WEBVTT 00:00:05.386 --> 00:00:06.866 I'm Paul Verschoor, and I'm speaking 00:00:06.866 --> 00:00:10.886 with Annie Sparrow about the role of collaboration in public health. 00:00:11.886 --> 00:00:16.126 Annie's commitment to public health is rooted in fieldwork conducted in response 00:00:16.126 --> 00:00:20.026 to natural disasters as well as devastating combat zones. 00:00:20.886 --> 00:00:26.286 She served as a UNICEF Global Fund Program Coordinator for Malaria in Somalia, 00:00:26.446 --> 00:00:32.486 and is currently an Assistant Professor of Population Health and Policy at Eken 00:00:32.486 --> 00:00:36.466 School of Medicine at Mount Sinai, New York. 00:00:36.466 --> 00:00:39.526 So, Annie, welcome to our podcast. 00:00:41.086 --> 00:00:46.386 So, before we really look and discuss around the topic of collaboration, 00:00:46.846 --> 00:00:54.266 maybe you could give us a short biographical sketch of your career path to understand 00:00:54.266 --> 00:00:59.506 from what perspective you look at these challenges around human collaboration. 00:01:04.226 --> 00:01:07.766 This is the part I hate. This is the part when people ask me what I do, 00:01:07.806 --> 00:01:11.466 and I'm more likely to say that I lap danced my way through medicine and met 00:01:11.466 --> 00:01:15.426 my husband as an escort than actually tell people what I really do, 00:01:15.506 --> 00:01:21.586 which is public health and pediatrics and working in various, 00:01:23.526 --> 00:01:27.746 often more difficult places of the world, teaching and practicing medicine. 00:01:27.746 --> 00:01:33.906 Listen, this is a super-industry field, 00:01:34.166 --> 00:01:37.886 and perhaps as a pediatrician, it's 00:01:37.886 --> 00:01:41.726 easier to even think about it or talk about it because it's not a profession 00:01:41.726 --> 00:01:52.106 you can even go into without being able to get down on the ground and collaborate 00:01:52.106 --> 00:01:56.906 to figure out what's going on with one's patients. It's a bit like veterinary 00:01:56.906 --> 00:01:57.786 science in that respect. 00:01:58.046 --> 00:02:03.346 You know, you have to be, I'm somebody who would much rather be on the ground 00:02:03.346 --> 00:02:05.166 and working with the people that I know. 00:02:06.439 --> 00:02:10.059 Often speak on behalf of, than managing people from afar. 00:02:12.759 --> 00:02:17.079 What interests me in terms of background is, okay, so your lab dance, 00:02:17.179 --> 00:02:20.619 your school, your time in the semester school, good. 00:02:21.199 --> 00:02:28.039 But, and congratulations, but that still means that at some point you discovered 00:02:28.039 --> 00:02:36.419 that what you really cared about was in these conflict zones to look at public health issues 00:02:36.439 --> 00:02:40.659 So how did that transition really happen? Was it coincidence? 00:02:41.939 --> 00:02:46.419 No, you're right. So that was a huge transition for me. 00:02:46.719 --> 00:02:50.199 I spent the first 10 years of my career doing pediatric intensive care. 00:02:50.419 --> 00:02:57.259 So in the UK, I did retrieval medicine at St. Mary's, at the Royal Brompton. 00:02:57.599 --> 00:03:05.359 And that's kind of high intense work that takes place in kind of an ivory tower. hour. 00:03:05.479 --> 00:03:09.359 And it's very fulfilling to do that kind of work. 00:03:10.179 --> 00:03:14.379 In Australia, we think of it as Australian doctors, the flying doctors, 00:03:14.459 --> 00:03:16.399 if you've heard of the flying doctors. 00:03:17.059 --> 00:03:20.859 But then I was exposed to how the rest of the world lives. 00:03:20.939 --> 00:03:26.899 My brother had spent 10 years or so in Afghanistan, and I put myself in a position in Australian, 00:03:27.199 --> 00:03:32.379 going to work in Australian refugee camps to see what was going on there because 00:03:32.379 --> 00:03:35.199 they were filled with people who were locked up as, you know, 00:03:35.199 --> 00:03:40.219 as illegal Q jumpers and, you know, the type of people that we don't want here 00:03:40.219 --> 00:03:42.039 and as criminals and as terrorists. 00:03:42.079 --> 00:03:45.979 So I thought I should go and, and, and see for myself. 00:03:46.199 --> 00:03:51.599 And that led to an extraordinary collaboration actually across, 00:03:51.859 --> 00:03:54.459 across all the different fields of medicine. 00:03:54.779 --> 00:03:58.519 So not just, you know, pediatrics, but psychiatrists, surgeons, 00:03:58.879 --> 00:04:02.799 you know, family medicine, you know, all sorts of, you know, 00:04:02.819 --> 00:04:04.359 every specialty that we have in Australia. 00:04:04.379 --> 00:04:07.859 And normally we have quite a hard time talking to each other. 00:04:07.999 --> 00:04:13.479 You know, we don't really talk to orthopedic surgeons or necessarily to plastic surgeons very much. 00:04:13.599 --> 00:04:17.299 But this was an issue, like children in detention under these very punitive 00:04:17.299 --> 00:04:20.619 circumstances in the middle of the, you know, the Australian desert was something 00:04:20.619 --> 00:04:22.579 we could all get around, and we did. 00:04:22.779 --> 00:04:27.459 And as a medical community, we managed to get children out of detention and 00:04:27.459 --> 00:04:30.559 to sort of really change conditions in a way that goes, wow, 00:04:30.719 --> 00:04:31.879 that is the power of collaboration. 00:04:32.259 --> 00:04:36.999 That was a long time ago, but that was probably my starting point in terms of 00:04:36.999 --> 00:04:42.499 moving away from simply paediatric intensive care and into public health more broadly, 00:04:42.599 --> 00:04:47.719 figuring out how to effectively advocate and work on behalf of people who don't 00:04:47.719 --> 00:04:55.699 necessarily have a voice and how to figure out how to be effective at that. 00:04:56.753 --> 00:05:01.413 That was where I started, yeah. But you also feel today you're still in the 00:05:01.413 --> 00:05:04.853 trenches of this kind of public health challenges, 00:05:05.393 --> 00:05:10.753 or now you stand at a different position relative to those trenches with more 00:05:10.753 --> 00:05:16.073 of an overview and more a link to, let's say, policy, policymaking, guidelines, and so on. 00:05:16.133 --> 00:05:18.633 So where do you position yourself there today? 00:05:20.293 --> 00:05:24.373 So my position is quite interesting and unusual because I'm one of those few 00:05:24.373 --> 00:05:26.053 people who still practice medicine. 00:05:26.753 --> 00:05:30.493 So I still can get down in those trenches. And I say that by, 00:05:30.613 --> 00:05:34.113 you know, for example, pretty much every year, 00:05:34.773 --> 00:05:39.273 except for, you know, since the pandemic began, I go to Eastern Congo and work 00:05:39.273 --> 00:05:42.113 on an island called Idjwi, 00:05:42.893 --> 00:05:47.813 where there's about 300,000 people and they have a life expectancy at birth of 26 years. 00:05:49.853 --> 00:05:55.213 That's, you know, that's pretty much medieval. And there's only half a dozen 00:05:55.213 --> 00:05:56.433 doctors on the entire island. 00:05:56.753 --> 00:06:03.553 And to go there and work is something that is deeply fulfilling for me, 00:06:03.613 --> 00:06:13.093 but also it's a way of every year helping to give kids the best way to start 00:06:13.093 --> 00:06:16.773 the school year healthier and better off, like by deworming them, 00:06:16.833 --> 00:06:17.673 treating them for malaria. 00:06:17.893 --> 00:06:25.213 And that's just an ongoing collaboration, as it were, where it's effective because 00:06:25.213 --> 00:06:31.173 of the ability to be both a doctor and to know how to treat people, 00:06:31.293 --> 00:06:39.453 but also to then be able to make the case at the higher policy levels. 00:06:41.433 --> 00:06:45.793 So it's interesting straddling those areas because not many people actually do it. 00:06:45.933 --> 00:06:50.973 I mean, WHO, for example, is filled with doctors who haven't seen a patient for 20 or 30 years. 00:06:51.873 --> 00:06:56.353 And that puts you in a very different position. There's not many of us who can 00:06:56.353 --> 00:07:01.213 be both clinicians and academic and also understand how to write policy effectively 00:07:01.213 --> 00:07:04.293 or to create the solutions that are necessary. 