Were we set up to fail? And how does our failure affect the most vulnerable people in society? Abdul reflects on the nature of prevention itself. He speaks with Prof. Sandro Galea, Dean of the Boston University School of Public Health and author of the new book “The Contagion Next Time.”

Transcript

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Dr. Abdul El-Sayed: The decline in COVID-19 cases is leveling off, as shots go into children’s arms around the country. As the proportion of fully vaccinated adults climbs to over 70%, the Biden administration set a January 4th deadline for vaccine mandates by large companies. That said, a federal court has put a stay on the mandate. Syphilis is surging in America that says a lot about the state of public health funding right now. This is America Dissected. I’m your host, Dr. Abdul El-Sayed.

What if I told you I could tell you five MRI’s for $500? That’s a steal, by the way, considering the average MRI in America costs thousands of dollars. You can’t sell them. They’re nontransferable, but they’re there for you in case you need them. Would you buy them? Chances are you wouldn’t. Why? Because most people don’t have a spare $500 to spend on something they don’t particularly need right now. And let’s face it, unless you need an MRI right now, you probably assume that you won’t need one anytime soon, let alone five of them. Now, let’s say you’re out playing your favorite sport and you fell a pop in your knee iand some throbbing pain as you hit the ground. Now you come back to me. “Abdul, I thought I heard something about five MRIs for 500 a pop. Can I get some?” Ha! Nope. Now they’re just one MRI for a thousand bucks. Just when you need it, the price goes up on you. The point I’m making here is that we don’t want health care. What we want is health. We’re not willing to pay for health care when we don’t need it. But when we need it, we’re willing to pay almost anything for it. We’d be way better off keeping ourselves healthy. Right? Well, here’s the central challenge: we almost always assume that if we’re healthy, we’ll stay healthy. But because we’re already healthy, we’re not really willing to invest in keeping ourselves healthy because it’s not immediately obvious what might make us sick. That friends, is called the prevention paradox. That we’d always rather prevent illness, but we’re not willing to invest in doing that so we’re constantly investing far more in getting healthy again only after we get sick. That paradox is why we pay 18% of every dollar spent in our economy in health care costs, more than any other high-income country in the world. All of that to be number 40 in life expectancy. We live an average of six years shorter than folks in Japan, who live the world’s longest lives on average. So much of our conversation about COVID has been about what to do after the pandemic struck. What’s missing? A conversation about what we ought to have done to prevent such a pandemic in the first place. After all, viruses emerged naturally, but pandemics, pandemics are a function of all of these choices that humans make, both before and as a virus hits community. Homelessness, precarious employment, epidemics of chronic illness, a broken food environment and chronic poverty—all of these are kindling for a pandemic. And when a pandemic does emerge, all of these make the cost of intervention, like lockdowns, so much more damaging to the very communities we’re trying to protect. America is as unequal as it’s ever been, and that’s in part because of the pandemic. Black and brown communities, rural communities, low-income communities all suffered worse from the pandemic itself, the contagion of the virus and its consequences. But also from the consequences of our attempts to intervene. We were unequal and divided before the pandemic. We are more unequal and divided now. The key is preventing the pandemic in the first place, which is where today’s guest comes in. Dr. Sandro Galea is the author of a new book, “The Pandemic [Contagion] Next Time” which is about the lessons we need to learn—and I fear we’re not learning—to make sure that we’re not in the same exact boat the next time this happens. Because make no mistake, viruses occur naturally, but pandemics, pandemics are human made. We’ll hear from Professor Sandro Galea, dean of the Boston University School of Public Health, after this break.

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Dr. Abdul El-Sayed: All right. Ready to get started?

Dr. Sandro Galea: Yep.

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

Dr. Sandro Galea: I’m Sandro Galea. I’m the Dean of the School of Public Health at Boston University.

Dr. Abdul El-Sayed, narrating: Today’s interview is a bit personal for me. Sandro Galea is the reason I became an epidemiologist. As a college student interested in politics and biology, I reached out to him and found someone fully engaged in the questions that matter for keeping people healthy. I found a mentor and a friend. Since, our careers have diverged a bit, and you’ll hear some of that in our conversation today. But I always find that talking to Sandro offers a level of clarity and honesty that’s as refreshing as it is insightful. His new book, “The Contagion Next Time” isn’t about COVID-19, it’s about how we make sure another COVID never happens again. There are lessons inside I deeply hope we learn.

