In This Episode
Abdul shares how he found his passion for public health. He lays out why we have to pay attention to the space where science, culture, and politics meet to understand what really shapes our health. And he shares what listeners can look forward to in Season 3 of America Dissected.
Dr. Abdul El-Sayed: When the coronavirus pandemic began, a safe and effective vaccine seemed years away. The average vaccine takes a decade to research, develop and test, and only 6% reach the market. For the coronavirus, the best-case scenario was that a vaccine might arrive in late 2021. Instead, it took just under a year. The latest season of the Business Wars podcast follows the unprecedented race to save lives. Contenders must make scientific breakthroughs, supersize their manufacturing and wrestle with near impossible distribution logistics, all in a toxic US political climate. And just as the deadly virus takes more lives and pushes society to the brink, it mutates. More than 100 companies enter the race, but only four become front runners. We know that the end of this pandemic is going to happen because enough people get vaccinated. This is an inside look into how that happened, and into the way that government funded the research and development, and created a competition between companies to make sure that we could bring these important vaccines to the public. Listen to “Vaccine Wars” from Business Wars on Apple podcasts, Amazon music, or listen early and ad-free by joining Wondery Plus in the Wondery app.
Dr. Abdul El-Sayed: Cases of COVID-19 continue to climb in India, as the virus has led to the collapse of India’s health care system. Authorities in Florida will release 144,000 genetically modified Aedes aegypti mosquitoes that produce non-viable offspring in the wild to kill off the strain of mosquito that carries Zika, dengue, and yellow fever. And science itself is being brought to a standstill by a shortage of the tiny pipette tips that are ubiquitous in wet labs around the world. This is America Dissected. I’m your host Dr. Abdul El-Sayed. Welcome to Season 3.
Dr. Abdul El-Sayed: For the last 71 episodes of America Dissected—yes, 71—you’ve tuned in for updates, takes and perspectives on the biggest public health story, not just this year, but in the last century:
[clip of Dr. Antony Fauci] Pandemics, infectious diseases that spread rapidly—this is the worst that we’ve seen in 102 years.
Dr. Abdul El-Sayed: Look, the pandemic’s not over. And if India’s teaching us anything right now, we’ve still got a long way to go. Today marks the beginning of our third season of the show. In the first season, we brought you deep documentaries about the way that politics and spin interfere with the science and policy that are so important for our health. In the second we dug into the COVID headlines, keeping you up to date and informed from the earliest days of the lockdown to the moment we all got our vaccines. This season, it will be a bit different. We’ll be zooming back out of the pandemic to examine all of the stories we missed while we were focused on COVID-19: all the deeper explanations behind how we got in this pandemic in the first place, and all of the stories on the horizon that could clue us into what’s coming next. As always, we’ll be focused on the place where history, culture and politics meets science. Take the current surge in India, for example:
[news clip] The so-called double mutant variant of COVID discovered in India is suspected of fueling the continent’s current wave of infections.
[voice clip] These raging fires will continue all day and through the evening. The surge in cases has been so much that there’s a waiting really for these bodies to be put on the pyre by family members.
Dr. Abdul El-Sayed: The situation in India is complex, but part of the story goes back to, well, patent rights. India is actually the biggest manufacturer of vaccines in the world. They’re just not able to manufacture all the vaccine they need because they aren’t allowed to. The vaccine manufacturers, mostly based here in the United States, [wont?] allow Indian manufacturers to make their vaccines without having bought the rights. It leaves India and much of the world without the vaccines we’ve been combating this pandemic with here in the United States. In an effort to overcome this, the Indian and South African governments have been asking the World Trade Organization for some time, even before this monster surge, to waive patent rights on the vaccines so they can manufacture enough at home to protect their population and stave off the pandemic. But the US is blocking the path.
[speaker] Civil society organizations calling on the Biden administration to stop blocking the emergency COVID-19 waiver of World Trade Organization intellectual property monopolies that are now imposed on all 159 WTO member nations.
