“First 100 days,” said Means, a former consultant to Big Pharma who uses the social platform X to focus attention on chronic disease. “What should be done to reform the FDA?”

The question was more than rhetorical. Means is among a cadre of health business leaders and nonmainstream doctors who are influencing President Donald Trump’s focus on health policy.

Trump’s return to the White House has given Means and others in this space significant clout in shaping the nascent health policies of the new administration and its federal agencies. It’s also giving newfound momentum to “Make America Healthy Again,” or MAHA, a controversial movement that challenges prevailing thinking on public health and chronic disease.

Its followers couch their ideals in phrases like “health freedom” and “true health.” Their stated causes are as diverse as revamping certain agricultural subsidies, firing National Institutes of Health employees, rethinking childhood vaccination schedules, and banning marketing of ultra-processed foods to children on TV.

Public health leaders say the emerging Trump administration’s interest in elevating the sometimes unorthodox concepts could be catastrophic, eroding decades of scientific progress while spurring a rise in preventable disease. They worry the administration’s support could weaken trust in public health agencies.

Georges Benjamin, executive director of the American Public Health Association, said he welcomes broad intellectual scientific discussion but is concerned that Trump will parrot untested and unproven public health ideas he hears as if they are fact.

Experience has shown that people with unproven ideas will have his ear and his “very large bully pulpit,” he said. “Because he’s president, people will believe he won’t say things that aren’t true. This president, he will.”

But those in the MAHA camp have a very different take. They say they have been maligned as dangerous for questioning the status quo. The election has given them an enormous opportunity to shape politics and policies, and they say they won’t undermine public health. Instead, they say, they will restore trust in federal health agencies that lost public support during the pandemic.

“It may be a brilliant strategy by the right,” said Peter McCullough, a cardiologist who has come under fire for saying covid-19 vaccines are unsafe. He was describing some of the election-season messaging that mainstreamed their perspectives. “The right was saying we care about medical and environmental issues. The left was pursuing abortion rights and a negative campaign on Trump. But everyone should care about health. Health should be apolitical.”

The movement is largely anti-regulatory and anti-big government, whether concerning raw milk or drug approvals, although implementing changes would require more regulation. Many of its concepts cross over to include ideas that have also been championed by some on the far left.

Robert F. Kennedy Jr., an anti-vaccine activist Trump has nominated to run the Department of Health and Human Services, has called for firing hundreds of people at the National Institutes of Health, removing fluoride from water, boosting federal support for psychedelic therapy, and loosening restrictions on raw milk, consumption of which can expose consumers to foodborne illness. Its sale has prompted federal raids on farms for not complying with food safety regulations.

Means has called for top-down changes at the U.S. Department of Agriculture, which he says has been co-opted by the food industry.

Though he himself is not trained in science or medicine, he has said people had almost no chance of dying of covid-19 if they were “metabolically healthy,” referring to eating, sleeping, exercise, and stress management habits, and has said that about 85% of deaths and health care costs in the U.S. are tied to preventable foodborne metabolic conditions.

A co-founder of Truemed, a company that helps consumers use pretax savings and reimbursement programs on supplements, sleep aids, and exercise equipment, Means says he has had conversations behind closed doors with dozens of members of Congress. He said he also helped bring RFK Jr. and Trump together. RFK Jr. endorsed Trump in August after ending his independent presidential campaign.

“I had this vision for a year, actually. It sounds very woo-woo, but I was in a sweat tent with him in Austin at a campaign event six months before, and I just had this strong vision of him standing with Trump,” Means said recently on the Joe Rogan Experience podcast.

The former self-described never-Trumper said that, after Trump’s first assassination attempt, he felt it was a powerful moment. Means called RFK Jr. and worked with conservative political commentator Tucker Carlson to connect him to the former president. Trump and RFK Jr. then had weeks of conversations about topics such as child obesity and causes of infertility, Means said.

“I really felt, and he felt, like this could be a realignment of American politics,” Means said.

He is joined in the effort by his sister, Casey Means, a Stanford University-trained doctor and co-author with her brother of “Good Energy,” a book about improving metabolic health. The duo has blamed Big Pharma and the agriculture industry for increasing rates of obesity, depression, and chronic health conditions in the country. They have also raised questions about vaccines.

“Yeah, I bet that one vaccine probably isn’t causing autism, but what about the 20 that they are getting before 18 months,” Casey Means said in the Joe Rogan podcast episode with her brother.

