Dr. Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health
Dr. Angela Rasmussen, Virologist, Department of Vaccine and Infectious Disease, University of Saskatchewan  
Moderator: Clifton Leaf, Former FORTUNE Editor-in-Chief and Founder, Fortune Brainstorm Health


Brainstorm Health 2022 - Existential Threats: Preparing For The Next Global Health Crisis 

Conferences

Dr. Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health
Dr. Angela Rasmussen, University of Saskatchewan  



Preparing For The Next Global Health Crisis 


Dr. Sandro Galea, Dean and Robert A. Knox Professor, Boston University School of Public Health
Dr. Angela Rasmussen, Virologist, Department of Vaccine and Infectious Disease, University of Saskatchewan  



Dr. Sandro Galea,  Boston University School of Public Health
Dr. Angela Rasmussen, University of Saskatchewan  



Brainstorm Health 2022 - Existential Threats: Preparing For The Next Global Health Crisis 


Okay, I'm not gonna lie to you. I'm excited for this conversation. I really am. Um two of the smartest people on public health. Um, and the pandemic that we've just been going through and probably the next one that that's coming our way. Um Sandra, I want to start with you because I've known you a long time. Um You've written 21 books. Your latest is called the the contagion next time. I wish we had a copy. Um uh, and we can hold it up here, but imagine I've got Alan Marie's book here and then we're but we're gonna have a different title on it. Um, I've read many of the books you write beautifully, um, and truly insightful e about public health, about the social determinants of health, about population health, urban health. Um, and all of the the elements that make up a well being. This, this latest book on the pandemic the next time. Um this is a change in tone. It's, it's really as as eloquent and beautiful. It is, it's also strident and urgent and and you seem a little bit scared if you don't mind me saying talk a little bit about what changed in your thinking. Um that that may have that pushed this book in the direction that went Good Morning. Thank you, Everybody so privileged to be here and thank you Cliff for very kind words. So the book is called The Contagion next time. And I think the title the tone because the book is an homage to William baldwin's the Fire next time and for those of you who don't know fire next time is a bit of a searing indictment of racism in America. And the argument of the book is actually very straightforward. It is we're going through a pandemic and this will pass and we'll take lessons from it. And there's gonna be a lot written about how we need better vaccines, better sentinel surveillance system, better coordination across countries. And all of that is true. It is entirely all correct. But what really killed us in this pandemic is the fact that we had economic conditions where a lot of people were exposed to the virus and they couldn't get away from it. You know, one of our key strategies to dealing with the virus at the beginning was locked down. Well, lockdowns are really a way for rich people to protect themselves and get more people to stretch things for them. Which of course exposes people. And I know when they say that it's like sending a chill down your spine. But it is sort of what it was because you know, raise your hand if you are in lockdown and didn't get amazon or didn't get groceries delivered. None of us right. So we have economic structures that create conditions where people have no choice but to be exposed. We have underlying disease. We have things like obesity, 35% of the US is obese and when you have a virus which then affects people with underlying illness, it doesn't matter how quickly to get the vaccines were still going to have unnecessary death. So the point of the book is unless we deal with these underlying conditions, the next contagion the next pandemic will have will be just as bad. It doesn't matter how good we get on vaccines and that doesn't obviate the importance of focusing on the curative. But we've been under investing in in the social and economic conditions that make our populations unhealthier and unprepared for the next viral contagion. Well the the the the simple observation is that the U. S. has been living shorter and sicker lives for decades before COVID. I mean we've had the lowest life expectancy of any high-income country despite spending far more any hanging up country for the past 40 years. And when we think that I think sometimes we make the cognitive error of saying well we have some people who are not doing well but we're doing well. In fact the analysis is very clear that even those in the country who are doing the best our life expectancy is still worse. Then it is another high income countries. So covid was nothing new. Covid surfaced what was already there and I think it's a message that we need to wrap our brain around because if we don't the next contagion will come and will be just as fast. Let me angie Let me flip the framing a little bit globally. We had the who reports more than half a billion cases of of covid infection that they record. Um it really is a remarkable learning experience in the sense that we have seen, you know, dozens of variants of SARS cov to emerge and die off in a kind of real time evolution. This is sort of natural selection playing out in hyperspeed. We've seen clinical manifestations of this virus in in variable forms. I mean it's it seems to be affecting people in lots of different ways of taxing many different organ systems. We've seen learn lots of billions and billions of data points if you will, what can we learn from this pandemic, which is maybe the best learning experience we have for our own sense of immunology or protection against disease. That's a really difficult question to answer in a short period of time. But I think you know, I get asked a lot of sort of lessons learned questions especially about the virology and I think one point that I'd like to make is that the things that we know now about the science about the virology, I really kind of inextricably linked with what Sandra was just talking about. So one of the reasons for example, if you want to talk about the variants that we have so many variants is because we've perpetually under invested in basically everything we would need to do to have fewer of those variants. Um so we haven't invested nearly enough in terms of global vaccine equity. Um, one way that variants emerge is through and this is true. We've known this for a long time about RNA viruses like SARS coronavirus two as they replicate, they acquire mutations that means more variants. So the more opportunities to replicate the more that we will see new variants. So it's really crucial to get population immunity on a global scale rather than just a national or a regional scale. In addition to that, we've under invested in the research that we would need to track these variants before their arising. So surveillance. And if we want to talk about the next pandemic, it's not just about monitoring SARS coronavirus two variants are monitoring strains of influenza for making vaccines. It's also about monitoring the novel viruses that could potentially emerge. And that is a real serious challenge that we are just starting to wrap our heads around because it's not as simple as just going out and and trying to find new viruses, we actually have to figure out which of those new viruses pose the biggest threat. You know, the thing about cliches is that they're often true. And so when we say that viruses know no borders, it's a familiar thing to say, but it's it's true and and we've experienced that with this pandemic. Um