00:07:04.873 --> 00:07:10.653 Right. Well, so thank you. This is very clear. Now we know where you're coming 00:07:10.653 --> 00:07:12.193 from, which is multiple directions. 00:07:13.593 --> 00:07:17.993 So to you, what is collaboration and what is it good for? 00:07:29.416 --> 00:07:32.096 Collaboration means that you can get anything done, 00:07:34.376 --> 00:07:39.576 and I think that is the lesson of the pandemic like that is the nut we have to crack. 00:07:41.136 --> 00:07:45.216 If we're going to move forward globally I mean the pandemic has taught us that 00:07:45.216 --> 00:07:49.496 of course we're never going to have international collaboration on the way that 00:07:49.496 --> 00:07:51.316 we did post-world World War II, perhaps. 00:07:51.636 --> 00:07:55.736 So we need to build global coalitions more effectively in order to get things done. 00:07:56.216 --> 00:08:02.916 But what I've seen and experienced myself is that after a career in medicine 00:08:02.916 --> 00:08:04.896 and public health, where I've always 00:08:04.896 --> 00:08:08.976 been interested in other people's specialties and areas and so forth, 00:08:09.436 --> 00:08:14.536 suddenly in the last 18 months, I've collaborated with more people with more 00:08:14.536 --> 00:08:16.376 specialties within science and medicine, 00:08:16.536 --> 00:08:19.956 but also across every other sector, across trade 00:08:19.956 --> 00:08:24.356 across business across sport across education it's 00:08:24.356 --> 00:08:27.576 like wow i mean you know it's 00:08:27.576 --> 00:08:33.776 we really do know how to get things done and we can and i've that has also been 00:08:33.776 --> 00:08:39.496 my experience trying to you know with the tokyo olympics for example where um 00:08:39.496 --> 00:08:46.396 understanding how to and forgive me i don't I don't know how much you know about 00:08:46.396 --> 00:08:47.316 what I've been doing recently, 00:08:47.496 --> 00:08:52.396 but in my role as an advisor at the Centre for Sport and Human Rights, 00:08:53.216 --> 00:08:59.036 then a lot of us have been concerned about the safety of the Olympics and not 00:08:59.036 --> 00:09:01.296 just for athlete health, but for public and global health. 00:09:01.596 --> 00:09:06.096 And although journalists have been key in driving some of the issues. 00:09:06.996 --> 00:09:10.236 People don't tend to listen until you put something in an academic journal. 00:09:10.596 --> 00:09:14.636 So with the help of the colleagues that I've developed over the last year, 00:09:14.636 --> 00:09:17.336 for example, at the International Confederation of Trade Union. 00:09:19.476 --> 00:09:25.736 Then I reached out to several colleagues, my co-authors in this piece in the 00:09:25.736 --> 00:09:26.696 New England Journal of Medicine, 00:09:27.456 --> 00:09:30.416 Lisa Brosseau, who is an industrial hygienist, Bob Harrison, 00:09:30.596 --> 00:09:34.556 who is an occupational health and safety scientist and doctor, 00:09:34.656 --> 00:09:38.416 and Mike Osterholm, who is an American public health heavyweight across so many areas. 00:09:38.856 --> 00:09:43.576 And then to write an article that had the legitimacy of a peer-reviewed journal 00:09:43.576 --> 00:09:49.236 can suddenly start to move mountains that otherwise aren't movable. 00:09:49.456 --> 00:09:53.856 So you can sort of realize that when you all come to the table with the same 00:09:53.856 --> 00:09:57.796 agenda, which is not about self-interest but about the common good, 00:09:57.956 --> 00:10:03.756 and you each have these valuable contributions, then it's much easier to move these mountains. 00:10:04.156 --> 00:10:08.596 And I think the currency of collaboration is trust. 00:10:10.176 --> 00:10:12.596 And I think that's the lesson I keep learning over and over again. 00:10:12.616 --> 00:10:14.496 You can get anything done if you trust each other. 00:10:15.736 --> 00:10:22.416 Okay. But now, so you had the last 18 months, you collaborated with many people 00:10:22.416 --> 00:10:24.036 in many different contexts. 00:10:24.236 --> 00:10:28.676 Actually, in some sense, if I understand it right, beyond what you had expected. 00:10:30.716 --> 00:10:35.596 But in these different areas, what made that collaboration? 00:10:35.756 --> 00:10:41.636 Is it common objectives and trust? Was that the common feature of all these 00:10:41.636 --> 00:10:44.656 processes or were they also different? 00:10:44.996 --> 00:10:48.196 Are there other features that we should consider? 00:10:55.816 --> 00:11:00.916 Well, public health per se always involves, you know, you can't really get public 00:11:00.916 --> 00:11:02.756 health done unless it's a collaborative effort. 00:11:05.996 --> 00:11:13.316 It. I find it perhaps easier in my capacity as an independent clinician to work 00:11:13.316 --> 00:11:15.776 behind the scenes to build the kind of collaborations. 00:11:19.276 --> 00:11:26.136 And perhaps because it's a criteria for being a pediatrician, really, 00:11:26.156 --> 00:11:31.576 that you're not really allowed to have an awful lot of ego or bothered it about 00:11:31.576 --> 00:11:34.576 being wrong because lives are at stake. 00:11:34.756 --> 00:11:38.836 So we learned that lesson very early on. And if I don't know the answer, 00:11:38.976 --> 00:11:41.136 the most important thing is to ask somebody who does. 00:11:41.636 --> 00:11:47.496 And so I think that's how I operate where I think I don't know, 00:11:47.516 --> 00:11:50.436 but I can know how to find somebody or I'll ask somebody who does know, 00:11:50.516 --> 00:11:52.996 and that way you establish the connections to get things done. 00:11:53.176 --> 00:11:56.916 I found myself far more effective outside the UN than within it. 00:11:56.916 --> 00:12:01.736 And I think part of that is because the UN 00:12:01.736 --> 00:12:07.836 doesn't have this kind of institutional inertia that makes it very difficult 00:12:07.836 --> 00:12:15.276 to create an ethos or a sense of purpose amongst staff that actually fulfills 00:12:15.276 --> 00:12:17.916 the organisational mandate. And I think... 00:12:21.902 --> 00:12:27.762 It is so easy to work with people when your common agenda is more important 00:12:27.762 --> 00:12:37.802 than your personal ambition or financial interest because those things can really get in the way. 00:12:39.502 --> 00:12:48.462 And that is a really difficult issue, I think. 00:12:49.082 --> 00:12:53.242 But that's also where collaborations might face challenges. 00:12:53.422 --> 00:12:56.162 But let's focus on the ones you build. As you said explicitly, 00:12:56.422 --> 00:12:58.642 I go out and build collaboration. 00:12:59.322 --> 00:13:03.682 Right? So if you go out and build collaboration, how do you do that? 00:13:03.862 --> 00:13:08.802 What are the steps? Do you follow if you want a specific approach there? 00:13:08.942 --> 00:13:14.442 Do you have certain benchmarks that you then set yourself in building collaboration? 00:13:21.142 --> 00:13:24.762 Well i think that depends what needs 00:13:24.762 --> 00:13:28.962 to be done so in my work in uh in 00:13:28.962 --> 00:13:35.382 syria for example on something as specific as a polio outbreak well then i know 00:13:35.382 --> 00:13:39.382 the limits of my own expertise so then i reach out to people who i know more 00:13:39.382 --> 00:13:47.322 than who know more than i do and i ask them and that's That's sort of the thing that's so fundamental. 00:13:47.562 --> 00:13:50.702 Like no one has to know everything. You just have to know who to ask. 00:13:50.942 --> 00:13:56.502 And in doing so, that's engaging in itself because I think most of us want to 00:13:56.502 --> 00:14:00.022 be able to do the right thing or help or participate in achieving a greater good. 00:14:00.202 --> 00:14:05.342 And when you all bring a different thing to the table, then you, it's just, 00:14:06.333 --> 00:14:10.173 there's a natural energy, I think, towards moving forward. 00:14:10.393 --> 00:14:16.853 It's like, so this is what we, and I found that that process in itself is a 00:14:16.853 --> 00:14:19.373 way to then build upon a strategy. 