Inside COVID-19 Pandemic & State of Global Health with Laurie Garrett

In this episode of FMC Fast Chat, get an inside look at the state of global health and the COVID-19 pandemic with featured guest Laurie Garrett, noted science journalist and bestselling author of The Coming Plague. Support for this podcast comes from Northwell Health, Henry Schein, Protiviti, St. Joseph's College, and the Bartol Law Firm.

FMC Fast Chat takes you inside the news so you can be in the know in 30 minutes.

Hosted by Fair Media Council CEO and Executive Director, Today we are very fortunate to have with us the very notable Lori Garrett to talk about the pandemic and basically bring us up to speed on some of the issues in the news and maybe some of the things that the news has been missing. So first of all, Lori, thank you so much for joining us today. Thank you for having me. At the very beginning of the pandemic, the news really focused on comparing this to the Spanish flu. Do you believe that holds true today or have we learned much more? Are we where you thought we would be at this point in the pandemic?

We have several questions. Let me try to unpack this a bit.

Okay.

Prior to the appearance of COVID all the planning for pandemic was very much oriented towards influenza. The consensus among most scientists in the field and policymakers, national security people, across think tanks, across WHO, and the whole international sector was that a worst-case scenario would be a sort of modern-day version of the 1918 pandemic. And so whether it was in the White House or at its counterpart institutions around the world, preparedness was really very flu-focused. To a lesser degree, because of our experience with anthrax, because of the multiple outbreaks of Ebola, and of course because of HIV, there was a recognition that, well, we could be wrong. It might not be flu. We've certainly had quite a number of other microbes make ugly appearances and take huge death tolls. So there was a nervousness. There was a sense in some of the smarter niches and corners of governance that we weren't really keeping our eye on the right ball. But pretty much everything was oriented around the influenza model. So when COVID first appeared in Wuhan, the most immediate comparison was made to SARS-2003.

Because—

and that made sense because it was a cousin of the SARS virus. And I was in the SARS epidemic in 2003 in China and in Hong Kong and saw it up close and personal. And there were certain things about what was happening in Wuhan that certainly resonated for me, looked very much like what I had experienced with SARS. And in terms of China's response, they were using their 2003 playbook. The response was exactly the same. Build instant overnight hospitals, massive quarantines, shut down whole cities, stop all movement within the country. I mean, it was all right from that playbook. But the response capacity in the rest of the world was still very much based on lessons from influenza. Certainly mistakes made by our Centers for Disease Control reflected a bias towards the influenza model as the guidance. What we were all late to appreciate was how much more contagious COVID would prove to be by airborne transmission than anything we've dealt with in recent history, and how little it had to do with fomites, you know, dirty hands, the things that we do worry about with influenza and with common colds. The idea of the contaminated doorknob that 25 kids touch at the same school and how then all 25 of them end up getting a cold, you know, within the next few days. And so a lot of our early focus— and when I say our, I mean humanity, not blaming any particular institution or or advisors or scientists. A lot of our early focus was on what sort of preventive measures had worked for SARS in 2003 and for influenza over more than a century of efforts to fight flu. And of course, now we can look at it and say, oh, you know, we undervalued the necessity of wearing really tight-fitting masks. We undervalued the necessity of ventilation and limiting indoor exposure in enclosed spaces. We overvalued the necessity of antiseptic treating our hands, constant hand washing, scrubbing surfaces, sterilizing everything anybody touches and all of that. Where we are now is Down the road, entering year 3 of this pandemic, that we've— I think we have to recognize that the virus is still evolving. It has not in fact found its comfortable niche within our species. It is still poking at our immune system. There's still a very aggressive natural selection process going on, and we are aiding and abetting that process. By throwing all sorts of drugs and monoclonal antibodies at the virus willy-nilly, and especially in the patients most likely to be ill who are in fact immunocompromised. They are less able to put up their own appropriate immune response against the virus. Now we throw a selection process at the virus, it's a little like having a highly immunocompromised individual that you treat with antibiotics by giving them only penicillin and in a massive dose. And the result is penicillin-resistant strep or staph or whatever it is. And so we're— I think we are still trying to learn what the hell we're doing. And the virus is definitely on a trajectory of mutation and continued evolution. The good news, if there is some in this picture, is that this virus is not capable of mutating at the pace that we're accustomed to with HIV. So we're very unlikely to end up with co-circulating in the world profoundly different clades of the virus with really remarkably significantly different immunological characteristics so that— one vaccine after another is defeated. But we definitely are on a trajectory that is the result of a decision made early on to seek vaccine that would block serious disease, not block transmission.

