Time to Get Serious About Public Health

HEFFNER: Richard, do you attribute our transformation in our capacity to address this multiplicity of diseases to technology, human ingenuity through the achievement of new technologies, obviously the creation of antibiotics. But as you charted this history and chronicle it thoroughly, are there different periods that we attribute our ability to battle the diseases to something different? Or is it a string that is one throughout?

CONNIFF: Well, so there’s one that people don’t think about. The obvious ones are vaccines and antibiotics. But also in the middle of the 19th century in London people began to think about sewage disposal and clean water, and separating the two. At the time, the Thames was both the source of drinking water and the place that sewage got disposed of. And so that was the beginning of the development of clean water coming into cities and sewage being piped out of the cities. And that had a huge effect on public health. Diseases like cholera and typhoid disappeared from areas where there was proper sanitation. And even today that’s still is and can still be a major factor in improving public health. So there’s much of the world where people don’t have drinking water clean drinking water. A lot of places in the world where there’s no sewage and no sewage disposal, rather, there’s plenty of sewage. And, that’s a problem. People get sick, people die.

We think of tuberculosis as a disease of 19th century poets. In fact,
it still kills 1.5 million people a year in the developing world.

Richard Conniff

HEFFNER: Is what you’re saying that a good chunk of the elements of disease, you know, from the history you chronicle still exist in their spread in a percent of the globe. And is that a significant amount of the world that that still lives in that previous condition?

CONNIFF: Yeah. So you take a disease like tuberculosis, which we think of as a disease of 19th century poets, kind of almost romantic. And, in fact, it still kills 1.5 million people in the developing world. It could be prevented if we could just have the determination and the money to get proper treatments to people. There’s lots of good new tools to treat those people. We just don’t do it.

HEFFNER: I think the Gates Foundation and some of its partners endeavor to make extinct some of these outdated diseases that Americans do not have to be concerned about. But what is the prognosis on assessing how much they’ve achieved? Because that work began to be undertaken decades ago.

CONNIFF: Yeah, so there’s one story that is a really promising possibility for eradication, maybe this year, next year. Polio was killing or paralyzing 350,000 people when an eradication campaign began in 1988. This year, so far, we’re down to just seven cases of wild polio virus paralyzing children, and only in one narrow part of the world the border of Pakistan and Afghanistan. And if we can get there, and the Gates Foundation and others are working to do that, a Rotary International, another, if we can do that, then, you won’t have children being paralyzed the way my uncle was or the way children still are being paralyzed now. And, eventually you, you won’t even have to vaccinate children for polio. A huge expense that we could get past.

Polio was killing or paralyzing 350,000 people when an eradication campaign began in 1988.
This year, so far, we’re down to just seven cases

Richard Conniff

HEFFNER: There was concern in water samples in the U.S. over the last year of the reemergence of polio. Is it safe to say that that’s not a serious threat in the way that some may have feared that there was going to be a resurgence or a reemergence of that here?

CONNIFF: Yeah, that case was in New York state, and it was temporary and didn’t spread beyond one individual case, I think. But when say, you get the impression we’re safe, So polio, I’m sorry not polio. Tuberculosis is an infection that 13 million people in the United States carry it. It’s just in a latent form. Malaria. Malaria is a disease we used to have as far north as the Great Lakes. And then because a campaign for public health, we got rid of it. And yet homegrown cases of malaria turned up this year in Texas and Florida. So, you know, if we stop working to protect public health, then we’ll lose it. And we’ll go back to what we were like before. And the terrible thing is that right now people in Congress want to lose it. They want gut the CDC, they want to cut excess of spending in the NIH, without regard for what that means to our public health, because again, there’s this assumption that we are somehow protected, somehow innately immune, when in fact we’re not innately immune at all. We are protected by the medical measures we have taken.

HEFFNER:  Understood. There is a feeling even after the pandemic struck that we are somehow not vulnerable, that we are in this post-disease state.

CONNIFF: Yeah.

HEFFNER: And to our astonishment, millions of people, including Americans, have died from COVID-19. And that did not have the psychological effect on our consciousness, on our mental fortitude to wear masks in situations that warrant it in, in our ability to under pandemic protection and preventive measures are important, and funding to prevent new emerging diseases. In my mind, I wonder if COVID-19 had been more of a visible disease in the sense of an Ebola scare years earlier, where our fellow citizens were bubbling up on the street, and you could see the blood in a more emotive way, if that would’ve had a greater impact than what has been called the “invisible killer” of COVID-19. Does something like Ebola trigger a consciousness about pandemics or epidemics and the necessity to fund protective measures more so than a respiratory illness like COVID?

