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XBB.1.5 is being called the most transmissible subvariant of Omicron to date. With multiple mechanisms to evade our immune system, including getting around our monoclonal antibody treatments, it’s driving our January wave and leading to worse outcomes than previous mutations. Andy speaks with science journalist Laurie Garrett, who explains what makes XBB.1.5 unique and why the lack of global surveillance and federal funding could easily erode the advances we’ve made so far to combat COVID.

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Transcript

SPEAKERS

Andy Slavitt, Laurie Garrett

Andy Slavitt  00:18

This is IN THE BUBBLE with Andy Slavitt. Welcome to yet another show about COVID. Here as we enter 2023. As a reminder, our email address here is inthebubble@lemonadamedia.com. I’d love to hear from you. We’d love to hear show topics that you might have feedback on shows, anything you want to send to me directly, I will get those emails. So how are we feeling about COVID right now, how are we feeling about this new variant called XBB 1.5, I believe it is. There’s a couple of us out there that I really want to endorse. And there’s a few that I really would like to examine and put under the microscope a little bit. Let me start with first principles. COVID-19 is a deadly infectious disease. And that while it may be here with us to stay and stay steady state, it has become the third leading killer in the United States. So we lose about 300,000 people a year. That’s a lot. And that is a really sad and profound addition or subtraction. Better said from our health. So it’s not something that’s large enough for a lot of people to pay attention to still if you’re 85, or 75. Or if your other eye was vulnerable. As millions are it is still scary. It is important. I think it’s a first principle that even if something isn’t scary to all of us, if it’s an infectious disease, and it is scary as hell to some of us, we need to understand that. Secondly, a lot more damage gets done from COVID. Then you see in the fatality rates, if you are someone who needs to show up for work, in order to get paid, this is a really big problem when you see people wearing masks around. By and large, many of them are people who need to show up for work every day or they will not get paid. If you’re a waitress, if you work in the service industry, if you do deliveries, there are 10s of millions of people who work all over the economy who can’t afford to lose an hour of work. This is incredibly scary for those people because their livelihood depends on it. And this is a disease that has chronic manifestations for many, many people, including young people like Zach, who is our youngest son is as you know, because you if you’ve listened to the first season of the show, he was on as the co-host. Now at college, he was home for break.

Andy Slavitt  03:11

He had long COVID, as I’ve talked about publicly, it’s largely better. Maybe he would say it’s entirely gone. Yet, still, his nervous system is funky. It is doing weird things; it is still showing up in weird ways. And doctors say it is most likely from his COVID. And that was a COVID case from 2020, the fall of 2020, two and a half years ago. And he’s not alone there. So this is also something that we need to pay attention to. Third, is that vaccines, therapies, boosters, they work very well for now, if people use them, but a couple of flies in the ointment. One is that not a lot of people are taking advantage of them. And the second is the arsenal is shaky. We need the new innovations that are coming in vaccines and therapies. But there’s no funding and Congress such that it is will not pay for it. And there’s little to any chance that this new Congress will. So we have ourselves a situation where it’s good for now but could easily erode. So people are now focused on this new variant which is understandable. It’s the next bounce the ball and we can try to understand it. And on this episode, with the great Laurie Garrett we will but all that being said I can can’t hyperventilate over each new variant nor should you. This is what the virus will do this is the state we’re in the virus has put itself in a place where it will evolve to become more fit every year, multiple times a year in fact, and there is no reason for us to take our eye off the first principles, which I stated earlier, still the ones that are true, there’s no evidence that SBB should change any of our approach to life. Vaccinations makes sense. Masks are easy to use on occasions when you need them. Staying home, when you’re ill is the humane thing to do. It always is. Testing before and after exposures, particularly to vulnerable people is a really important idea. Those are all true. Equally now as before. One more time, I’ll tell you a reminder, send me an email at inthebubble@lemonadamedia.com. Tell us what you’d like us to cover this year. Tell us what’s on your mind. Tell us how you react to certain shows. That feedback is important to me and to all of us in the bubble so we can adjust and make the shows better and exactly what you want. Laurie Garrett is the OG science journalist. She’s got the triple piece of journalism, a Peabody, a poke in a Pulitzer. She writes most frequently in Foreign Policy magazine. And what I love about Laurie is you’ll hear now, she has opinions. So she is really fun to talk to. Here she is.