Dr. Abdul El-Sayed: All right, well, Sandro and I go way back all the way back to when I was in college, and Sandro is very much the reason I got my start in public health and why you all get to listen to this podcast? So you get, you know, Sandro and Sandro acolytes here for for the next 30 minutes. I want to just jump right in. You’ve been a unique voice among epidemiologists careful to highlight the unintended consequences, and there are many, of the interventions that we have leveraged to put a stop to or at least a damper on COVID. Can you explain the balance between COVID and the other health needs that come at the consequence of some of our interventions?

Dr. Sandro Galea: Yeah so was a respiratory disease, right, so to stop COVID we needed to keep people away from each other. And when COVID first hit in March of 2020, we were all afraid. We were all afraid. We didn’t quite know what to do, and we did a number of things very quickly. So that’s fine. But after a few months, it became clear how COVID transmitted and COVID is transmitted from person to person. And we, as a country opted to keep in place a lot of efforts to minimize our contact with each other. Now the problem with that is that that actually created problems, particularly employment problems, and particularly problems for low-wage workers who were losing jobs and whose jobs were essentially disappearing. So in deciding that our approach to COVID was going to be a blanket approach, that essentially we social distance for as long as possible and keep away from people, away from each other as long as possible and close jobs that ultimately could not cope because of the fact that people were not coming to them—things like retail, manufacturing and all that—we were actively disadvantaging people who are already marginalized, who were disadvantaged people, low wage workers, many of them people of color. And what we were essentially doing is we’re widening gaps between the haves and have nots, because the haves were able to continue working and work from home. And in fact, while there was a dip in jobs for everybody in the first couple of months after COVID, but by June of 2020, jobs had fully recovered for high-wage workers and in fact, now they’re 10% higher than they were pre-COVID. For low-wage workers, it never recovered, and they remain about 20 to 25% lower. So the efforts we took to mitigate COVID were efforts that selectively disadvantage particular groups, particularly groups, low-wage workers, which overlaps a lot with people of color. And these are, I mean, this was predictable. We knew this was going to be the case. And I suppose my argument is that we could have done things differently, could have thought about it differently. And it really depends on what we value and what we prioritize.

Dr. Abdul El-Sayed: And so if I’m summarizing the argument correctly, it’s that the consequences of the pandemic that we experienced led to a set of reflex interventions that cemented a level of structural inequity that we had had before the pandemic, but made them that much worse after the pandemic. And I guess the alternative, obviously, is that there was a series of things that we could have done, that we should have done that might not have had the same consequences. So, you know, we go back to March 2020, you are in the White House and you are advising the then-president and you get to stay in the White House and advise the now-president. What should we have done differently and what should we be doing differently now that might not have cemented the same structural inequities, the same disproportionate impact on low-income and marginalized people?

Dr. Sandro Galea: Yeah. So I suppose I’m giving us a bit of a pass for March and April 2020. I said that it was a time when it was a new disease. We did not know what was, how it was transmitted. We didn’t know very much about it and people acted very quickly because it felt like an urgent time. So giving ourselves a pass for March, April and May 2020. But let’s get to June of 2020. By now, we understand transmission of disease. We have a brought mortality down by better in-hospital care. We know that the people who are at risk of mortality are people who are over a certain age, mostly over the age of 75, and people with underlying morbidity. We know that COVID is not really, does not really affect children. Children do not get it as much. They do not transmitted as much. And if they do get it, they rarely get severe COVID. All these things we now know, we now know by June of 2020. Well, a rational approach that limits the spread of COVID, but also protects jobs and make sure that we don’t introduce health gaps would be an approach that protects those who are most vulnerable. Those are people who are over 75. Those are people with underlying morbidity. So an approach would be to selectively make sure that we protect those people, but we keep the economy going. We keep an economy going, we allow people to remain employed. We open schools come the fall because we know that children are at low risk of transmission, and take a measured, graded approach to protecting those at high risk, but also continue to protect the economy, recognizing that affecting the economy affects those who are most vulnerable to economic downturns.

