Public Health In A Post-Evidence World

[on-hold music] It's Quinn. Maybe you're like me, and sometimes you just spiral out, not just because everything is a lot all of the time, but because some part of you actually wants to do something about it. But, I mean, holy shit, where to start, right? Great news. We built an app for that. It's called What Can I Do? Even better news, it's free and it's fast. It takes just three clicks to start unfucking the world. Visit whatcanido.earth to get started for free.

[on-hold music] [upbeat music] Just because we're done caring about an outbreak or anything doesn't mean the outbreak is done with us. Over the last year, we have watched something unsettling happen in plain sight, the quiet, active dismantling of the systems built to catch outbreaks early, coordinate a response, and keep hospitals and communities from getting overwhelmed. Websites have been scrubbed, teams have been hollowed out, early warning signals have gone silent.

And at the exact same time, diseases that many of us haven't thought about since childhood, like measles, are being let back into the present. Which really leaves a lot of people with the same question, said a little differently than usual. If the safety net is being shredded, what do we do now? Every week, thousands of people ask us the most important question, what can I do?

Every week, I turn around and ask someone who actually knows what the hell they're talking about the very same question, and I've had this guest on three times to do the same thing.

They have already answered it for themselves. They are affirmatively working on the front lines of the future. I am your host, Quinn Emmett, and my returning guest today is Dr. Nahid Bhadelia. Dr. Bhadelia is the founding director of the BU Center on Emerging Infectious Diseases, a board-certified infectious diseases physician, and an associate professor at the Boston University School of Medicine.

She served as the senior policy advisor for global COVID-19 response on the White House COVID-19 Response team in twenty twenty-two, twenty twenty-three, where she coordinated US global vaccine donation programs and helped lead Project Next Gen, a five billion dollar effort to develop next generation vaccines and treatments for pandemic-prone coronaviruses.

Dr. Nahid Bhadelia also served as interim testing coordinator for the White House Mpox Response Team, and she is the founding director and co-founder of Beacon, an open source outbreak surveillance program we talk about quite a bit today, actually.

Today, we're gonna try to make sense of what's being dismantled, what threats don't wait for politics to catch up, what's starting to fill the gaps, and most importantly, what you can do right now to protect yourself, your family, and to help rebuild the public health infrastructure we all rely on, whether we have to think about it or not. Let's go talk to Nahid. [upbeat music] Nahid, welcome back to the show. Thanks for having me, Quinn. As always, it's, it-- That means there's good news.

Someday I just wanna have a conversation about birding and nature photography. I think we should totally do that. Maybe after your trip, that would be great. Yeah. I was gonna say, the number of people who say, "Oh, you're back on the news, that can't be good news." Yeah. I mean- I know. That doesn't seem fair. That doesn't seem... You're such a wonderful...

All you do is try to help. We appreciate it, obviously, not just the hands-on work you're doing, but the communications work you're doing, even if it feels like you constantly have to be reactive these days. We talked a little offline about this, but tariffs, whatever it is, everything is very unpredictable, seemingly done over a tweet or whatever it might be these days, whether it's someone getting named to a position that doesn't require Senate confirmation.

I wanna start at this basic level, how we talk about this stuff, and I'm gonna use one other example. Last month, the US food pyramid was basically reversed, right? Meat, meat and whole milk at the top. Got a bunch of headlines, and if you actually read the supporting documents, there's a bunch of mixed, sort of misinformed guidance.

But at the same time, we know most Americans have never given a shit about the food pyramid, unless, of course, it's, you know, Michelle Obama trying to do vegetables, even if it can actually affect structurally snap, right, and school meals stuff. So this month, reportedly, some staff members in, let's just say, the US health infrastructure as it exists, were maybe told to remove words like biodefense and pandemic preparedness from the institute's website.

Maybe, like everything else, it's gone back or it happens, whatever it is, or it's a different version. On the surface, not great, right? If you apply the rule of sort of this, if this, then what else. But also on the surface, like the food pyramid, it's not a website that gets a ton of traffic from, like, your average American people around the world. But why does it actually matter?

Quinn, I think it matters because it's not the only thing that's happened in my world of pandemic preparedness, of outbreak response, of emerging infectious diseases. It's that tip of the iceberg after, you know, once in a lifetime, let's hope, pandemic, where the very agency that was able to deliver quickly a vaccine that saved millions of lives, it is that very agency that's now being either... We don't know, right?

The, the reports were, uh, this news is, this was shared off the record by a bunch of staffers, and we don't know if it's actually true or not, but even the consideration of it.

In the article that was published by Jay Bhattacharya and others on, in January, right, which kind of frames it this way, which is we are moving away from pandemic preparedness because NIAID had never done anythingMeanwhile, NIAID did 20 years of research that led to the creation of the COVID-19 mRNA vaccines that saved millions of lives.

