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It’s World Immunization Week! Aside from basic plumbing, no public health intervention has saved more lives than vaccines. But misinformation, corporatism, and disinvestment are keeping them from those who need them most. Abdul reflects on the consequences of COVID for global vaccination efforts. Then he talks to Martha Rebour, Executive Director of Shot@Life about the effort to vaccinate the world.

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Dr. Abdul El-Sayed, narrating: The Supreme Court overturns lower court rulings preserving broad access to the abortion medication mifepristone. The FDA issues new recommendations for bivalent COVID-19 boosters, for seniors and people with compromised immune systems. U.S. birth rates persist near an all time low since the pandemic. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] It’s World Immunization Week. I wish I could tell you that wasn’t a crunchy holiday pointy headed public health nerds created to raise important attention on a critical issue that just, well, isn’t sexy enough on its own terms to get the attention it deserves. It is. That’s exactly what it is. But this one, like most of them, matters, and it has never mattered more. If you’ve been with me since the bad old days of the worst of the pandemic. You’ve already heard me talk a lot about vaccines. And you’ve also heard me talk about mis and disinformation. About how Covid’s emergence during the Internet era joined these two at the hip. Don’t get me wrong, vaccine mis and disinformation have been around way before COVID. There’s a reason our first episode ever was about exactly this. And that was back in 2019. Even before COVID, there were a number of high profile measles outbreaks as social media drove parents to question vaccines that are so damn effective against the diseases they prevent. Most parents forgot what the diseases even look like. COVID was like a pressure cooker for anti-vaxxers. We had a new, unfamiliar virus hit us, presumably from a nation with which ours has a strained relationship. All in a time when we had a carnival barking reality TV star in the Oval Office. The pandemic forced us into our homes where we had way too much time to spill our anxieties all over the Internet. The cauldron boiled over. Across the U.S. vaccination rates are still down. They’ve been declining by about a percentage point among new kindergartners every year since 2020. And while that’s a serious problem unto itself, we are truly blessed and privileged to live in a society where vaccination rates have been so high for so long. But in too many parts of the world, that’s not the case. An infection we fail to prevent with a vaccine in Malawi or Pakistan is way more likely to end in a death that we failed to prevent. And that’s why the fact that children in low and middle income countries fell behind on their vaccines during the pandemic is one of its most bitter consequences. It’s hundreds of thousands of kids who didn’t just have to live through the COVID pandemic, but are now left exposed to so many of the other diseases like diphtheria, typhoid fever, measles and hepatitis that have been taking young lives for centuries. To add insult to injury, a new report from UNICEF found that global trust in vaccines is down 44% since COVID. Worse among women and people under 35. You know, the folks most likely to be moms. So even as our COVID vaccines were way too slow to hit some of the poorest countries in the world, our disinformation made its way just fine, and it could hobble efforts to catch children up on these lifesaving vaccines. And about those slow COVID vaccines, that goes back to a debate about whether or not U.S. corporations making money on these vaccines hand over fist should be forced to hand over the recipe, which, by the way, our tax dollars paid for. It would violate patent rights, they say, and without those patent rights, what would drive all that innovation they asked? What innovation? It’s that same system of corporatism that’s kept those same corporations from innovating new vaccines for diseases like HIV or malaria, for which we’re only now seeing breakthroughs. After all, poor folks don’t have the same kind of cash to pay. So those vaccines, well they wouldn’t pay out enough for them to research and develop them to save millions of lives. That’s another story for another week. This week, it’s World Immunization Week, where the theme is the great catch up. That’s as in catching up with vaccines after the pandemic, not overly inflated versions of Red Tomato Condiment. I wanted to learn more about the effort being put into catching children up on their vaccines around the world. So I sat down with Martha Rebour, executive director of Shot at Life, a critical organization on the front lines of global vaccines for children. Here’s my conversation with Martha Rebour. 

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

Martha Rebour: Yes. Hi. Martha Rebour. I’m the executive director of the Shot at Life Campaign, which sits within the United Nations Foundation. 