Dr. Abdul El-Sayed: And you know, the pushback—and I’m sure you’ve gotten it because you know what I’m about to say is sort of the conventional wisdom on COVID prevention—but Sandro, you’re an epidemiologist, you know that there’s herd immunity that we have to be thinking about and that contagions occur in exponential waves and so, you know, as hard as we try to protect our most vulnerable, the more we allow COVID to bounce around less-vulnerable people, i.e. people younger than 60, the higher the probability that we overwhelm our hospitals and allow this pandemic to continue to perpetuate. What’s your response to that?

Dr. Sandro Galea: Well, the response to that is a difficult one, simply because I think we’re uncomfortable with the idea that young people could get COVID, the vast majority of which was asymptomatic and certainly very mild. And that, of course, builds immunity. And we’re uncomfortable with the idea that we would allow some case’ness—which does not translate into severe cases—which would then get us closer to having fewer susceptibles. I think the term herd immunity has become so politicized that it’s probably best to stay away from the term altogether. But fundamentally, infectious diseases transmit if you have enough people who are susceptible to them. If fewer people are susceptible, infectious diseases stop transmitting. And of course, we get there through vaccines or through people having had COVID. Now, when we essentially said we are not going to tolerate any cases—and there was the whole zero COVID way of thinking, which was a distraction as I’ve as I’ve written,—it fundamentally said that we’re not going to tolerate any COVID cases. But was that really the right approach? Was a really great approach, when we know that for young people, people who are healthy, COVID cases were not necessarily associated with severity. And I think it’s a difficult question because we always get into this question of, well, some cases may get into severity. But of course, it is false to say that we do not tolerate risk at all. We tolerate risk all the time. We tolerate risk every time we get into our car. So we as a society tolerate some risks and not others. And now the important thing about this conversation is that this is not happening in a vacuum. It is one thing to say: look, why would you tolerate any COVID risk—because by protecting ourselves from COVID, we are minimizing risk—in the absence of recognizing the other bad things are happening because of what we’re doing about COVID. 2020 we had, there were 93,000 deaths from drug overdose, which was a 25% increase over the previous year. I never saw in the paper to the figure that said the number of overdose fatalities every day. But that was happening in no small part because of the efforts we were taking to keep everybody indoors, to keep everybody distanced. So the efforts we’re taking to minimize risk from COVID incurred other risks. So we need to balance these risks and recognize that it is, it is not a simple matter of saying we can have zero COVID risk and we’re not incurring other costs. We actually are incurring other costs and ultimately it’s on us to balance those costs.

Dr. Abdul El-Sayed: So, you know, to folks who are listening, a lot of folks will say, well, that was the, we’ll say, conservative approach in states like Texas and Florida that morphed into what has now become an anti-vax approach, etc. And I know you’re arguing that rather than thinking about this in political terms—which of course is very difficult to do considering how politicized this pandemic has become—the argument that you’re making is that every effort to prevent COVID had a consequence. The consequence often gets hidden because of what we choose to pay attention to and who we choose to pay attention to. And in some respects, going back to the first point you made, is that the consequences of our intervention to really try and suppress COVID to zero, fell deepest on the folks who were, we were least likely to pay attention to in the first place. And so in some respects, you know, the progressive argument here, right, and the argument around a more equitable approach to public health here is that we were relying on society’s blindness to a group of people and their suffering to be able to sort of push the suffering attributable to COVID to the fore and focus solely on that without having to think about what the consequences on the back end are.