It is the framing that matters because it is rewriting history in favor of political and it ignores a future where not only is there a risk of spillovers for infectious diseases as we change our environment, climate change, you and I have talked about it in the past, land use, travel connections, all these other things.

But we are, Quinn, at a moment in time where it is not futuristic to think that synthetic biology is at a point where pretty soon it will allow non-state actors to potentially create smallpox-like viruses and release it. CDC had a stock of smallpox vir-viruses, and we think others, there might be others who have it, but there are a limited number of places where a smallpox virus exists and research is done on it.

And all our preparedness, for example, you know, where the vaccines are stocked, how we think about diagnostic deployment, it was all based on this idea that there's only some places the threats are gonna come from. We're now entering an era of biotechnology where synthetic biology makes it possible for others to generate and release it anywhere. Think about the impact that has, and that's just smallpox.

I was in th-this National Academies task force to talk through preparedness and medical countermeasures for smallpox, and it just blew my mind about this idea of what future we're at the precipice of. Other things, CRISPR, already at a place where it could help alter pathogens, you know, make regular pathogens more deadly, easily transmissible, make some pathogens that are already deadly change their profile so they can be airborne or whatever, right?

Yeah, it's difficult to do, but it is not impossible. So in that environment to declare to the rest of the world, "Hey, we no longer care about biodefense, forget pandemic preparedness," you know, and for what? For political posturing? Because, you know, the US is a smart country, yet hopefully there are very smart people in government who are looking at them that and saying, "That's not a good idea.

We shouldn't be telling everybody in the world we are taking down and no longer prioritizing or investing in biodefense and pandemic." Awesome. Ugh. [laughs] Just so everyone knows, like we're doing this to set the tone because you need to understand how... like what is happening with the infrastructure and to, you know, to back up even further, like you said, hopefully a once in a lifetime thing with COVID, hope is not a plan as the screenwriter for Apollo 13 said.

While so many meaningful folks, yourself included, with everything, your entire new center and even the beacon alerts, which by the way, like I subscribe to and I'll open it like a kid's swim meet and I'm sure other parents are glancing at my laptop like [sighs] But so many people have spent the past six years, right?

And of course, all this time before, spent time and political capital arguing for not just better preparation for biodefense in the next pandemic, assuming synthetic biology ever worked out and AI to, to help us build these things or help other people build these things. But also just like, "Hey, look, we should finally give post-viral conditions their due," right? We should finally use wastewater tools in a real way. We should finally

really fund and equitably fund and distribute new drugs and vaccines like the malaria vaccine, right? And things like this. But at the same time, it's really been the opposite direction. So we talked about like m-may or may not happen on this website, whatever it is, and like you said, it's about what else. In the meantime, you've been building this new center. What has ac- You are.

Almost five years old. Good God, time changes. Right. How was that? It's crazy. I have aged one thousand years. I can't imagine. What have you actually seen as part of sort of your day-to-day work- Yeah... with the dismantling? What... Like, if before you're like, "Oh, well, this might happen," what has actually been dismantled so we understand? Quinn's talking about my center, the Boston University Center on Emerging Infectious Diseases.

So it's the university-wide center that does research on public health, data science, and policy related to health systems preparedness from the threat of emerging and re-emerging infectious diseases. Very interesting you should mention what has been lost.

One of the, one of my faculty, Brooke Nichols, actually, we actually helped her fund a program, the Impact Counter, that she's looked at in terms of the impact of the US withdrawal from a lot of public, global public health programs under USAID and the dismantling of that agency. So for those who are interested in that, you can go to www.impactfound- counter.com just to see what has been lost.

Brooke's work shows the impact that's had since the discontinued continuation of funding has caused additional two hundred and seventy-one thousand adult deaths and five hundred and sixty-four thousand child deaths for programs that address malaria, tuberculosis, diarrhea, malnutrition, pneumonia, neglected tropical diseases.

So what that's doing is basically creating a scenario with many of the countries that depended on US funding for some of these basic programs will have health systems that are overwhelmed, doctors that will see many more malaria patients and many more tuberculosis patients may not have the resources for laboratory testing.

So think about that scenario if it was harder to pick out a needle from the haystack, if the haystack is the endemic infections like tuberculosis and diarrheal diseases and HIV, and the needle is that one scary bug, like Ebola, Marburg, something new that you wanna find. It makes it much, much harder to find the needle in a larger haystack when health systems are overwhelmed. So that's partly what's been cut.

I saw a report that said there are about twenty percent of HHS staffing has been cut overall. That includes significant cuts to global portfolio on the CDC side in addition to the cuts that were made on the USAID side. We have withdrawn from the WHO, and that means that all of our proactive planning around emergencies, it makes it harder to do that.