00:14:19.553 --> 00:14:24.573 So, for example, with Syria, my aim with polio was to, which is a small part 00:14:24.573 --> 00:14:27.353 of the war, the first outbreak in 2013, 00:14:28.373 --> 00:14:32.413 when polio re-emerged after not having been there since 1995, 00:14:32.413 --> 00:14:37.573 but it was a way to get a much bigger interest in conflict and to re-humanise conflict. 00:14:39.513 --> 00:14:45.833 It was also a way to help accelerate getting the borders open and to remind 00:14:45.833 --> 00:14:49.713 people that health is a way which requires every other sector to collaborate. 00:14:49.933 --> 00:14:52.813 You can't get health done unless you actually get everything else right too. 00:14:53.133 --> 00:14:56.673 Health requires nutrition, it requires water, it requires safety, 00:14:56.753 --> 00:14:58.973 it requires communication, it requires a place to do things, 00:14:58.973 --> 00:15:00.393 It requires, you know, the shelter. 00:15:00.553 --> 00:15:05.753 It requires, you know, pretty much every other, you know, piece of the cluster 00:15:05.753 --> 00:15:09.193 that the humanitarian organization draws out. 00:15:09.293 --> 00:15:14.293 But it requires, you know, it's just, and I think that's what the COVID has shown too. 00:15:14.353 --> 00:15:16.673 It's fundamental to getting anything done, but you can't have, 00:15:16.793 --> 00:15:18.953 you know, there's no such thing as a right to health per se. 00:15:19.053 --> 00:15:22.393 It depends on the right, you know, to educate, you know, education. 00:15:22.613 --> 00:15:28.053 It depends on getting to work. It depends on food and communication and providing 00:15:28.053 --> 00:15:29.493 people with the tools to look after themselves. 00:15:29.733 --> 00:15:36.793 So when you show people that this is how we actually are going to move this particular mountain, 00:15:36.953 --> 00:15:40.353 then I think it's much easier to see, okay, this is my area of expertise and 00:15:40.353 --> 00:15:44.813 this is what I can contribute and this is how we'll then build upon it to say, oh, and by the way, 00:15:44.993 --> 00:15:47.453 now you can like not only this strategy to get the border open, 00:15:47.573 --> 00:15:49.393 but have you thought about the G7 00:15:49.793 --> 00:15:51.993 and because, you know, at that stage, for example. 00:15:53.019 --> 00:15:58.879 In 2014, Russia had to provide a state of the world where we were at with polio, 00:15:58.999 --> 00:16:02.399 which was another way to then put pressure on Assad to stop the bombing, 00:16:02.499 --> 00:16:06.219 for example, to create humanitarian pauses, to then allow polio vaccination, 00:16:06.599 --> 00:16:08.519 but also many other things. 00:16:09.039 --> 00:16:18.439 But that wasn't my idea. That was Ron Moldman's idea, who's a guru at the Milken Institute. 00:16:18.439 --> 00:16:25.219 And I think that's that, you know, when you have these conversations, then they have amazing, 00:16:25.579 --> 00:16:30.479 you know, they can go amazing places when you're not invested and you're open 00:16:30.479 --> 00:16:33.759 to other people's ideas. 00:16:33.759 --> 00:16:37.099 For me, there are several things that stand out now. 00:16:37.359 --> 00:16:41.459 On the one hand, your definition of health, of getting health done, 00:16:41.719 --> 00:16:46.899 actually then only a tiny fraction of the world population lives in an environment 00:16:46.899 --> 00:16:48.799 where we get health done. 00:16:49.919 --> 00:16:53.939 Because you see it more as an integrated process pertaining to the whole of, 00:16:53.979 --> 00:16:55.539 let's say, the sustainable development goals. 00:16:56.039 --> 00:17:00.819 All of that has to work together constructively before we can really speak of 00:17:00.819 --> 00:17:07.059 health. So this really defines it at a very global integrative perspective. 00:17:07.919 --> 00:17:13.579 But then you also said, well, earlier you said, look, I do believe everybody 00:17:13.579 --> 00:17:19.979 has an interest in serving the common good of health. Now, do you really believe that? 00:17:23.659 --> 00:17:26.879 That i think when you show people 00:17:26.879 --> 00:17:30.959 how they can actually contribute people can 00:17:30.959 --> 00:17:34.139 be deeply interested and invested in in in doing 00:17:34.139 --> 00:17:36.959 so you know the mistake with the sdgs is that 00:17:36.959 --> 00:17:42.619 you know 17 goals paul i mean that's either adorable to think that we could 00:17:42.619 --> 00:17:48.039 do 17 things at once or just play nuts and and unfortunately people are you 00:17:48.039 --> 00:17:52.839 know invested of course in that at each of their goals and while sort of paying 00:17:52.839 --> 00:17:54.139 lip service to the fact that, 00:17:54.179 --> 00:17:56.439 of course, they're all connected, you know. 00:17:58.479 --> 00:18:02.579 And the one thing that, you know, think about this time two years ago, 00:18:02.659 --> 00:18:05.359 we were all, you know, it was all about climate change, which, 00:18:05.419 --> 00:18:08.499 of course, is an enormously important global problem, but that was it. 00:18:08.679 --> 00:18:13.859 And then suddenly in the space of a few months, we were laser focused on a single 00:18:13.859 --> 00:18:15.999 common health agenda, stopping COVID. 00:18:15.999 --> 00:18:20.979 And it showed you know like oh we can't actually get anything done without actually 00:18:20.979 --> 00:18:24.239 having a foundation of health but we didn't really understand and we still don't 00:18:24.239 --> 00:18:28.899 really understand how to do that and what that actually means we we even talk 00:18:28.899 --> 00:18:35.059 about you know the importance of nutrition or controlling diseases and and you know. 00:18:36.939 --> 00:18:41.079 You know sanitation and safe water and we don't actually realize that, 00:18:42.486 --> 00:18:48.226 One of the most, perhaps the single most important determinant of our health is our work. 00:18:49.446 --> 00:18:53.386 And for children, it's their education. And I don't mean like online, but the schools. 00:18:53.726 --> 00:18:58.646 And investing in education, investing in actual work. 00:18:59.906 --> 00:19:06.266 Is incredibly important at a time when education per se is one of the vanishingly 00:19:06.266 --> 00:19:08.926 few ways out of poverty and the gigantic recession. 00:19:08.926 --> 00:19:16.006 Session and you know we can't weight all these goals equally and it's but it i'm not sure that, 00:19:16.526 --> 00:19:19.426 you know saying to people oh you know we have to focus on 00:19:19.426 --> 00:19:24.406 health first is going to have a lot of buying on the other hand um you know 00:19:24.406 --> 00:19:29.526 health provides a way to overcome a lot of the other barriers because it is 00:19:29.526 --> 00:19:32.746 universal you know it's one of the things that we can all experience in different 00:19:32.746 --> 00:19:37.526 ways whether you need a hip replacement or a you know a pacemaker or you know 00:19:37.526 --> 00:19:39.226 and now Now we're all frightened of some COVID, 00:19:39.406 --> 00:19:42.826 but that doesn't apply equally in all countries. 00:19:42.966 --> 00:19:45.086 But it is something that we all understand. 00:19:45.286 --> 00:19:51.266 You can use it as a way to not talk about the political issues that are otherwise barriers. 00:19:52.106 --> 00:19:55.026 But there are two things here. So on the one hand, you're saying, 00:19:55.086 --> 00:19:59.746 look, you go out under the assumption that other people want to collaborate, 00:20:00.506 --> 00:20:05.026 because also they care, as you do, about these health issues. 00:20:05.026 --> 00:20:07.826 So you said earlier, look, if I don't know it, I'm going to ask someone. 00:20:09.026 --> 00:20:14.466 But it must have happened to you as well. I'm sure that that someone doesn't 00:20:14.466 --> 00:20:20.866 want to give you the answer because they're not necessarily sharing that overall objective with you. 00:20:20.946 --> 00:20:23.206 Take the Syrian situation, right? 00:20:23.486 --> 00:20:28.626 There were people who indeed were weaponizing health, so they would not give you the answer. 00:20:30.226 --> 00:20:34.246 So how do you deal with that in your model of collaboration? 