Dr. Sandro Galea: Well, I agree with everything you said and I think it’s a rich set of sentences, so let me just take them apart one by one. Number one, let’s talk about the politicization. One of the really difficult elements of our dealing with COVID was that it became a political story, not big P political, partisan red and blue. So it became if you were blue, then you were for mask wearing. If you were red, you were against mask wearing. Which of course, is silly. It’s silly because mask wearing should be a purple issue, and we should all be able to evaluate what the utility is of mask wearing or of social distancing and what we’re trying to balance. So unfortunately, it became quite difficult to even have a line of reasoning like the one I’m proposing right now without being told, well, you are now Republican. I don’t think it’s a Republican line of reasoning or Democratic line of reasoning, I think is a rational line of reasoning based on what we know and based on what we’re trying to to prevent. So accepting that the politicization, or more accurately, the partisan occupying of different positions, made it very difficult to have nuanced arguments, accepting that. The second part then becomes: what are our goals as a society? And to my mind, our goal should be always to try to improve our collective health but at the same time, to narrow health gaps. And those two, those two goals are sometimes at odds and we don’t like to admit that. I have written about this over the years, that there is a trade sometimes between equity and efficiency. Efficiency meaning achieving overall health and equity meaning narrowing health gaps between health haves and health have nots, which are often in this country defined by socioeconomic lines between do those with more resources and those with fewer resources along color lines: white Americans, black Americans, etc. But our goal should be simultaneously to improve overall health and pay attention to health gaps. And COVID early on presented a challenge in this front because the safest thing to do to minimize COVID would have been to create a permanent lockdown where everybody stays in their house, nobody leaves the house. Because if nobody lives their house, there would be no transmission. It’s as simple as that. And of course, some countries have tried that. I mean, countries like Australia, cities like Melbourne, they’ve have had a 111-day lockdown. But of course, even places like Australia, you’ve seen that after months and months of trying this, they eventually gave up on what’s come to be called a “zero COVID” approach because actually very difficult to contain COVID that way because of the economic consequences and ultimately because it’s a very transmissible virus. So we needed to have the intellectual sophistication to say this is a challenging, highly-transmissible disease, but we know that certain groups are vulnerable to it, certain groups are less vulnerable to it and we also have other goals in society, which is to protect those who are more vulnerable from other conditions to begin with so we should take apart the threads the needle finely. That protects those vulnerable from COVID, but also protects those whose health, whose welfare in general depends on society’s functioning. And that’s the path that what we did not thread. In the defense of everybody who was in a decision-making position, the whole debate became so partisan-colored that it became very difficult to actually even have this conversation. As you said, my argument could be called something like what the southern states did. Well, the southern states didn’t really do any of this either. They sort of took a blunt approach on the other side at the extreme to be COVID denialism, saying, well, this isn’t really a problem, we should just keep doing what we’re doing. That’s not the right approach either, it’s obviously not the right approach. So we need to get more comfortable occupying the middle space. And the middle space is almost always where truth exists. That’s almost always where complex, complex, evolving stories, the answer is almost never the extremes. It’s almost always in the middle.

Dr. Abdul El-Sayed: I want to step back, right? Because what are the implications, so you’ve written a book, The Contagion Next Time, which I think is a really thoughtful look into, frankly, a theory of public health and application to these kinds of mass scale public health challenges. And one of the central arguments here is that we shouldn’t have been in the circumstance where we were forced to be making these decisions in the first place because public health, the sine qua non of public health, is prevention. And that doesn’t just mean prevention in the midst of a pandemic, it also means prevention of pandemics. And I want to ask you, how do you think we should have prepared? So let’s go all the way back to pre-March 2020, pre-the emergence of this virus, what would have left us in a situation where the kind of pandemic that we witnessed—five million people across the globe, 700,000 people in this country—where the pandemic could have been easily managed without the cost and consequence to lives and livelihoods that we witnessed?