And it's interesting the US withdrew from the WHO and didn't wanna contribute to the WHO, but then I just saw a reporting that the Trump administration is recommendingRegenerating something that would be the WHO equivalent would, you know, cost two billion dollars, right? [chuckles] Talk about loss of efficiency. All of that withdrawal was partly made under this sort of like political posturing that W- being part of WHO takes away from our sovereignty. The WHO does not tell countries what to do.

It is a technical partner that br- is a convening board that brings people together and makes recommendations and creates channels of communications between regions and countries which may not otherwise be able to do it bilaterally. We were able to receive data on China, Russia, you know, through that collaboration, through that sort of like multilateral platform. So that's another thing that's lost.

But then the bigger impact, I mean, is that we've created chaos not just abroad, but also here in the US. The questions about the support for STI, the sexually transmitted infections laboratories here, and some of the work we do with WHO on influenza strains, right, HIV funding here in the US.

The impact on our US public health is not just through that funding or the cutting of the HHS staff, but also what we've seen from the HHS in terms of messaging and gutting of the evidence base around vaccination, which is... blows my mind. How did we get here as a country where we had eliminated measles, you know, decades ago, and we have had over t- almost twenty-three hundred cases in twenty twenty-five and are nearly close.

It's not even the end of February when we're recording this, Quinn, and it's like almost a thousand cases already two months into twenty twenty-six. And we have a advisory committee on immunization practices that was vetted by Secretary Kennedy and replaced with members by this administration who are part of the anti-vaccination arm of disinformation and misinformation around vaccinations in this country.

It's comprehensive. It's a lot, isn't it? When you stand back and look at it, like you said, we definitely still... Aside from the brain drain, which I know you've thought about and is pretty comprehensive in every version of- Yeah. Yeah. Seriously. That's just operational public health. Yeah. Mm-hmm. Right. [upbeat music] Okay. So I wanna tell you all about one of my f-favorite tools I have.

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[upbeat music] The point is institutional knowledge, people who give a shit that are still there, haven't been replaced, can't replace, whatever it is, it can feel and it can be comprehensive because whether we're talking about at home or abroad, and as you always say, you taught me the most obvious thing in the world, pathogens do not respect borders, kind of like carbon emissions.

Whether it's underfunding or ignorance or intentional dismantling, it's not just posturing, and it's very easy for us on a superficial level for folks who are not in this to, to focus on this, right? The CDC, and I'm gonna probably get parts of this wrong, I think they issued six health alert network notices in all of twenty twenty-five.

So for people who have no idea what that means, don't work in public health or maybe on the receiving end at a hospital, practically, can you explain what we lose when an early sy- early warning system like that goes quiet? What does silence look like at the regional hospital level? I spoke to that reporter who did the study on that actually as well, and one of the things they said was, you know, it's hard to know what is, like, year-to-year just frequency.

But then I looked through, and I looked at things that I would have expected a HAN from the CDC on. Certainly the measles outbreak, like last year. They should have been a HAN on that, right? Yeah. The big infant formula recall that's going on because there was a contamination of some of the infant formula brands globally with Bacillus cereus, which is a bacteria that comes from one of their source suppliers for a component that they use.

So a single source supplier that's supplying a bunch of folks. I would've just wanted to see that 'cause ki-kids, we don't generally see kids with those diseases, right? But I would've wanted as a clinician to be given a heads-up to say, "Hey, this is what it could look like." I didn't-- We didn't see that. So what the Health Advisory Network alerts areAnd they can be like, "Hey, just an FYI," versus, "Hey, be on the lookout. This is increased risk." Sure.

Provide clinicians and hospitals with guidance about what to look out for, how to access resources, how to take care of patients when they present from an infection control laboratory and clinical perspective. The heads-up is a way for the public health authorities to increase their eyes and ears on the ground.

And the, my understanding is that part of the reason the HAN, you know, I don't know why the pullback happened, the number, but I'm guessing part of the reason why is because twenty percent of the HHS staff have been cut, right? If I, I don't know actually. [chuckles] Right. Yeah. Whether it's direct or indirect, right? Right. And whether it's direct, intentional, indirect, unclear. I will say there are still incredibly dedicated...

You know, I, my limited time in government, I gotta tell you, I, I was just so impressed with so many people who work in government, these career scientists who, like, will never look for recognition, who do this inside out, and who are still working to this day so hard to maintain science and evidence and effective public health, you know, as much as they can.

So I do wanna say that it's not all of CDC, but CDC's been gutted, and there's a concern about the political influence of the White House on the CDC. The first time we ever spoke, I, all I could imagine, you know, is you having completely lived this parallel experience of interacting with these things that are usually only in movies because we, quote-unquote, "beat measles and polio and these things." So when I

read either the statistics or these personal stories about measles happening more now, where, like you said, we are just blowing by the twenty twenty-five record here, right? Kids hospitalized all over South Carolina. We might lose our measles elimination status for the first time in, like you said, thirty years or something. When you read these personal stories, for someone of my generation, I'm a thousand, but

at least got their MMR as a kid, and maybe hasn't even thought about measles since. Maybe they have kids now or they don't. Whatever. What do they need to understand about the infrastructure of this moment? Why is South Carolina happening the way it is? Why are we already so far past the twenty twenty-five cases, besides viruses are gonna do what they're gonna do? Yeah. I think there's been a...

