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One of the most galling examples of inequity in America continues to be the stunningly high rate at which Black mothers die in pregnancy and childbirth and Black babies die before during their first year of life. Abdul reflects on how structural inequity continues to take mothers’ and babies’ lives. Then he talks to Rep. Lauren Underwood, Chair of the Black Maternal Health Caucus and sponsor of the “Momnibus” package to eliminate these disparities.

Transcript

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Dr. Abdul El-Sayed: Pfizer submitted its COVID-19 vaccine to the FDA for emergency use authorization for children aged six months to four years. A new variant has emerged and it may be more transmissible than the original Omicron, but scientists don’t believe it will cause another surge. Billionaire Mark Cuban launches an online pharmacy for generic drugs, and President Biden relaunches his cancer moonshot. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. There are few moments in life as singular as childbirth. For the parents out there, you know there’s no moment that changes you as suddenly as meeting your new child for the first time. It’s a rush of joy and gratitude, excitement and responsibility that fundamentally changes you. For a long time, though, giving birth was one of the most dangerous things a human could do. That hand off of life from mother to baby too often failed. One or both, mother and baby, wouldn’t make it through. It took millions of mothers’ lives, right in their prime, and if they lived too often, they had to bury their infants before they even had a chance at life. For the past couple of weeks, we’ve been planning to have a conversation about this relationship between mother and baby, and how even in 2022, there’s a lot of work to be done to protect it. I had the privilege of interviewing Congresswoman Lauren Underwood on this topic about two weeks ago, and you’ll hear that interview later on in the episode. But after I sat down for that interview, a tragedy too close to our hearts and too close to our topic today occurred: our friend Tommy Vietor, co-host of Pod Save America and Pod Save The World, and his partner Hannah, they just recently lost their daughter, born at just 24 weeks. First, I want to say our hearts go out to them and so many others who suffered a loss too profound to fully describe in words. When Tommy and Hannah shared this news with the Crooked family, they asked that we get out the word about a handful of groups in the Los Angeles area. There’s Baby2Baby, a L.A. nonprofit that provides children living in poverty with diapers, clothing, and basic living necessities; the Star Legacy Foundation is a nonprofit organization dedicated to reducing pregnancy loss and neo-natal death; and Baby Quest Grants, a nonprofit providing fertility grants to those who can’t afford costly procedures like IVF and egg freezing. All of them are fantastic organizations doing great work. If you want to show your love for Tommy and Hannah, please do support these groups. We’ll have the link at the end of the episode and in the show notes. As I reflected on the conversation I got to share with Congresswoman Underwood, I’m drawn back again to how close maternal and infant mortality are to so many of us. To me, it’s also personal. Somewhere in Alexandria, Egypt are buried in aunt and uncle I never got to meet. They too, died in infancy. My grandmother carried the scars of those losses through her whole life. My father, their eldest brother, remembers their passing vividly. It’s something he can’t really discuss without tearing up. Right here in America, in 2022, through the death of a mother or infant at that tenuous moment is thankfully rare, but it’s far less rare if you’re Black. Black people die in pregnancy or childbirth at three to four times the rate of their white counterparts. And even if they make it through, Black babies die at two to three times the rate. It’s shameful that in the richest, most powerful country in the world, race and misogyny and the persistent legacy of injustice against Black people in the forms of slavery, segregation, and compounded structural and institutional discrimination, continue to threaten the lives of some of the most vulnerable people we have. In a high-income society like ours, childbirth shouldn’t be so deadly. It shouldn’t be deadly at all. And the fact that it still is for so many Black people should be a stain on our moral conscience. But there are leaders around the country who are working on solving it. I’m proud to have had the opportunity to work alongside incredible Black women leaders like Leslie Welch, whom I interviewed back in season one, episode eight. Together, we built a program called Sister Friends that partnered new expecting mothers in Detroit with peer mentors called Sister Friends. We use the program to take a 360 degree view of the challenges that pregnant people faced in doing routine things like getting to prenatal care appointments. One of the breakthroughs the team implemented was providing free Lyft rides to those appointments. Within a year of implementation, the Black infant mortality rate dropped by a third and the Black-white infant mortality gap dropped by 82%. These kinds of local solutions, they need to scale, and that requires federal leadership. And right now, there is no voice speaking louder for Black maternal and child health than Representative Lauren Underwood, one of just three nurses, all Black women, in Congress. Representative Underwood brings her own personal experience with Black maternal mortality and expertise as a nurse to bear on this work. Most recently, her comprehensive “Momnibus” package of 12 bills to do everything from expand the perinatal workforce, to protect birthing people in jails and prisons, to improve data collection and analysis to improve our understanding. She joins us to talk about this work after the break.