Andy Slavitt  06:56

Laurie Garrett, welcome back to the bubble.

Laurie Garrett  06:58

It’s been a while. Hi, happy new year.

Andy Slavitt  07:00

It’s been a while how have you been?

Laurie Garrett  07:02

Oh, you know, ticked off.

Andy Slavitt  07:05

Okay, well, I’m gonna, I’m going to try to get into that with you while you’re ticked off. But let’s start out with what we’re facing here in the US is we’re in the third year the pandemic now. Should we expect January wave to come to the US a significant one.

Laurie Garrett  07:24

It’s already happening. And it is driven heavily by the ex BB variant in its various permutations. And we’re seeing upticks in cases and hospitalizations, but we’re operating in the dark compared to a year ago, because so few people are getting PCR tested in any medical facility. Everybody’s home testing or not even bothering to home tests, they’ve sort of decided like, if I feel lousy, I’ll just assume it’s COVID. And stay home.

Andy Slavitt  07:54

And those tests are what gives us the surveillance and know how much COVID There actually is. So when you see in the New York Times that there’s only 65,000 cases, and you saw that if you saw that six months ago, or 12 months or 18 months ago, it could be very, very different. So let’s talk about this XBB 1.5, the latest variant spreading in New York. It’s not what 40% of the country’s cases.

Laurie Garrett  08:18

Right now. It’s 42% of New York City’s cases. And it’s approaching 40% nationwide. It’s also as of today, who has it confirmed in 29 countries, although who is now very frustrated that fewer countries are reporting data, and few are even doing sequencing, genetic testing, so they don’t even know what variants they have. So, you know, we have to assume it’s going global, like its predecessors did

Andy Slavitt  08:50

it we’ll talk about China and the globe in a little bit. But this is, as far as we know, the fastest growing variant now not just in the US, but the fastest growing one we know of globally. Is right?

Laurie Garrett  09:03

Ever yes, very fast.

Andy Slavitt  09:06

And it has a mutation, which allows it to both see if I get this right Laurie, both bind to the cell as well as evade kind of immune response that either comes from prior immunity or vaccines pretty well as I write.

Laurie Garrett  09:23

It has multiple mutations. It’s highly mutated. It sort of plucked the most successful mutations from the prior Omicron strains, and then has some completely novel ones. So one of the things that it’s capable of is binding the ACE2 receptor, which is the receptor protein on cells that all the COVID viruses attached to, but it binds it really hard. I mean, it’s stuck like glue it says if it came up with an epoxy glue mechanism, and that means that it just keeps signaling those cells, make more of me make more of me make more of me. And the result is that the cells turn into factories on overdrive, just punching out viruses like crazy. And that’s why it’s so contagious on the first level, because there’s just so much of it, any given person who’s infected with it has far more viruses, you know, emitting and shedding from their bodies than with prior strains. And then the second is that it has multiple mechanisms for evading our immune system. And that includes getting around our monoclonal antibody treatments, it seems to be very resistant to most forms of treatment, most of the drugs that we’ve invented in the last two and a half years, and it, you know, is evading immunity that’s conferred by prior infection. So the vaccines so far, especially if you’re fully boosted with you’ve had the entire full schedule, as recommended by the CDC, of vaccinations seems to still protect you from the most severe, you know, forms of illness associated. But whether or not it fully protects you from infection is an open question. It’s not looking really good.

Andy Slavitt  11:23

So it’s more infectious, in you describe this more infectious in two ways. One is it binds better to ourselves. And secondly, it evades prior immunity, it’s sort of evolving. Does it also make us sicker? Or do we not know that yet?

Laurie Garrett  11:37

What we know is that for senior citizens, people that are certainly over 70, if not over 60, this is causing some pretty profound illness and reinfection. There’s real, real serious concern about populations of senior citizens that have not completed their booster schedule. And I should add, for those out there that may be in that category, you better run and do it fast, because it takes at least two weeks for the effect of a booster to be felt in your immune system. The virus is circulating right now.

Andy Slavitt  12:16

And we also will have a potential while supplies last probably at some point, although we don’t have it yet. Here’s an  interesting question, Laurie is COVID becoming largely a disease of the elderly?