Even before COVID-19 pandemic, you know, in twenty nineteen, the WHO ranked vaccine hesitancy as a top ten global health issue concern. So this has been ongoing for a while. It's been accelerated by the COVID-19 pandemic. It's been politicized and, you know, and now we have an HHS secretary that has a history promoting anti-vaccination narratives.

What's happened in that period of time is basically organized anti-vaccination groups in this country that are targeting communities, that are wellness influencers, un-under the umbrella of wellness influencers, if you will, and others. Like, everywhere. It's pervasive. It's organized. There was some figures after COVID about how much money, you know, I, I think some of those places made, and it was insane.

But it's translating into parents exempting their kids in more and more states from vaccines. Many of the states have gotten rid of non-medical exemptions, but not all. Some states have made overtures and tried to sort of reduce barriers even to getting parental exemption.

Texas made it so last year they had a bill where you can download the exemption forms easily and email it to them, like, you know, to make it much easier for parents to exempt their kids so they don't need vaccination to go to public schools. And so private institutions may still ask for it and, you know, and I... So it's unclear. Like Ave Maria University, for example, in Florida, there's another outbreak that's happening.

They actually say many of their, but many of their, they have high levels of vaccination. But what happens when you have so much disease is even those who are vaccinated, even though they may have milder disease, may get infected. So the unin, the unvaccinated are getting the brunt of this in terms of it's more severe disease, hospitalizations.

But because there's now so much virus, because it's been accelerated, we don't have herd immunity, which is where herd immunity really, you know, came from. We have an acceleration. I would imagine there is some intersection. We wrote an article, I wanna say about six months ago, about how there's this intersection about this cutting back of public health resources on public health people.

Think about communications for health. The, think about laboratory access to state departments for testing for measles, you know, if it's not available. Think about where the outbreaks may be happening. In Texas, for example, not the South Carolina case really, but for the Texas case, part of the issue early on was many of those who were getting infected were farther away from testing facilities, and so it accelerated.

In some cases, you hear stories that people are not coming to care 'cause they don't wanna, you know, share that they got the virus for whatever reason. Sure. So all those factors, multifactorial vaccination, I will stress again, two-dose vaccination is, you know, over ninety-seven percent effective in reducing your chances of severe disease and death and probably also actually reducing your chances of infection.

It's not completely, but, you know, reducing your chances of infection. We keep coming back to communications, and obviously that's been an issue for two thousand years. It's just now at scale, right? And it has become very... We've almost had to flip our instincts of what to believe on online, right? From content creators, whoever it might be.

This, like you said, this entire MAHA movement of which, you know, the leader may become the surgeon general, which is an, like an educational position foundationally. There was a piece in The Atlantic written from the secondhand perspective, what happens to a family when an unvaccinated child contracts measles. It is pretty tough to read. It is pretty necessary to read.

But I bring it up not just in the context of all of your lifetime work, but also these past years and your brief time in government and these failures of publicHealth communications, directly or indirectly, from Hans to your, you know, y-your beacon emails I get. Half of them I'm like, "Didn't know that existed. Now here we go." I bring it up because, like in COVID, when people said, "It's just the flu,"

or, "It's not as bad as this," one of the failures of public health communication has been making the disease experience real for people who've never seen it. And they've never seen it 'cause we put such effort into beating these things. I think I might have told you in one of my conversations, my best friend growing up, his mom had polio and was on crutches. And

I didn't understand any of the macro of that until much later, and then realizing, oh my God, she was like one of the last ones, right? How do you think now about this, we can call it communications or storytelling, how do we make people feel the weight of these diseases that, again, at least in the global north, they have been protected from their entire lives? What do we actionably do to do that?

Well, what you're referring to, if you-- with my experience, as you know, is most of my work in Ebola treatment units. Like, for good God, a decade ago at this point, I was in Sierra Leone, and I was deployed a few times, and I served as an Ebola treatment unit physician.

And one of my lessons coming out of that was just the horrific way that we were losing our patients because of not enough resources coming to the ground in time. But also how easy it was for people to humanize patients with Ebola, dehumanize patients with Ebola, right? It's interesting to me how over res- overly responsive and, like, dehuman- dehumanizing the response was to Ebola, othering patients with Ebola. I know, like, the blood coming out of everywhere.