Dr. Abdul El-Sayed: We’ll just start with where we’ve come to. Give us a picture in a world before vaccines, what are the leading causes of death, particularly in lower and middle income countries in the world? 

Martha Rebour: So before the, you know, widespread uh dissemination of vaccines, children were dying still are, but were dying in very large numbers of measles, of pneumonia, of rotavirus, which is a diarrheal disease. Um before vaccines you know, smallpox was a scourge. Smallpox had been around for thousands of years. The global health community got together and said and the scientific committee said, let’s get let’s eradicate this disease. And they were able to do it. So before vaccines, uh infectious disease used to spread wild. And uh, you know, children used to die in very large numbers. 

Dr. Abdul El-Sayed: You talked about children in particular. Um. You know, one of my pet peeves and um a lesson we regularly come back to is about how you calculate life expectancy, right? Oftentimes when you say life expectancy was 38. And people sort of assume that everybody just dropped dead at 38. [laughter] But really what life expectancy is, is an average uh age at death. And when a child dies, it disproportionately brings down the life expectancy. So if you made it through your childhood, you were looking at, you know, 60 years of healthy life, not too dissimilar from where we are now. Obviously, people did die a lot younger, you know, by a decade or so. But but, you know, the real issues were death in childhood and then again, death in um in pregnancy and childbirth and then often death in war. But that death in childhood piece is you know so fundamentally critical. Um. Can you tell us a little bit just about what is the state of child and infant mortality today um in lower and middle income countries, uh in places without the kind of access to medication, medicine, even vaccines and clean water that we take for granted here in the U.S.? 

Martha Rebour: Yeah, I mean, you make a really good point. Children are still dying of infectious disease in many low resourced countries. But, you know, I tend to and our campaign tends to also like to look at the optimistic side of things. And vaccines are really they are, you know, what Bill Gates calls the best buy in public health. They have made the biggest difference in saving children’s lives around the world. And the thing is, I think we’re at a really exciting time. Like we have the vaccines. It’s a question of access. We know um I’ve had the privilege of visiting a lot of uh countries in Africa and um really have met with health care workers and talked to mothers. And people want these vaccines. You know, it’s a question of access, but we don’t have a lot of the same issues we have here about being afraid of vaccines or spacing out vaccines or, you know, people see measles come through their village and wipe out children and they know what it means for to get especially measles if you don’t have regular access. Like you made a great point to to clean water. Clean water is another big thing. And it’s important when you’re ill. Right. We know that um you need to regularly be hydrating to help your body deal with a fever and work out a virus. So I think what’s really important to to underline is that the solution is there. Vaccines do save lives, but what’s important and what where I’m from, at shot at life. We work on increasing access to those vaccines. And that’s a really important point. I think, um as I said, compared in this country, I think people could be can be a little more skeptical about vaccines and they’re sort of a victim of their own success. Right. We don’t see polio, you know, anymore. Maybe we have grandparents or know older people who uh contracted polio. But thanks to vaccines, we don’t see polio in this country anymore. But if you travel to other countries where there are children who, you know, cannot walk and they have the paralysis due to polio, well, those parents are more than ready to line up and get those vaccines because they know they’ll protect their children. 

Dr. Abdul El-Sayed: Yeah, you make a really good point. And I raised the point about about childhood mortality to remind folks that, you know, there is a real difference when we talk about vaccines here in what we call the global north or high income societies versus when we’re talking about the global south or lower and middle income societies, which is that, you know, on the one hand um you have a true and deep, profound need, and on the other you have a situation where people can’t necessarily get to them. And in the United States, our health care system is really quite broken. And at the same time, though, no matter where you live, you can get access to a vaccine no matter where you live. Uh. 

Martha Rebour: Yup. 