Dr. Sandro Galea: Yeah, as I say in the book, we were sitting ducks for the consequences of COVID. Now why were we sitting ducks? We’re sitting ducks for two reasons. Number one is that we have for many decades, about 40 years, under invested in what makes us healthy. And number two is we have underinvested in what could keep us healthy when a pandemic hit. So let’s take these one at a time. What makes us healthy are the conditions of the world around us, the air we breathe, the water we drink, the food we eat, whatever we can exercise or not, whether we have stable housing, whether we have livable wages—that’s what makes us healthy, and that’s broadly understood. But we have underinvested in that, at the expense of investing in doctors and medicines and cures. Now, this is not an anti-doctor argument at all. When I’m sick, I need a good doctor, you need a good doctor. It simply says that we have chosen to treat health as a personal commodity, something to be bought and sold. But what can be bought and sold is not health, what can be bought and sold is sick care. Fundamentally to create a healthy society, you need to invest in the world around us. This is why, although we as a country spend much more on health than all other high-income countries, we live sicker, shorter lives than all other high-income countries. And it’s fundamentally because we do not invest in the forces around medicine. So number one, by doing that, we had a country that was sicker, had more underlying morbidity, more underlying disease, and all of these things ultimately became risk factors for severe COVID. Because when you got COVID, what was the principal risk factor for severity of COVID was having underlying illness. And we’ve known that rate from February of 2020 from the early China CDC data. So number one, by underinvesting and what makes us healthy, we had a country that was secured and had to be and as a result, more vulnerable to COVID. Number two, we’ve underinvested in the forces of public health. We’ve underinvested in local, state, federal public health workforce. In most counties in the US, we spend more on a police force than we spend on health care. And that ultimately meant that we were not, we did not have the surge capacity needed for public health to scale up and protect us from something like this. So those two conspired to us being essentially fertile ground for COVID to wreak the havoc that it did. Now the book, the premise of the book The Contagion Next Time is just this, that says there’s nothing there, there’s nothing new about this. We knew we were under-investing in health. I’ve written about this, many have written about this. Abdul, you’ve spoken about this for years and decades, so we’ve known this. But we still did not act. The pandemic hit us, it had a devastating effect, in large part because of our underlying conditions. And what I’m trying to do is to say we should not let this moment go to waste and we should not let this moment pass us without us fixing these underlying conditions because there will be an next pandemic. There is no question that there will be a next pandemic. The question is only when. And in some respects we have been lucky with this pandemic. I mean, this was a very infectious virus, but it was not particularly lethal virus. And with something like SARS, which was, which we simply, we got lucky that we were not hit by SARS. SARS case fatality rate was substantially higher than was the case fatality rate for SARS-CoV-2, which was the virus behind COVID-19. So the argument is that we should not let this moment pass us by without taking a long, hard look at ourselves and saying, why is it acceptable that this country spends more on health than any other high-income country, by a lot, by, like 40% more, but actually we have the shortest life expectancy and the most morbidity in that life than any other high-income country. What other sector do we know where we accept us paying more but getting less? I really know no other sector. If I were to, I would challenge anybody listening to say, if I told you that your smartphone cost more, but it held less data and was slower than a comparable smartphone you could buy in Canada, where’d you buy your smartphone? You probably would give ii, you know, you’d probably think about it twice. But that’s what we do with health. We are willing to pay more and get less for health, and we should not be willing to do that. And we should be, we should have the wisdom to pause and say, why is that, how do we fix it? And if we don’t do that now that we are emerging slowly from this COVID tragedy, I don’t know when we will.

Dr. Abdul El-Sayed: So I’ve got several questions. One is, do you feel like we’re learning that lesson?

Dr. Sandro Galea: My answer to that is informed by hope. I hope so, because if we are not, then I think we’re irredeemable.

Dr. Abdul El-Sayed: And I worry—as you all know, I’m a hopeful person, I try and bring a lot of hope to folks listening—and at the same time, I worry that we are actively learning along wrong lessons. And I worry that that’s because lessons don’t just emerge. They’re usually taught. And the systems that teach lessons, that spend the money and the time to teach lessons have often been the ones that have cemented us into the health care system that we have and, you know, the sick care system that we have. And you said something earlier, which is that the right answer is usually in the middle. And I worry that sometimes we forget that across the broader distribution of countries, we are very much on one side, and the middle is actually probably further beyond the far extreme on the other side of where our country sits in the broader international distribution on a lot of these questions. We have a sick care system because people can make a lot of money on a sick care system. And inevitably, when it comes to the distribution of scarce resources, whether it’s the money we spend to keep ourselves healthy or to take care of us ourselves when we get sick, those are political questions. And our politics, as we talked about earlier, have just superseded so much of our public debate and our public conversation. I wonder, how do you feel like public health professionals and public health-oriented citizens ought to be thinking about engaging the political system to try and create the means to prevent the contagion next time?