Okay.

And since we don't have any vaccine really nearby in the pipeline that actually is designed to block transmission of the virus, The virus will continue to infect those who are vaccinated as well as unvaccinated and find safe harbor for continued evolution.

Okay.

What about the promise of the COVID pill?

Well, we have several different ones. 2 are already in emergency use approval from the FDA, and there are more in the pipeline. And here again, if history guides us, we're going to screw this up because we're going to throw them willy-nilly about. In a lot of settings where there is opposition to vaccine, the pills may in fact end up getting used by people as if they were prophylaxis. We could very well and very quickly breed drug-resistant strains of virus. Again, we can look for guidance on that to show us how likely that is to the HIV example, where in the early years of the HIV epidemic, we threw one monotherapy after another, at the virus. AZT, DDI, DDC, you know, these were the acronyms of the early days of HIV in the '90s. And what we ended up doing was breeding monotherapy drug-resistant virus that overwhelmed and killed the patient. And the breakthrough came in 1996 with demonstration that combination drugs that cut across multiple different ways of attacking the virus at once would in fact block virus, stop it from reproducing inside the human body. It didn't eradicate it.

Okay.

Everybody has remained infected. But for those who stick to their meds and do not deviate from the proper course of treatment, an appropriate lengthy life expectancy is their reality. They can now think about retirement accounts and, you know, old age like the rest And we've seen the same with antibiotics, that combination therapy for complicated disease is preferred over monotherapy. So if that's a guidance, then we probably shouldn't be using these pills willy-nilly as monotherapy. We probably really should be looking at— and the President of the United States should be exercising legal authority to push for a new guidance that says, cross-patent agreements between manufacturers to look at creating combination therapy so that you have— you're attacking the virus's ability to create its furin cleavage, you're blocking its ability to poke its way into target cells, you're blocking its ability to latch onto the ACE2 receptor. So you get it 3 or 4 different ways at once. And it just is almost inconceivable that if you really have an effective multi-front attack, the virus will be able to mutate around it.

Okay. I want to give a shout out here to Kelly Raymond, who's watching us now. She doesn't have a question for you, but she has a comment, which is, Laurie Garrett does honest work. Always good to hear her words of wisdom, even the hard stuff. And she thanks you.

Thanks for that.

So, you know, there's a headline in the Times today talking about basically America is now 2 countries. We have the vaccinated and the unvaccinated. Is there anything in history that we can learn from in this particular regard? One of the things I find interesting is how countries attacked vaccination rather differently. So here in the U.S., we went for the double dose. You know, in England they said let's give everyone the first dose, as many people as possible. And then we look at Austria, which is coming out of another lockdown but saying only the vaccinated are allowed out and we're keeping the unvaccinated home so that they can't infect others. What can we learn from the history of vaccination in general here?

Well, first I want to reiterate a point I made earlier. We don't have a vaccine that blocks infection. So what we have made a conscious decision to do— or maybe it was unconscious, and maybe it was comatose, I don't know— but at any rate, we made a decision to view vaccination as an individualistic process.

Yeah.