HEFFNER: What do you think presents the greatest threat right now? Antibiotic resistance? The emerging diseases from animals, specifically bird flu which amazingly, we seem still to be free of. We had our COVID pandemic, but we have been free from a flu specifically or mosquito-borne illnesses that you mentioned malaria, and its emergence not only in Florida and Texas, but as north as Maryland. Before the season is over throughout the United States, there will be more examples of that. Which of these, from your reading of history and how it informs the future presents the deepest threat right now?

CONNIFF: Absolutely. If you see people bleeding from their orifices and they’re out on the street, that is obviously going to terrify people, and it does terrify people where it mainly occurs, which is in West Africa, Central Africa. The other thing about COVID is that it was a relatively minor pandemic. The mortality rate was down around four 3% in this country, with variation in different ethnic groups and age groups. But it was a relatively minor low mortality rate. And it also wasn’t all that in infectious. If it had been as infectious as measles, let’s say, it would’ve been a lot more frightening if it had been as deadly. What’s a good deadly one? I’m sorry. I’m not thinking of a good example right now, but sure. If there are things, things that happened much more dramatically and not been hidden away, yeah, people might have their minds changed.

We don’t know where it’s going to start next time. And we need to have a well-funded
public health establishment that will be looking out for us

Richard Conniff

CONNIFF: I really think the deepest threat is our failure to recognize that we can take care of these diseases and they are a threat. All of them are a threat. We don’t know where it’s going to start. And we need to have a well-funded public health establishment that will be looking out for us, and that we’ll be making basic medical care available to people everywhere. You can’t predict where threat is going to come from. You just have to be ready for it. It’s been said of public health that not having it is like trying to build a fire department when your house is burning down. You want the fire department to be there all the time looking out for you and looking out for the danger. And, and we’re in at risk of not having that.

HEFFNER: Richard, when you say the CDC or our public health utilities infrastructure are antiquated or underfunded, what do you mean?

CONNIFF: Well, so right now in the Republican platform, they want to gut the CDC. The state budgets have routinely underfunded their state public health departments and state public health departments are the first line. So that’s the kind of thing that I mean.

HEFFNER: Right? And, and you are referring to the politicization of the public health protective measures and the insinuation that the leaders of those entities are not being straight with the American people or alternatively that monies are going to dubious cause. I think the most high-profile cases in point are the still unknown origin of the pandemic, and the fact that U.S. monies did contribute to research that was going at a lab in Wuhan. And then of course, the very conflicting guidance around mask wearing from Tony Fauci, who had been viewed as a credible public health leader. But did, if you’re being objective, offer very conflicting guidance around mask wearing, if not vaccinations, mask wearing over the course of the pandemic. So if you’re seeing dwindling support for public health institutions to protect us from pandemics or epidemics, to what do you attribute it? Conspiracy theories or actually intellectually honest concerns about the veracity of information from the government or scientists?

CONNIFF: So at the beginning of this pandemic, there was a lot of confusion, and there’s always confusion at the beginning of a pandemic about what to do, and how to protect ourselves. But yeah, the CDC and Fauci and NIH all flubbed it. They made statements that were contradictory and they confused people, and that was really unfortunate and could reasonably create doubt. On the other hand, there are things that happened that are deliberate misinformation. So, in Florida, the state government put out statements saying that young men, men up to the age of about 40, had a vastly increased risk of dying from heart conditions if they got the vaccine. But when people look more closely at what that was based on, the actual drafts leading up to the final document contained evidence showing that the risk of getting the disease was 10 times higher for heart disease if you got the vaccine. So they were deliberately misleading people, telling them not to get the vaccine, and people died as a result. And so you have government-sponsored misinformation in cases like that. So yeah, both sides were at fault, and we have to do better.

HEFFNER: In our pursuit of doing better, what does the reading of history and periods of growth teach us? Because I don’t see, since 2016 and the online disinformation around the political campaign of that season, through the COVID-related disinformation and conspiracy theories, I don’t see that relenting. So in this environment of unrelenting unceasing disinformation, does history teach us anything about how we can get back on track to funding institutions of public health that have credibility and that will demonstrate their integrity so that they are credible?

CONNIFF: So what history shows us is that when we invest in public health, it results in solutions to diseases that allows us to prevent those diseases across large share of the population. And I’ll give you an example at the state level. So in the in World War I men were in short supply and it became possible to hire women for the first time in these laboratories. And among those women, women was one named Pearl Kendrick. Pearl Kendrick got interested in the diphtheria. I’m sorry. She got interested in whooping cough, in particular, and she began to study it on the side after she did her normal routine work in the public health laboratory she worked in. And over the course of relatively short period, she developed a vaccine and the entire male establishment said it’s not going to work, and cast doubt on her work, largely because she was female. And further studies were done, and they demonstrated that in fact, it was an effective vaccine. And that was the vaccine that made a whooping cough frequency just drop off a cliff in the 1940s and fifties. And so from 4,000 children dying every year in this country, by the 1970s, it was down to hundreds. And so a huge savings in ordinary people’s lives resulting from state funding of a public health laboratory. And there are stories like that throughout history that show that when we invest in public health, people’s lives are better.