Most of these patients just look like they have, like, severe septic shock or diarrheal infection, right, diarrheal disease. And then when you look at something deadly like measles, which is everywhere, people are like, "Eh." You know? [chuckles] Like, which is, yes, it's a much higher mortality with Ebola. Yes, it's something we're not experienced with, but part of that is the priming that's been done by those who are anti-vaccination in this country that's made people immune to it.

And the places and opportunities where I see potential areas of, you know, input is that you still have a lot of studies that show people trust their clinicians. I'll tell you two stories that parked recently that scare me from that. A medical school somewhere, I, you know, that basically was seeing increased number of incoming medical students who are asking for a vaccination exemption. Medical student

going into medical practice, and yes, it's a small number, right? But, like, it would, like, wow. And then another scenario in a state where there was a, you know, the federal government does not, you know, recommend COVID, I think, for everybody. And so a clinician, based on state recommendations, made a recommendation for a COVID vaccine, and the nurse refused to give it to the patient despite the physician prescribing it.

So we gotta look inside our own house within the medical world here in the US as well to look to see how we are better communicators. And I think that requires something at our education level, where so-- we have to sort of, like, work with our own community. We have to include this in the curriculum. We have to teach clinicians, nurses, and PAs and doctors how to talk about vaccination and effectively counsel patients, and that's an opportunity that I see missed, and we need to do better.

I think the professional socie-societies are stepping up a little bit on it. It has to be systemic, and it has to be something we work on. Opportunity number one. Opportunity number two, humanizing a disease, as you said. One of the best ways it could be done is by people who lived through it. I think some of these narratives that are coming out of, you know, parents who've gone through illnesses in their kids are important because ten is a number you can wrap your mind around.

You know, a hundred is a number you could be like, "Okay." A thousand already becomes a statistic. But one, the power of that one story is probably bigger than me telling you that we've already had a thousand cases of measles in twenty twenty-six. And I... Those are powerful narratives that we need to promote, and I don't know, you have a platform. You should invite someone who's had, like, you know, found measles in their family.

I come back to, you know, again, we talk about how direct some of this may be, how indirect some of this may be, from your Project 2025s to the complete defunding of public health departments in certain places or bans on masks, you know, this, whatever it might be. And I just, again, think about how we talk about things and how we normalize things. On the one hand, I lo- I really loved John Green's book about everything is tuberculosis. It's, he's...

Those two guys are such a model. They've done such an exceptional job. Congratulations to them. Literally, I'm just opening up their long, like, decade-long effort to open this hospital in Sierra Leone. They said, "We're gonna... There are gonna be a thousand births here in the first month," which is incredible. [upbeat music] I'm gonna tell you a little story here.

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Again, it's right there in your show notes. It really is the future of reading. I can't recommend it enough. Probably the most essential thing I use every day. Check out Reader today. [upbeat music] But on that note, again, to personalize things, we talk about how compared to other global north countries, our maternal health statistics are not great.

And there's been some back and forth about how we measure them over the past year or so. Still not great. We don't-- We're not out of it, especially, for example, Black women, which is so much worse. And I had this really great guest on, a woman, her name is Kat Bohannon, and she wrote a book called Eve. It's like how two hundred and fifty million years of evolution were driven by the female body, vice versa.

It's fantastic. It's funny. She's amazing. And she talks about how uniquely bad Homo sapiens in specific, specifically is at childbirth, compared to not just other animals, but also other mammals, right? How dangerous it still is. And again, we can give these statistics, but it's difficult to wrap your head around until you have either experienced it or watched, for example, like I did, your wife like bleed out from this emergency C-section and go, "This shit happens all of the time."

Yeah. And I think about, you know, now, which probably you and I growing up would have thought was crazy, but like the, you know, the skulls on the packets of cigarettes and things like that, what it took to do that or to show these pictures of what it looks like when people have these diseases. But they are the things we have to do. Like you said, having someone on this show who has experienced measles or lost someone to it, right? Look at what the, the HIV movement did in the '80s, right?

What's their famous phrase? They would bury people in the morning, march in the afternoon, you know. Yeah. Just incredible. Throwing blood because they were like, "What else is going to move the needle here?" And you wish it didn't have to go to those extremes. Meanwhile, like you said, most people still trust their clinicians. The person nominated for surgeon general said, "Trust yourself, not your doctor."

This is not fringe anymore. It is the leadership. She would not be the first one. Personally, how do you process that as someone whose life work is protecting people from infectious disease? And then I wanna move more into sort of the action, but I wanna understand how this affects folks like yourself. One of the things that personally hits like so hard is like when you try to speak out about these things,

the, just the ridiculous sort of like pushback of like, "Oh, you must be getting money from vaccine manufacturers." No, man. Like not only do I not get money from vaccine manufacturers, I make sure I have no stocks in vaccine manufacturers, right? Like I talk about the importance of pandemic preparedness. "Oh my God, you must be creating bioweapons." I don't even work in the lab. I'm a clinician.