Laurie Garrett  12:27

Well, it certainly looks that way in Western Europe and the United States. I don’t think that’s the case everywhere in the world. I think it’s a reflection in part of our unique demographics, that we are older societies. But certainly, the ability to evade an immune system is easier for any virus in older populations, because older people tend to have weaker immune systems just that’s part of aging. So is the virus evolving? Or is it simply opportunistically finding advantage? That’s a hard one to say. But it definitely is the case that the primary driver right now of evolution, and change in the viral populations is the human immune system. This virus is clearly trying, I don’t want to confer anthropomorphic, you know, free will, but it’s trying to get around the human immune system.

Andy Slavitt  13:28

So if you take someone with a young or middle aged immune system, and somebody who has some protection, either from prior infection, or vaccine, or both, it appears that the impact now of COVID is people are far less likely to be hospitalized. But we are still seeing, you know, what will end up looks like steady state it somewhere between 250,000 -350,000 Americans dying every year that weren’t dying. Three years ago, that would make it a new top three cause of death in the United States. And that is happening. And that’s, by the way, you know, five times the number of people that die in a typical flu season, right. So that’s not insignificant. That’s a lot of elderly people. And it would seem to me that this thing is shaking out to be something that many people who are non-elderly feel that you know, it’ll be a bad flu, but they’ll get through it. And if you’re over 65, or certainly over 75, maybe not so much.

Laurie Garrett  14:43

I actually will dispute something you just said Please, and it’s not uncommon, actually to have it laid out exactly as you did. But what I will dispute is this, we are seeing more and more evidence that young adults infected with COVID are more likely to go into long COVID than seniors perhaps it’s because the seniors are more likely to suffer fatal COVID. But whatever the reason, we have a massive population globally in the labor force or trying to be in the labor force that are suffering long COVID. And there’s more and more evidence that it’s not something you’re going to bounce out of. In other words, there are some folks that are fortunate that their long COVID may be just a kind of lingering malaise, a lingering fatigue, and that they can somehow shake their way through it. But we’re getting more and more very, very clear, emphatic evidence that neurons are affected, there’s direct brain damage, there’s direct cardiovascular damage, and this is not something you bounce out of, this is lifelong impact. And if this is the case, then this is not like flu, I mean, influenza, the biggest sort of lifelong effects of influenza, at least, the routine forms of influenza that circulate have been the result of in utero exposure, you know, so that we know, if you’re a woman who gets in your second or third trimester gets the flu, you have a set of possible outcomes that are damage for that fetus. And, you know, some things you wouldn’t think about have been associated, for example, higher rates of schizophrenia, and other psychiatric disorders, expressed in particularly males that were exposed to influenza in the third trimester as the brain is getting wired. But we’ve never seen anything like what we’re seeing now with, you know, you could almost think of it as take every single person that’s ever had Lyme disease in America. And we know a very sizable percentage of them struggle for years, years, with the whole sequela of effects caused by having had Lyme disease. Sure do. And, and a lot of them, it just seems to permanently alter their life. And so we don’t think of Lyme disease as a terrible terminal illness. But it certainly is a terrible, new chronic disease in the life of whoever suffers it. So, I think what we’re seeing now is a virus that is perhaps going to increasingly affect the human population in two very distinct ways that go after two very different demographics. One is going to be this sort of lasting effect on the human body, you survive, you may never be hospitalized, you may never have even felt like you were terribly sick with COVID. And yet, you now permanently have a certain cardiac issue, a certain neurological issue, a sense of fatigue of muscle achy, of just less interest in life.

Andy Slavitt  18:10

So what do we know Laurie about what portion of people who get COVID end up with long COVID?

Laurie Garrett  18:17

Yeah, we have a lot of data now. And the NIH, you know, has now enrolled 10s of 1000s of people into a massive, long COVID study. Similar studies are underway across Europe. And it seems to be that somewhere in the neighborhood of 40% of people who get sick with COVID, meaning they actually had symptoms, are likely to experience some lingering impact. Does that become the extremes of long COVID know exactly what subset of that 40% goes on to have? Very serious long COVID? That’s still a matter of study. And there’s still some questioning? It certainly will be. And I hope it’s a very small percentage, but you’re looking at actuary data already. And employer related data saying this is going to affect the labor force going forward. This is a huge economic burden on societies.