The movement, which challenges what its adherents call “the cult of science,” gained significant traction during the pandemic, fueled by a backlash against vaccine and mask mandates that flourished during the Biden administration. Many of its supporters say they gained followers who believed they had been misled on the effectiveness of covid-19 vaccines.

In July 2022, Deborah Birx, covid-19 response coordinator in Trump’s first administration, said on Fox News that “we overplayed the vaccines,” although she noted that they do work.

Anthony Fauci, who advised Trump during the pandemic, in December 2020 called the vaccines a game changer that could diminish covid-19 the way the polio vaccine did for that disease.

Eventually, though, it became evident that the shots don’t necessarily prevent transmission and the effectiveness of the booster wanes with time, which some conservatives say led to disillusionment that has driven interest in the health freedom movement.

Federal health officials say the rollout of the covid vaccine was a turning point in the pandemic and that the shots lessen the severity of the disease by teaching the immune system to recognize and fight the virus that causes it.

Postelection, some Trump allies such as Elon Musk have called for Fauci to be prosecuted. Fauci declined to comment.

Joe Grogan, a former director of the White House’s Domestic Policy Council and assistant to Trump, said conservatives have been trying to articulate why government control of health care is troublesome.

“Two things have happened. The government went totally overboard and lied about many things during covid and showed no compassion about people’s needs outside of covid,” he said. “RFK Jr. came along and articulated very simply that government control of health care can’t be trusted, and we’re spending money, and it isn’t making anyone healthier. In some instances, it may be making people sicker.”

The MAHA movement capitalizes on many of the nonconventional health concepts that have been darlings of the left, such as promoting organic foods and food as medicine. But in an environment of polarized politics, the growing prominence of leaders who challenge what they call the cult of science could lead to more public confusion and division, some health analysts say.

Jeffrey Singer, a surgeon and senior fellow at the Cato Institute, a libertarian public policy research group, said in a statement that he agrees with RFK Jr.’s focus on reevaluating the public health system. But he said it comes with risks.

“I am concerned that many of RFK Jr.’s claims about vaccine safety, environmental toxins, and food additives lack evidence, have stoked public fears, and contributed to a decline in childhood vaccination rates,” he said.

Measles vaccination among kindergartners in the U.S. dropped to 92.7% in the 2023-24 school year from 95.2% in the 2019-20 school year, according to the Centers for Disease Control and Prevention. The agency said that has left about 280,000 kindergartners at risk.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

The post Make America Healthy Again: An Unconventional Movement That May Have Found Its Moment appeared first on Medika Life.

Climate change is the worst crisis humanity is currently facing. The evidence is clear with the stark differences in climate-related incidents across the globe. While Dubai received torrential rainfall, causing flash floods, people across various parts of Asia are grappling with heatwaves, leading to severe water shortages, with poorer communities being the worst affected. The Earth is boiling, quite literally, and resources have been stretched to the limit as the population grows, foreshadowing devastating consequences for future generations. Public health, in particular, is reeling from this crisis as the prevalence of communicable and non-communicable diseases grows at a startling rate. Between 2000 and 2019, almost 489,000 people died each year due to heat-related illnesses, with 45% in Asia and 36% in Europe.[1] Rising temperatures are responsible for not just public health emergencies, they can affect health services. Public health is the first line of defense during a crisis of this magnitude, and as systems across the globe struggle to cope, the outlook seems bleak.

Disease prevention, treatment, accessibility, equity, and protection of the environment are all essential facets of health that aim to enhance the well-being of the public. The main goal of sustainability is to meet the needs of the current generation without compromising the needs of future generations. The crux of both these concepts is the adoption of holistic practices that provide long-term welfare over short-term respite. Hence, it is crucial to understand how health and sustainability go hand-in-hand to help humanity weather the current crisis.

Making health sustainable

The health sector is responsible for between 4.4% and 5.2% of the world’s greenhouse gas emissions.[2] This creates a paradoxical situation wherein the systems created to help can harm the well-being of the public. Health services comprise energy-intensive activities, from maintaining hospitals to creating life-saving medicines. Reducing the carbon footprint would be the first step towards making health sustainable. The solutions to this problem boil down to three categories — switching to non-fossil energy, storing energy, and conserving energy. Rather than solely depending on non-renewable sources of energy, the sector must start adopting renewable sources such as wind or solar energy. This helps build resilience to adverse climate-related events and can provide a positive socioeconomic impact.

