Is the U.S. Ready for the Next Biothreat?

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Hey folks, Ashish Jha here, trying out something new.

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We're launching a new podcast.

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It's called A Moment in Health.

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Coming to you live today from Providence, Rhode Island, where the idea behind this new

podcast is very straightforward.

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Every week, we try to it every week, we're gonna introduce one interesting data point from

a study that has come out recently.

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We'll talk about one study that I think is compelling, has big public health implications,

and then we will answer one question.

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Sometimes I will answer the question, sometimes we'll have a guest.

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Today we have a very special guest answering this question.

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We'll get to that in a few minutes.

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So let's get started with one data point.

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The data point today comes from a fantastic study here from the Brown School of Public

Health, from our colleague Irene Papanicolas, a paper published in the New England

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Journal, The Association Between Wealth and Mortality in the US and Europe.

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It's in the April 2nd, I think, issue of the New England Journal, and it is worth checking

out.

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And here is the key data point for you, which is that the wealthiest Americans have a

survival rate that's about the same, maybe a little worse, than the poorest Europeans.

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Let me tell you why I find that really compelling.

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We know there's a huge gradient between sort of wealth and life expectancy, about 10-year

life difference.

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life expectancy difference between the wealthiest Americans and the poorest Americans.

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But what Papa nicolas and colleagues did was they looked at wealth gradients inside the

United States compared it to Europe and what they find that if you're in the top quartile

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of wealth, the wealthiest Americans, your life expectancy is no better than the poorest

Europeans.

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Lots of explanations of what might be going on, differences in underlying risk factors.

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Maybe in a future episode we'll come back and we'll unpack what exactly explains it.

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but pretty compelling data point.

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Being wealthy is helpful for living a longer life, but bottom line is wealthy Americans

are not outliving the poor Europeans.

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They're certainly not outliving the wealthy Europeans, suggesting that there's something

deeper happening in public health and health systems.

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All right, that is your data point of the week.

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Let's talk about a study.

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Really cool study out this week in Nature that I think is super interesting.

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It's called a natural experiment on the effect of herpes zoster vaccination on dementia.

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It's a study that took advantage of a natural experiment that happened in Wales.

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In Wales, they introduced the zoster vaccine, the vaccine against shingles, and they made

some people eligible essentially based on age.

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Anybody 80 and younger was eligible.

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People over 80 were not eligible.

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And what they did was they followed people over the next seven years to see who developed

dementia.

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And what you might imagine is people under 80 were far more likely to get the shingles

vaccine than people over 80 because people over 80 weren't eligible, people under 80 were.

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But then as they followed people out over the next seven years, what they found was that

dementia rates for people who had gotten the shingles vaccine was about 20 % lower than

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people who had not gotten the shingles vaccine.

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They went through all sorts of potential explanations and ultimately come to the

conclusion that this is most likely due to the vaccination and the impact it is having on

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prevention of shingles.

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So a pretty compelling case for a connection between shingles and dementia.

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Why is this interesting?

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Well, a couple of things.

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First of all, we don't really know what causes dementia.

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With dementia, there are lots of different types of dementia.

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The idea that a chunk of the patients who are developing dementia is driven by...

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shingles or the herpes zoster virus is very, very interesting because it suggests that

there is an infectious cause here.

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To me, one of the most interesting parts of this study is that it blows up this notion

that there is somehow a separation between infectious disease and chronic disease.

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In fact, I think over last 20 years, we've been learning that a lot of things that we used

to think of as chronic or non-communicable diseases actually have an infectious etiology

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underlying it.

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We know that for a lot of cancers, cervical cancer is the most common and famous one.

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We think that there's an infectious basis, possibly for multiple sclerosis, another

chronic disease, and now some compelling evidence that a lot of dementia may be caused by

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an infectious disease, suggesting that we have to stop separating out infectious and

chronic disease and understand that they are probably very well linked.

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All right, so that paper is in nature, worth checking out, and I would suggest you read

the whole thing.

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All right, now moving on to one question and we have a very special guest, Stephanie Psaki

distinguished senior fellow here at the Brown School of Public Health.

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Welcome Stephanie for the first, the inaugural podcast of A Moment in Health.

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you so much for having me.

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It's an honor.

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All right.

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So here's the question.

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You and Beth Hammer had a fantastic piece earlier this week in a magazine called Just

Security, which is focused on national security issues.

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so the question for you.

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is we're seeing all of these cuts in HHS and the health infrastructure of our federal

government.

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I generally think about this as a health problem.

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You think about it potentially differently.

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So the question for you is what do these cuts

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that health and human services have to do with health security, with national security,

with keeping Americans safe?

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Yeah, so we think about preventing and preparing for biological threats broadly and the

types of biological threats that most Americans are unfortunately most familiar with are,

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you know, the COVID pandemic, measles outbreaks, influenza, things like that.