Andy Slavitt  19:22

So could be high single digits or 10%, something like that. Well, let’s take a quick break. We’re going to come back and we’re going to talk about what’s happening in China in other parts of the world with the world expert at a very big class with Laurie Garrett. Laurie, so you painted the picture of what’s going on in the US. And you’ve also made the point that we are, to some degree hamstrung by our lack of surveillance capabilities testing here. And that also extends to abroad and probably no more important place to focus now then once again, as we did a few years ago, the place with the most significant spread and outbreak in China, what do you know, about what’s happening in China right now?

Laurie Garrett  20:25

Yeah, so the China picture is very difficult to decipher. And all, you know, the top China watchers are using surrogate markers to figure out what’s going on because China’s not reporting data that anybody believes. And, you know, if you believe China, city after city is now recovering, and the worst is behind us. But if you look at crematoria, data, burial data, you look at what’s going on, in factory outputs, and so on. Very significant parts of the country are still really suffering. So what it looks like is upwards of 70% of Chinese people either have already gotten COVID, or are likely to get it in the next week or so. It may have peaked already in Beijing. And people are concluding that based on subway ridership, which is now soaring. So it looks like people are going back to work, traffic congestion has resumed in Beijing. So perhaps Beijing seen the worst of it for them. But other parts of the country are showing different pictures. I don’t think we’ll ever know how many people died, in the last three weeks.

Andy Slavitt  21:45

we were talking about cities that have upwards of 20 million people. So you’re talking about millions of people with COVID? Is that what we were expecting? And you know, I’m seeing numbers, and I’m sure you have as well, I don’t know what’s accurate, that there could be hundreds of 1000s of data million deaths from this current wave.

Laurie Garrett  22:07

People have tried to model the situation, to reckon just how bad could this get and, you know, some of the estimates are a million dead, some go up to 2 million dead. You know, keep in mind, the United States hit a million dead. When we were two years into our epidemic. This is talk of a million dead in less than a month. So that’s a very, you know, that is equivalent to if you recall, in 2021, when India was, you know, at peak crematoria use and there was hysteria across the entire nation. That’s what China appears to be going through. Now, we don’t really know, a lot that would help us understand how dangerous the Chinese situation could get for the rest of the world. The Chinese government has been slow to release specific viral information sequencing and so on. Some private Chinese laboratories and academic labs have been collaborating with their counterparts around the world, and have in fact, released some data and looks like they have been dealing mostly with the VA variants of Omicron.

Andy Slavitt  23:24

A few generations earlier. Right?

Laurie Garrett  23:25

Yeah. It’s what was in circulation in Hong Kong, back in October, November, even September, what it doesn’t look like they’ve been hit with yet is SBB. And so that opens the door to a lot of..

Andy Slavitt  23:41

More misery for them. One thing I don’t understand, you know, you, you think a lot about the foreign policy issues naturally, of public health issues. And you could think what we want about China zero COVID policies, but the one thing could certainly say is, as long as they had a zero COVID policy, you would assume that a country like China would have been vaccinating its elderly population. So that, you know, when they came out of zero COVID, which they were gonna have to do eventually, that you wouldn’t have this sort of impact. And yet, we know we still have a very significant portion of the population in China, including the elderly portion of the population that’s unvaccinated. And the USA department has on a number of occasions, offered to ship mRNA vaccines, just in case the […] foreign vaccine wasn’t doing the job. And that hasn’t been accepted by Chinese counterparts. So why didn’t they use this time to vaccinate the population?

Laurie Garrett  24:46

You know, this? This is the $20 billion question. There’s no evidence that there was ever any really serious vaccination campaign executed over the last 12 months. And it’s a lost opportunity for Sure, but keep in mind what was going on behind the scenes are not so much behind the scenes, but as part of Chinese politics, and that was she seeking to take over the country is the only leader since Mao Zedong to serve third term three terms to essentially be leader for life. He had this, you know, huge state council and People’s Party council meetings coming up these landmark events, of which he intended to exercise, you know, fantastic levels of power. So much including, you know, public humiliation of the former president of the country who Jintao on stage and on live television, you know, and his sort of key domestic policy, over the 12 months leading up to that event was zero COVID and constantly telling the nation hard is it is it’s working? Look at how many Americans are dying. Look at the total failure in the United States and in Europe. They’re dropping like flies. And look here in China. Our lockdowns are working. And they were. I mean, the truth is China was the only nation in the world with a real strategy. Now, it was a hideous strategy.