Dr. Abdul El-Sayed: A public health department offers those in in your town, your community, free of charge for kids. Um. And so the way we think about health and health care and the consequences of the lack thereof fall hardest on literally dead children. And I say that in that way so that folks understand exactly what it is we’re talking about. Right. And the upside, of course, is that um you can solve that. And you guys are working uh every day to solve that by way of getting that vaccine access uh to folks who need it. The other point that you raise, which I really appreciate, is a point about um about the obvious need that sort of defeats the mis and disinformation that can spread, which is, you know, when you see a disease ravaging your own community, when you see uh and have to visit the the families of children who just died because they they could not get the treatment that they needed of the disease your child could be vaccinated against, you’re going to rush home and do everything you can to get that kid vaccinated. And– 

Martha Rebour: Yup. 

Dr. Abdul El-Sayed: You know, when you talked about vaccines being a victim of their own success here in the United States, you know, COVID is sort of the perfect example of that. COVID is a disease that had a low enough mortality rate that there was plausible deniability that you would die of it if you got it right, 1% mortality rate. But it had a high enough mortality rate that it ended up killing, you know, 1.1 plus million people in this country. It is extremely deadly by by virtue of just how many people died of it. But also 1% mortality is nothing to sneeze at. That’s one in 100. That’s that’s a lot of mortality. But the thing about it is that that plausible deniability is is actually super dangerous. And because the pathology itself and we talked about this in earlier episode because the pathology itself comprised of symptoms that people have had in the past, it’s not the kind of thing that’s so gruesome that everybody looks at it and says, Oh, my God, like I have to do something about this. Versus smallpox, we interviewed uh Andrew Wehrman just recently who wrote a book about um called The Contagion of Liberty, about smallpox. And smallpox is like extremely gruesome. And so when you saw it, you said, oh, my God, I have to do everything I can to protect myself against that. 

Martha Rebour: Yeah. 

Dr. Abdul El-Sayed: Which sort of led people past their skepticism and past the power of misinformation to just do the thing that they needed to do to protect themselves. And now smallpox is no more. But um we forget that, you know, in this country we have the luxury of having a debate. Right. Which should never really be a debate because you can’t really debate facts. But, you know, we have the luxury of having a ongoing public conversation about whether to vaccinate. Um. Whereas if you go to other communities, they’d probably slap upside the head and just say, you fools, you idiots, you have all of this access and yet and yet you’re choosing not to take it. And still, like grandparents are dying um still to this day, you know, whatever. 

Martha Rebour: Yeah. 

Dr. Abdul El-Sayed: Uh. Federal officials want to say about a state of emergency. So um tell us a little bit about the state of access. How many people go unvaccinated for lack of access in the communities of the countries that you’re serving? 

Martha Rebour: Yeah, I’m so glad you brought that up, because as I said, you know, on the on the bright side, vaccines have saved millions of lives. But as we know, babies are born every day. We can’t let up. And unfortunately, during the pandemic, health care workers and resources were diverted to, you know, masks and PPE and actually uh vaccinating adults. So in 2020 alone, 23 million children missed out on their basic vaccines, 23 million. So that’s from 2020. Now we have more children that are born, as I said, every day. Right. 2021, 2022. So we’ve got to catch up. The ones that we missed during the height of the pandemic. And then we have all these new babies being born. So um we’re actually uh going to be partnering the W.H.O., World Health Organization during World Immunization Week. They’re launching a campaign called The Big Catch Up. And that is a real effort to illustrate how important it is to catch up children with their basic vaccines, because we have made such incredible progress over the last you know 25 years. But with the pandemic, rates have slipped back to where they were 30 years ago. So we have the technology and the resources to get back there, but it’s going to take a lot of effort. And so a lot of what we do at Shot at Life is we work to make sure that the U.S. federal government is properly funding these immunization programs which again, I said that they’re the best buy right they’re the best investments you can make, um you know, in global immunization. Because, you know, to your point about COVID, something we did learn is that diseases don’t need a passport, right? They jump on an airplane and the next thing you know, they’re here. Um. And we have had we had a polio uh case in New York State. We had a pretty big measles outbreak recently in Ohio. So the two sides of it are, of course, um you know, we all need to continue to protect ourselves. But part of protecting ourselves is also making sure people around the world are getting protected, because that’s how this works, right? We’re in a global community. 