A critical aspect of health that is often overlooked is the significance of preventive care. Countries that are a part of the Organisation for Economic Co-operation and Development spend less than 3% on preventive care.[3] Prevention is important in reducing the overuse of resources in health, which can result in reducing the carbon footprint. Several short and long-term sustainability goals can be achieved through primary, secondary, and tertiary prevention. A robust global vaccination programme must be implemented to decrease resource consumption. Furthermore, encouraging the public to adopt a healthy lifestyle empowers them to take an active role in enhancing their well-being.

Public health is often highly fragmented as patients may have to go to several points along the treatment pathway. Improving access to early diagnosis and providing one-stop solutions can make this process easier and more sustainable. Policymakers and other stakeholders can drive systemic change by encouraging people to adopt preventive measures to reduce the disease burden and health consumption.

There are several indirect ways in which health can become more sustainable. For instance, encouraging the adoption of telemedicine in cases where the patient does not need to be physically present. Governments must create policies that encourage the sustainable procurement of ingredients for medicines, using greener methods of transportation, embracing a circular economy, and employing safe waste disposal methods.

Public health and sustainability have a symbiotic relationship that requires our utmost attention. COVID-19 may not be the last health crisis we witness in our lifetimes. This is especially true due to climate change, which can exacerbate more than half of the known human pathogenic diseases.[4] As health communicators our task is twofold — drawing attention to the brewing health crisis while shedding light on climate change and its implications. The future hinges on sustainability and integrating it into the health system while not compromising on quality. The transition needs to start now.

[1] https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

[2] https://magazine.hms.harvard.edu/articles/confronting-health-cares-carbon-footprint#:~:text=Data%20suggest%20that%20the%20global,contribute%202%20to%205%20percent.

[3] https://www.oecd.org/newsroom/boosting-investment-in-health-systems-will-be-essential-to-deal-with-future-shocks.htm

[4] https://www.nature.com/articles/s41558-022-01426-1

The post The intersection of Public Health and Sustainability: Why it Matters Now More Than Ever appeared first on Medika Life.

The global population is ageing. This has long been a trend in Western nations. However, many developing countries are now witnessing a similar societal shift. This will profoundly affect our economic well-being (as I wrote about here) and security and cohesion (as I wrote about here) unless countries focus much more on the health of older people. Health systems must adapt to this new reality, or we will all face dire health and economic burdens in the future.

Adult vaccination is a key area where we are simply not keeping up with shifting dynamics. Pneumococcal disease is a prominent example. Pneumococcal disease is a name for any infection caused by bacteria called Streptococcus pneumoniae, or pneumococcus. Pneumococcal infections can range from ear and sinus infections to pneumonia, meningitis and bloodstream infections[1].

We have made great strides when it comes to pneumococcal disease prevention. However, there is a lot of work that needs to be done to improve protection through vaccination, most prominently among the adult population.

Paediatric pneumococcal vaccination had been introduced in 155 WHO Member States by the end of 2022. Though coverage rates vary considerably by region, the global third dose coverage was estimated at 60%[2]. This is contrasted sharply by the situation regarding adult vaccination. Despite WHO recommendations, only 31 countries currently include adults in the pneumococcal vaccination schedule. Coverage rates are often lacking in countries with a programme in place, and the implementation is suboptimal.

It has been estimated that between 2004 and 2040, the economic burden of pneumococcal pneumonia will increase by US $2.5 billion per year[3]. A global burden of disease study on lower respiratory tract infections (LRTIs) indicated that in 2016, a total of 2,377,697 deaths occurred from LRTIs in people of all ages. Of these, close to half, or 1,080,958 deaths, occurred in adults over 70 years of age[4]. Streptococcus pneumoniae was the leading cause of LRTI morbidity and mortality globally, causing more deaths than all other etiologies combined in 2016. As the population ages, the at-risk group is increasing. Despite nearly half of current deaths already being associated with older adults, adult pneumococcal vaccination remains a low priority for policy makers in most countries. This is a major mistake.

Health system recommendations are not the only issue. Perceptions and visibility of the pneumococcal vaccine also limit uptake where they are available. One assessment suggests that the two most cost-effective adult vaccines are flu and pneumococcal[5], but the pneumococcal vaccine uptake is much lower. A survey conducted by the International Longevity Centre (ILC)[6] found that in adults over 50 across a number of European countries, 94% had heard of the flu and COVID-19 vaccines. Still, only 42% had heard about the pneumococcal vaccine. This lack of knowledge translated directly into uptake rates. Flu vaccine uptake was 59%, 85% got the COVID-19 vaccine, while only 18% got the pneumococcal vaccine. “We know that knowledge is a key driver for vaccination…when people aren’t aware a vaccine exists, they won’t get it,” said Arunima Himawan, Senior Health Research Lead, ILC, UK.