And the pitch to convince people to comply with vaccination has been about preventing you from being hospitalized. So the pitch is, for your good, You should get vaccinated. What we haven't done is a sort of, um, 1960s Sabin oral polio vaccine pitch, which is, here's a vaccine that prevents you from pooping virus into the environment and therefore protects everyone around you, all the kids at your school, all the kids in the swimming pool with you, etc. We lack the capacity in this country right now. And I think there— we could spend an hour just talking about how January 6th and Charlottesville and all the Black Lives Matter and all the street demonstrations and everything demonstrate this. But we are so divided as a people that it may not be possible to make a pitch to community spirit work. And there we have a huge difference. with past experience. The one that I always find so remarkable is 1947. A tourist came to the United States. He had been in Mexico and a number of other places, and he went straight to New York City and went to every one of the big tourist spots, you know, Empire State Building, Statue of Liberty, Metropolitan Museum of Art, etc. And he didn't know it, but he was carrying smallpox. And he had a very acute case eventually of smallpox. The city was, you know, immediately post-World War II. Americans really believed in their government. It was a heroic government. We had triumphed in World War II. And when government said do this or do that, the American people darn well did it. There was tremendous community spirit. You had organizations like United Way, the Boy Scouts, you know, Girl Scouts, YMCA and so on. People were engaged in their communities. So when the Commissioner of Health went on the radio and told the people of New York, smallpox has come and I want every single New Yorker to line up, whether you've been vaccinated before or not, we need to have everybody vaccinated, the entire city complied. You had Boy Scouts and Girl Scouts going out and guiding people in huge lines. that formed all over the city where people patiently awaited their turn to get the smallpox vaccine. And, you know, 6 million smallpox vaccinations were administered in a matter of days. We could not replicate this today. This cannot be done in America today because America does not have faith in government anymore. America doesn't believe in sacrificing for the good of the community at large. America is no longer, you know, the country that triumphed in World War II. It's a very dispirited, divided nation. And unfortunately, it's not just America that's in this state of affairs. You look across Europe and you're seeing much of the same going on. It varies country by country, but basically, you know, there are those who say, I won't get vaccinated until you can prove to me That there's a zero possibility of any side effect and a zero possibility that Bill Gates has somehow come up with this amazing thing where in a 3-nanopore hole, he has a battery and a transmitter that can actually send a signal to a satellite and tell that satellite every single movement I'm making. And it can make it out that little tiny microscopic hole in the In the syringe and get into my body and circulate around and tell everybody what I'm up to and transmit my conversations. And, you know, friends, it's already happening, and it's this, and you voluntarily grabbed it and you use it every day. Um, so I, I don't know how exactly we're going to get out of this moment, and I fear that we're going to have a lot more carnage. before we get to a better place as a people.

Now, with the rise of what you just described, or at least the decline of trust in government, is that what we can also attribute this controversy between public health versus individual rights?

Yes, absolutely. Okay, I mean, public health— in my second book, after I wrote The Coming Plague, The one— the only criticism that really got leveled against the book was that I didn't offer enough in the way of solutions. And, uh, well, I said, okay, the solution is strong barriers of public health. So let me spend a fair amount of time and travel on 5 continents to assess the state of the world's public health. And that led to Betrayal of Trust: The Collapse of Global Public Health, because The state of public health in the world was dire, particularly in the post-Soviet world, where it had been a big lie under the Soviet Union. And the big lie became not even a lie, just nothing, with outbreaks all over the former Soviet Union. So I would say this. Public health is a trust. It only works as a two-way trust. The trust on one side is that the public trusts that government will provide them with prevention, response, rapid recognition of threat, and judicious efforts to get solutions to all the people in an equitable way, right?

Yeah.

trust on the other side is that the public will go along with the recommendations of government for the sake of society as a whole, even those that may be inconvenient. So you take a classic example of, um, what if there is a deadly poison that has seeped into the water supply? In order to intervene and effectively protect the whole public, government has to have the right to enter private property and examine water sources and ensure the safety of the water supply all the way down the chain, right?

Mm-hmm.

But if the public says, I don't trust government and I'm carrying guns and I'm not letting you on my property, and then it has to go to court and you have to have a whole, you know, weeks-long brouhaha How many people are poisoned down the road while this standoff occurs? That is a good metaphor for where we are right now. We are in a situation where the trust has completely broken down on all sides. There is an absolute betrayal of trust. And as a result— And you have politicians actively pouring salt on the wounds. actively— I mean, as we speak today, there is a hearing in the Senate with Rand Paul leveling threats against Tony Fauci. And Tony Fauci saying, you know, because of the lies that you're saying about me and about the NIH here in the Senate, I am receiving daily death threats. My family is under death threats. My children are under death threats. This has got to stop, sir. You cannot— whip up a political fever based on attacks on science that are not based on reality. But this is the world we're in right now. We're in a world where, you know, the president of France has grown so impatient with the anti-vaccine movement in his country, which, by the way, is not only right-wing as it is here, it's also the whole homeopathic movement and the nature path movement and all of that in France. He's grown so impatient that he's taken to the pulpit to denounce them and called upon the Senate to pass a resolution, which they did, making many aspects of vaccination in France mandatory. I'm not sure that our Congress would ever pass Anything that tried to impose on a federal level a mandate for vaccination.

How much of health is political?

All of it.

Yeah. Has it always been that way?

Yes, absolutely.

Maybe we just didn't know it. Is that what happened?