Dr. Abdul El-Sayed: What was the impact uh in in numbers of the COVID pandemic in terms of global vaccinations for these other diseases? 

Martha Rebour: So as I said, 23 million children missed out on their basic vaccines. That was uh part of the fallout from COVID but– 

Dr. Abdul El-Sayed: Okay, so those 23 million are attributable to the vaccine. These are people who like children who otherwise would have been vaccinated. But for COVID? 

Martha Rebour: That’s right. 

Dr. Abdul El-Sayed: Wow. 

Martha Rebour: But for the pandemic um now some children uh live in hard to reach areas. There’s internally displaced and refugee children, and it’s very hard um to keep records and to reach these children. There are incredible efforts being made to make sure that those children also get protected. But the the effects of the pandemic now I can’t trace, you know, exact line, but we do know that there were 23 million children who missed out. And we know that health care systems were ravaged and majorly disrupted and, you know, ran out of resources because of the pandemic. Health care workers, you know, were ill themselves. They were um trying to protect themselves with very little uh protective equipment. And a lot of these countries said they were falling ill. So then clinics had to close, uh it really took a toll on health care systems, um particularly in sub-Saharan Africa. 

Dr. Abdul El-Sayed: Yeah, I was going to ask, where are the tolls the greatest? Um. You talked about sub-Saharan Africa, um where uh there and then also where else in the world? 

Martha Rebour: So um specifically, you know, I would say sub-Saharan Africa, as I said, I also think that places where there are people on the move. So, um you know, we could talk about Syria, it’s it’s tragic what’s happened there with the civil war. And now they’ve had an earthquake. That’s probably an example of a place where it’s just very hard um to get health supplies uh in. It’s hard to find people. It’s you know, people are on the move. There are camps, it’s reaching those people is critically important. But as you can imagine, it takes more resources than simply, you know, shipping, shipping medications to one central clinic. These are this is a real challenge uh for our U.N. agencies to to make sure that those people are getting the health services they need. 

Dr. Abdul El-Sayed: We’ll be back with more with Martha Rebour after this break. [music break]. 

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Dr. Abdul El-Sayed: I want to ask you also just about mis and dis information. Obviously, we talked a little bit about the fact that, you know, a lot of these communities where you see the consequences of these diseases upfront and regularly in the lost lives of people you love and care about, that you’re a lot less likely to believein mis and disinformation. And yet at the same time, Internet still exists. And I would argue that–

Martha Rebour: Yes. 

Dr. Abdul El-Sayed: As poor as Internet literacy is here, um Internet literacy is often really quite poor um in some of the communities that we’re talking about. And on top of that, there is the added issue of centuries of um colonialism and mistrust between the places where vaccines are coming from and the places that they’re going. There was a you know highly uh publicized case of a CIA organized vaccination drive in Pakistan uh in order to obtain DNA from a mark um that then really, really hobbled vaccination efforts in that community uh as as people boycotted vaccination drives that were completely legit and that kind of meddling in the ways that our government and other governments in high income countries have systematically um taken uh the lives of people in these other countries less seriously, um has had an impact. And then there’s also the just the question of, you know, COVID vaccines and whether or not they were made available and when they were made available and the way that um people in lower middle income countries then look at um what comes out of our pharmaceutical industry with a lot of skepticism and well-earned mistrust. I want to ask, you know, what is the impact of the consequences of that kind of behavior and the consequences of just the spread of mis and disinformation, um of the the more mundane type on, you know, what you’ve been seeing on the ground? 