HEFFNER: What was the most compelling history that you would like to recount from the book? That we as a citizenry or as human beings, were able to escape contagion against all odds, and folks still stood at the end of the day?

CONNIFF: Yeah. So the best example really is that in 1966 audaciously and probably the World Health Organization declared that it was going to eradicate smallpox a disease, which has been maiming and murdering us for thousands of years. And people rose to the audacity of that challenge because they also privately said they were going to get it done in 10 years, which is crazy because at that time, they were really struggling to eradicate malaria and failing. So to take on a second challenge was really a big deal. But what happened was that they started out in countries like Brazil and Indonesia, which were then relatively isolated, less likely to be reinfected. They managed to figure out how to control the diseases there. And then people from those countries went out to other countries that were vulnerable. And it became this, basically, international effort 150,000 people at a time working traveling by elephant, by donkey, by any means available to the most remote areas of the planet. And they didn’t get it done in 10 years. But they got it done in, in 12, I think. They got it done, and it was officially declared. The last case was, I think, October of 1977. And then it takes a while to actually declare it eradicated. And so that happened in 1980. And so after that smallpox is just no longer a factor. And you have to remember that you would walk down the streets in the past and routinely see people pockmarked and maimed and was ordinary for people at every level of society to have lost relatives, close relatives to smallpox. And that was done. I’d like to say one other thing about that. Because of that success the World Health Organization then moved on to a global vaccination campaign, and there were certain basic childhood vaccines basic to us in the United States, but elsewhere in the world the uptake was as little as 5% in certain countries. And they began this campaign to make those basic childhood vaccines available everywhere. And by 2019, they had gotten that uptake to 89%, I think, if I’m remembering correctly. That is the vaccines became available everywhere. The level of disease dropped drastically, and the life expectancy increased proportionally. And that’s the kind of thing we need to be doing everywhere.

HEFFNER: And yet, there is this vast arsenal of disinformation that is still quite prolific on vaccinations and the risk of vaccinations.

CONNIFF: The risks of vaccinations. They usually talk about the measles vaccine and the risk of actually getting measles is so much worse. So I told you about that year when 552 American children died. But many, many more children came away with permanent neurological damage, which is standard side effect in measles. And no one has ever demonstrated in any scientific study that there is any form of heightened risk of autism [from vaccines], whereas neurological damage occurs routinely in measles. And so you have to understand relative risk, and your relative risk from a vaccine is vastly smaller than the risk of actually getting the disease.

HEFFNER: And do you think that the public health campaigns are doing everything they can to be as persuasive as they can on whether it’s measles or COVID-19? Are there ways to communicate with the public that have not been tried yet that would be more successful?

CONNIFF: I wish I could say I knew. But my solution is to look at history and to look at how effective we have been in the past, and to think about all those diseases that we had, that our parents had, that our grandparents had that no longer exist. And to recognize that our life expectancies have basically doubled in the last century. And that doubling is one historian called it the greatest change in human history over the past 200 years. I would call it flat out the greatest change in human history. Instead of living to be 35 or 40, we live to be 75, or even 80, in some 83, in certain parts of the world. So look at history. History has changed our lives for the better. Medicine has changed our lives for the better, and we need to be doing more to understand that and to make sure we continue to do it.

HEFFNER: Your point also, Richard, is that it is not necessarily guaranteed that that trajectory, specifically the longevity.

CONNIFF: It’s not being continued. The longevity has already begun to decrease in this country. Partly that’s because there was a drop off of public health generally of routine vaccination during COVID Pandemic. And, in fact, internationally it dropped from, I think I said 89% uptake of childhood vaccines. And it’s down to like 81 now. I may not have those numbers quite right, but it was a serious drop because of COVID-19. And every time that happens, tens of thousands of people die. And we need to be aware of that, and we need to make sure it doesn’t happen, and make sure that the best medical care gets available to people everywhere.

HEFFNER: Richard Conniff, author of Ending Epidemics, A History of Escape From Contagion. Thank you for your time today, sir.

CONNIFF: Thank you, sir.

HEFFNER: Please visit The Open Mind website at thirteen.org/open Mind to view this program online or to access over 1500 other interviews. And do check us out on Twitter and Facebook at Open Mind TV for updates on future programming. Continuing production of The Open Mind has been made possible by grants from Ann Ulnick, Joan Ganz Cooney, Lawrence B Benenson, the Angelson Family Foundation, Alfred P. Sloan Foundation, the John S. and James L. Knight Foundation, William and Flora Hewlett Foundation. JoAnne and Kenneth Wellner Foundation. And from the corporate community, Mutual of America.