Dr. Sandro Galea: Well, I think more and more people who understand public health need to engage with the political system. Abdul, you’re at the leading edge of that wave I think of a generation of people who are trained in understanding public health, who are willing to engage in the political system in a in a real and meaningful way. And I think that will eventually change the conversation and my hope springs from observing the world around us. I thought that the last presidential debates, the mental health consequences of COVID were raised. They were actually raised by President Trump in the debates, not by any of the Democratic contenders. But I actually thought it was quite a remarkable moment, actually that mental health consequences of a pandemic were raised in a presidential debate. And I don’t think we should undersell the important shifts that are happening. We are seeing right now with the Biden administration an extraordinarily ambitious effort in investing in social safety nets, much more ambitious than any of us might have thought possible four years ago. So these actually are real shifts now. You could say to me, well, it may not pass, not all of it may pass. I mean, that’s fine, but in some respects, that is arguing around the margins, because we are seeing these efforts that recognize that unless we invest in the world around us, we are going to have a far less desirable country on multiple axes, including a far less healthy country. A lot of the protections for workers who were being laid off and were unemployed at the beginning of COVID actually were put together under the Trump administration. Iin many respects, the Trump administration was much more Keynesian than one would ever have imagined them capable of being, just at least by virtue of their rhetoric and their political pedigree. So when you see that, I say to myself, OK, we’re certainly not there, but we are slowly lurching towards a place where we recognize that health is a universal aspiration, that our collective well-being is a universal value. And the reason politics exists should be to maximize the common good, to maximize good for all people. And health surely is a core part of it.

Dr. Abdul El-Sayed: I agree with you. I worry that a large part of our country does not. You know, we talked, we talked earlier about, you know, some of the public policy debates in the midst of the pandemic last year and you know, a lot of the country has sort of fallen to a denialism about the pandemic, and a not just a disagreement with or a disregard for, but a fundamental refutation of expertize and reason as a means of making smart decisions about how to promote our health. And yes, I think everybody’s individual health is important to them, the problem, though, is that when you start pushing back on reason as a means of promoting health, then you definitively lose touch of the role that the collective has in maximizing all of our health, rather than what you yourself can do or maybe a doctor can do for you to maximize your individual health. I worry that that’s a broader consequence, not just of our politics, but actually of a balkanization of our conversation. And you know, you spent your career trying to inform the discussion, whether that’s the academic discussion or the public discussion, about what we do to live long, healthy lives collectively. This is what we’re doing right now. I worry that the nature of social media, that the nature of of our conversation right now means that we’re talking more and more to fewer and fewer people who already kind of agree with what we have to say. And I wonder, what does the role of our discussion and our collective and our culture, what is the role there in terms of being able to achieve a certain understanding or at least shared narrative about how we improve our health? And you know, is there a way for public health folks to do a better job discussing with people who don’t necessarily agree that we have expertize to share or that our expertize matters or is legitimate?

Dr. Sandro Galea: Yeah, so I’m glad you’re worried. Actually, I don’t want to disabuse you of this worry. I would like you to worry because I want you to worry because you are part of the voices that are shaping our public conversation. As you know, my previous book was called, “Well”—that’s the main title—but the subtitle was “What We Need to Talk About When We Talk About Health” and fundamentally, I’ve come to feel like the game here is in changing the conversation about health so that everybody in the country, when people are having the proverbial kitchen table conversation and the question is, mom, what do you think matters most to your health? We need to make sure that the answer is not, well, my doctor and my pills. The answer is that I have a stable roof over my head, that I can make a wage that allows me to live a full rich life, and that I’m safe from violence. That’s fundamentally what it is that promotes my health. And we need everybody to understand that. Now, when you do surveys of the population, you realize that that’s not widely understood. The majority of people still think that the most important thing for our health are doctors and medicines. And again, doctors medicines matter. We actually want to make sure we have doctors and medicines. But it’s the other elements that generate our health. And how are we going to get there? We’re going to get there by changing the public conversation. Now you mentioned your worry, the fragmentation of the public conversation, social media, social media algorithms, and I think this is a real concern. I think it becomes a real concern when we are not having a genuine conversation with one another, and instead we are simply talking in our own echo chambers. And you know, a colleague of mine says that if we disagree, it means we haven’t talked long enough. And I quite like that. The only problem with that is that we actually have to genuinely be talking. And I think we have for years now mistaken social media for the public square but it is actually not. What social media is an algorithmically-mediated approach to make sure that you only listen to people who agree with you. That means that things become articles of faith. They do not become genuine conversations. So how does one get around that? Well, first of all, I think there’s a whole set of thinking that needs to happen about how to deal with social media algorithms. And Abdul, you’ve done some writing about that, which I respect. Number one. But number two one has to relentlessly engage the conversation. One has to keep pushing this forward. And we need more people who actually understand these problems who are willing to engage with that conversation, sleeves rolled up. So that what we talk about when we talk about health, changes. And it will change because it is already changing.