Martha Rebour: Yeah, well, you make an excellent point. And that the Internet is it reaches the whole world um and a lot of misinformation that starts in this country has spread. You know, there there was a lot of vaccine misinformation in Senegal, in Nigeria. And it’s interesting because for our campaign, we used to say we didn’t really want to wade into domestic debates about vaccines because we’re focused on making sure uh children around the world are protected. But what we’ve come to realize is that with a vacuum of, you know, fact based uh messages about vaccines and real, you know, human stories about how they save lives, this misinformation has seeped in. And as people go to search when they’re, you know, looking to, should I vaccinate my child or not? There’s been so much misinformation out there that we’re working really hard with other global health partners to make sure that good factual information is out there. Because you’re right, the Internet does, you know, reach around the world. And so certainly there are um some communities in in um where we work, where there where there has misinformation. But I think we’ve learned a couple of things. Uh. First of all, it’s best to work with local leaders. So as you said, of course, there is some skepticism. If there’s somebody you don’t know who comes in, who knocks on your door and asks you to to vaccinate your child. But working with local leaders, whether they’re faith leaders or just people respected in the community and making sure that they’re equipped with the information to be able to ask what are often very legitimate questions from mothers. Right. You don’t want to just inject anything into your child. So I think it’s important to work with local trusted leaders and make sure um that they have the information. Something else I think we learned uh about COVID and not so much on the trust side, but just sort of on the equity side is we need to increase manufacturing in some of these countries. So all the vaccine manufacturing or the largest part of it was mostly Europe uh and the U.S., some in South Africa, some some in other countries. They probably the largest vaccine manufacturer, is based in India. The Serum Institute of India is manufacturing millions of vaccines and doing an incredible job. But there’s a real effort now to make sure that vaccines and other medications can be manufactured in countries. And it makes sense uh from a economic point of view. It makes sense from quote “of a trust point of view” so uh I think you’ll see a lot more of that. 

Dr. Abdul El-Sayed: Yeah, you know, in so many ways, um our country and European countries have given um folks in sub-Saharan Africa, parts of Asia, so much to mistrust. And um and, you know, when we uh in in complete earnest are trying to uh invest in the upside of of health, that mistrust comes in the way. And I think the more that we can. Um. Rather than thinking about we are the only uh country where we can manufacture these things safely, we come to appreciate that actually, a lot of our a lot of our science expertise comes from those countries. 

Martha Rebour: Sure. 

Dr. Abdul El-Sayed: Uh. And frankly, a lot of the medications that we take comes from those countries and that um the more we can uh let loose um a lot of the recipe um and allow for local manufacturing uh and local leadership, the better off we are. And, um you know, and I think that has been we’ve been slow to the uptake, but I’m glad to hear about a lot of those efforts. The other place where um where this comes up is all the vaccines that are not researched or made because they are um for diseases that people in high income countries don’t suffer. 

Martha Rebour: Yes. 

Dr. Abdul El-Sayed: Right. So you think about um a uh vaccine for uh malaria, how long it’s taken um for us to make any breakthroughs. And there have been some breakthroughs which are really exciting. Or um river blindness. Right. Another disease for which uh you could imagine a safe and effective vaccine that literally uh allows people to see uh protects their vision um against a disease that that just ravages that. And there is not a um there is not a market base uh in our market based health care system to research, develop and bring to market these kinds of vaccines. And so we’ve been really slow on the uptake. And that itself is its own kind of um neglect. What what gives you hope about the future? And then how do we take on um the that the pernicious, you know, neglect uh by our um or by the world’s you know, and I want to just clarify this. Our pharmaceutical industries. Right. You can imagine other countries creating pharmaceutical industries and researching and developing these things. What happens oftentimes because of consolidation is that our industry just buys them up. And then when we buy them up, we end up just focusing on the things that we make. It’s kind of like, you know, Facebook just buys up all its possible competitors and then they all just become Facebook or you know Instagram by Meta. Right? 

Martha Rebour: Right. 

Dr. Abdul El-Sayed: And the same thing happens when it comes to um pharmaceuticals. So what vaccines on the horizon give you uh hope? And then also, how do we take on um the way that consolidation has sort of robbed us of research and development on diseases that affect a lot of folks um who our system can’t monetize? 