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Dr. Abdul El-Sayed: I just started mine, so when you’re ready to go, I am as well.

Rep. Lauren Underwood: OK, yes.

Dr. Abdul El-Sayed: All right, can you introduce yourself for the tape?

Rep. Lauren Underwood: Hi, I’m Congresswoman Lauren Underwood, and I represent the 14th District of Illinois.

Dr. Abdul El-Sayed, narrating: I’ve been hoping to have Representative Underwood on the show for some time. Her leadership as a health provider in Congress and a champion of Black birthing equity would have been enough. But she also graduated from the University of Michigan just a year after I did, so I knew it was going to be a great conversation.

Dr. Abdul El-Sayed: Well, thank you so much for joining our show today. I want to just jump in because as a public health professional and former health official, it’s frustrating that there just is not enough representation of folks with health care backgrounds in Congress. And I hate to say it, those who share similar training to me as physicians tend to be on the other side of the aisle and tend to have some crazy opinions. One Rand Paul comes to mind. But you are one of three nurses in Congress. How does being a nurse, in this moment in particular, shape your public service?

Rep. Lauren Underwood: Yes, I am honored to serve with the legendary Eddie Bernice Johnson. She is fabulous. She is the chair of our Science, Space, and Technology Committee, and she’s a nurse, and the dynamic Cori Bush, who just joined us last year with her election, and she’s pushing all of us forward with this lens towards equity and justice. And you know, one of the things I think that folks that don’t know is that the three nurses in Congress, we’re all Black women. And so it’s really interesting to be able to do this work in an intergenerational way with kind of a range in ideology and really be on the same team to advance health equity and health and well-being for the American people. You know, my perspective as a nurse, it’s really been surprising in a lot of ways because, you know, I didn’t expect my interactions with my community to feel so similar to those interactions with patients. So like people in my district will come to me and they’ll be like, Oh my God, Lauren, I need help. And there’s some, like this really intimate part of that exchange where they’re very vulnerable and they’re calling me as a last resort or coming to an event as a last resort, and in that interaction, it reminded me so much of learning how to introduce myself to a patient and building that rapport, very quickly. But that’s like the foundation of that therapeutic relationship. And there’s something, it’s a very similar interaction. I will say that throughout my career, I’ve been very focused on helping the American people improve their health and well-being, and that work continues during my time in Congress. I’ve been very clear that that is why I’m here. That’s why I ran in 2018, and how I won is focusing on these health care issues, and I’m grateful to be able to lead in the Congress, you know, really with this unique perspective as a House Democrat with a healthcare professional background.

Dr. Abdul El-Sayed: Yeah, I love that parallel, because I think the overwhelming lesson from my experience in medical school that I take with me every single day, even though I don’t really practice, is the ability to sit with someone in pain and listen.

Rep. Lauren Underwood: Yes.

Dr. Abdul El-Sayed: And I think that is a cornerstone of good public service. Unfortunately, too few public servants either understand how to do it or do it very well. But I can imagine, you know, in any clinic or hospital, the folks who directly care for patients are nurses, and there is a caring, empathic approach that nurses take to their patients that if you can port that over to your public service, I can imagine will do wonders, most importantly, for your constituents and also for you. I also think that there’s something really important in understanding from the ground level how the health care system tends to pile up on folks. And that’s patients and providers alike. And I really appreciate that you bring that to the halls of Congress every single day. One area in which you’ve distinguished yourself is your service on maternal health equity. And I know that part of that is rooted in a very painful personal experience with a close friend. Do you mind sharing that with us today?