Need for policy prioritisation and igniting longer-term thinking amongst decision-makers

Scientists working in the field of pneumococcal disease and immunisation feel that a key challenge is convincing policymakers to implement strategies within their five-year election cycles. This focus on reelection often favours spending on the immediate and the concrete rather than on prevention policies which will pay off over decades.

“Now, how can we make the same argument for adults? I think the argument is beginning to emerge in the concept of healthy ageing and living, and there are dividends in this. Healthier populations result in higher economic productivity and more societal cohesion. I think these are the things we need to be framing to policymakers,” said Dr Sipho Dlamini of the University of Cape Town, South Africa.

Policymakers make the same errors in value calculation over and over again. Officials calculate value in the short term without looking at the associated costs. The narrative must shift from thinking of pneumococcal vaccination as just preventing hospitalisations directly from the illness.

Many of the longer-term effects of pneumococcal infection are delayed and masked. Myocardial infarction risk is significantly elevated following a bout of pneumococcal infection[7]; however, due to the delay or a focus on the immediate issue of the myocardial infarction, the diagnosis of the infection may not occur. Without clear visibility of an issue, and a lack of data, there is no immediate political incentive to address it.

The relationship between viral and bacterial infections is another matter that must be highlighted. In many instances, a viral infection may be an instigator of a secondary infection from a bacterial pathogen.

Antimicrobial resistance (AMR) brings enormous costs — even in 2013, the US Centers for Disease Control and Prevention estimated that antimicrobial resistance added $20 billion to direct healthcare costs in the United States alone and a further $35 billion in loss of productivity annually. Vaccines reduce antibiotic use and this slows AMR, especially in life-threatening illnesses such as pneumonia where clinicians are reluctant to postpone treatment until lab results on bacterial susceptibility are available.

If a policymaker wishes to implement longer-term strategies, they must be reelected. It is vital, therefore, to have evidence-based information available to them. To justify the immediate expense of vaccination campaigns, they also need immediate rewards that alert the electorate or their superiors to their far-sighted decision-making. This might come from social media posts or press events with heads of NGOs and professional societies or through recognition in international comparisons.

Productivity as an incentive for vaccination

Productivity may be a critical narrative focus for adult immunisation. Politicians, in the face of an ageing society, are more interested in getting older people to stay in work.Employers may fund vaccination too to keep an older workforce engaged and productive.

Population demographics across the globe are aligning to effectively make it a necessity for adults to work into older ages. The world’s median age has been projected to increase from 31 to 36 by 2050. Europe is projected to have the oldest median age, at 47 years[8]. A considerable, and ever-increasing proportion of the population will fall into the over-65 category. Keeping these individuals healthy and productive will be essential to the economy.

Businesses must also be persuaded of the merits of adult vaccination, as they both directly benefit from them, and can also be one of the most powerful advocates for changes in government policy. “The reason that Rotary was so successful in their polio campaign was that they had so many business leaders there who could influence governments and had access,” said Michael Moore, former member of the ACT Legislative Assembly of Australia and Former District Governor, Rotary.

Younger workers also benefit, as they will not be taking time off work to care for their older family members.

Delivering the data to policymakers

A very small proportion of health budgets is earmarked for preventative health, and less specifically for immunisation and even less for adult immunisation. According to ILC UK, if preventative health spending increases by just 0.1% of GDP, it could unlock a 9% increase in annual spending by people aged 60 plus and an additional 10 hours of volunteering[9].

Data may not be enough; we need charismatic individuals. Australia is a clear example of the benefits of having a champion to rally around. Professor Ian Fraser, one of the inventors of the HPV vaccine, had a significant impact on the uptake of the vaccine by the government and was named Australian of the Year. Having a well-known, trusted advocate can be invaluable in providing policymakers with support.