Dr. Abdul El-Sayed: I appreciate that note of optimism, and I deeply appreciate your intervention on the public conversation, The Contagion Next Time is an excellent book. And it is a different viewpoint than we often hear about a public health-informed approach to both the pandemic writ large and what we could have done on COVID-19 in a moment, and you know how we should be thinking about the future that we face. I think if we have an opportunity to address the contagion next time, it’s going to be because we fundamentally rethink basic temples of the way we organize society, and you talked to that about really quite nicely in the book, Sandro. I appreciate you coming on to speak with us. And that was Dr. Sandro Galea. He is the Dean of the School of Public Health at Boston University and author of the new book The Contagion Next Time. Sandro, thank you so much.

Dr. Sandro Galea: Thank you for having me.

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. The massive decline in COVID-19 cases since the height of the Delta surge back in early September appears to have leveled off a bit over the past week. Though cases remain low compared to the height of that surge, there’s still far higher than we’d like. That said, the fight against the pandemic got a shot in the arm—like what I did there?—as children aged 5 to 11 began to receive their vaccines around the country following the FDA’s approval last week. The CDC’s advisory panel gave the childhood vaccines unanimous recommendation. Meanwhile, the effort to get adults vaccinated was about to get a boost. Hah! Did it again. The Biden administration’s vaccine requirements for companies with more than 100 employees was set to officially go into effect on January 4th. But a three-judge federal court has put a stay on the requirement. It’s unclear whether this is a mere bureaucratic hurdle or a real obstacle. But even the specter of these requirements has already spurred companies into action. Tyson Foods, for example, didn’t wait. They announced one of the boldest requirements beginning back in August across their 120,000 person workforce, and the requirement alone led to 62,000 employees taking their vaccines and 96% of their workforce is vaccinated. These requirements are a big reason why, as of this week, 70% of eligible adults across America are fully vaccinated and 80% have had at least one vaccine. That said, it’s not all sunshine and lollipops. So much of the havoc wreaked by COVID wasn’t attributable to the coronavirus alone. So much of it was the result of other diseases let loose because so many of our resources were recruited into the fight against COVID. Syphilis, yes, the easily treatable, sexually transmitted infection is way up. Most cases of syphilis through sexual contact can be easily treated, but without testing and treatment, mothers can pass syphilis on to infants through childbirth, leading to congenital syphilis, which results in 40% mortality if it’s not treated. And congenital syphilis is on the rise. Why? A big part is that the resources Public Health Agency would have been investing in tracing and treating syphilis has gone to fighting COVID-19, leaving cases of syphilis, untraced and untreated. It’s a reminder, as Professor Galea says, that COVID isn’t the be all and end all public health. It’s one of many diseases, all of which can harm us.

That’s it for today. On your way out, do me a favor and go to your podcast app and rate and review our show. It goes a long way to getting it to other folks. And if you really like us, go on over a Crooked Media store and pick up some drip. We’ve got our new logo tees and mugs, are Safe and Effective shirts, and our Science Always Wins shirts and dad caps. They’re perfect for the upcoming holidays. Oh, and if you haven’t already, don’t forget to get your flu shot.

America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivier Martinez, Veronica Simonetti mixes and masters of show. Production support from Tara Terpstra, Lyra Smith, and Ari Schwartz. The 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.