Rep. Lauren Underwood: Yep. Before I get to the maternal health, I just want to say that, you know, I come from a swing district, you know, very purple area. And one of the things I think is so important is when you’re willing to listen, when you’re willing to show up with folks, it doesn’t matter if you agree. You’re not, it takes like this partisanship kind of out of that conversation because people want to be heard. They want to be seen. They want to be acknowledged. And they’re looking for solutions, even if it’s not necessarily the solution that they would have identified. And so I think that for, you know, your audience of health care providers or people who care about health care, right, like this is an opportunity to build those connections, which are so powerful in this time when people are scared to talk to their neighbor and talk to their family members because the division in our country runs so deep. And so I just, I didn’t want to let that pass. In the maternal health space, you know, I ran and I launched my campaign in twenty seventeen. I was 30-years old and I had just lost a dear friend of mine. Her name was. Dr. Shalon Irving. I met Shalon during my graduate program at Johns Hopkins. She had enrolled in the program already as a dual gerontologist and sociologist. She already had a Ph.D.—brilliant! And after we finished our MPH, she went on to become a lieutenant commander of the United States Public Health Service Commission Corps. She was working down at CDC on health equity issues and found out she was pregnant and was so excited. And you know how it is with your friends, right, you can be in it with like just share that joy. And so when I was wrapping up my service in the Obama administration in January 2017, Shalon gave birth this beautiful baby girl named Soleil, and literally three weeks later, she died from complications due to high blood pressure—preeclampsia. And you know, it was stunning to me because in my clinical training, obviously we learned about, you know, health disparities, particularly related to maternal mortality in Black women. The data tells us that Black birthing people are three to four times more likely to die of pregnancy-related complications than their white counterparts. There are similar disparities we see among Native and indigenous people in the United States, in rural communities in the United States. There’s certainly some regional variation. And we know that the disparity for Black birthing people, you know, if you control for factors like income, education, insurance status, prenatal care, right, like all these things, the disparity persists. I knew this intellectually, but for this to happen to my friend, someone who had been doing this work, was stunning. I remember going to her funeral and the CDC Director was at the funeral talking about how stunning it was for Shalon to die in this way. And you know, obviously we know that the health care system failed her, right, like her death was preventable. And so I knew that if I won my campaign and I was elected to Congress, this would be an issue that I wanted to work on. When I was sworn in in January 2019, I became the youngest Black woman ever elected to Congress. And I think that representation matters, and part of the responsibility that we have when we enter these roles is to solve problems that never have received the full attention that they deserve. And we’re talking about a disparity in maternal mortality that’s been around in our country for decades. I mean, we’ve seen this disparity my entire lifetime and we never had a surgeon general’s report, right? We never had comprehensive federal action. And so I was really grateful to be able to find a great partner in Congresswoman Alma Adams. She is a representative from North Carolina whose daughter had what I would consider like, severe morbidity, right, like very severe complications related to pregnancy. And she shared this commitment and we watched the Black Maternal Health Caucus in April 2019 to tackle this issue. Ultimately, because of the outpouring of interest from stakeholders around the country, we pulled together this comprehensive suite of policies that we call the Black Maternal Health Momnibus Act to end our nation’s maternal mortality crisis and solve this problem.

Dr. Abdul El-Sayed: Well, I really appreciate you sharing the story. I’m really sorry to hear about your loss and frankly, all of our loss in such a talented, capable person, and that’s someone that we knew, but we also know that this epidemic steals lives in their prime in communities and in cities across our country. And I appreciate you taking your pain and your experience and turning it into leadership to take on the issue. You know, I worked in the city of Detroit as a health director, and it was a primary issue for us.