00:20:35.506 --> 00:20:38.226 You're right i mean that that's where you know that that's a 00:20:38.226 --> 00:20:41.386 huge problem because i mean you know 00:20:41.386 --> 00:20:45.066 to a large extent when you find people you know you find your 00:20:45.066 --> 00:20:49.586 co-collaborators because you have the same common purpose so you sort of naturally 00:20:49.586 --> 00:20:54.066 attract each other and you introduce to each other and that's how you know you 00:20:54.066 --> 00:20:57.466 enter into other people's circles of trust so you know there's any number of 00:20:57.466 --> 00:21:02.966 people that i can point to and ring up and say you know i need your help and 00:21:02.966 --> 00:21:04.626 And they'll just say, yes, Annie, what do you need? 00:21:04.746 --> 00:21:07.946 And vice versa, without having to go through the, what is it for? 00:21:08.106 --> 00:21:11.006 How much? What does it mean in terms of time, investment, money, 00:21:11.146 --> 00:21:12.166 blah, blah, blah? It's just a yes. 00:21:12.466 --> 00:21:14.606 And that's the value of trust. 00:21:15.326 --> 00:21:21.126 And those people then, with those, you can move mountains, or at least to a certain extent. 00:21:21.546 --> 00:21:25.566 Of course, I mean, this is the problem with the political agenda. And yeah. 00:21:26.247 --> 00:21:30.007 And those that are invested in the status quo or those that, 00:21:30.007 --> 00:21:34.207 you know, or the institutional inertia that characterises the United Nations. 00:21:34.467 --> 00:21:38.307 And it's the same with, like, the Tokyo Olympics. I mean, the International 00:21:38.307 --> 00:21:42.007 Olympics Committee, you know, President Bach makes, you know, 00:21:42.007 --> 00:21:45.427 Seth Blatter, the ex-president of FIFA, look like Mother Teresa. 00:21:45.747 --> 00:21:51.087 There's absolutely no interest in health, public health or global health of any kind. 00:21:51.267 --> 00:21:54.387 I mean, that's an organisation that's characterised by, you know, 00:21:54.387 --> 00:21:59.267 maximizing its revenue streams and maintaining its feudal control system. 00:21:59.447 --> 00:22:04.427 So, no, there's no openness there, despite what we have worked so hard to do. 00:22:04.567 --> 00:22:08.987 But at least we can try and shine a light to create greater accountability going 00:22:08.987 --> 00:22:11.687 forward so that we don't repeat this five-star fiasco. 00:22:12.247 --> 00:22:16.107 Yeah, but this is interesting, right? Because now you start to speak first of first. 00:22:16.327 --> 00:22:21.007 It means we have to qualify successful collaboration because, as you describe it now, 00:22:21.107 --> 00:22:25.487 it depends actually very much on a subset set of all possible collaborations 00:22:25.487 --> 00:22:32.347 among people who do share these common, more idealistic goals and who share trust on that basis. 00:22:32.707 --> 00:22:38.367 So that means successful collaboration also for you was very much within those networks. 00:22:39.427 --> 00:22:43.287 But now if you step outside of the networks, now you mentioned the National 00:22:43.287 --> 00:22:47.707 Olympic Committee as an example, and you mentioned also Russia in case of the 00:22:47.707 --> 00:22:53.727 polio campaign, vaccination Nation campaign, then you see it is also an opposition. 00:22:53.987 --> 00:22:59.967 Now you have multiple collaborative systems in opposition, and there apparently 00:22:59.967 --> 00:23:02.187 another approach is required. 00:23:02.327 --> 00:23:08.087 You mentioned someone who then proposed to use more diplomatic economic power, 00:23:08.327 --> 00:23:13.887 if you want, to change the approach of such an opponent. 00:23:13.887 --> 00:23:20.627 So is that then a natural collateral of the collaborative system? 00:23:20.667 --> 00:23:25.347 Like within there are shared values, there are shared goals, there's trust. 00:23:25.527 --> 00:23:29.267 But between such systems, we speak about power relations. 00:23:30.262 --> 00:23:32.782 And is that and also the role of the United Nations, for instance, 00:23:32.822 --> 00:23:39.122 to manage those power relations between multiple, partially exclusive collaborative systems? 00:23:40.642 --> 00:23:47.462 Well, it's certainly in their role to broker those relations and to provide a platform. 00:23:48.102 --> 00:23:51.402 It's not something they're clearly very successful at doing so, 00:23:51.502 --> 00:23:57.162 and we all know that. I don't think there's been that natural trajectory towards 00:23:57.162 --> 00:24:03.022 self-interest, nationalism, retreat from multilateralism, which doesn't help. 00:24:08.302 --> 00:24:13.342 Historically, there's always been a commercial interest, particularly for public health. 00:24:13.342 --> 00:24:17.542 And I say that where 150 years ago, 00:24:17.662 --> 00:24:24.022 the nations started meeting and arguing over the cholera pandemics because they 00:24:24.022 --> 00:24:31.142 didn't want Europe and America and the UK infected by those Asiatics or those 00:24:31.142 --> 00:24:36.462 Muslims bringing cholera across the Mediterranean. Right. 00:24:37.239 --> 00:24:41.339 But they argued about it for like four decades' worth of sanitary conventions and conferences. 00:24:41.739 --> 00:24:45.179 And the only reason that they then became to a consensus was when the British 00:24:45.179 --> 00:24:48.959 lost control of the Suez Canal in 1898 or so. 00:24:50.979 --> 00:24:54.679 And when it opened up, then there was a commercial, you know, 00:24:54.699 --> 00:24:58.019 common incentive to actually standardise quarantine measures. 00:24:58.499 --> 00:25:00.859 So that drove that standardisation. 00:25:01.379 --> 00:25:04.499 And that then became the sort of international sanitary regulations, 00:25:04.499 --> 00:25:07.419 which was a forerunner of today's international health regulations, 00:25:07.579 --> 00:25:12.839 which countries are meant to adhere to, you know, particularly to control pandemic threats. 00:25:13.879 --> 00:25:17.879 You know, that's, but that only goes so far. 00:25:18.059 --> 00:25:22.079 You know, we can say the same thing, I married in New York and New Yorkers are 00:25:22.079 --> 00:25:25.399 very famous for talking about their tap water, which is, you know, 00:25:25.399 --> 00:25:28.359 which is delightful, but it wasn't always like that. 00:25:29.819 --> 00:25:33.799 You know, we all know the history now, courtesy of Hamilton, 00:25:34.499 --> 00:25:38.439 and how, you know, the famous fight between Hamilton and Ehrenberg was altered 00:25:38.439 --> 00:25:42.639 in, you know, Ehrenberg took the money, you know, created a bank, 00:25:42.779 --> 00:25:45.079 you know, forgot about the water, 00:25:45.259 --> 00:25:50.439 you know, invested, I don't know, you know, like a few thousand relative to 00:25:50.439 --> 00:25:54.839 the 200,000 that was meant to be put into it. And it took another six years. 00:25:55.019 --> 00:25:57.799 And it wasn't until people started complaining about the taste of their beer 00:25:57.799 --> 00:26:01.099 that the water source became cleaner. 00:26:01.219 --> 00:26:04.919 And so it was, again a sort of a profit-driven incentive but 00:26:04.919 --> 00:26:07.619 i don't think that's enough anymore you know because 00:26:07.619 --> 00:26:10.519 without trust you know that you know a commercial 00:26:10.519 --> 00:26:13.299 incentive also is not enough we have seen the fact that there's 00:26:13.299 --> 00:26:17.639 a commercial incentive to vaccinate everybody for companies to transfer tech 00:26:17.639 --> 00:26:24.299 to you know to to waive the ip it's not happening and and just saying that you 00:26:24.299 --> 00:26:27.859 know we would make their world would be you know you know more profitable if 00:26:27.859 --> 00:26:30.859 we did so well that is not a sufficient argument argument. 00:26:32.019 --> 00:26:36.979 And, you know, that's, you know, it's, it's not enough, 00:26:38.040 --> 00:26:43.100 anymore I think without figuring out the ways where we reconnect to each other so, 00:26:43.780 --> 00:26:47.020 that is that's when it comes back down to this global shortage 00:26:47.020 --> 00:26:50.260 of trust which should not be a surprise I mean investing in 00:26:50.260 --> 00:26:54.020 a vaccine is amazing we can see the power of scientific collaboration to produce 00:26:54.020 --> 00:26:58.640 these vaccines but if you don't invest the same amount in figuring out how to 00:26:58.640 --> 00:27:01.800 get people to roll up their sleeves you know the best vaccines won't work without 00:27:01.800 --> 00:27:06.260 social traction and trust and quite apart from the misinformation that is deliberately 00:27:06.260 --> 00:27:09.360 sown or the conspiracy theories, 00:27:09.860 --> 00:27:17.600 I have found time and time again that showing up and listening and building 00:27:17.600 --> 00:27:21.040 those relationships of trust, that's what pays dividends. 