Dr. Abdul El-Sayed: Why? Lobbying from those vaccine manufacturers. Big Pharma in the US is one of the most powerful industries in the country, and they have the power to decide who quote unquote “deserves” their vaccines and who doesn’t, because of the years they’ve spent pouring money into reelection campaigns, creating corporate PACs in the wake of Citizens United and of course, being one of the highest-spending lobbying industries in the country. They spent $4.7 dollars in the last four years alone. I digress. This season there will be a lot of stories like that one. But today, I want to take this opportunity to hit the reset button. Rather than bring you an interview like usual, I want to set the stage for this next season for you. How do we get beyond COVID? Later in this episode, I’ll walk you through some of the stories and guests to look forward to in season three of America Dissected. Don’t you worry. Together we’ll be dissecting everything from the bills in Congress we need to be watching, to the way structural racism and inequity get under the skin in America, and the ways that scientific advancements are changing the future for generations for good and bad. Genetically modified mosquitoes, anyone? Before we get to all of that, I want to step back and explain why I’m so passionate about public health, and why it’s so important to me to make sure you hear and understand these stories. So today, I want to put you in my mind, give you some context about what it was like being an epidemiologist and former public health official watching this pandemic in real time. Here’s a hint: it’s not great, especially not in a pandemic. So let’s go back to the beginning.
[voice clip] China has more than 200 confirmed cases of coronavirus, it’s called. Three people have already died from this illness, which has spread to at least three other Asian countries.
Dr. Abdul El-Sayed: Actually, I’m talking about way back to the beginning. [music starts] It was the ’90s. There was fat, sassy beats, chunky sneakers, and the Pistons were good at basketball. You get the feeling. I’m a brown kid named Abdulrahman Mohamed El-Sayed growing up in the American burbs. What does this have to do with being an epidemiologist? Well, everything. You see, epidemiology is a science of contrasts. We contrast the likelihood of disease among people in different circumstances. How many people who got a shot got COVID compared to those who didn’t? How much more likely were frontline workers to get sick than those who couldn’t work from home? I learned the power of contrasts early because I was walking contrast. I was raised by my father, an Egyptian immigrant, and my stepmother, a daughter of the American Revolution. My dad immigrated here from Alexandria, Egypt in the 1970s. He was a star engineering student and he had one of two choices to pursue a graduate degree. It was either Detroit, Michigan or Bayreuth, Germany. My dad was a democracy agitator in Egypt and he knew that Detroit was in the United States of America, which meant, despite his name, his faith and his olive complexion, maybe he could aspire to be just as American as everyone else. Germany, well, it was still partitioned because of the Cold War, and it was only a few decades past World War Two. He chose Detroit. My father is the perfect contrast to my step mom, Jackie. Her family has been in this part of the world since before the American Revolution. She’s also an engineer, raised by multiple generations of teachers and farmers. Together, they raised me. Confusing, indeed. In fact, I didn’t even become ‘Abdul’ until I was about to start kindergarten. My step mom realized that my name ‘Abulrahman’ with sounds that come out of parts of people’s throats they don’t even know exist, was a nonstarter for a kid who still had a thick Arabic accent. She needed an alternative.
[Movie clip] Wait a minute. I know you. You’re Kareem Abdul-Jabbar. You play basketball for the Los Angeles Lakers.
[clip of Arsenio Hall] Crank your fists for Paul Abdul. [applause]
Dr. Abdul El-Sayed: Kareem Abdul-Jabbar had just finished his stellar basketball career, and topping the billboard charts that fall was the one and only Paula Abdul. And that’s how I became Abdul. So let me explain why I became Dr. Abdul, epidemiologist. So here’s the thing about being a child of immigrants, you’re never quite from one place. In America, I stood out for being Egyptian, and in Egypt—as I’d learn in the summer of 1997—you stick out for being, well, American. That summer, my parents decided it would be a good idea to just ship me to Egypt for the entire summer. I spent most of my summer hanging around with my cousins under the care of my Teta [unclear], the person who’s done the most to shape my understanding of who I am. Even today, she remains the smartest, wisest, most intelligent person I’ve ever met. She never got to go to school. Despite that, she taught me the deep power inside a contrast. One day, my Teta pulled me aside and she pointed to one of my cousins, see that one over there? She said, that one’s smarter than you, that other one over there, taller and better looking. That other one over there, nicer and kinder, that one more athletic and so on and so forth. At some point, I started to wonder if I had anything at all going for me. Habibi, you’ve got the most important thing of all she said, you’ve got opportunities. That’s the power of a contrast. How much more opportunity did the cousin growing up in the US have than the cousins growing up in Egypt? And what did that cousin owe. Teta was reminding me that the opportunities I have that I took for granted were simply an accident of history. My cousins smarter, taller, better looking, nicer: they live very different lives than I do. And that’s simply because I got to grow up in a place where my talents were nurtured. Teta is also the reason I became a doctor. She raised six kids, my dad was her oldest, but she gave birth to eight. Two of them died before their first birthdays. She had a personal infant mortality rate of 25$. My dad still remembers losing his siblings, a girl and a boy who would have been my aunt and uncle. Back in season one. I asked him about it:
[clip of Mr. El-Sayed] You see your mom suffer and it really affects you tremendously, and it, it leaves a stamp on your own life.