Like the last time I was in a lab, I think I was like a second-year resident learning to do a, do a buffy coat, create a buffy coat or something, right? Like that is the extent of my laboratory experience. Yes, I backed up a medical response to important, you know, biological research in a university setting, Boston University, that does not do bioweapons research. It is, it is, it is... That is an open research where all the protocols are presented in a public setting, in an institutional work.

I, I'm saying all this stuff because the part of any response to this chaos is the other side just throwing baseless claims around, you know, which is are like, you may be, I may be making my, my money on it. How do I process all this? I mean, I'm looking at, thinking about Casey Means in particular, right?

I was just talking to somebody about this today, which is like the biggest, the most powerful role of surgeon generals is this bully pulpit that they have regarding public health communications. And when you look at the power, you just talked about smoking, like the power that the surgeon general had during that whole tobacco study with the linkage of supreme health or not.

The recent surgeon generals have talked about gun violence and mental health. Yeah. Who do you want in this moment where there is chaos in public health who can speak with confidence? Casey Means finished her medical school, but she actually didn't finish her political training, and she's not a practitioner clinic, practicing clinician, which would be a departure from other places.

If she was talking about evidence-based medicine and she was pursuing things in a way, I... In this moment, I will take anybody who bases their questions in real-- you know, like suggestions in reality. My biggest concern would be the promotion of pseudoscience from that pulpit rather than what is needed in this moment. Do you see this division of like choose your own adventure public health advice at this point where professional societies are still holding on to these evidence-based things?

Federal government is suggesting something else when it comes to vaccination. States are doing something else, right? They're following the professional societies. It's creating confusion for patients, for parents, and to what end? My goodness. Mm-hmm.

To what end most Americans believe even when both sides, I mean, it is a minority of the Americans still, you may not believe me, but take a look at the statistic, the recent polls, minority of the Americans believe in some of this anti-vaccination stuff that you're hearing. In COVID, yeah, it was a lot more for childhood vaccinations. There's strong support on both sides of the aisle for that.So it is to cater to a fringe that is supporting the assistant secretary and the movement.

And the thing is, there are things about the MAHA movement that are like, I think are worthwhile looking at. Like looking at, you know, like- Sure... coloring, food coloring and, you know, sure. Like let's look at the safety of food. Let's talk about, you know, fast food and how it's unhealthy. Abso- Hundred percent... you know, like there's definitely like clearly, yes, physical health. Absolutely.

I mean, maybe don't go in a sauna with a gym, like a jeans on, but other than that, like physical activity is so important and- Yeah... absolutely we need that as part of health. It's actually improves immunity, impro-improves like the response to... You know, as a longtime runner, I will tell you, like when I'm running, when I'm healthy, I feel better able to beat odds. Hundred percent. Hundred percent. I have a friend on my run to save me from Ebola.

Like that- No, uh, but at the same time, like without becoming like another version of conspiracy theorist, we do have to look at it and go, but we can't let them use those legitimate things as cover to also reduce childhood vaccination, you know, infrastructure basically. Yeah. It's not an either/or, man. No. It's not either. It's not. It's not. So you talked... You, you briefly mentioned some of the states doing, right?

So now we've got these regional consortiums of states forming to at least share public health intelligence. Caitlin Rivers at John Hopkins has her own clinical newsletter. You get independent disease reachers. Again, you got m-my beacon alerts. What else are you seeing in terms of as much as it can seem fractured to people who grew up with CDC and NIH and these things as being the gold standard, what are you seeing in terms of people and institutions stepping into the gap?

And can that be enough for now? Quinn's referring to a program that's based at my center called the BU Center on Emerging Infectious Diseases, of which I'm the director. Something called Bio Threats Emergence Analysis Communications Network, BEACON, partly also 'cause we're based in Boston, you know.

What BEACON is, is an event-based informal surveillance where we have a network of subject matter experts that are part of our staff who are based in thirteen countries that look at incoming signal, either from online or they're getting from public health partners or they're seeing in their own region.

And we developed a large language model at Boston University with my center assisted in, in terms of training, which then they use in their workflow to extract main information like we do a lot of the chat bots that are commercially available. The difference is that ours has been trained specifically on infectious diseases. So that one generates, extracts the information, gives us a draft to work from. We then verify those signals on the ground.

We talk to public health partners. We talk to l- regional stakeholders. We do digital investigation, and then we make decisions about what to publish. What you see on the BEACON website, which by the way is beaconbio.org, is about, you know, six to ten break responses that we highlight that are happening globally that show something of importance that's gonna affect public health response or a clinical response or a changing pattern we need to pay attention to, like chikungunya, right?

All of a sudden locally transmitted at high levels, which is a mosquito-borne disease that we'd never seen in, in like southern Europe becoming a big part of... gonna be probably a big part of their like summer seasons from now on in terms of burden. We're seeing it here in New York, it's now a locally transmitted disease. We reported on that. So things that like matter.