and when we talk about the variants emerging with the South african variant, the Brazilian variant, the UK variant. Um Sandra, you know, this conference is about this global connectedness but we don't direct health policy in from a global in a global way. Yes, we have the World Health Organization which I think we're finally funding again in the US but but we don't really have a policy that is directed globally. So how do we how do we address? Yeah, a couple of comments. First of all, I just want to add something to what Andrew said in that you have written about this. If we were trying to design a world where we were sitting ducks for a pandemic to hit and hit us hard, we did a terrific job because of these under investments that angie was talking to give yourself a round of applause everybody. So we we we we we really I mean looking at the U. S. And many other countries we've been under investing in say public health infrastructure for the past two decades and that means we're simply saying to the virus come on in and wreak havoc and that's what happened now. In terms of the global perspective, I think there are a number of conversations right now about global framework. The truth is we are never going to get to a place where you have global governance with enforceability and accountability. To my mind. I think we should sort of forget about that. What we need to do is shift our collective understanding of the importance and the mutual benefit of actually working together and shift our collective culture that the best way to resist a virus like this or any new pandemic is to have underlying population health and that your health actually benefits my health. And that's something we forget all the time because while we, we sort of pretend that we care. I'm being harsh here. But the truth is in the back of our minds were like, well, you know what cliff is just you like I'm actually gonna be okay. But recognizing that your help in your country matters for my health in my country. And the point of the variance and tomatoes is terrific is I think a critical global understanding. So we can finally invest in a global approach and a shared global understanding the importance of you know, angie I know this is a topic close to heart in terms of the global connectedness of the research community as well. One of the nice things that's come out of this is the growth of pre prints and the ability to quickly disseminate the science that's just breaking at that moment. Obviously you need a peer review process. But, but that sort of marketplace of medicine that's happening on a global scale um, has been, is a change in this in this uh SARS cov age. Yeah. So I think that's a great .3 prints have been really fantastic and they've been around for a while. But this is the first time that we've really seen pre prints uh sort of in the public eye the way that they have been, they were around for example, during the 2014 2016 Ebola epidemic. But we just weren't paying as close attention to those pre prints and they've been fantastic. They've also been a source of misinformation. Now, I think the thing that we really need to take from pre prints is that when we are talking about this global connectedness and this collective action, we really need to be thinking about ways that people, especially in other countries with less infrastructure, can also share their data. I think one thing that's crucial, crucial for the research community is to not just think like, hey, we're going to go into this country where there's an outbreak, we're gonna get some samples were going to parachute in parachute science or scientific colonialism. Take those samples back to a wealthy country and not do anything to build infrastructure there. We're not gonna do anything to give people credit in country. When you're talking about a pandemic, you're talking about an outbreak that affects the entire world. So part of our efforts, in terms of data sharing as through pre prints as through databases like decide where sequence data is stored, um, really needs to be inclusive of building infrastructure in other countries so that those scientists and clinicians in those countries can really contribute to the overall public knowledge marketplace. So I want to follow up with you because you're a veteran of the Stars. The original Stars Stars Classic. I think they call it now. It's like coke classic. Um, Mars Fight Ebola before this. Have we learned anything in those frightening moments of history? Uh, during the SARS Cov two? Well, I mean certainly virologists have um, scientists have, I'm not sure that policymakers have and especially the people who are investing in this research and the corona viruses are a great example of this. So Stars classic emerged in 2000 and three. Everybody has agreed that it was a near miss and it could have become a pandemic but it didn't. And so all of the investment initially that occurred sort of reflexively to that outbreak then went away. So promising research was started including vaccine research and people were not able to continue doing that research because of this sort of funding boom and bust cycle. The same thing happened with murders and the same thing is really happening now. Um, we need to stop thinking about doing this type of research, especially when it comes to developing new vaccines. Things like pan coronavirus vaccines that could potentially prevent a pandemic in response to an outbreak that's already accepted. Moving from reactive to proactive, you know, Sandra. Oh, there are so many things we need to fix in the health care system. But if you have to prioritize, how do we, what what should we start with to make sure that we are at least healthier population when the next one comes. I think the answer to the question is always we need to talk about it because I've come to feel like, you know, policymakers, anybody, anybody with with the position of authority who can make policy that can change things ultimately is responding to where the conversation is just came up a little bit in one of the, one of the panels yesterday that there is a window of things we talked about the overton window, which is essentially we agree that these are the things we talked about and unless we shift what we're talking about, the policy will never change. So I'm not sure that there's any one concrete thing. You know what I can give you a long list, but I think having this conversation at a meeting like this and having this conversation at the at all policy levels is critical. The good news is And just to end on a sort of optimistic note, I actually do think that things are shifting actually. I despite everything else, despite where we are in the pandemic, despite some sort of what we've all been through in the past 2.5 years, we are having conversations now that we were not having before. We are. I mean the very fact that we're having this conversation on the stage to my mind is a step in the right direction. I agree with that completely. I mean, I think that this is not a conference that I ever would have been at prior to the pandemic. And you know, I don't know that I would have met Sandra, Oh, I don't know that. I would have met people who are in public health, you know, fields adjacent to mine. Um previously I was hanging out with only virologists and now I know people who are in public health who are clinicians for epidemiologists. I think that really is helping a lot. Um in terms of building these collaborations that are gonna be essential moving forward. So how wonderful that we get to end this great conversation on a note of optimism, I want to thank you Angie and Sandra. Oh, thank you so much. Thank you. Thank you.