Dr. Abdul El-Sayed: Before that, I’d never heard him tell those stories before, and they taught me something about him. See, contrary to immigrant parents stereotypes, my dad was never that excited about me becoming a doctor. In fact, my Teta had wanted him to be a doctor, and he never wanted to be either. And it’s because for him, the earliest memory of a hospital, of medicine, was watching his siblings die. He never wanted any part of it. My Teta had taught me the power of a contrast and I began to see them everywhere. In the 15 hours it took me to come home from Egypt. I traveled 10 years difference in life expectancy. I didn’t quite have the language to quantify it then, but I could see that difference in the faces and the bodies of the people on the wrong side of it. But here’s the craziest thing. Growing up just outside Detroit, I didn’t have to go 15 hours to travel 10 years in life expectancy. I did it every weekend without even leaving my state. See, my dad’s dad was a vegetable vendor. And so my dad loved the Eastern Market, one of the largest and best outdoor markets in the country. And every time we’d cross into the city of Detroit to go to the Eastern Market, I would cross that 10-year life expectancy gap in 15 minutes. With all this swirling in my mind, I was forced to grow up one September day when I was in high school. More after the break.
Dr. Abdul El-Sayed: I remember being a junior in high school, sitting in my morning chemistry class when this happened:
[news clip] There has been a plane crash on the southern tip of Manhattan. You’re looking at the World Trade Center. We understand that a plane—
Dr. Abdul El-Sayed: My name is Abdulrahman Mohamed El-Sayed, remember. My brother’s name? That’s Osama. That was the moment I went from being an olive complexion guy with a funny name to being a very specific kind of olive complexion guy with a very specific kind of name. That morning forced me to consciousness about what it meant to be a person of color in America. Already I was trying to make sense of the profound disparities I traverse on weekends to Detroit, or every summer to Egypt. I was trying to understand the impacts of colonialism, the transatlantic slave trade, Jim Crow, the Great Migration and Michigan’s racist history, on the place where I was growing up. 9/11 forced me into the conversation in a much realer way. I read and reread Alex Haley’s Roots, and the autobiography of Malcolm X, and Howard Zinn’s People’s History of the United States. And I realized how much I struggle to understand myself, the colonialism that shaped my Teta’s experience, and the structural racism that created a 10-year chasm in life expectancy in 15 minutes, all that came together, and were actively shaping the lives of billions of people. But up until then, I hadn’t really understood the power of contrasts, the power of epidemiology to help us understand all that. That didn’t happen until college. I was working in a research group at the School of Public Health at the University of Michigan when a colleague suggested I check out this paper by a researcher at the University of Chicago. Her name was Diane Lauderdale, and she analyzed birth outcomes among women with Arab names to understand how they changed after 9/11. Dr. Lauderdale found that after 9/11, the proportion of babies born with low-birth weight increased by nearly 30% and almost doubled if the infant had an Arab name too. In reading that paper, I saw my worlds collide. Biology and politics, life and science, all in one 22-page paper. My life had been an exercise in contrasts, but I’d never seen a contrast weaponized as a tool for science, as a tool for truth, like that. From that point on, I became obsessed with the public health science of epidemiology, specifically social epidemiology, understanding how social factors shape the differences in health and disease that I came to understand so intimately in the social geography of my childhood. The science was about the way that cells and societies interact, biology and politics clash. For so long, I’d been studying biology to understand the bad decisions that cells too often make to create disease in a body. But this confirmed that health isn’t just about the pathology that happens beneath the skin. It’s a lot more about the pathology that happens above the skin, the bad decisions that societies make that leave so many without basic access to the means of a dignified life, whether reliable housing or good schools or even just pure air and drinkable water. I got the opportunity to do something about that when I was named health commissioner in the city of Detroit. I was 30 years old and had never worked in a city health department. And I was walking into what was probably the hardest situation in local public health. See, the city’s health department had been privatized three years earlier, when the city of Detroit went through bankruptcy and financial takeover by the state under a brutal set of austerity measures that were the brainchild of the now infamous governor, Rick Snyder. You may know him better from this:
[news clip] Nine current and former city and state workers in Michigan have been charged in connection with the Flint water crisis that began in 2014
Dr. Abdul El-Sayed: Before he poisoned 9,000 kids in Flint, his emergency management program led to the shutdown of a 185-year old health department. My job was to rebuild it, and we rebuilt it around the well-being of kids. We wanted to break down the barriers that kids had to learning and earning in Detroit, like we’d want for any child anywhere. We built a program to provide every child a free pair of glasses at school because if you can’t see the board, you can’t learn what’s on the board. We took on major polluters, building an environmental justice practice out of the department to stand up to them. We forced a Marathon petroleum refinery in southwest Detroit, the biggest polluter in the most polluted zip code in the state, to reduce its emissions when they wanted to increase them. And we had every school, daycare and Headstart tested for lead in the water after Flint. But every single problem we took on led to the door of a politician. And those doors are almost always locked when it comes to kids. I was growing frustrated with the limitations that our politics put on our work and then this happened:
[CNN clip] CNN projects Donald Trump wins the presidency.