Rep. Lauren Underwood: Oh yeah! You know it

Dr. Abdul El-Sayed: And the reality of it is that we tend to think of ourselves in the United States as being a country that has moved beyond the kinds of deaths that rob people of their lives, either at the beginning of their life in infant mortality or in the prime of their lives in maternal mortality. You know, my grandmother lost two infants before the age one. They would have been my aunt and uncle, I never got to meet. But that was in that was in Alexandria, Egypt, in the ’60s. And the crazy thing is that the infant mortality rate in Detroit when I took that position was as high as it was in Egypt.

Rep. Lauren Underwood: Yeah.

Dr. Abdul El-Sayed: And it is a failure in our society to have thought through what it takes to take this on. And the reality of it is, you know, both you and I were trained as health care providers, but so much of this disparity starts well before anybody gets into a clinic or a hospital. Can you talk to us about some of the antecedents of maternal mortality? What are the the experiences, social and societal and structural, that lead to the death of a mom around pregnancy and childbirth?

Rep. Lauren Underwood: Yes. So we see this in so many settings. I’m grateful that you shared, you know, your journey and your perspective coming out of the city of Detroit and what’s going on in Michigan. There are local initiatives to solve this problem throughout our country—often, you know, without what I would consider to be sustainable support. And so what we’re trying to do is offer that right? So we know that there are these things called social determinants of health: housing, nutrition, transportation—that impact pregnancy outcomes. They do. And some people are stunned when we talk about it, but if you don’t have access to proper nutrition so you’re food insecure, are experiencing homelessness in the various iterations that it presents—which we know for birthing people is a phenomenon across this country—if you lack access to reliable transportation to get to a health care provider that you trust, right?—because that’s the key here, there needs to be that trust and relationship between the provider and the patient—you’re more likely to have negative birth outcomes. The data is so clear on the nature of this problem, and we’re learning more every day. So for example, over the last year, we’ve seen national data come out, published in the CDC’s journal The Morbidity and Mortality Weekly Report in JAMA, the journal the American Medical Association, describing the linkages of climate change, right, the impact of extreme heat and air pollution on maternal and infant health outcomes. I think that the biomedical evidence is so clear of the relationship between these social determinants of health and maternal health outcomes. But we cannot ignore implicit and explicit bias, aka. racism. I think the health care system right now is very interested in having a conversation about implicit bias. I don’t know that I am doing these things that lead to certain patients dying, right? I don’t know that I am treating my Black birthing people in a way that minimizes their pain, that discounts their reports of something being wrong, that dismisses their requests for additional attention, and so, you know, oops, my bad, let me sit in a webinar and learn about implicit bias, right? That is—listen, we appreciate the training, we appreciate the grand rounds, we appreciate the opportunities to learn from our colleagues about these biases that we bring to our health care settings, however, if we are going to save mom’s lives in this country, we’ve got to be honest about the role of racism, aka explicit bias, in the way that health care is delivered in our country and that that has been systemically perpetuated. And there is racism in our health care system. It manifests in any number of ways. It undergirds the health disparities that we see across outcomes in health care. For maternal mortality, it is undeniably a culprit. And so what we try to do is create a space that’s not punitive, but says, let’s be honest and forthcoming about the nature of the problem so that we can advance solutions, not just to solve it in an abstract sense, but literally we’re talking about a family that gets to be together instead of mom dying. That’s what we’re talking about. And I think that right now we’re in a really special moment where in our country we are interested in having that conversation.

Dr. Abdul El-Sayed, narrating: We’ll be back for more with Representative Underwood after this break.

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Dr. Abdul El-Sayed, narrating: And we’re back with more of my conversation with Congresswoman Lauren Underwood.

Dr. Abdul El-Sayed: It is easy to assume that everyone’s blameless and that there is not, there are not very clear and obvious culprits of this. And, you know, to take those two points about both the structural and social determinants of health and explicit racism, every single time we mis-allocate our funds, we decide not to invest in predominately urban communities that are predominantly Black, whether it’s the city of Detroit or it’s the south side of Chicago or the west side of Chicago, we are making decisions that are explicitly racist, even if we don’t call them that. And the responsibility we have to take this on, to keep families whole because moms or babies are not dying, that is probably the most profound responsibility that we have. It’s basic stuff as a society. You’ve championed what you call Momnibus legislation—I love the name.

