should, I think we should do what day of the week is that. [SPEAKER_02]: the 23rd. [SPEAKER_02]: That's a Tuesday. [SPEAKER_02]: 23rd. [SPEAKER_02]: It's going to be a Tuesday. [SPEAKER_02]: Yeah. [SPEAKER_02]: I think I think we do a frying apple pie show. [SPEAKER_02]: Oh, yeah.

[SPEAKER_02]: I think that's what we'll do. [SPEAKER_02]: So if you want, you can just abandon your family and come here to Wellington, North Carolina, you can eat one of us. [SPEAKER_02]: Um, absolutely. [SPEAKER_02]: You got a beach so that's better than why aren't where I am right now. [SPEAKER_02]: It's definitely better than the swamp you're in right now. [SPEAKER_02]: Um, well, look, thanks for coming today. [SPEAKER_02]: It's been a fascinating conversation.

[SPEAKER_02]: Hopefully, people got some information out of it. [SPEAKER_02]: Hopefully, they will go to malariainomor.org and get some more information and stay safe out there and all of that and tell everybody where they can find you and everything else before you get out of here. [SPEAKER_00]: Sure. [SPEAKER_00]: Thanks so much, Melaryna Moore, Melaryna Moore.org. [SPEAKER_00]: We're also on Instagram.

[SPEAKER_00]: We're on LinkedIn and Facebook, all the platforms, and it's hashtag, Melaryna, no more. [SPEAKER_02]: Yeah, great. [SPEAKER_02]: And we do something on Drinking Bros. We don't do on Citizen. [SPEAKER_02]: It's called the Drinking Bro the Week. [SPEAKER_02]: And it is someone who has inspired you or helped you become the person you are today. [SPEAKER_02]: You want to nominate somebody?

[SPEAKER_00]: Yeah, I'm going to nominate a great American former governor of Wisconsin, Tommy Thompson, who was my first boss in mentor, and really one of the people responsible for both pepfar and PMI, and he always believed that we were better off being engaged overseas for lots of different reasons, commercial and security, and he actually made it happen in his life. [SPEAKER_00]: So I owe him a great debt personally, and I think we all do.

[SPEAKER_02]: Yeah, you're, uh, [SPEAKER_02]: Let's see, did your dad ever work with him? [SPEAKER_02]: Your dad wasn't politics back in the day. [SPEAKER_00]: Yeah, he was. [SPEAKER_00]: They knew each other quite well. [SPEAKER_00]: The governor's from the same part of the state as my family's from. [SPEAKER_00]: And my dad was actually in Congress when the governor was in the state legislature. [SPEAKER_02]: There we go. [SPEAKER_02]: Good. [SPEAKER_02]: Well, that's a good history.

[SPEAKER_02]: Tommy Thompson, RIP, died a couple of years ago. [SPEAKER_02]: Well, good. [SPEAKER_00]: No, he's still alive. [SPEAKER_00]: He's still alive. [SPEAKER_00]: He's still alive. [SPEAKER_00]: He's still alive. [SPEAKER_02]: He is still alive, sorry about that. [SPEAKER_00]: I'm getting, I'm getting an angry phone call that I announced his death on your podcast. [SPEAKER_00]: Yeah, yeah, he's still alive. [SPEAKER_02]: I was reading the wrong field.

[SPEAKER_02]: I thought he had read about him. [SPEAKER_02]: He's a military veteran as well. [SPEAKER_02]: US Army, good for him. [SPEAKER_02]: That's a good one. [SPEAKER_02]: Captain, that's not great. [SPEAKER_02]: Officers are great. [SPEAKER_02]: Yeah, personally not a fan. [SPEAKER_02]: Yeah. [SPEAKER_02]: Yeah, but Tommy's a good dude. [SPEAKER_02]: He worked for, he went on to be the HHS Secretary for a good while, right? [SPEAKER_00]: He was there for the first term of George W Bush.

[SPEAKER_00]: That's right. [SPEAKER_02]: For the whole first term, right? [SPEAKER_02]: The whole first term. [SPEAKER_02]: Yeah. [SPEAKER_00]: That's right. [SPEAKER_02]: Yeah. [SPEAKER_02]: That's good. [SPEAKER_02]: And that's when, um, weight did he start PMI then, because it was in 2003, right?

[SPEAKER_00]: So, PEPFARS 2003, he was involved absolutely in the first design and convincing the president to do it, and then he was also involved in early conversations about malaria that then turned into PMI by 2005. [SPEAKER_00]: He was gone, but he had already laid the groundwork and saw some of the seeds. [SPEAKER_02]: I see, well, that's good. [SPEAKER_02]: I mean, that's two of the big ones right there, so. [SPEAKER_02]: definitely props to Mr. Thompson.

[SPEAKER_02]: Well again, thank you for coming today. [SPEAKER_02]: I'm really appreciate the time. [SPEAKER_00]: Thank you. [SPEAKER_00]: Great to see you. [SPEAKER_00]: Great to be with you. [SPEAKER_00]: It's an honor and appreciate your listeners' attention and interest. [SPEAKER_02]: Yes, sir. [SPEAKER_02]: Everybody go check out Bill Stuyer, go check out malariainomor.org. [SPEAKER_02]: It's an information. [SPEAKER_02]: Don't be a dumb dumb. [SPEAKER_02]: And thank you for watching.

[SPEAKER_02]: This has been very good news.