Dr. Abdul El-Sayed: I figured if an orange reality TV star could get elected, maybe a brown Muslim doctor could get elected too. So I ran for governor on a platform centered on providing a state health insurance program for all Michiganders, fighting for environmental justice, and investing in a green economy. It didn’t work out. And I finished second of three in the Democratic primary to Michigan’s current governor. I had run for governor believing that great policy should speak for itself. That’s definitely not how it works. Instead, we’ve got to speak for it. Our politics is a byproduct of our culture, the narrative we tell ourselves about who we are, and who we want to be. Our culture makes our policy possible. Politicians are just there to do the translation. So I resolved to do my part to try and shape our culture through my writing, my work on television and yeah, through this podcast. We did a great first season trying to tell the story of public health. We had ten fantastic episodes and I was ready to move on. Then the world changed.
[news clip] As a number of coronavirus cases soars above 3,000.
[news clip] Hospitalizations related to the coronavirus are jumping and hitting a record in the US.
[news clip] One fourth of Americans are now being ordered to stay home.
Dr. Abdul El-Sayed: I remember watching the pandemic take shape in January. Embarrassingly, I told Tommy Vietor this Pod Save the World:
[clip of Abdul El-Sayed] The high, high probability is that we’re not going to be affected by this, thankfully, because we have a strong public health infrastructure in this country and we’ve got to keep it strong.
Dr. Abdul El-Sayed: I hadn’t accounted for the fact that Donald Trump was now president, a reminder of just how intertwined our politics and our public health really are. By mid-February, I had realized what we were in for. And by mid-March, as the whole country locked down, Sarah and I moved in temporarily with my in-laws to accommodate our daughter, Emily’s, child care. Like all of you, we were aggressively wiping every box of chocolate, every jug of milk, that came into the house. With all the panic, Jon, Jon and Tommy called me up and asked if I’d be willing to do a second season of the podcast focused on the pandemic. I’m sure all of us look back on that time last year with our own emotions. For me, it was surreal. All the things that I’d been thinking about throughout my life were now what—for better or no, definitely for worse—everyone was being forced to think about, too. How does the way that we communicate shape the flow of misinformation in the absence of strong science? How do we communicate science being done in real time, especially when it contradicts what we initially thought we knew? How do people with means and privilege insulate themselves from major public health disasters, leaving poor and marginalized people even more exposed? How do you convince people to engage in collective action, like wearing masks or getting vaccinated, in a toxically individualistic society like ours? How does the for-profit nature of our health care system leave it fragile in the face of the pandemic? How do we protect ourselves from autocrats who are trying to control the news and hurting people in the process? All of these questions became centrally important to our survival. There was going to be plenty to discuss. Rather than recap the news, my goal was to surface all the dynamics that were operating just below the surface—dynamics that so many of us had been trying to warn society about for years, starting way back when they were set in place. I wanted to show you the place where history, politics and science meet in one moment. I wanted to shine our light on the people whom our society so often fails to even acknowledge, the double standards in the way we were asking low-income people, usually people of color, to step up, even while society has so often failed to step up for them. I wanted to show you how government decision making, not just during the pandemic, but before it even started, was shaping the consequences in real time. I wanted to share how the scientific process was the key to leading us out if we let it. The pandemic’s not over, but it shouldn’t take a pandemic for us to pay attention to these life and death dynamics that can create one in the first place. COVID-19 forced us to pay attention, and now we shouldn’t stop. This new season of America Dissected is about paying attention. My goal isn’t just to explain what’s happening, but how it could change the future. See, public health is all about the setup. What happens is a product of how well we’ve prepared for it. So to tell the story of