Well, if you go back to the ancient writings of Hippocrates, for example, and some of the early Greek, you know, most famous what we would today call a physician, there was a clear understanding of miasma, of the notion that health of the individual was related to the environment the individual lived in. And they had all sorts of complicated notions of the humors, what came from air, what came from water, etc. But the basic idea was that the individual's health was linked intimately to the environment they lived in and that that environment was controlled by political leaders. This is an ancient concept. Of course, once we get to germ theory in the late 19th century and we come to understand with Louis Pasteur and Robert Koch and all the great heroes of early germ theory understanding, we see that microbes cause infectious diseases, not, you know, the Jews did it, or, you know, the guy you don't like down the street did it, or lack of godliness did it. It's microbes. And we begin to understand that it's possible to control these microbes, but that they are intimately related to the conditions in which people live. And so If you take that forward, you reach a very sort of sophisticated level of the first creation of real political systems of public health, which really was born in the city of New York with Biggs and his followers and the attacks on tuberculosis, on various forms of respiratory disease. And exercising it, realizing that there had to be real power and authority placed in the public health commissioner's hands, and they had to have the ability to order physicians to comply, not to protect, as they did in those days, their client lists because they didn't want other physicians to take their rich clients away from them. But if your client, regardless of whether rich or poor, had tuberculosis, The city had to have that name.

Okay. Now, if we take this conversation and put it into today, can you say the same argument is what's going around now when it comes to the issue of masking, especially masking of children? I'm wondering in particular, is there any research that shows it's harmful to anyone's health to either wear a mask, whether they're an adult or a child?

There has been absolutely no proof that masking, if worn properly and it's a genuine medical mask, not, uh, you know, you've seen people wearing gas masks and crazy stuff, but if it's a genuine medical mask and worn properly, there's no evidence whatsoever that it's harmful to human health.

Okay.

Um, it may be annoying, um, Some people have had things where the rim of the mask gets into their eye and then they get an irritation in their eye or something of that nature. But as long as you're not wearing them to the point where they're thoroughly contaminated and 3 weeks old and disgusting, and you're wearing them properly, there are no negative effects. And this claim that children can't breathe through a mask is absolutely ridiculous. And the and compared to the protective effect of a properly worn mask, I mean it's just the balance sheet is weighing so heavily on the side of masking. It's ridiculous. I live in a city where my primary mode of transportation besides walking and biking is the subway. And that means I'm commonly getting in relatively crowded spaces with total strangers. I take great comfort in wearing a proper K95 mask or N95 mask, and I can't understand individuals who are not doing so. It seems madness.

I have a question from the audience, which is the conversation we're having now— is all of this covered in your book?

Which book? I've written several. Well, shout them out.

We'll have them by the collection. How's that sound?

Yeah, I mean, if you—

I have—

well, there's 3 books in particular to look at: The Coming Plague, Betrayal of Trust, and I Heard the Sirens Scream. And between the 3 of them, everything we're talking about is indeed covered.

Okay. All right. Do we have a question on the different variants of COVID Is there anything history can tell us in terms of how many variations can we expect to see happen here?

What history tells us is that when a virus is new to a species, for the sake of understanding, let's not think of humans. Let's imagine a virus that's new to canines. Your dog is getting sick. When a virus type that has circulated in a completely different animal species, for millennia first hits those dogs, it will indeed be mutating at quite a pace because the virus is adapting to the canine species and the canine species is throwing everything it's got at the virus. So you have a kind of ongoing selection process versus warfare in a way between the canine immune system and I speak here of multiple thousands and thousands of canines, right? And the viral population, which of course is billions and billions of viruses. Over time, in most cases, you end up with an attenuation, a sort of standoff. The virus finds a form, evolves to a form that can have a sort of peaceful coexistence with the canine. Meaning that most canines can get mildly ill but not die, and during their illness can be ambulatory, therefore affording the virus the opportunity to spread to other canines.

Okay.

But there, of course, are exceptions. Rabies is the most startling exception. It has never attenuated. It is a 100% deadly virus. If you get rabies and you do not immediately get an appropriate series of vaccines, You will die. If your dog gets rabies and is unvaccinated, it will die. There is no coming back from that. So that is a virus that never did really attenuate, but it is also very hard to spread. You must be bit.

Yeah.