Rep. Lauren Underwood: Yes. Thank you.

Dr. Abdul El-Sayed: Can you walk us through what’s in it? And I know it passed the House, but it’s stalled and we can talk a little bit more about that. But what’s in the legislation?

Rep. Lauren Underwood: Sure. So the Black Maternal Health Momnibus Act was first introduced in March of 2020, literally a week before COVID. I was so honored to work with then-senator, now Vice President Kamala Harris to introduce the omnibus. And so then COVID sort of became all consuming, rightfully so. So we reintroduced the omnibus this year—I’m sorry, I guess it’s 2022—so in 2021 we reintroduced it. We have a new Senate partner, Cory Booker, who is fabulous, and the Momnibus expanded from 9 bills to 12. We added two related to COVID. Maternal Vaccination Act, right, for example, what we see the data that, like moms have not been, and birthing people across so prenatal, postpartum lactating, not included in these clinical trials for vaccines or treatments, for sure for the first month of the pandemic, or first year of the pandemic. But you know these, the problem among birthing people has continued, and now we’re seeing like red alerts to pregnant people encouraging them to get vaccinated because of the misinformation and the confusion among health care providers in this country. I mean, it’s criminal what’s happened. We added legislation to address the impacts of climate change in response to those data that came out. And then other bills within the omnibus, the social determinants legislation to address housing, transportation, nutrition assistance. We are expanding WIC for mom and baby in the Momnibus to 24 months.

Dr. Abdul El-Sayed: That’s huge.

Rep. Lauren Underwood: Which is huge.

Dr. Abdul El-Sayed: Yeah, just for listeners who don’t know what WIC is, it’s women, infants and children. It is an incredible program that takes on food insecurity and health care insecurity among moms and new babies, both through pregnancy and into childhood. And right now, WIC ends at the first year, but this would extended a whole another year that’s so critical.

Rep. Lauren Underwood: Ends at the first year for the baby.

Dr. Abdul El-Sayed: Right.