public health, we have to explain the setup and what it means for the future. Those are the stories, the perspectives, I want to bring you now. And as you’ve come to expect from America Dissected, our scalpel is sharp, and we don’t hesitate to cut to the heart of what matters, because to understand what’s happening, it’s not enough to stay shallow. You’ve got to cut through the skin. Throughout the season, we won’t hesitate to call out the bullshit that too often gets in the way of science, or the responsibility we as a society have to the most vulnerable, whether it’s media spin, corporate greed or political opportunism, we’ll cut through it all. My whole career has been about trying to understand why some people get to live long, healthy lives, while others don’t. And more importantly, it’s been about doing something about it. So here, we’re going to center the stories, experiences and perspectives of those on the wrong side of the chasms in life expectancy to understand how everything from our politics to, yes, our scientific establishment, has too often failed them, and what we need to do about it. And we’ll meet the heroes who are working every day to solve those profound inequities through science, advocacy, policy and culture. Over the course of the next month, we’ll talk to Representative Cori Bush, the nurse turned Black Lives Matter activist who got elected to Congress in the midst of the pandemic.
[clip of Cori Bush] We shouldn’t be talking about good police and bad police. There should just be police that are doing their job to serve and protect.
Dr. Abdul El-Sayed: She’ll share her perspective on how activists and organizers have to harness this moment to move legislation that protects Black and brown Americans hurt most by this pandemic. Then we’ll talk to CNN’s Sanjay Gupta.
[clip if Dr. Sanjay Gupta] To go out there and say it was a pandemic, it was a different phase, as you mentioned, but it was correct because that’s what the data showed.
Dr. Abdul El-Sayed: He’ll talk to us about how the pandemic has changed medical journalism, and about what he’s learned about how to cover fast-changing science in real time, and what his experience tells us about science education in America. We’ll talk to Dr. Ibram X Kendi, author of “How to Be an Antiracist.”
[clip of Ibram X Kendi] When you really think about the history of Americans expressing racist ideas, you’re really talking about a history of people who have claimed they’re not racist.
Dr. Abdul El-Sayed: Together, we’ll break down the racism in America’s health care system, and what we need to do to bring the lens of anti-racism to it. All of this and more in season three of America. And don’t worry, we’ll still be bringing you insights and perspectives on the pandemic. So stick with us. This next season, I’m really excited for and one, in the wake of this pandemic, I think we all need. I’m so excited to share it with you. For now, enjoy your week. I’ll see you back here next Tuesday with Congressman Cori Bush.
Dr. Abdul El-Sayed: Oh wait! Before we go, let me walk you through, as usual, what I’m watching right now. India’s surge has emerged as an international crisis. It’s setting single-day COVID case records every single day. And most epidemiologists agree that they’re underestimating cases by upwards of a factor of 10. The Biden administration pledged to send 30 million doses of the as-yet unapproved AstraZeneca vaccine to support that effort, and yet that’s just a drop in the bucket in a country of 1.37 billion, with a B, people. Meanwhile, in America, cases are starting to fall across the country, although there’s been a profound demographic shift in the burden of cases: children and young adults now make up the higher share of those who are falling ill or dying of COVID-19, which reminds us that these vaccines work. If it weren’t for the vaccines, we’d be seeing thousands more of our seniors having died.
Dr. Abdul El-Sayed: That’s it for today. Tune in next week, and if you like our pod, please make sure to rate and review. It really helps our discoverability on the podcast apps. And don’t forget to check out our Science Always Wins Tees, Dad hats, and sweats on the crooked merch store. And last but not least, there is still time to do your part to support our bid for a 2021 Webby Award. Go to vote.webbyawards.com and search for America Dissected. Again, that’s vote.webbyawardscom. Get your vote in by May 6th.
Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Olivier MartinezVeronica Simonetti mixes and masters the show. Production support from Tara Terpstra and Lyra Smith. The theme song is Taka Asuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.