Andy Slavitt  26:16

Short term strategy. Yeah.

Laurie Garrett  26:18

It required the existence of a police state, and required huge economic tolls. It definitely cut China off from many of its trade partners. But it worked. It kept COVID down.

Andy Slavitt  26:32

It did for the short term, it would only have been a good strategy if they could have vaccinated people and then open the economy.

Laurie Garrett  26:38

Exactly. But that would have required demonstrating, saying out front to the Chinese people in the lead up to she’s big, you know, I’m the ruler for life, it would have required saying, but there are limits to the zero COVID. And the strategy isn’t foolproof. And so we want all of you to go out and get vaccinated, and we’re going to set up vaccination stations all over the place, and we’re going to go into old people’s homes, and then we’re gonna use the power of the police state to force you to get vaccinated.

Andy Slavitt  27:11

Well, they can force quarantine. So I’m surprised they didn’t force vaccinate. Laurie, you write a lot about and talk a lot about how dependent we are on global cooperation, global cooperation to spot variants, to look at other forms of surveillance, talk a little bit about what you see occurring and the breakdown you see occurring around the world. It’s not just in China, although China is certainly a shining example. But in other parts around the world that limits our ability to see what’s going on and be able to respond to it effectively.

Laurie Garrett  27:46

Well, Andy, I mean, the first one is something that actually started here in the United States, which was this whole political movement, to shift the public health priorities away from testing that would allow public health authorities to have their fingers on the pulse and really know who’s infected and how it’s spreading inside any given community to home testing, that is completely private, that is utterly individualistic, and provides no database to anybody. And so we have less data coming in, even here in the United States. But the same is true all over the world, either because of home testing, or because governments have decided, you know, it’s really not that big a deal. And we don’t want to spend XYZ amount of money out of our national budget on these endless PCR tests, and the codifying all the data and analyzing all the viruses, so the heck with it. And so WHO is getting far less data now? And they’re less able to say what the world trends are.

Andy Slavitt  28:57

So does this mean that if another variant emerges out of China, which you got to write at least some probability to it, given the amount of, of growth there, or in other parts of the world, we’re going to be slower to see it?

Laurie Garrett  29:10

Absolutely. And it also means that and by the way, there scientists are saying that loud and clear. You know, we’re we don’t have our hands on what’s going on anymore. And the other thing that to think about, since the whole question of the origins of this entire pandemic got mired and remain mired in are only going to get worse, mired thanks to the Republicans take over the House, in politics, in accusations between the United States and China, claims that it was manmade that Tony Fauci funded the creation of the virus all this crazy stuff out there. And now here we are letting it recirculate back in whatever animal species it was.

Andy Slavitt  29:55

Then it sounds like we don’t know about it. Let me do one more break. We’ll come back and talk about some promising signs that we may be seeing, as well as how the politics that you’re referring to just now are really good at potentially change the outcome of what happens to us next year, we’ll be right back with Laurie. We’re back with Laurie Garrett. Laurie, this whole period has been also somewhat a story of innovation started with mRNA vaccines with Pexels, COVID, and therapeutics with rapid tests coming on the market. Now, that only happened, as we’ll get to in a second, because governments decided to make this a priority. And while this was considered to be an emergency, that’s exactly what happened. You know, we could look at some of the next potential promising things on the market, you know, things we would love to have a universal vaccine, a nasal vaccine, rapid wastewater surveillance, so that we could really be collecting information in the background without anybody having to test and say, Boy, you know, those things would really make significant progress against further threats. And so the first of all, do you agree with that? Do you think there are promising things out there? And then of course, we’ll get to the big butt in a second?