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But there can be threats, biological threats coming from all different sources, naturally

occurring threats, accidental threats that come from a lab accident or intentional threats

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that are from actors who want to do harm to the United States or to America.

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You often don't know where it's coming from, so we just think about preparing for all

sorts of threats and making sure that we're ready for what's to come.

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The thing about preparing for any threat or emergency is that if you're doing it well,

most of the things you prepare for never happen, but you are ready.

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And then when things do happen, you're ready to go on day one instead of scrambling on day

one and thinking about what you need to do.

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So a lot of the critical work, both for preparedness but also response, has been housed

historically.

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at HHS.

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And that is actually, know, some of those capacities are ones that were put in place by

the Bush administration after 9-11, after the anthrax attacks, which was of course a

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deliberate threat, a deliberate biological attack on Americans.

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But those capacities have evolved over time.

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So I think coming out of the COVID pandemic, it's very reasonable to think about

revisiting whether our capacities are working, what else we need to do differently.

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But it's not a time to completely destroy those capacities because

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those threats are coming at us.

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All right, so let me drill down a little bit.

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Makes total sense, we gotta be prepared for biological threats of all kind.

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What does the gutting of HHS, give me a couple of concrete examples of we have cut this

office and therefore we have lost this expertise or capability that's really important in

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this way.

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Yeah, so I think.

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are a few, there are many offices at HHS that play important roles, but a few to focus on

in particular.

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the National Institutes of Health, you know, the world leader in investing in research and

development, the envy of countries around the world that has focused for decades on

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investing in innovation and doing research ahead of time.

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So the research that was funded and happening at NIH is part of the reason we ended up

with COVID vaccines so quickly.

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So you want to be doing that research for decades in advance, really.

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so that you have innovation ready to go.

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You also want to have medicines, know, vaccines, therapeutics, diagnostics that are

available for all sorts of potential threats before you're faced with the threat.

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So FDA plays a really important role in making sure that they are reviewing the evidence

on those types of medicines, approving them, making sure they're safe for Americans,

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ideally before a threat happens, but if not, very quickly when a threat occurs.

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The Administration for Strategic Preparedness and Response

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which we call ASPR, and is likely going to be folded into CDC, has played a really

important role in just anticipating looking at the landscape of threats and making sure

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that we have the tools in our toolbox that we need.

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So that includes medicines, but it also includes things like oxygen and other capacities,

PPE, that we might need if there's an emergency.

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And then of course, CDC, that plays a critical role both tracking threats, so making sure

that we know very quickly when a new threat is emerging.

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communicating to the American public, but importantly working closely with state and local

health authorities so that they have clear guidance and they have resources to respond

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quickly in an emergency.

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Now, if you're in the administration, can't you say, look, if there is an outbreak, if

there is a threat, we'll get ramped up and we'll manage it then.

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Let's just stay on this for one more second.

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Like, what should we be doing now that you think is going to get harder?

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Like, give me two or three things that you think we should be doing now that's going to be

harder to do because of these cuts.

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So I think what you need is a plan that is a clear plan.

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Everybody knows what the plan is and they're ready to act on the plan on day one.

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So there is just, you know, very concretely, you need a plan.

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And with a full restructuring of the federal government and a lot of these agencies, it's

not clear what the plan would be for day one.

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That's doable, but they do need to come up with a new plan.

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You also need financial resources to be pre-positioned and medicines and other supplies to

be pre-positioned around the United States.

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or to have clarity on how you would move them.

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It's very difficult to suddenly get new money and move money out of the states in an

emergency.

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What you need is for them to have the capacity not just to respond immediately, but

actually to be the ones who detect what's happening because it's going to happen at the

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state and local level.

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It's not going to happen at the federal level.

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To detect what's happening, respond quickly and communicate internally within their state,

but also with other states and with the federal government.

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So we need to make sure there are resources.

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need to make sure

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there are people.

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The people are so critical, not just in the federal government, but in the state and local

governments, and they need resources to employ those people.

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And actually 80 % of federal workers are based outside of the DC area.

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So a lot of the people who have been laid off or fired would have been playing part of

this response and the plan.

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Awesome.

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So a reminder that for preparedness, and by the way, the military does this very, well.

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So we often look to them.

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You need a plan, you need people, you need money, and you need stuff.

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I think about during the mpox, outbreak, thank God we happened to have vaccines.

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That wasn't random.

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That was preparedness that allowed us to have those vaccines.

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That made such an enormous difference.

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Okay.

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Stephanie Psaki, thank you for those thoughts.

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Thanks for a great piece.

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Again, it was a piece by Stephanie Psaki and Beth Cameron in just...

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security on why the cuts in HHS are really putting our national security, our health

security at risk.

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Thanks for coming by and thank you all for joining us for the inaugural episode.

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Huge thanks to Benjy Renton and Liz Gallagher who are helping pull this whole thing

together and we will be back soon again with one piece of data, one study and one question

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that needs to be answered.

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Thanks everybody.