So certainly our own efforts, we didn't design BEACON as a response to what's happened to global health surveillance, like in terms of retraction from the US. We just happened to be there at the right time. [chuckles] We started actually building BEACON about a year and putting our team together about a year before the elections happened.

But what's happened in this period of time is you've seen this gap w-that for free resources, BEACON is completely free resources that not only share with you what's going on around the world, but tell you why the context, why, what the context, why does it matter? What could be... Is it bad? Is it could be bad? Is it not that bad? Do I n- do I need to worry? Nipah is a great example of this. There was a Nipah virus outbreak in West Bengal in India.

There was all these media stories about Nipah virus and oh my God, COVID, you know, level like transportation restrictions, and we put out a report saying it's low risk. So in some cases we see our responsibility as like really s- level setting the public- Sure... sort of this stuff. So aside from BEACON, and you mentioned Caitlin, PopHive is another group at, at Yale led by Anne Sink.

More communicable and communicable diseases data within here, within the US. They present data that a lot of it, there is a lot of CDC data sets have been taken down, and so they help with that. Michael Osterholm's work at the RED Center on Infectious Diseases Policy and Research, they want something called the Vaccine Integrity Project that looks at evidence-based for the vaccines, releases policy briefs as well as educational materials and response to ACEPs.

Brave of them to sign up and [chuckles] to speak during those committee meetings. A lot of these are the background to states to be able to make those decisions.

Of course, the states themselves, the consortia on the West Coast and, and here in the w- and the East Coast, and a partner that we just started working on at with, at SEED, which is the public, the Governors Public Health Alliance, which is twelve sitting governors thinking through public health issues and coordinating across these different things. So to your answer of is this enough, it is not enough. We need a functional public, federal public health infrastructure.

We need to be able to go back to something, and I'm a little worried about what happens even if we have a new administration, you know, in twenty twenty-eight onwards about bringing back everybody we've lost, the intellectual capital we lost of all this government science- Sure... all the CDC folks.

I'm concerned about all that institutional memory that's been lost and what will happen and how we'll recover from all the broken trust globally, all the withdrawal of like, you know, all the infrastructure globally. It will take a long time to rebuild.

It will, and you're not, certainly not the only person who works or ha-has worked in federal, state, even local government, civil servants of every kind, who has been very direct with me about that, which is-A lot of these folks are just not gonna come back no matter what you offer them because they've been a part of this, and they've seen how toxic it can be.

As much as, again, there's incredible people that somehow are still there or have chosen to stay, whatever it is I wanna focus on what people can do, and we really try to, if we are reacting to something that is pretty comprehensive, directly or indirectly, long in planning or something like MAHA that is an evolution of a thousand other things, feels recent, sort of soup to nuts.

Let's start with these basics, and again, like see your doctor, trust your doctor, but what should every person and family be doing right now on the health and preparedness front, knowing that they are their own version of a nuclear family, whatever that means, but also a part of, quite literally, public health, checking vaccination records, seeing what's in their community? What can they be doing on sort of an ongoing basis, not to freak out, but to do their own part?

More important than ever, make sure you reach out to your representatives and senators and tell them what's important and that you'll support evidence-based sort of public health responses. The other part is like, yes, it's hard to find reliable resources, but professional societies have really come out on top in terms of taking leadership and guidance around some of these things, like the American Association of Pediatrics and, you know, and others.

Asking your doctor, I mean, that's exactly where you should look. But being a messenger yourself, once you've educated with that, like speaking up and saying, "No, you know, I, I vaccinate my kids. I, I think it's safe," and being a voice in your community I think takes a probably a little bit of courage in this environment 'cause you have no i-- you don't, just don't wanna pick any fights.

You have no idea who lives in your community. But like, honestly, that's the little amount of bravery that would go a long way. Normalize what is the majority view, you know? The other things that, that I would sort of talk about is, you know, I looked at the...

In these dark times, and I think a lot of people will agree, and you don't, you know, it doesn't have to be whether you're in politics, but the, the Mamdani win in New York, one of the key features of that campaign was how positive it was, and just focusing on that part, like focusing on their methodology, not necessarily like whatever it is, and how much it was about caring about the community.

And this one message that I'm taking out of that is that rather than you and us and them and, you know, like... And I say this to myself too, I need to do this. After an entire hour that we spent, Quinn, you and I complaining about what others are doing, that maybe in the end we need to focus on what is the end goal, which is really the safety, the health of our communities, which I think everybody can agree on, which everybody can come together on.

And how do we build a coalition out of that in a way that I saw a lot of successful sort of campaigns do. I, I think I've told you this before, but very early in COVID, my son, who was, I don't know, at the time six, seven, I don't know, his little best friend in Los Angeles was one of the first kids to have a birthday and was told, "No, you cannot have a party." And we're talking to the parents that live right down the street.