Clear messaging, confidence, and convenience

Often unclear messaging permeates where vaccines are available, and this can have an impact on coverage rates. South Africa has provided a case study on how to address this. A group from a number of medical disciplines met with the aim of producing a simple-to-use guide. “The idea is that you produce a one-stop document. So any clinician anywhere, whether it be a GP or other specialist can say, I’ve got a haematology patient, how should I give vaccination? And the document is there.” said Dr Sipho Dlamini. This massively simplified the process and allowed for standardisation, overall improving access. It also meant that cardiologist, rheumatologists, diabetologists and others could be reassured that their own colleagues had endorsed the guidelines.

Confidence and awareness play important roles in the acceptance of vaccination. However, convenience is a factor that is often overlooked. “Older adults may need to rely on their children and their schedules to be able to take them to get the vaccines. That can make a very big difference,” said Lois Privor Dumm, Johns Hopkins Bloomberg School of Public Health.

A documented success story is the availability of vaccines through pharmacies. Pharmacists are a well-trusted source, but they’re also convenient, and many people are used to going to their pharmacy much more regularly than a general practitioner.

If we are to convince both policymakers and the public that adult vaccination for illnesses such as pneumococcal disease is a necessity, the narrative must shift. The health of older adults has an impact on the entire community. Vaccination has a significant positive economic impact on the productivity of older adults, the people who are taking care of older adults and the people who rely on older adults for childcare. Much like childhood vaccination, life course immunisation is an investment opportunity that will pay dividends for years to come and improve the health of the population.

[1]https://www.cdc.gov/pneumococcal/index.html#:~:text=Pneumococcal%20%5Bnoo%2Dmuh%2DKOK,to%20help%20prevent%20pneumococcal%20disease.

[2] WHO Immunization Coverage https://www.who.int/news-room/fact-sheets/detail/immunization-coverage

[3] Wroe PC, Finkelstein JA, Ray GT, et al. Aging population and future burden of pneumococcal pneumonia in the United States. J Infect Dis. 2012;205(10):1589–1592. doi: 10.1093/infdis/jis240

[4] Anderson R, Feldman C. The Global Burden of Community-Acquired Pneumonia in Adults, Encompassing Invasive Pneumococcal Disease and the Prevalence of Its Associated Cardiovascular Events, with a Focus on Pneumolysin and Macrolide Antibiotics in Pathogenesis and Therapy. Int J Mol Sci. 2023 Jul 3;24(13):11038. doi: 10.3390/ijms241311038. PMID: 37446214; PMCID: PMC10341596.

[5] Leidner AJ, Murthy N, Chesson HW, Biggerstaff M, Stoecker C, Harris AM, Acosta A, Dooling K, Bridges CB. Cost-effectiveness of adult vaccinations: A systematic review. Vaccine. 2019 Jan 7;37(2):226–234. doi: 10.1016/j.vaccine.2018.11.056. Epub 2018 Dec 4. PMID: 30527660; PMCID: PMC6545890.

[6] https://ilcuk.org.uk/european-pneumococcal-vaccination-a-progress-report/

[7] Ohland, J., Warren-Gash, C., Blackburn, R., Mølbak, K., Valentiner-Branth, P., Nielsen, J., & Emborg, D. (2020). Acute myocardial infarctions and stroke triggered by laboratory-confirmed respiratory infections in Denmark, 2010 to 2016. Eurosurveillance, 25(17). https://doi.org/10.2807/1560-7917.ES.2020.25.17.1900199

[8] https://www.imf.org/en/Publications/fandd/issues/2020/03/infographic-global-population-trends-picture

[9] https://ilcuk.org.uk/major-conditions-strategy-time-to-act-on-prevention/

The post An Ageing Population Underlines Need for New Strategies to Improve Uptake of Adult Pneumococcal Immunisation appeared first on Medika Life.

Smallpox was certified eradicated in 1980, but I first learned about the disease’s twisty, storied history in 1996 while interning at the World Health Organization. As a college student in the 1990s, I was fascinated by the sheer magnitude of what it took to wipe a human disease from the earth for the first time.

Over the years, I’ve turned to that history over and over, looking for inspiration and direction on how to be more ambitious when confronting public health threats of my day.

In the late 1990s, I had the opportunity to meet some of the health care professionals and other eradication campaign workers who helped stop the disease. I came to see that the history of this remarkable achievement had been told through the eyes mostly of white men from the United States, what was then the Soviet Union, and other parts of Europe.

But I knew that there was more to tell, and I worried that the stories of legions of local public health workers in South Asia could be lost forever. With its dense urban slums, sparse rural villages, complicated geopolitics, corrupt governance in some corners, and punishing terrain, South Asia had been the hardest battlefield the smallpox eradicators had to conquer.