Martha Rebour: Great question. So first of all, I want to talk to you about a fabulous organization called GAVI, the Vaccine Alliance. If you or listeners don’t know about it. And GAVI was created, in fact, to fix that marketplace problem or one of the marketplace problems, which is that there were vaccines that were simply too expensive to for um, you know, governments to be able, ministries of health to be able to purchase. So GAVI works in what we call almost like a Costco bulk method, where uh GAVI will work on pulling together orders for millions of a vaccine, then going to a pharmaceutical company and saying, we’re putting in such a high order, you know, instead of $4 a dose, you’re going to sell it to us at a dollar at dose this just as an example. So I do think some of that marketplace uh problem did get fixed with GAVI. And in fact, GAVI right now is working to make sure that the malaria vaccine got can get rolled out. They’ve started a pilot in three countries in Africa, and it’s been very successful and GAVI is comprised of people from around the world uh and they meet regularly with ministers of health and they were told from the ministers of health, this is the vaccine we all want the most. As you said, malaria is a terrible disease that takes many lives and many children’s lives every year. So I’m very hopeful about the malaria vaccine. It’s not perfect, but few vaccines are when they first hit market. And then as they prove that there’s a market for this vaccine, we know that other uh manufacturers will come in and they’ll improve upon this model. And I think what’s really exciting that came out of COVID is this whole mRNA technology. It gives me a lot of hope. There are vaccines that we didn’t even you know, we didn’t even know we could vaccinate against certain diseases. But I think mRNA is going to help um really leapfrog progress. So I think we’re going to see a lot of new vaccines come to market. Um. Another vaccine that unfortunately, um rates went down during the pandemic. But that’s really incredible is the HPV vaccine. You know, the Dr. Tedros, the head of W.H.O., always says we actually have a vaccine that can prevent cancer. Like why wouldn’t we all be doing everything we can to get it out as much as possible? So HPV is also a really uh exciting vaccine. I think we’re going to see other vaccines against cancer. As I said, the malaria vaccine gives me a lot of hope and I think um it will become even more uh effective as the as the technology evolves. So I feel like we have got the tools and technology. Um. And really, I think we’re going to see a lot more um progress and a lot of new vaccines coming on. So I feel optimistic if we can rally people uh to care about this issue. Um. Those of us, as you said, living in this country, you know, at at our organization, Shot at Life, we provide a portal for people who care about this issue and want to do something. We actually make it really easy to reach out to your policymaker and say, please, you know, when this comes up for a vote, please make sure you fund these programs. And I just want to remind um listeners that overall foreign aid in the in the U.S. federal budget is less than 1%. So as people say, well, why should I fund this? And then we can’t fund that. It is it’s not even pennies, hundreds of pennies, thousands of pennies on the dollar uh compared to the federal budget. And it’s morally the right thing to do to allow uh people around the world to protect themselves from disease as we can. But it also makes sense economically. We are also it’s our global health security. You know, as we as I said, diseases don’t need a passport. They do come into this country. So if we don’t help provide that protection around the world, the diseases are going to come right back here. And as we know cost our economy a lot of money and cause a lot of suffering. 

Dr. Abdul El-Sayed: Yeah, I really appreciate that that perspective. And um I want to get to the point on U.S. funding in a second. You know, the white whale of uh of vaccines is an HIV vaccine. Um. And there has been some question about whether or not mRNA can uh offer that that great leap forward, now I’m mixing metaphors um [laughter] to help us catch the white whale. I don’t even know where I’m going here, [laughter] but um [laugh] uh what is your sense on that? And um and uh do you feel like um that kind of vaccine would fall prey to the same challenges that we’ve had in the past? Or do you feel like that, given the state of PEPFAR, um the president’s emergency plan for AIDS Relief signed under uh George Bush, um do you feel like that that one might have a chance of really blanketing? 

Martha Rebour: Yeah, I, I can’t comment too specifically on the HIV vaccine because I’m not I haven’t been following it. And I’m not a scientist. But certainly um if there were a vaccine made available that could protect people from that terrible virus, I think we would all be falling all over ourselves to make sure we did everything we could to get it, to get it out and as as widely available as possible. And I think it’s really exciting to think that there could be could be a vaccine to protect people. 