00:27:21.360 --> 00:27:26.160 But you can't do it with that aim. 00:27:26.280 --> 00:27:34.100 It has to be an agenda with an integrity that is without intention and that 00:27:34.100 --> 00:27:37.960 I learned that it took me a long time to even learn that lesson and I'd say that with. 00:27:39.300 --> 00:27:42.060 Humility and probably the 00:27:42.060 --> 00:27:44.720 arrogance of thinking that you know I knew what I 00:27:44.720 --> 00:27:47.800 was doing but I got I went back to Syria with my 00:27:47.800 --> 00:27:50.620 son um who made me 00:27:50.620 --> 00:27:53.960 go back at a time when I felt I had nothing more to give that 00:27:53.960 --> 00:27:56.900 I you know I was kidding myself if I was doing anything 00:27:56.900 --> 00:28:00.060 more than a drop in the the ocean and i was what who did 00:28:00.060 --> 00:28:03.440 i think i was you know a white australian showing up you 00:28:03.440 --> 00:28:06.380 know treating a few people with typhoid or diagnosing a 00:28:06.380 --> 00:28:09.140 few cases of polio and he said mom there are friends we have 00:28:09.140 --> 00:28:13.800 to go back and it was that that taught me you know the true value of solidarity 00:28:13.800 --> 00:28:19.880 and hanging out and it's you know it's years later when we need each other and 00:28:19.880 --> 00:28:26.100 and that trust is there because it's built on a foundation of that is you know 00:28:26.100 --> 00:28:28.220 there's really literally built on the ground, 00:28:28.260 --> 00:28:30.680 being together, eating together, sharing together, 00:28:31.960 --> 00:28:33.700 laughing together, and crying together. 00:28:35.560 --> 00:28:43.980 But now can you describe in more detail then how you build up this polio initiative in Syria? 00:28:44.260 --> 00:28:48.780 Because it's one thing to decide to do it and to create the conditions that 00:28:48.780 --> 00:28:53.900 can be done, but then you need a huge network of participants who actually are 00:28:53.900 --> 00:28:58.580 out in the different clinics or the shelters or whatever to inoculate people, 00:28:58.900 --> 00:29:02.540 plus you must convince the population to also participate in this. 00:29:02.620 --> 00:29:06.040 So how was that process structured? 00:29:09.765 --> 00:29:13.425 That's where the syrians you know the syrians 00:29:13.425 --> 00:29:16.185 did that not me i mean i was somebody who 00:29:16.185 --> 00:29:19.125 was simply started going there uh to explore this 00:29:19.125 --> 00:29:22.785 relationship between health and human rights because i think that when you violate 00:29:22.785 --> 00:29:26.605 people's human rights it comes out in health both individually and at the population 00:29:26.605 --> 00:29:31.805 level but because i was there and as a pediatrician i you know i gradually became 00:29:31.805 --> 00:29:37.445 involved you know increasingly involved in in and you know, 00:29:38.425 --> 00:29:41.885 and open to you know providing advice 00:29:41.885 --> 00:29:44.785 and help and clinical services and 00:29:44.785 --> 00:29:47.985 training wherever and whenever it was asked with me and 00:29:47.985 --> 00:29:50.805 because I kept going back and back you know I started going to the border 00:29:50.805 --> 00:29:53.565 first in Lebanon and then in Turkey and then you 00:29:53.565 --> 00:29:57.285 develop these relationships of trust and access to those networks but the Syrians 00:29:57.285 --> 00:30:02.765 were amazing at managing the polio piece which the government in Damascus was 00:30:02.765 --> 00:30:06.625 busy trying to cover up and had no interest of course and vaccinating the northern 00:30:06.625 --> 00:30:12.385 politically unsympathetic areas which had been neglected for years. 00:30:13.285 --> 00:30:20.865 That was, I think that's the power of a civilization which has enormous reach 00:30:20.865 --> 00:30:30.105 within its networks and enormous trust within itself because that can't happen. 00:30:31.825 --> 00:30:35.945 Unless that has been there for a long time. 00:30:36.105 --> 00:30:40.525 I mean, they're a very civilised people to be able to pull off these amazing, 00:30:40.725 --> 00:30:46.485 you know, massive campaigns and get 92% of the population vaccinated at a time of conflict. 00:30:46.725 --> 00:30:49.765 I mean, we couldn't do that in the States. I mean, look at what we're, 00:30:49.765 --> 00:30:54.205 you know, so it's, you know, this is the thing about trust, of course, 00:30:54.285 --> 00:30:55.385 it's a long-term investment. 00:30:56.905 --> 00:31:02.305 And I was sort of able to be the person who conveyed it at a policy level and 00:31:02.305 --> 00:31:04.605 could write about it and hold the argument. 00:31:05.045 --> 00:31:08.845 And, of course, as an advantage, it sounds really precious, but I have a lot 00:31:08.845 --> 00:31:12.105 of degrees off my name because every time I change countries, I have to re-qualify. 00:31:12.225 --> 00:31:16.245 So I qualified in Australia and the UK and the US, but it's helpful when you 00:31:16.245 --> 00:31:17.065 need to have the argument. 00:31:17.505 --> 00:31:21.905 And I spent some time at Human Rights Watch learning the law as well so I could understand the law. 00:31:22.025 --> 00:31:27.385 But it's then, you know, I can then take the heat, 00:31:27.425 --> 00:31:33.805 as it were, so that 2Ns could receive some funding and support to be able to 00:31:33.805 --> 00:31:37.285 do these things and to protect their population. 00:31:37.565 --> 00:31:43.425 But I can only take my hat off and kneel thinking, I've never seen a population 00:31:43.425 --> 00:31:46.885 withstand so much and still get so much done. 00:31:47.505 --> 00:31:51.305 How did they do it? How did they do it? Was it top-down leadership? 00:31:51.725 --> 00:31:56.485 Was it bottom-up trust and a shared set of values and goals? 00:31:56.785 --> 00:31:58.625 How did they do it? Can you explain it? 00:32:00.501 --> 00:32:08.481 It was certainly driven from the ground. It's the people who stayed and made 00:32:08.481 --> 00:32:10.521 that choice to keep working, 00:32:11.181 --> 00:32:17.641 to volunteer, you know, I'm not just talking about the doctors or the nurses, the pharmacists. 00:32:17.661 --> 00:32:21.541 I mean, and honestly, like the pharmacists and the dentists are absolutely fundamental 00:32:21.541 --> 00:32:26.021 in that kind of situation because they're super good at managing both the logistics 00:32:26.021 --> 00:32:30.361 and understanding the patients and the drugs and so forth, 00:32:30.521 --> 00:32:33.621 where doctors alone, like I can manage a cholera camp or an ER, 00:32:33.701 --> 00:32:38.101 but you really need a dentist or a pharmacist to do all of the supply chains 00:32:38.101 --> 00:32:40.541 and get those things done. That's a huge feat. 00:32:40.921 --> 00:32:43.601 But the process of... 00:32:47.641 --> 00:32:50.361 It still is remarkable to me, and it's a very good question, 00:32:50.461 --> 00:32:53.001 and I would need to come back to you more about that. 00:32:53.001 --> 00:33:01.581 I feel that they demonstrated solidarity in the face of such brutal oppression 00:33:01.581 --> 00:33:05.241 and determination that, 00:33:05.341 --> 00:33:08.401 you know, they would do it for their children. 00:33:08.861 --> 00:33:12.881 Like, you know, they didn't go out, you know, they didn't decide to stand up 00:33:12.881 --> 00:33:15.701 and to figure out all the different ways of dying, you know, 00:33:15.701 --> 00:33:18.501 being shot at, being starved, being tortured, being, you know, 00:33:18.501 --> 00:33:21.081 gassed, you know, being bombed, being incinerated. 