I decided to capture some of that history. That work became a podcast, an eight-episode, limited-series audio documentary, called “Epidemic: Eradicating Smallpox.”

My field reporting began in summer 2022, when I traveled to India and Bangladesh — which had been the site of a grueling battle in the war on the disease. I tracked down aging smallpox workers, some now in their 80s and 90s, who had done the painstaking work of hunting down every last case of smallpox in the region and vaccinating everyone who had been exposed. Many of the smallpox campaign veterans had fallen out of touch with one another. Their friendships had been forged at a time when long-distance calls were expensive and telegrams were still used for urgent messages.

How did they defeat smallpox? And what lessons does that victory hold for us today?

I also documented the stories of people who contracted smallpox and lived. What can we learn from them? The survivors I met are not unlike my father, who grew up in a rural village in southern India where his childhood was shaped by family finances that limited access to opportunity. The stories he shared with me about the big social and economic divides in India fueled my decision to choose a career in public health and to work for equity. As we emerge from the covid pandemic, that connection is a big part of why I wanted to go back in time in search of answers to the challenges we face today.

Unwarranted Optimism

I sought out Indian and Bangladeshi public health workers, as well as the WHO epidemiologists — largely from the U.S. and Europe — who had designed and orchestrated the eradication campaigns across South Asia. Those smallpox leaders of the 1960s and ’70s showed moral imagination: While many doctors and scientists thought it would be impossible to stop a disease that had lasted for millennia, the eradication champions had a wider vision for the world — not just less smallpox or fewer deaths but elimination of the disease completely. They did not limit themselves to obvious or incremental improvements.

Bill Foege, a campaign leader in the 1970s, said by contrast today’s policymakers can be very reluctant to support programs that don’t already have data to back them up. They typically want proof of sustainability before investing in novel programs, he said, but real-world sustainability often only becomes clear when new ideas are put into practice and at scale.

The smallpox eradication visionaries were different from these cautious current leaders. “They had ‘unwarranted optimism,’” Foege said. They had faith that they could make “something happen that could not have been foreseen.”

In India, in particular, many leaders hoped their nation could compete with other superpowers on the world stage. That idealism, in part, stoked their belief that smallpox could be stopped.

During the smallpox program in South Asia, Mahendra Dutta was one the biggest risk-takers — willing to look beyond the pragmatic and politically palatable. He was a physician and public health leader who used his political savvy to help usher in a transformative smallpox vaccination strategy across India.

The eradication campaign had been grinding in India for over a decade. India had invested time and resources — and no small amount of publicity — into a mass vaccination approach. But the virus was still spreading out of control. At a time when India’s leaders were eager to project strength as a superpower and protective of the nation’s image on the world stage, Dutta’s was one of the voices that proclaimed to India’s policymakers that mass vaccination wasn’t working.

Dutta told them it was past time for India to adopt a new, more targeted vaccine strategy called “search and containment.” Teams of eradication workers visited communities across India to track down active cases of smallpox. Whenever they found a case, health workers would isolate the infected person, then vaccinate anyone that individual might have come in contact with.

To smooth the way for the new strategy, Dutta called in favors and even threatened to resign from his job.

He died in 2020, but I spoke with his son Yogesh Parashar, who said Dutta straddled two worlds: the in-the-trenches realities of smallpox eradication — and India’s bureaucracy. “My father did all the dirty work. He got enemies also in the process, I’m sure he did, but that is what he did,” Parashar said.

A Failure to Meet Basic Needs

Smallpox workers understood the need to build trust through partnerships: The WHO’s global smallpox eradication program paired its epidemiologists with Indian and Bangladeshi community health workers, who included laypeople with training and eager and idealistic medical students. Those local smallpox eradication workers were trusted messengers of the public health program. They leveraged the region’s myriad cultures and traditions to pave the way for people to accept the smallpox campaign and overcome vaccine hesitation. While encouraging vaccine acceptance, they embraced cultural practices: using folk songs to spread public health messages, for example, and honoring the way locals used the leaves of the neem tree to alert others to stay away from the home of someone infected with smallpox.

Smallpox eradication in South Asia unfolded against a backdrop of natural disaster, civil war, sectarian violence, and famine — crises that created many pressing needs. By many, many measures, the program was a success. Indeed, smallpox was stopped. Still, in the all-consuming push to end the virus, public health writ large often failed to meet people’s basic needs, such as housing or food.