Rep. Lauren Underwood: Right, and so you get mom and baby to 24 months. It would be transformative, for not only maternal and infant health outcomes, but to end food insecurity in this country. This WIC expansion is essential. We when we designed the Momnibus, I just want to say that we did not want to be duplicative. We were trying to fill the gaps. So before I was, you know, sworn into Congress, we have had initiatives to expand postpartum Medicaid. And I want to shout out Congresswoman Robin Kelly, who is from Illinois, who has been working with Senator Durbin for a long time on this postpartum Medicaid expansion. And if we only could do one thing in this country, expanding Medicaid coverage to the full year postpartum, saves moms lives, undeniably, right? Because we know that the Medicaid program pays for two thirds of deliveries for Black birthing people in this country. And so, and in those states that didn’t expand Medicaid, it cuts off after 60 days and so, you know, the data tells us that we’re losing between a quarter and a third of moms after that 60-day period. So if you can get from 60 days to the full year, you can save lives. Right? So I just want to acknowledge the Medicaid aspect to this. The Medicaid expansion is not in the Momnibus. We’re doing everything else. So we’re doing the WIC expansion. We’re dealing with a climate change-related impacts. We’re supporting the community-based organizations that have been on the ground doing this work for a long time without support. They have the best practices, understand the regional dynamics, and the challenges in these communities, and they need our support. So we have grant programs to fund that. It’s named after Kira Johnson. I don’t know if you’ve ever met Charles Johnson. Charles and Kira have a beautiful family. Kira died after giving birth to their son Langston, and he has started an organization 4Kira4Moms to lift up this problem of maternal mortality and he’s been a great partner in our work, and I just want to honor Kira by saying her name in this context. We are honored to be able to name that bill after her. We’re actually so excited. One of our Momnibus bills have been signed into law, it the Protecting Moms Who Served Act, which is to help the Department of Veterans Affairs. So, you know, we talk about universal health care and we talk about federally-run health care systems, well the VA is the largest federally-run health care system, and disparities persist. And so this is an opportunity, particularly given the exposures and the risk factors that this population has, our veteran moms to make sure that we’re not seeing the perpetuation of this maternal mortality disparity. That was signed into law in November of 2021. It was so exciting to be at the White House with the president for that signing ceremony. We are investing and growing and diversifying the perinatal workforce: more doctors, more midwives, more nurse midwives, more doulas, right? We know that we need more health care workers and birth workers in our country, and they need to be people of color. Why? Because the data tells us that the outcomes are better when there is that congruency, whether it’s linguistic or cultural or racial or, you know, all the factors we know that we can save moms lives when we diversify this workforce. We’re dealing with maternal health conditions like substance use disorders. And if, we can be candid, suicide prevention. It is hugely important to be able to have specialists in communities that are prepared to address maternal health crises, mental health crises that go beyond postpartum depression. Culturally in this country, we’re prepared to have this conversation about postpartum depression. I think that when it gets beyond that to anxiety and suicide, providers don’t know what to do. And we are losing moms every day because of that disconnect. In the Momnibus we have a bill Justice for Incarcerated Moms that Ayanna Pressley is leading, dealing with the inequities and, you know, really the unacceptable practices within our Federal Bureau of Prisons. We have investments in digital tools, right? Telehealth has really exploded, particularly in the context of COVID-19. It needs to be in an equitable way. And in this space, in the maternal health space, there’s such an opportunity to get these tools in the hands of moms that need it. Everything from like counting kicks to, you know, other trackers basically. So we’re investing there, you know, dealing with vaccinations, investing in payment models to incentivize high-quality maternity care, right? It’s really comprehensive and it’s at outlined online if people want to learn more at our Black maternal health page.

Dr. Abdul El-Sayed: No, that is an amazing, very comprehensive, very thoughtful set of legislative priorities that, most of which have, unfortunately with Build Back Better, they’ve stalled. And a lot of that is because it seems as though your colleague in the Senate, Senator Joe Manchin, feels like he somehow can’t explain this to his voters in one of the poorest states in the nation in West Virginia. I don’t know if you’ve had the opportunity to talk with him specifically about this, but if you did, if you could look him in the eye and tell him about why this matters so much, what would you say?

Rep. Lauren Underwood: So we know that first of all, every eligible provision of the Momnibus was included in Build Back Better. Everything was not included. So like the Justice for Incarcerated Moms wasn’t, the WIC expansion. And that’s just because of the rules, it’s not because of any policy disagreement. But we know that these policies are broadly popular, bipartisan, in fact. The Black Maternal Health Care Caucus is bipartisan, several of the bills are bipartisan. And we know, for example, that leading Republicans in this country, like DeSantis has been polling on this work that we’re doing on maternal health, right? So I don’t want to give an impression that this is somehow controversial or in any way divisive, it is just in a larger package that is being renegotiated. So but I would just emphasize to Senator Manchin is that West Virginia, like so many other states in our country, has a disparity and we have an opportunity to save moms’ lives. When we talk about political winners, this is one that unequivocally gets the job done. He should be excited to be able to cast his vote in support of these policies. And I am looking forward to continuing to work with Senator Booker and our Senate colleagues and the Vice President to make sure that these Momnibus provisions remain in whatever this new package looks like and is called. But I just don’t want folks to walk away thinking that this is somehow being perceived in an extreme partisan way.

Dr. Abdul El-Sayed: I mean, Build Back Better was a huge—talk about omnibus, right? A huge package.

Rep. Lauren Underwood: Yeah. [laughs]

Dr. Abdul El-Sayed: And a lot of this unfortunately broke on price tag rather than any of the constituent parts in the package and yes, I mean, saving babies and moms, there’s—like we talked about—there’s very little else that could be as important, as critical int his time—

Rep. Lauren Underwood: But you know, I think we have to say, right, we’re able to do this work because we’re requiring these corporate tax evaders to pay their fair share, right? So at a time when insurance companies are making record profits during a pandemic!