00:33:21.081 --> 00:33:24.681 You know they came out to figure out all these different ways of living for 00:33:24.681 --> 00:33:27.581 their children and you think that you know we will all do 00:33:27.581 --> 00:33:30.701 anything for our children and they would figure that out too but the 00:33:30.701 --> 00:33:34.521 the the the masses of 00:33:34.521 --> 00:33:37.661 people who who became you 00:33:37.661 --> 00:33:40.581 know um you know volunteers or paramedics who 00:33:40.581 --> 00:33:44.001 educated themselves and they shared their sort of skills in 00:33:44.001 --> 00:33:46.681 a way that is counter um you know 00:33:46.681 --> 00:33:49.621 contradicts what we understand of medical ethics you're 00:33:49.621 --> 00:33:52.341 not allowed to operate in anybody else's field but you have to do 00:33:52.341 --> 00:33:55.401 that you know in war zones and in these settings and to 00:33:55.401 --> 00:33:59.781 share skills and they i think 00:33:59.781 --> 00:34:03.821 that you know when when people can see the length to which you will go to help 00:34:03.821 --> 00:34:09.661 protect you know children from being paralyzed and needlessly suffering then 00:34:09.661 --> 00:34:15.221 that also it helps then you know at receiving end but it is also a lot of work 00:34:15.221 --> 00:34:16.341 and you can imagine Imagine two-way. 00:34:17.512 --> 00:34:25.912 Western, like say the children, for example, would come and do a cultural sensitivity exercise. 00:34:26.352 --> 00:34:30.392 So then you have to get everyone in the village and you have a lunch together 00:34:30.392 --> 00:34:33.272 and you say, this is what we're going to do. This is why we need to do it. 00:34:33.572 --> 00:34:38.032 We're going to want your help in planning, whether it's a polo campaign or Mises campaign. 00:34:38.412 --> 00:34:43.092 Oh, and then we need all your signatures to sign so that we can get reimbursed for the lunch. 00:34:44.232 --> 00:34:49.832 It's like, seriously, I mean, it is like, It's just so insulting in a way that 00:34:49.832 --> 00:34:53.792 you think, I mean, I cannot believe that you would do these things. 00:34:54.692 --> 00:34:59.212 It's so counterintuitive to what we would really call cultural competence. 00:35:00.892 --> 00:35:05.592 And especially in such a population that is so generous and hospitable and is 00:35:05.592 --> 00:35:07.252 suffering such tragedies. 00:35:07.372 --> 00:35:13.292 But in the polio campaign, would you also see people collaborating across the lines of conflict? 00:35:13.292 --> 00:35:19.232 So people who were supporters of the government would still work together with 00:35:19.232 --> 00:35:23.032 the revolutionaries, so the people who want to build a new nation, 00:35:23.212 --> 00:35:27.852 they would still work together across these lines of conflict in order to advance 00:35:27.852 --> 00:35:30.112 the polio vaccination campaign. 00:35:31.352 --> 00:35:33.932 As far as possible, absolutely. Absolutely. I mean, it's more, 00:35:34.092 --> 00:35:37.292 it's much more so from the, you know, from the North, you know, 00:35:37.292 --> 00:35:42.132 who would, you know, with, you know, the Northern ethic was like, 00:35:42.232 --> 00:35:44.932 we will help people everywhere insofar as possible. 00:35:44.932 --> 00:35:49.972 So, for example, yes, they would, you know, they would hide the polio canisters 00:35:49.972 --> 00:35:54.552 in milk, you know, in what you call the big canisters of milk, 00:35:54.592 --> 00:35:59.752 you know, hold the polio vials in milk canisters and, you know, disguise themselves, 00:36:00.052 --> 00:36:04.532 disguise them so that they could cross into villages that were under government 00:36:04.532 --> 00:36:07.372 control and then vaccinate, you know, kids. 00:36:07.772 --> 00:36:11.752 And they would then not, like, do the usual marking of the finger with purple 00:36:11.752 --> 00:36:15.772 ink because otherwise, you know, then retaliation could be expected. 00:36:16.132 --> 00:36:19.992 But certainly, you know, some government people would, you know, 00:36:19.992 --> 00:36:23.372 look the other way in order that this could happen because there is some, 00:36:23.592 --> 00:36:24.772 you know, common understanding. 00:36:25.112 --> 00:36:28.872 But, you know, I mean, that also was deeply impressive. 00:36:29.032 --> 00:36:32.472 I mean, the polio vaccination campaign was so successful that in the end, 00:36:32.552 --> 00:36:40.392 you know, UNICEF even encouraged and supported the Syrians to cross the border through Iraq. 00:36:41.692 --> 00:36:46.672 And vaccinate those in Iraq as well because we know, too, that Poland actually is fed into it. 00:36:46.752 --> 00:36:50.992 And so that was the extent of the trust and the reach that they could actually do that. 00:36:51.072 --> 00:36:56.552 And that was only because people stayed and they stayed and they –, 00:36:58.431 --> 00:37:03.571 They demonstrated, I suppose, every single day that they were going to do the 00:37:03.571 --> 00:37:06.971 right thing, no matter what. What's the vaccination rate? 00:37:07.151 --> 00:37:11.631 What was the end result there? How big a fraction of the population got vaccinated? 00:37:12.891 --> 00:37:16.891 Well, the first round alone was 92%, which was just massive. 00:37:17.071 --> 00:37:26.651 I mean, Apollo doesn't, you wouldn't expect to have that high in a conflict 00:37:26.651 --> 00:37:30.531 zone. And you have to do several rounds, of course, multiple rounds, 00:37:30.671 --> 00:37:31.931 six, seven, eight, nine. 00:37:32.351 --> 00:37:38.191 And certainly that's what stopped the polio outbreak. 00:37:38.331 --> 00:37:41.311 And it took several months, but that was successful. 00:37:41.391 --> 00:37:46.971 I think by the end of it, then 93, 94% of the population was vaccinated. 00:37:47.511 --> 00:37:53.331 And then, you know, then it then, despite government undertakings, 00:37:53.351 --> 00:37:56.571 of course, it then came back in 2017. 00:37:56.771 --> 00:38:03.451 But this time it was vaccine-derived polio, which shows too that there had not 00:38:03.451 --> 00:38:06.291 been a serious effort to vaccinate the population. 00:38:06.471 --> 00:38:10.791 You know, by that stage, Darazor was under government control because vaccine-derived 00:38:10.791 --> 00:38:14.991 polio only comes back when you haven't vaccinated people for a long time. 00:38:15.331 --> 00:38:18.451 Right. So this is a massive public health effort. 00:38:18.651 --> 00:38:25.431 It's collaborative, right? As you described it, they reached 94% more or less vaccination rates. 00:38:25.591 --> 00:38:30.971 Now in the US, in response to COVID, where we have infinite resources basically 00:38:30.971 --> 00:38:36.751 to get the population vaccinated, for the last seven months or more, 00:38:36.831 --> 00:38:39.731 we have reached about 50% vaccination rate. 00:38:39.731 --> 00:38:43.371 What's the difference between these two collaborative systems. 00:38:48.691 --> 00:38:49.451 Well, 00:38:53.516 --> 00:38:57.556 You know, it's been a very long time since we've actually paid any attention 00:38:57.556 --> 00:39:00.976 to the importance of trust. 00:39:02.216 --> 00:39:11.976 And we have adopted a model that is disease-driven and subordinates people to 00:39:11.976 --> 00:39:13.476 the virus and to the vaccine. 00:39:14.176 --> 00:39:19.756 So as long as you do that, it's very hard to see how we will get sufficient 00:39:19.756 --> 00:39:22.856 social traction to get people to roll up their sleeves. 00:39:23.576 --> 00:39:28.976 Because we are effectively saying this is all we need to solve the pandemic. 00:39:29.316 --> 00:39:30.676 Everybody has to get vaccinated. 00:39:31.136 --> 00:39:34.976 Well, that's not true. I mean, that is absolutely not true. And we see that right now. 00:39:35.076 --> 00:39:39.776 I mean, you know, more broadly, you know, across the world, 00:39:39.896 --> 00:39:45.116 you know, the effort that has gone into sort of this, you know, 00:39:45.136 --> 00:39:51.476 let's keep those nasty diseases there in the, you know, in what we would used 00:39:51.476 --> 00:39:52.516 to call the global south. 00:39:52.516 --> 00:40:00.256 Will make every effort to make sure that Ebola or SARS or whatever the threat is doesn't come here. 00:40:00.816 --> 00:40:06.556 But we won't address these Canadian killers like malaria or the other ones that 00:40:06.556 --> 00:40:12.016 kill your children much faster and at a much higher rate on a daily basis because 00:40:12.016 --> 00:40:13.816 they're no longer a threat to the West. 00:40:14.076 --> 00:40:23.196 And that is not an ethos that can last very long. And across America, 00:40:23.396 --> 00:40:27.336 we can see that people who have been. 00:40:28.193 --> 00:40:33.013 Whose health has been neglected, they don't have services, they don't have access 00:40:33.013 --> 00:40:38.213 to a decent standard of living, a great job, their kids are not going to school. 