Dr. Abdul El-Sayed: I want to talk a little bit now about U.S. funding for um for global vaccines. You addressed the question on its head earlier. You know, why should we pay for this? And I want to ask you just why do you think that’s increasingly a question now? I mean, it would make sense that so many of the folks who have who would be asking that question in the past would have used this metaphor of a shining city on a hill. Right. And you would imagine that the shining city on a hill with all its prosperity would want to rain down its wealth on everyone else, because that’s what shining cities on hills do. And it seems like the same folks right and from the Reagan era um who would say, yeah, this is definitely a good thing to do um now question whether or not we should be invested in in these kinds of things at all. Whether it’s because of vaccines being what we’re sending or it’s whether or not we should be investing money in what a former president called s-hole countries, which, by the way, is what he would have called the country that my parents came from. And um I want to just ask you, like, what does it look like to advocate against that kind of a politics that says we should tuck in and not care about the lives of of folks in other countries? Because, you know, I think most of the people who listen to the podcast see this as self-evident. You don’t have to make the case here. But what do we do when we have that conversation with folks who don’t believe in a politics that says that we actually are um we are all in this together and that we should care about the well-being of our you know of kids that we’ll never, ever meet. We have to, you know, even talk about these premises now. And how do we talk about them? 

Martha Rebour: Yeah, well, I, I have to say, about a month ago, we had our annual summit, our meeting where we bring about 100 volunteers to D.C. and we march them up to Capitol Hill and meet with policymakers. And I can tell you there were very few congressional offices that didn’t say, yes, great, we’ll do what we can to fund these programs. So that I think the the people that we met with on the Hill, this is this is not a partisan issue. Global health and, you know, as you I think you pointed out, PEPFAR, president’s malaria initiative, you know, those were under George Bush. There has been strong support from both sides of the aisle for global immunization overall on the Hill. Um I think you’re right. There are some individuals who tend to say, well, we need to take care of our own first. And I’m wondering if some of that might be coming from a lot of people suffered, uh you know, financially from the pandemic. A lot of people lost family members, you know, had family members or themselves get very ill. So I’m I’m wondering if some of that sentiment, maybe more uh sensitivity around, you know, my government isn’t doing enough for me or for my community and our health. So now why should we, you know, reach out and help others? Shouldn’t we be taking care of our own citizens first? I’m guessing from what I’ve the things that I read of that opinion, that’s where it’s coming from. But I am pleased to say that on the Hill we really get very little pushback um for the funding. As I said, it is a also a incredibly small part of the budget. So I think also when people understand that the full pie realize this is a very small piece of it. 

Dr. Abdul El-Sayed: You know, my cynical response to that is we offered you vaccines. 

Martha Rebour: Yes. 

Dr. Abdul El-Sayed: You didn’t take them. [laughing] But no, in all seriousness, the broader point you make is a really important one. And it’s a reminder of the fact that, you know, when we tolerate the level of inequity and despair in our own country, it poisons the well abroad. And in some respects, the point that these folks are making, which is we should take care of our own. Forget first, last, whatever. That we should take care of our own is a really important point. And we in this society have been tucking away or disinvesting in the kinds of services that uh that do take care of our own. The thing that kills me is that the purveyors of this kind of politics would then turn around to a proposal like Medicare for All and say, oh, we can’t do that. It’s socialism. Like we’re trying to take care of our own! Like honestly, everybody in this country should have health care and also everybody abroad should have vaccines like those those two things are not mutually exclusive. We can actually do all of them. 

Martha Rebour: Right. 

Dr. Abdul El-Sayed: And we probably would be better for it because you know what? All those people are getting health care and not spending 15% of their take home pay uh to pay an insurance company. 15% of that is winding up in in profits for that company. Maybe they’d be healthier on the back end and could produce more. Right. Like, the thing kind of works, and I’m not trying to make just a utilitarian argument here, but like the utilitarian argument is there. 

Martha Rebour: Yeah. 