Dr. Abdul El-Sayed: That’s right.

Rep. Lauren Underwood: This is the least that we can do, right, turn it around, make them pay their taxes so that we can save moms’ lives. Just wanted to make sure we covered that.

Dr. Abdul El-Sayed: What a crazy thought, the notion that corporations should pay their taxes too, and we should use that money to save moms and babies. I want to, on that note, I want to end just thinking a little bit about this moment. It has never been harder to be a health care provider in America than it is right now and many of your nurse colleagues are really struggling. Many of them just leaving the profession entirely because of their experiences with COVID-19. What do we need to do to protect and support our health care workforce right now?

Rep. Lauren Underwood: Yes. So there’s so much that needs to be done to truly thank our health care heroes, right? It’s not a hashtag, like it requires action. We’re so pleased that the President signed that Lorna Breen legislation into law, which offers up some crucial mental health support and funding to, you know, help folks who are in crisis. And we have a lot of health care workers who have seen and experienced tremendous trauma as a result of the pandemic, and we want to make sure that they have access to that incredible support. Beyond that, the nursing workforce has really been stretched. I mean, in every community across our country, we are seeing incredible shortages and the incentives for nurses to leave their hospitals and clinics and join a travel agency have really never been higher. And that is not really a sustainable phenomenon when we think about the way that health care is provided in this country. And so I was really pleased that in the Build Back Better Act, my legislation to offer $500 billion in support for nursing scholarships and loan repayment was included in the bill. We have never seen that level of federal investment for our nursing workforce. There was another $500 billion included for the nurse corps, which is, you know, a program that’s already been around at the federal level. That’s why it’s so important that we pass Build Back Better, right, or whatever is going to be called moving forward, to make sure that these critical funds are moved forward to help our nursing workforce and to, you know, improve this pipeline for diverse providers.

Dr. Abdul El-Sayed: Well, I really I really appreciate that. I appreciate your leadership on behalf of everybody in this country, frankly, but in particular, taking on the provision and the support of some of our most vulnerable folks: birthing people and their children, and then the folks who are working day in and day out to keep them safe and our health care providers. And you know, this conversation, I know that it is en vogue sometimes to be dour and down about the state of our democracy, but this conversation should remind folks that there’s a lot that we can do and there are a lot of good folks trying to do it and so I really, really appreciate you taking the time out of what I know is a busy schedule to talk to us about this important work. That was Congresswoman Lauren Underwood. She serves the 14th District. In Illinois.

Rep. Lauren Underwood: Thank you. Take care.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. Pfizer has just submitted its COVID-19 vaccine to the FDA for emergency use authorization for use in children aged six months to four years. As a father of a four-year old, I know I speak for all of us when I say: It’s about damn time. That said, there’s a good reason why this is coming so late and why there still might be a few hiccups. When Pfizer and BioNTech analyzed the results of their original clinical trial among kids aged six months to four years, they found that a two-dose regimen left kids two and under with a high level of antibodies, but curiously, it didn’t leave kids aged three and four with the same level of antibody protection, so they had to initiate a study of a third dose, the results of which we expect in March. They found no significant side effects in any group. So considering the rush to get kids in this age group some level of vaccine protection, they’ve elected to submit their findings to the FDA so that the kids can get a head start on their vaccines in hopes that they’ll have the rest of their data on the third dose to submit in time for kids who need to get it. I’ll tell you this, it’s certainly a departure from the usual approach where you wait for all your data to come in before you submit. The FDA is just now beginning to review the data, but if it’s approved, I’ll tell you what, I’m going to be the first to line up my kid for a shot, even without the data about the third dose. Why? Because the evidence shows that the vaccine is safe, and I’d rather my daughter get two doses, which will offer her some antibodies even if not at a level that is as high as two doses for adults—better any dose than none. And if results from the studies ending in March show that a third dose remains safe and effective, then she’ll be well on her way to full vaccination. A new COVID-19 variant is spreading across Europe, now representing 82% of cases in Denmark. The variant, called BA.2, appears to have emerged alongside its cousin BA.1, which you all know as Omicron. BA.2 appears to be more transmissible than the OG Omicron variant though. A Danish study found that it was up to 1.5 times more transmissible, while the U.K. contact tracing study found that people infected with BA.2 were about 30% more likely to spread it to family members than BA.1. It doesn’t appear to be more severe than BA.1, and it’s just as susceptible to vaccine-mediated immunity as BA.1 is. Look, I know, you’re hearing all this news about a new potential variant. We’ve seen this movie before, but don’t despair. Most scientists believe that it’s unlikely that BA.2 is going to cause another Surge. And that’s because the huge wave of Omicron we’ve just endured has left behind it a residue of immunity that’s likely to prevent another mass infection so soon after. That said, it could slightly prolong the current surge as it spreads, or potentially cause a small bump in cases.