00:40:40.093 --> 00:40:45.893 I mean, if you ignore what we would call the social or the political or the 00:40:45.893 --> 00:40:51.413 economic, the environmental determinants of health, and all that we say is you 00:40:51.413 --> 00:40:53.673 just need to be vaccinated, well, that's not true. 00:40:54.313 --> 00:41:00.153 It's a very negative approach to public health. and ignores the positive issues 00:41:00.153 --> 00:41:04.093 like, if we want you to stay home, let's give you some social protection. 00:41:04.253 --> 00:41:09.433 Let's give you some financial protection to actually allow yourself to withstand this. 00:41:09.553 --> 00:41:12.493 Let's give you the tools to look after your own health. Let's give you everybody 00:41:12.493 --> 00:41:16.073 rapid tests so that you can test yourself every day and have some agency. 00:41:16.413 --> 00:41:20.293 These are measures that actually build trust so that when the vaccine comes, 00:41:20.613 --> 00:41:24.333 you are much more likely to accept it because you're actually part of the solution. 00:41:24.333 --> 00:41:27.733 Solution but you know this paternalistic prescriptive approach 00:41:27.733 --> 00:41:31.053 which has you know ignored the 00:41:31.053 --> 00:41:33.913 importance of communication and says do this do this 00:41:33.913 --> 00:41:38.393 do this and hasn't explained along the way you know and takes a long time to 00:41:38.393 --> 00:41:42.613 update their priors so you know telling people to wash hands and wash services 00:41:42.613 --> 00:41:47.213 when it's an airborne viruses and then when you finally say okay in may okay 00:41:47.213 --> 00:41:50.993 it's airborne but you feel still fail to actually say okay now this is what 00:41:50.993 --> 00:41:52.833 we need to do not very helpful. 00:41:53.213 --> 00:41:59.533 And it's, you know, saying mask up everybody at a time when masks are even probably 00:41:59.533 --> 00:42:04.493 becoming less effective as Delta virus and Delta variant and the others become more infectious. 00:42:04.973 --> 00:42:07.893 What are people going to do? It's like, you know, a year ago, 00:42:07.913 --> 00:42:11.633 we watched the world lay down their tools willingly. 00:42:12.827 --> 00:42:16.127 To control this we've never seen that kind of paradigm before 00:42:16.127 --> 00:42:18.847 of course governments you know think we'll have to shut down 00:42:18.847 --> 00:42:22.187 but people did it willingly and we shut down and now 00:42:22.187 --> 00:42:24.967 of course people are fed up not only 00:42:24.967 --> 00:42:28.087 just fed up with the economic you know cost but because 00:42:28.087 --> 00:42:30.827 where is the truth where's the trust we're not 00:42:30.827 --> 00:42:33.947 going to do something unless we can see why we have to do it and where 00:42:33.947 --> 00:42:42.007 are the tools now give us a time but then your description in some sense what 00:42:42.007 --> 00:42:48.787 you are than saying is that the COVID-19 crisis also shows how healthcare systems 00:42:48.787 --> 00:42:52.487 are not working anymore as collaborative systems. 00:42:53.147 --> 00:42:58.347 Absolutely. And in that way have lost effectivity from a public health perspective. 00:42:59.007 --> 00:43:04.227 Well, we commoditized health. And the minute we made it into a commodity, 00:43:04.667 --> 00:43:08.807 then it stops being held in healthcare. healthcare, you know, 00:43:08.807 --> 00:43:13.127 the real global public good here is not vaccines, it's care. 00:43:13.367 --> 00:43:16.547 And that's what, you know, the Syrians demonstrate in spades. 00:43:16.667 --> 00:43:19.647 They know how to care for each other. They have an architecture of care that 00:43:19.647 --> 00:43:25.627 is just so obvious and so deep that it cuts across, you know, 00:43:25.687 --> 00:43:30.587 racial, ethnic lines in a way that is, you know, we need to learn from that. 00:43:30.727 --> 00:43:37.887 And we need to remember that even investing in healthcare workers, 00:43:38.027 --> 00:43:40.227 which we obviously need to do of every kind, 00:43:40.447 --> 00:43:46.247 not just called doctors and nurses, but the janitors, the porters who push the 00:43:46.247 --> 00:43:47.767 trolleys, everyone who's in the line. 00:43:47.987 --> 00:43:53.547 But in itself, it's hard to see how that will work unless we also invest in 00:43:53.547 --> 00:44:02.187 caring for each other, and that theory of care, is that what it's called? 00:44:02.187 --> 00:44:06.527 But it's that how, and, and, but part of that is, 00:44:07.272 --> 00:44:12.732 Part of that, of course, is finding the tools which help us reconnect at a time 00:44:12.732 --> 00:44:15.032 where we're already disconnected and digitally living. 00:44:15.252 --> 00:44:19.692 And some of those tools include things like rapid tests, which can help us then 00:44:19.692 --> 00:44:23.192 look after our own health, our family's health, our community's health. 00:44:23.332 --> 00:44:25.472 Right. Those are the building blocks for collaboration. 00:44:26.252 --> 00:44:30.552 But this is what we see here as well, is that with that, we've reached the end 00:44:30.552 --> 00:44:33.772 of the sustainability of healthcare systems, right? 00:44:33.852 --> 00:44:39.392 By commoditizing health, especially in the U.S., It also is at the point of 00:44:39.392 --> 00:44:41.852 just not being sustainable anymore. 00:44:42.332 --> 00:44:49.212 So is the current system future-proof or are you arguing for a complete reorientation 00:44:49.212 --> 00:44:54.672 here of the approach towards health that is based on collaboration and different 00:44:54.672 --> 00:44:56.292 values? How do you see that? 00:44:56.692 --> 00:45:00.912 I think it's essential. And this is the opportunity because we've seen, 00:45:00.972 --> 00:45:06.832 we've gone as far as we can with this biomedical approach that there is an antibiotic 00:45:06.832 --> 00:45:08.712 or a drug or a treatment for everything. 00:45:09.112 --> 00:45:11.892 It's not. I mean, Pasteur was 00:45:11.892 --> 00:45:15.912 a PR genius and he really knew how to market the germ model and he did. 00:45:15.912 --> 00:45:19.352 And and that really um that 00:45:19.352 --> 00:45:22.752 really was the the point at which people diverged 00:45:22.752 --> 00:45:25.652 from burkoff and who was you know 00:45:25.652 --> 00:45:31.632 fully recognized the importance of of social justice of shelter of decent living 00:45:31.632 --> 00:45:36.512 of a decent standard of living of a decent job of all these other things that 00:45:36.512 --> 00:45:41.712 that the building blocks of health and we simply went down the biomedical model 00:45:41.712 --> 00:45:44.652 as if there's every Every disease has one single cause, 00:45:44.712 --> 00:45:48.272 and there's a drug or an antibiotic for all of this. That's just not true. 00:45:48.512 --> 00:45:52.112 And it's pretty lazy, actually. I mean, it's low-hanging fruit, right? It's not. 00:45:52.832 --> 00:45:56.812 And that was the, you know, when WHO, the World Health Organization, 00:45:56.852 --> 00:46:01.252 actually was created out of the ashes of World War II and the... 00:46:01.754 --> 00:46:06.914 The health office that was in Geneva, it recognized this shift that health wasn't 00:46:06.914 --> 00:46:11.614 just the absence of disease, but the presence of physical and mental and emotional health. 00:46:11.934 --> 00:46:15.314 I mean, mental health, we know is like a prerequisite for physical health, 00:46:15.394 --> 00:46:17.054 but we still just pay lip service to it. 00:46:17.214 --> 00:46:20.714 But, you know, even having recognized that, and it was given the mandate to 00:46:20.714 --> 00:46:25.074 get beyond these negative approaches to public health, which is like vectors and vaccination. 