Dr. Abdul El-Sayed: That the broader just tug at your heartstrings is probably the right thing to do argument is also there, and that should be the one that carries the day. It just it just doesn’t anymore. And that that kind of kills me. And I really appreciate you doing the work every day um to make that argument because it’s an important one. And I’m glad that, you know, a lot of these folks who uh in the glare of a camera uh might start spouting off about about about vaccines. And, you know, s-hole countries, at least in the had the good sense in the privacy of their own offices to recognize that giving um poor folks in uh lower income countries vaccines is a sensible and moral thing to do. Um. So thank you for for doing that work and that advocacy. Really uh grateful to have you on the show. Our guest today was Martha Rebour. She leads Shot at Life, an organization advocating for um vaccines and vaccine equity abroad. Uh Martha we really appreciate you coming on the show. 

Martha Rebour: Thank you. Thank you so much. Pleasure talking to you. [music break]

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. 

[clip of unspecified news reporter] Breaking news. The Supreme Court has blocked restrictions on the abortion pill, mifepristone. 

Dr. Abdul El-Sayed: The Supreme Court put an end to all of the lower court insanity surrounding the abortion medication, mifepristone. That’s right. The Supreme Court issued an interim ruling with two justices dissenting, overturning two lower court rulings and preserving broad access to Mife. The ruling overturns previous ones from both the district court wxtremist Matt Kacsmaryk banning mifepristone entirely, as well as a three judge appeals court that had opposed Kacsmaryk’s full ruling but would have repealed 2016 rule changes allowing Mife to be delivered by mail. And well this Supreme Court ruling returns us to a world before all of that ever happened. The ruling now heads back to the appeals court, which will hear further arguments next month. Once again, we’ll keep you posted. The FDA and CDC have announced that Americans over 65 who haven’t been boosted in the last four months or those with compromised immune systems who haven’t been boosted in the last two months are now eligible for another round of Bivalent boosters. This might sound like just another COVID vaccine update and well, it is, but there are three things I want to highlight about this that are notable. First, this finally does away with the OG monovalent vaccine, and this sets up for a scenario that feels quite a bit like the flu shot, an annual updated vaccine that releases in the fall with a booster for high risk folks later on. Second, the fact that the FDA and CDC are not recommending another dose for lower risk folks reflects the fact that COVID cases, hospitalizations and deaths are near an all time low in the COVID era, and we should all be extremely happy and grateful about that. Third, this recommendation comes as the federal government is actively decommissioning its vaccination infrastructure. Toward that end, the administration is trying to backfill the public health emergency with a system of stopgap measures that they hope will address the gaps in coverage that could result as the emergency winds down. Of particular note here, the administration announced that it was investing an additional billion dollars into a free vaccine program for uninsured Americans, modeled after an extremely effective program designed to provide free vaccines for kids. Nearly 30 million Americans could be eligible. Today in things the pandemic did to America, birthrates. Between 2019 and 2020, America experienced the fastest drop in birth rates in its history, dropping rates faster than they’d fallen in the past half century. There was, of course, that mini baby bump after the first few months of lockdown, which has obvious reasons. But overall, birth rates have stayed low. Here’s what’s interesting, though. The states that experienced the biggest hit in birth rates were the states that were hit hardest and first by COVID. For example, New York, where COVID wreaked havoc in the early months, had one of the country’s biggest drops in fertility, whereas states like Idaho actually experienced increases, suggesting that, well, in part, access to family planning services could have played a role. Why should we care about birthrates? Because America’s population simply isn’t growing fast enough to sustain so many of the structures our society depends on. Think about it. The way we’ve structured our economy requires persistent population growth to fuel economic growth, and it requires young people to pay into support programs like Medicare and Social Security that older people rely on. As our population ages and people live longer, more generally, we could face the kind of population contraction that countries like Italy and Japan have faced. Challenging our ability to care for our seniors. And this all exacerbates one of the biggest misses of the build back better turned Inflation Reduction Act saga. And that’s the failure to invest in long term care. And without that, the challenge of caring for elders will fall on individuals and families, as it does today. That’s it for now. On your way out. Don’t forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Michael Martinez and me. Dr. Abdul El-Sayed. Your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.