Laurie Garrett  31:26

Well, absolutely, there are. And the one that is really a revolution is wastewater surveillance, or general environmental surveillance for viruses. And, you know, Andy, I started advocating for application of genomic sequencing, testing in the environment, going back to 2015. I was saying, Look, we can’t eradicate polio, because we know that Polio is turning up in wastewater. So we need to start doing wastewater surveillance for polio. What we see now is that here in New York, for example, a collaboration between the City University of New York, and the Health and Hospitals Corporation, the HHS service, and the city’s wastewater and treatment facilities, basically, the city now gets a two week headstart on the virus, we know that new strain is circulating, or that the amount of virus that’s in the city has risen, based on wastewater surveillance about two weeks before it results in an increase in hospitalization. And that’s fantastic. Because what that means is that literally the hospitals know, okay, we have to buy more PPE, yes, we have to get more drugs in the hospital, we have to make sure our oxygen supply is up to snuff in the ICUs. And we’re going to have to change the shifts on key nurses and make sure we have enough people called in from holiday to staff, the ICU, that sort of thing. And that literally saves lives. And of course, we were able to track polio, when we had a case appear outside New York City, we were able to track where it moved and how it was turning up in different parts of the state of New York by monitoring polio and wastewater. And monkey pox was monitored in wastewater. What we’re seeing all over the world now is that by monitoring the wastewater, and using more and more sophisticated genetic surveillance techniques, it’s possible not only to say, Oops, there’s a virus here, and somebody’s pooping it out. And it’s ending up in the wastewater system. So we have an infected person upstream. But folks at UC San Diego have even figured out how to measure the volume of it in a wastewater sample, and do a statistical analysis that tells them roughly how many people were upstream contributing so that you know, are you looking at a handful of cases? Or is this like half of Queens, half of Brooklyn has this virus? There are so many ways to do this, that remove the stigma, remove that sense of burden on the individual and become a whole new way of thinking about public health. This is a whole new toolkit that we’ve never had before. So what’s the problem? The problem is it has to be funded in a permanent way.

Andy Slavitt  34:34

Let’s talk about funding. And that inevitably gets us to the conversation around politics. It seems like me just to review the bidding. The Biden administration has said to the Congress, we need about $25 billion to continue to protect the public against COVID. The Republicans said, you know PROVE IT spend the money you have already show us some accountability. The White House spelled that out in pretty good detail, including things like anticipating future variants, being able to create more vaccines, being able to make sure that people who were uninsured could get vaccines and therapies. But also importantly, making sure that when the next wave of boosters came out, or when something more profound came out that we needed to fund, like a nasal vaccine, that Americans could be first in line again, or at least in line with everybody else. The last Congress didn’t fund it. This next congress is obviously even more reluctant to put money towards COVID. Because I think as far as they’re concerned in their districts and many of their districts COVID just doesn’t exist was completely overblown. And many of them don’t think people should get vaccinated. And I’m painting with a broad brush, but I don’t think I’m that far off. What that does is it creates a stalemate in effect where literally anything related to COVID has very little if any chance to get funding barring a disaster, which brings people back to the knees again, is that the state of affairs?

Laurie Garrett  36:06

Yeah, unfortunately, it is. And many programs, some programs of the COVID response in America, I’ve already run out of money, they’re already tapped out. And, you know, one of the reasons a city like New York would say, we’re not going to have free PCR stations all over the place, is they don’t have the money to have free PCR stations all over the place. The federal funding for that is gone. I was just looking at a report out of the Kaiser Family Foundation, which is a completely nonpartisan, private organization connected to the Kaiser Health chain, they are saying that the best guess is that the cost of the mRNA vaccines is going to quadruple this year, and that fewer and fewer people are going to find that they can obtain it for free. So we’re going to either see higher co pays if you have insurance, or if you’re on Medicare, or we’re going to see whole communities unable to get vaccinated for economic reasons, they can’t afford to buy it, they can’t afford to pay for it. The same is true for PCR testing, and likely to be true for all the drugs that have any efficacy at all against the new variants as they come forward. And at the very moment when we should be revving up our whole R&D effort to get ahead of the virus to come up with ways to counter new variants that our immune system evaders, we’re actually seeing the reverse that funding is going down. And then there’s a final piece of this, which is that Rand Paul, and his counterparts in the House have vowed to make 2023 the year that they bring Tony Fauci, you know, before congressional committees, and they take on the NIH, and they quote, unquote, prove that all of this was a giant conspiracy created to make profits for vaccine makers, by falsely creating a vaccine, I mean a virus and then falsely telling the American people that they were facing dire circumstances and forcing this huge expenditure needlessly on these quote unquote, terrible vaccines. And so the environment politically is going to move exactly the opposite direction. That would make sense given what we’re up against.