You know, by a rabid animal or human. That means that there's fortunately limited amount of rabies out there. Again, there's a tendency to look at influenza to guide us. In 1918, we know the virus in fact underwent a very dramatic evolution while circulating the planet and circumnavigated Earth before commercial air travel 3 times and took on a different form each of those 3 times. It was in its second big circulation, which swept through North America in the fall of, uh, 1918 that proved to be the most deadly. And the bulk of all the deaths in 1918 basically occurred between September and January, uh, 1918-19.

Um.

In the United States, it was really just a 6-week period, and it just burned through populations. I mean, just like a forest fire going down the hill. In the end, it remains in circulation. I mean, its descendants of that virus are still in circulation on planet Earth, not so much in humans, but in some cases have retreated to other species.

Okay.

Do you expect that to happen with COVID Well, you know, early when COVID first appeared, we had reason to think. I mean, because it looked like SARS, I immediately, having been in the wet market and found where SARS originated in Guangzhou when it was still happening and seen the conditions in the wet market and understood how the animal trade worked and what kind of conditions these animals were kept in before they were sold and then how people slaughtered them and and so on. And the civets in particular and raccoon dogs were the really big carriers of the virus. You know, I thought, well, we have to swoop in, shut down all the wet markets all over China, immediately identify the target species and, you know, stop it at source.

Yeah.

That was not done for a whole bunch of reasons. And As a result, basically every mammalian species that we look at turns out now to have infection and often from a human. So zoo populations in particular have been carefully studied. And you're hard pressed to find a mammalian species in a zoo that hasn't been shown to be infected at this point. And we've had serious outbreaks in mink in particular, ferrets, now in deer, North American deer populations. These animals did not have COVID before we did. So this is demonstrating a process of zoonosis, cross-species spread, that is very profound. And that where the human is really now the major vector spreading outward to other animal species, including our pets. So the problem there is twofold. First of all, eradication now becomes impossible.

Okay.

Because the virus can retreat to cats, dogs, you know, civets, you name it. And secondly, in so doing, the virus has more opportunity to mutate. in yet another challenging environment, in a different set of selection circumstances. So what we can say from the experience with influenza is, you know, most flu is bird virus, and most of the influenza strains on the planet are in circulation in aquatic migratory birds— ducks, geese, swans, and so on. And when those viruses circulate around bird populations and jump species from one kind of bird to another, say to chickens, right?

Mm-hmm.

Poultry populations, and then occasionally to humans or occasionally to barnyard animals, more mutation occurs, more evolution occurs. And in fortunately relatively rare circumstances, in human history, that mutational process can result in something really truly lethal to human beings. In 1918, it looks like it was a virus that jumped from birds to pigs, evolved in the pigs, adapted to the mammalian host in the pig, and then to humans. Which is why in 1976, when a soldier died at Fort Dix in New Jersey, of what looked to be a very deadly flu, and it turned out the soldier had previously been at home and been around barnyard pigs, there was a pronounced reaction, an overreaction as it turned out, um, with fear that we were looking at a repeat of 1918.

Okay, Laurie, I want to ask you a question actually about your work in the process, because in this era of disinformation and straight-up misinformation happening so much, when people talk about your work, It's often regarded with the same 2 words put together, which is meticulously researched. Can you tell people who, you know, have nothing to do with news media how it is you do the research that you do?

Oh, goodness. Well, first of all, my dear friend John Cohen, who writes for Science magazine and is one of the best journalists on this beat you could possibly ask to read, has likened the COVID outbreak to having a fire hose hooked up to your mouth every morning and the stuff pours in. We've never seen it like this before. I mean, never. The amount of daily deluge is just overwhelming. You know, at the peak of the H1N1 swine flu outbreak in 2009, in the spring of 2009, when it was just You know, exploding. I would typically see maybe a dozen important scientific papers a day, and guiding news analysis and information and government documents on the order of maybe five or six a day that mattered, and that I would save and I would scrutinize and then follow up with. Questions. Today, I mean, you can't even possibly read everything you need to read on a daily basis. It's overwhelming, really. And it's deeply stressful. I have never felt the way I do have been feeling ever since I first had inklings of something going on in Wuhan at Christmas time 2019. I have never felt this constant pace of deluge of data and information and scientific analysis and politics and everything, and had an unrelaxed moment when I could say, ah, I feel like I've caught up.

Okay.

It never happens. I go to sleep every night feeling like, wow, there were 40,000 things I didn't do today.

Yeah.