We were like, "Okay, we're gonna stay on this side of the driveway. You guys stay on the way on the other side. Let the boys actually just see each other. They're not allowed to throw a ball.

They're not allowed to do anything." And the mom, she's out there, again, this is very early on, a-about the virus. In that moment, I remember her saying, "Not through me. Like, you're not gonna get this through me." And that is so important and defiant in such a positive way, not just like I vaccinate my kids, but whether it's, again, viruses or disinformation about them or anything else, to say, like, "I'm, I'm not gonna be a carrier of this. I'm gonna stop it right here." Yeah.

Th-that is really meaningful 'cause like you said, yes, it sounds crazy to have to normalize the thing that most people statistically agree with or believe in, whether it's climate change or vaccines or whatever it is. But you do have to take that stand, and it seems crazy, but guess what? We gotta do it. Sorry. It's like my kids every time. Mm-hmm. My kids are like, my kid's like, "But I washed my hands earlier," and I'm like, "Great.

That's great for you. Go do it again." You know, just say like, "I'm gonna go ahead and stop this right here, and I'm gonna be vocal about it." And that can go a long way, and it can actually help with herd immunity, right? What's on the positive side of this? I know that's hard, but I do wanna leave people with this.

My friend Amanda Litman, who runs Run for Something, who specifically recruits and trains progressive candidates under 40 at the state and local level, talks about... She, she's very honest and candid about this stuff. In our conversation, she was like, "Look, everything's in ashes, and you gotta come to terms with that, and then we gotta go to the other side." Like you said, a lot of these folks aren't coming back.

Some of these institutions aren't coming back. W- It's time to start planning, like, what is on the other side 'cause we're gonna get there in one way or another. I don't wanna say what gives you hope, but what's on the other side for you and your work in public health?

I could talk about something personally, right, b- before I even talk about work, which is in this moment of, like, being shell-shocked with everything that's going on, we haven't even started talking about the psychological impact of what's going on in Minnesota on the rest of us America, like- Yeah... what is happening, right?

I mean, but in these moments, people don't just sort of turn off the TV, and I think what I've seen, and I've seen this in my case as well, is that kind of forces you to be local and here in your life. And for me, that's meant, like, all of a sudden creating relationships on my own street in my own neighborhood that I never thought.

Like, all of a sudden on a street starting a conversation and then ending up in a group of, you know, neighbors last summer just having a conversation about, like, what is happening and what can we do. These local connections that are happening 'cause as people are looking at what's happening in Oregon and saying, "To me, that's a positive life." I mean, that would never happen if the world was all right, right? No.

And we don't want the world go back to being all right. But, like, the power of connecting to your every day with the people around you I think has the ability to get us to the other side. And what's on the other side is hopefully unlikely. You know, this whole scenario's shown us how vulnerable things that we thought were completely solid-Can be ability to identify how we create guarantees doesn't happen again.

I hope that's partly what happens where we can't dismantle the entire public health future and/or also a conversation about unlikely partnerships between private sector communities, you know, professional societies like these people who have been charged up now have been activated taking tho- that energy so that it's not passive recipients of energy, but like active coalitions and even more so I think this was happening before, but even more so now that all this energy has been generated for greater common good.

I love that whether again, the common good is, is in your kid's school or if you're a teacher at your school or your community, whatever version again, and you know, American and again, parts of the global north have been going through this transition of a lack of third places for decades, right? As church pros and cons has gone by the wayside, all these things. That doesn't mean we don't lose something, right? If we can

get to know one another in a way where again, we've, we're more connected but less connected than ever before. When something like this happens, again, it becomes more difficult to put your head in the sand- Yeah... on a proactive or reactive way because you know those people now, right? Which like you said, is maybe something that wouldn't have happened and certainly wasn't trending that way, but maybe that's something we can make of this, right?

Maybe it starts to make us more resilient than we even were before at that level, and maybe it can grow. Yeah. From your lips to God's ears. Last thing. Are you reading anything these days that has nothing to do with germs and viruses? You think if I just picked up the tuberculosis book that you just mentioned, Everything is Täuber? I'm gonna read it. I'll let you know on the other side of my flight. It's really great.

I made my thirteen-year-old read it because I was like, I think it's really important to start to understand like, not again, not just like this personalization of tuberculosis, but when a great storyteller is armed with something like, "Hey, here's this thing we've known what to do with for a long time, and here's all the reasons we don't do it, and here's what happens when we don't."

That storytelling, that communications really matters, right? Thank you as always for everything. I really appreciate it. And one day we'll, we'll meet up. Last time, almost. Almost here. We'll, we'll do another event together then. Ah, it's always... Get your beacon alerts, open them in front of other parents, normalize talking about things that are probably never gonna affect you, but they are affecting other people somewhere, and the more we pay attention, the better.

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