Last week, billionaire investor Mark Cuban launched an online pharmacy for generic drugs. The, I quote, “Mark Cuban Cost Plus Drug Company”—yes, that’s the real name—is focused on distributing generic drugs online. Get this: rather than deal with the insurance system, they’re selling straight to consumers. Here’s what Mark Cuban himself had to say about it.

[clip of Mark Cuban] We’re trying to keep the price as low as possible. And, as anybody who’s had to deal with the claim or bought a medication knows, that there’s there’s a lot of induced anxiety dealing with insurance.

Dr. Abdul El-Sayed: Look, I’ve got mixed feelings about this. On the one hand, I support anything that’ll deliver high-quality prescription drugs affordably to people. That’s a great and important thing. That said, this is what government should be doing! Not a billionaire investor. And finally, some hopeful news. Last Thursday, President Biden announced a cancer moonshot.

[clip of President Biden] All those we lost, all those we miss—we can end cancer as we know it.

Dr. Abdul El-Sayed: As you may know, President Biden’s eldest son, Beau, died of glioblastoma multiforme, the most aggressive form of brain cancer, at just 46-years old. During the Obama administration, then-Vice President Biden declared his first moonshot on cancer. Last week, he was back to announce a goal of cutting cancer mortality by 50% in 25 years. One piece of the plan involves launching a new Advanced Research Projects Agency for Health, to house fund critical research on cancer and other intractable diseases. Look, it’s a fantastic goal, but cancer biology is tricky because there’s not just one cancer. While many cancers share similar DNA mutations, brain cancer differs from lung cancer, which differs from liver cancer, which differs from breast cancer. You get the picture. There’s another point here, too. Cancer isn’t simply about what happens under the skin. How much skin cancer could we prevent with basic public health measures that involve increasing the use of something as simple as sunscreen? How much lung cancer can we prevent by continuing to reduce smoking? So while it’s important to continue to press forward on the research toward understanding the biology of cancer, as COVID should have taught us right now, research, development, and technology aren’t enough. You can create a safe, effective vaccine in a year, but it doesn’t help people who don’t take it. And that costs all of us. We have to build a culture of public health such that we empower people to do the basic things too.

That’s it for today. Before you head out, I want to share the organizations I mentioned at the top of the episode that Tommy and Hannah are asking people to support. There’s Baby2Baby, an L.A. nonprofit that provides children living in poverty with diapers, clothing, and basic living necessities. Star Legacy Foundation, a nonprofit dedicated to reducing pregnancy loss and neonatal death. And Baby Quest Grants a nonprofit providing fertility grants to those who can’t afford costly procedures like IVF and egg freezing. Once again, that’s Baby2Baby, Star Legacy Foundation, and Baby Quest Grants. You can find links to where you can support them in our show notes.

Dr. Abdul El-Sayed: American Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez, and me, Dr. Abdul El-Sayed, your host. Thanks for listening.