The smallpox workers I interviewed said they were sometimes confronted by locals who made it clear they had concerns that, even in the midst of a raging epidemic, felt more immediate and important than smallpox.

Eradication worker Shahidul Haq Khan, whom podcast listeners meet in Episode 4, heard that sentiment as he traveled from community to community in southern Bangladesh. People asked him: “There’s no rice in people’s stomachs, so what is a vaccine going to do?” he said.

But the eradication mission largely did not include meeting immediate needs, so often the health workers’ hands were tied.

When a community’s immediate concerns aren’t addressed by public health, it can feel like disregard — and it’s a mistake, one that hurts public health’s reputation and future effectiveness. When public health representatives return to a community years or decades later, the memory of disregard can make it much harder to enlist the cooperation needed to respond to the next public health crises.

Rahima Banu Left Behind

The eradication of smallpox was one of humankind’s greatest triumphs, but many people — even the grandest example of that victory — did not share in the win. That realization hit me hard when I met Rahima Banu. As a toddler, she was the last person in the world known to have contracted a naturally occurring case of variola major smallpox. As a little girl, she and her family had — for a time — unprecedented access to care and attention from public health workers hustling to contain smallpox.

But that attention did not stabilize the family long-term or lift them from poverty.

Banu became a symbol of the eradication effort, but she did not share in the prestige or rewards that came after. Nearly 50 years later, Banu, her husband, their three daughters, and a son share a one-room bamboo-and-corrugated-metal home with a mud floor. Their finances are precarious. The family cannot afford good health care or to send their daughter to college. In recent years when Banu has had health problems or troubles with her eyesight, there have been no public health workers bustling around, ready to help.

“I cannot thread a needle because I cannot see clearly. I cannot examine the lice on my son’s head. I cannot read the Quran well because of my vision,” Banu said in Bengali, speaking through a translator. “No one wants to know how I am living my life with my husband and children, whether I am in a good condition or not, whether I am settled in my life or not.”

Missed Opportunities

I believe some of our public health efforts today are repeating mistakes of the smallpox eradication campaign, failing to meet people’s basic needs and missing opportunities to use the current crisis or epidemic to make sustained improvements in overall health.

The 2022 fight against mpox is one example. The highly contagious virus spiked around the world and spread quickly, predominantly among men who have sex with men. In New York City, for example, in part because some Black and Hispanic people had a historical mistrust for city officials, those groups ended up with lower rates of Mpox vaccination. And that failure to vaccinate became a missed opportunity to provide education and other health care treatments, including access to HIV testing and prevention.

And so has it gone with the covid pandemic, too. Health care providers, the clergy, and leaders from communities of color were enlisted to promote immunization. These trusted messengers were successful in narrowing race-related disparities in vaccination coverage, not only protecting their own but also shielding hospitals from crushing patient loads. Many weren’t paid to do this work. They stepped up despite having good reason to mistrust the health care system. In some ways, government officials upheld their end of the social contract, providing social and economic support to help these communities weather the pandemic.

But now we’re back to business as usual, with financial, housing, food, health care, and caregiving insecurity all on the rise in the U.S. What trust was built with these communities is again eroding. Insecurity, a form of worry over unmet basic needs, robs us of our ability to imagine big and better. Our insecurity about immediate needs like health care and caregiving is corroding trust in government, other institutions, and one another, leaving us less prepared for the next public health crisis.

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The scale of our collective progress can be measured against a timeline of vaccine milestones. The polio vaccine brought hope to millions of families from America to Zambia. Up until the mid-Twentieth Century, few could imagine the eradication of smallpox, but a global vaccination campaign against the disease starting in the 1960s ushered in an era of new possibilities for billions. And the roll-out over the past week of the first-ever approved malaria vaccine may mark another landmark: the moment when children across Africa have been given hope in the form of a tool that can help them escape a plague that kills 500,000 of them each year.

A future where malaria is eliminated as a public health threat in the African continent may remain out of reach for the immediate future, but that shouldn’t stop us from working to fulfil our dreams of a malaria-free Africa. As it has with other diseases, the introduction of a new vaccine has the potential to catalyze innovation and create new opportunities for economic growth.

If the malaria vaccines enter the immunization schedule of most African countries over the next year, as planned, the steady stride of the region’s economic power may accelerate. When more children survive past their 5^th birthday and the strain on health systems is reduced, that’s not only intrinsically valuable, it’s a good thing for economic growth.