Andy Slavitt  38:26

Let’s close by just talking about what’s happened with this political environment is political response in parts of the country, and that is the vaccine hesitant or anti-vaccine movement and whether you’ve seen spillover to things beyond COVID whether this is gonna more broadly impact public health here in the US?

Laurie Garrett  38:47

Well, it is globally, all over the world, we’re seeing a decline in child vaccination rates. Initially, it was thought by WHO and here in the United States thought by most state health authorities that this reflected lockdowns that people weren’t getting vaccinated because they just weren’t going to doctors during the height of our lockdown mode, but we’re way past that point now. And you know, everybody’s out partying and Time Square for New Year’s Eve. Why not? Take your kid in for a vaccination and a routine pediatric visit. But we have a serious outbreak of measles right now in Ohio. We’re looking at outbreaks of more and more diphtheria, pertussis or measles, the classic childhood vaccine preventable are all increasing all over the world as a result of a huge downturn in child vaccination rates. I had a child die in my arms of measles in Africa back in the 70s.

Andy Slavitt  39:54

Look as if we don’t have enough problems. We have to create more create our own fact that we’re sitting here 2023, we’ve had measles outbreaks, we’ve had polio outbreaks. You know, these are things that are controllable and preventable, Laurie. Well, that’s gonna keep you busy. It’s gonna keep us all busy. Thank you for coming in the bubble again and reporting for us on what’s happening, what to expect? And how do we remind people, particularly as they feel safer and safer, that not everybody feels that way and that everybody experiences it that way?

Laurie Garrett  40:31

You know, the focus of that specific question has become the mask. You know, we have a whole increasing population of Americans that are fed up with masks, and fed up with wearing masks fed up with seeing masks are likely to make derogatory comments against individuals who are wearing masks. And in many ways, this reflects that, from the very beginning of asking Americans and this is true in Europe as well, Europeans, to Dawn their masks, we, we incorrectly defined the reason why it should be done, it became individualistic, that you were protecting yourself by wearing a mask. And that led to and I want the best mass there is and I want n95s Another thing that by the way, with the changes in Congress, we’re likely to see a lack of funding for so we’re going to get more and more of a class bias in who has access to high quality masks. And who doesn’t. But the real reason to wear a mask is to protect others. You know, in Japan, they have a tradition of mask wearing that goes way back to long before there was COVID, you would think oh, these people are paranoid know that someone who doesn’t feel well today, they put a mask on so that whatever makes them not feel well, they won’t give to others at school, at the workplace. At home. We have always thought of public health protective measures in overly individualistic terms, not in terms of it’s my duty to protect those around me, my Girl Scouts of America oath, you know, on my honor, I will try to do my best for God in my country. And that duty is to protect others. What I have experienced is just a microcosm in my own apartment buildings that younger and younger people are no longer wearing masks. And it’s come down to just the older residents of the building, wearing masks in the elevators and worried about getting COVID and you see more and more disdain and sort of, oh, you’re wearing a mask? Or what do you mask for? Why are you wearing a mask? I think that we didn’t well describe why public health is about all of us pitching in to protect and defend all the rest of us. And that it’s a patriotic act. And it’s an act of love. And it’s an act of community. And now we find ourselves in an increasingly individualistic situation, where asking those around you to take steps to protect others is viewed as communism or some left wing conspiracy. It’s crazy ideas, you stupid, goofy people. And I don’t know that we can walk it back.

Andy Slavitt  40:49

Laurie, thank you for being in the bubble and sharing your thoughts. Great to talk to you, as always have a great, New Year.

Laurie Garrett  43:36

Always, take care and happy New Year, Andy.

Andy Slavitt  43:53

Wednesday, Governor Tim Walz from the great state of Minnesota is here. I know you’re going to enjoy that that’s going to be a fun conversation. We’re going to talk about what he’s going to do and what I think we can expect to see nationally from governor’s post-election. And it’s very interesting election of 2020 to Friday, we’re swinging over to see what’s going on inside Afghanistan, and particularly, what’s happened with women and the terrible state of affairs that the Taliban has wrought. What we can do about it, what our obligations are, what our commitment is, it’s really important to show so I hope you listen to both Wednesday and Friday. And to us throughout the year again, let me remind you, let us know how you’re feeling about any of these shows. Let us know what topics you want to hear. Email me at inthebubble@lemonadamedia.com

CREDITS  45:00

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.