And it's— I don't know how people making the key policy decisions are managing to, you know, siphon through all this every day.

It's—

when there are criticisms leveled against people like the director of the CDC or their counterparts in Europe and China and so on, saying, you know, you took this action based on this data on this day, Yeah. But now, 5 days later, the situation looks different. I want to say, and that's what it is, people. It is changing that fast. And on the, on the positive side of this, I'll say this, the world has never seen a scientific response like this before. And it's spectacular. And it is, you know, in past outbreaks, you had, you always had key players who were trying to be the guy that would discover the virus or discover this or discover that and become famous off of it. And they would monopolize information and try to get the paper published in the fancy journal and, and, you know, the virus would be named after them or whatever.

Yeah.

And in this case, everything is completely public domain almost immediately. I've never seen people publishing preprints that have not yet gone through the peer review process. You even see scientists posting their findings fresh from the lab to Twitter and to Facebook before they've even submitted a scientific paper. And at this point, nearly 7 million whole genome sequences have been posted to the public domain at a site called GISAID. So that you can look around the world right now in real time and know that 59% of all newly sequenced viruses found in Paris are Omicron.

Okay.

And that's— wow, we've never been in that position before. But what it means for somebody like me is an overwhelming amount of information. And the challenge in the past was getting information. The challenge with this one is figuring out what information matters and having time to shut it all out and think.

Yeah.

Analyze. That's the challenge.

One last question. You've been very generous with your time, but I can't help but wonder, how did this become your passion?

When you say this, what are you referring to?

This work that you're doing. And, and in particular, your interest in health and science.

So I was, uh, in grad school at Berkeley in immunology and had intended to be a research immunologist and did research at Stanford working with the Herzbergs on the development of the fluorescence-activated cell sorter, which is now how we know things like what's a CD4 cell, what's a T cell, a B cell, and how they how do they get triggered and all that. But during that time when I was in grad school in Berkeley, I started on the side as a sort of hobby being a science reporter at a local radio station and noticed that there were all these wire reports coming in from around— young people listening to this won't even know what a wire report is. But anyway, all these wire reports were coming in from all these exotic locations that I couldn't even pronounce or find on maps that, um, involved previously unknown super deadly diseases.

Okay.

And I thought that was remarkable because the mantra I was learning in grad school was that now everything was just about cancer and heart disease. We've conquered infectious diseases thanks to antibiotics and vaccines. We don't have to worry about any of this anymore. And I found that I was collecting these, you know, clipping the wires and collecting these things. I still have them somewhere. Oh, I know, I donated all the old clippings to the University of California San Francisco Medical School Library. So if anybody wants to see them, that's where they are. And in particular, there— 1976 was a, was a key year because that year you had a strange mysterious outbreak among, uh, conventioneers in Philadelphia for the American Legion. You had women dying mysteriously and horribly, um, and it seemed to be somehow related to the tampons they were using.

Okay.

You had swine flu and a huge scare about that, um, and, uh, there were 5 or 6 other things going on including first ever known outbreak of Ebola in, uh, what was then Zaire.

Okay.

Now called the Democratic Republic of Congo. And so all that happened at once. And I thought, you know, this doesn't make sense. How could we be supposedly having conquered all these things? And yet we have these utterly mysterious and deadly outbreaks? Well, the American Legion turned out to be what we now call Legionnaires' disease. A bacterial disease that recurs all the time now. It's a new permanent feature on our public health landscape, and it's intimately tied to air conditioning. The tampon thing turned out to be toxic shock syndrome caused by Staphylococcus aureus and a really insanely designed set of tampons that were meant to be kept in place for days. Rather than constantly removed, and of course they just harbored bacterial growth colonies. And the Ebola, the mysterious disease we now have seen recur over and over—I've personally been in three Ebola outbreaks, and there's nothing trivial about that disease. It's really quite, quite scary, quite dangerous, and despite now having a vaccine, it remains very difficult. to bring under quick control in places where the social atmosphere is not conducive to public health, you know, where there's an active war going on or violence or something of that nature. And as we go down the list, you know, we can see at the very time whenever— when the mantra was, we've got this stuff conquered, the reality was, here comes HIV. You know, here comes hepatitis C. Here comes— and the list gets longer and longer and longer. And of course, since then, we've just had an almost phenomenally long list of new microbes or previously unrecognized microbes take devastating tolls and challenge health systems and the lives of individuals all over the world.

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