Healthy children fuel healthy economies

With the coming decades expected to see the ascendance of several African markets as global economic players, malaria vaccination could be a catalyst to sustained development in the region. This serves as a benefit for nations around the world, including the U.S.

Yet, one of the most immediate ways to derail Africa’s economic potential is to hamper the very immunization programs that have delivered the most impressive returns on health investments, both in Africa and globally. That’s what is on the line later this year when Gavi, the alliance responsible for financing the delivery of more than 19 different vaccines to low-and-middle-income countries, is set to have its funding reauthorized by the U.S. and several other governments.

Gavi has written the playbook for creating an investment-driven approach to providing emerging markets with the immunization infrastructure they need to thrive. In the 24 years since its founding, the alliance has vaccinated half of the world’s children. That alone is a remarkable achievement, but the alliance has matched humanitarian outcomes with powerful financial results: Its model has proven so successful that $1 of investment in Gavi yields $54 in health savings among its beneficiary countries. Peer-reviewed research has shown a strong link between child survival rates from vaccine-preventable diseases and GDP growth.

As investments of U.S. taxpayer funds go, few if any can rival the return that Gavi brings for the roughly $300 million committed to it by the American government each year. Looking beyond the direct impact on lives saved – nearly 18 million children and counting – global immunization programs supported by Gavi have strengthened health systems in many of the most vulnerable countries of the world. These are the very places where deadly disease outbreaks have the greatest chance of growing undetected until they are uncontainable.

Continuing support for routine immunization is essential

Gavi funding helps protect Americans by blunting the relentless pace of viruses and bacteria to evolve beyond our control. Better immunization against known threats, more sophisticated early-detection systems in disease hot zones, new vaccine manufacturing capacity closer to the likely sources of outbreaks, and hospital systems that are less burdened by increasingly preventable maladies like malaria – these are the building blocks that Gavi has helped put in place to foster a healthier future for all of us.

At a time when disinformation further erodes trust in the institutions tasked with protecting public health and the spread of disease is supercharged by climate change, the value of Gavi’s time-tested model deserves to be acknowledged through funding replenishment later this year. This would send an unmistakable message to the world that we can still fulfill the hopes and dreams of billions of people by providing the lifesaving vaccines they need to have a shot at a more prosperous, peaceful future.

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The study, recently published in The BMJ, showed that the incidence of mortality from COVID-19 amongst those considered fully vaccinated increased with age, deprivation, being male, and for those with Indian and Pakistani ethnicity.

The study identified the following at-risk groups (HR indicates Hazard Ratio);

• Down’s syndrome (HR 12.7)
• Kidney transplantation (HR 8.1)
• Sickle cell disease (HR 7.7)
• Chemotherapy (HR 4.3)
• Care home residency (HR 4.1)
• HIV/AIDS (HR 3.3)
• Liver cirrhosis (HR 3.0)
• Neurological conditions (HR 2.6)
• Recent bone marrow transplantation or a solid organ transplantation ever (HR 2.5)
• Dementia (HR 2.2)
• Parkinson’s disease (HR 2.2)

Details of the study

The mean age of people in the cohort was 52 years and the data were drawn from 2031 COVID-19 deaths and 1929 COVID-related hospital admissions, of which 81 deaths (4%) and 71 admissions (3.7%) occurred 14 or more days after the second vaccine dose.

Researchers used the QCovid tool to analyze outcomes in adults aged 19 and over between December 8 last year and June 15 of this year. National linked datasets from general practice were used, national immunization, and SARS-CoV-2 testing, death registry, and hospital episode data, in order to analyze a sample of more than 6.9m vaccinated adults. Of those, 74.1% had received two vaccine doses.

According to Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Oxford, who co-authored the paper;

“The UK was the first place to implement a vaccination program and has some of the best clinical research data in the world. We have developed this new tool using the QResearch database, to help the NHS identify which patients are at the highest risk of serious outcomes despite vaccination, for targeted intervention. This new tool can also inform discussions between doctors and patients about the level of risk, to aid shared decision making.”

The study results are provided to allow individuals to assess their own personal risk more accurately and should not, in any way, be considered suggestive of any inefficacy of the vaccines themselves. The Covid-19 vaccines continue to offer a high level of protection against severe Covid.

If, however, you suffer from any of the listed conditions above, you need to be aware that your risk profile may remain elevated and that you will still need to exercise care with regards to exposing yourself to the virus.

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