00:46:25.674 --> 00:46:27.134 Vaccination, of course, we love 00:46:27.134 --> 00:46:30.694 it. It's our preferred tool of mass salvation, But it can only go so far. 00:46:30.974 --> 00:46:36.074 But that approach didn't last very long because Cold War starts, 00:46:36.314 --> 00:46:40.814 Iron Curtain comes down, and the superpowers prefer the model of disease diplomacy 00:46:40.814 --> 00:46:45.354 and sharing vaccines because it's much easier than actually putting in place these other measures. 00:46:45.834 --> 00:46:48.594 Governments like short-term solutions. They don't want to invest in it. 00:46:48.594 --> 00:46:51.334 Well, but maybe it goes actually deeper, right? 00:46:51.394 --> 00:46:56.914 Because also if you look at the scientific models, the epistemology of it, 00:46:57.034 --> 00:47:01.754 reductionism is the way in which we often end up looking at the world, 00:47:01.834 --> 00:47:06.254 even though what we try to understand are multi-scale integrated systems. 00:47:06.514 --> 00:47:10.794 And with collaboration, we, of course, face a similar challenge. 00:47:11.094 --> 00:47:16.114 But it also means that the way you described collaboration in public health 00:47:16.114 --> 00:47:24.114 is actually a very tiny minority of all our activities within health systems and in public health. 00:47:24.774 --> 00:47:29.074 The majority sits more in this incentive-driven, highly fragmented, 00:47:29.134 --> 00:47:31.794 commoditizing of health. 00:47:32.034 --> 00:47:38.234 And then, of course, we have enormous artifacts that are very costly for society. 00:47:38.254 --> 00:47:41.254 Take the opioid crisis that the US is facing. 00:47:42.274 --> 00:47:45.414 But are you fighting a rearguard battle here? 00:47:46.114 --> 00:47:50.474 Are you the left of the Mohicans of how things could have been? 00:47:50.474 --> 00:47:55.734 And we're off just in this direction and there's no return because of course 00:47:55.734 --> 00:48:03.274 the power behind it is enormous health as a non-collaborative if you want neoliberal 00:48:03.274 --> 00:48:09.914 exercise do you still have a chance to change that and if so where would you start. 00:48:14.074 --> 00:48:14.914 Well out, 00:48:17.409 --> 00:48:21.609 I am, we are, I suspect you are too. We are condemned by hope. 00:48:24.909 --> 00:48:29.269 And we didn't always have this homo economicus approach to health, 00:48:29.449 --> 00:48:32.289 nor did, you know, when you look at what Rockefeller did, 00:48:32.789 --> 00:48:37.949 at the turn of last century, they did basically what Mackenzie Scott is doing 00:48:37.949 --> 00:48:41.909 now, where there's a willingness to actually put money into areas that, 00:48:41.909 --> 00:48:45.449 you know, with a high degree of trust. 00:48:46.129 --> 00:48:49.609 And because we have to actually find a different way. I mean, 00:48:49.669 --> 00:48:55.989 it's very clear now with the variants that this here-there approach isn't working anymore. 00:48:56.149 --> 00:49:02.189 We can't keep things there and all we're doing, I mean, we did it before with 00:49:02.189 --> 00:49:06.549 HIV and while we won the battle in terms of making HIV drugs accessible, 00:49:06.849 --> 00:49:09.369 we certainly lost the war with big pharma and patents. 00:49:09.609 --> 00:49:13.909 But the idea was or the rationale was that we can't, 00:49:13.909 --> 00:49:16.869 you know they can't have them in the global south because people aren't literate they 00:49:16.869 --> 00:49:19.989 won't be able to read you know the label they won't take them on time and 00:49:19.989 --> 00:49:22.789 will create drug resistance that's not true 00:49:22.789 --> 00:49:25.849 at all of course and that was disproven because africans and are much 00:49:25.849 --> 00:49:29.229 much better more compliant you know and and than 00:49:29.229 --> 00:49:32.089 many you know people across america you know 00:49:32.089 --> 00:49:36.329 the rationale but you know 20 years later have we conquered hiv no because it's 00:49:36.329 --> 00:49:40.049 much more than about making drugs cheap you know we have to address all the 00:49:40.049 --> 00:49:45.669 other issues that go into to why people have AIDS and get AIDS and the agency 00:49:45.669 --> 00:49:51.069 and all of the human rights and the issues that, you know, it's like giving a woman, 00:49:51.689 --> 00:49:56.049 a woman's ability to inherit property will protect her, you know, 00:49:56.049 --> 00:49:59.969 not just from AIDS, but from poverty and from domestic abuse and provide their 00:49:59.969 --> 00:50:03.509 children with a much greater ability to go to school, et cetera, et cetera. 00:50:03.569 --> 00:50:09.149 There's an importance of actually recognizing the linkages that. 00:50:09.794 --> 00:50:13.254 Mean that you can do a normal, enormous amount if you put in the legal framework 00:50:13.254 --> 00:50:16.214 and uphold it, for example, and you understand those connections. 00:50:16.914 --> 00:50:19.974 More deeply, but, you know, looking at the variants, you know, 00:50:20.014 --> 00:50:24.374 we have created, you know, the equivalent, the viral equivalent of the Hydra, 00:50:24.394 --> 00:50:25.714 you know, the nine-headed monster. 00:50:25.954 --> 00:50:30.074 Every time we like, you know, create a new vaccine, it doesn't matter. 00:50:30.174 --> 00:50:31.594 You know, more heads will keep appearing. 00:50:31.734 --> 00:50:35.854 And if we can't learn this lesson now, then yes, we pretty much are doomed because 00:50:35.854 --> 00:50:38.054 the next pathogen is almost certainly here already. 00:50:38.054 --> 00:50:40.954 We haven't identified it yet and but an approach 00:50:40.954 --> 00:50:45.034 to public health that is limited to vaccines and doesn't 00:50:45.034 --> 00:50:47.754 actually take you know start with people as as 00:50:47.754 --> 00:50:51.934 part of the solution and figure out how to produce this you know this groundswell 00:50:51.934 --> 00:50:56.154 of collaboration i mean we can do that and that's actually the only way you 00:50:56.154 --> 00:51:00.274 can defeat that's the only way that we can defeat the virus i mean human collaboration 00:51:00.274 --> 00:51:06.314 is formidable but as you say the monsters that are lined up against that are also So considerable. 00:51:06.674 --> 00:51:12.334 Right. But in some sense, the medical professionals are one of the big obstacles 00:51:12.334 --> 00:51:17.254 in the way of building a true integrated health system. 00:51:19.474 --> 00:51:22.394 Or would you not agree with that? Go on. 00:51:23.274 --> 00:51:28.874 Well, look, they are the ones who are representing also a part of these power 00:51:28.874 --> 00:51:34.474 structures that have been following this route of the commoditization of health. 00:51:34.474 --> 00:51:36.654 They have been selected into that system. 00:51:36.834 --> 00:51:40.914 The ones who have more idealistic goals are not part of it because they wouldn't 00:51:40.914 --> 00:51:43.454 survive in that environment. It's highly competitive. 00:51:43.854 --> 00:51:47.634 It's very much about the monetization of health. 00:51:47.794 --> 00:51:52.914 The guys who are good in that game will protect that game because this is how 00:51:52.914 --> 00:51:57.034 they actually are important, have status, and make lots of money. 00:51:57.174 --> 00:51:58.754 And of course, usually they're guys. 00:51:59.734 --> 00:52:02.534 So are they not one of the big obstacles we face? 00:52:02.534 --> 00:52:05.654 Because in parallel, as you also indicate yourself, actually, 00:52:05.754 --> 00:52:09.974 for many pathologies, we see very little progress on actually curing anything 00:52:09.974 --> 00:52:16.134 because people are just climbing up the wrong tree and they think they're getting to the moon, right? 00:52:16.214 --> 00:52:20.474 So is this actually not one of our biggest obstacles that the way we have currently 00:52:20.474 --> 00:52:26.514 implemented health as a non-collaborative system is the first thing we have 00:52:26.514 --> 00:52:29.354 to dismantle to make progress? Yes. 00:52:32.834 --> 00:52:39.634 Yes, everything you said is true. I think dismantling something is very difficult, 00:52:39.674 --> 00:52:46.254 and it's probably easier to provide a way forward that enables people to start 00:52:46.254 --> 00:52:51.854 to collaborate positively so that they don't have to necessarily detach or declare 00:52:51.854 --> 00:52:58.794 their attachment to that model. 00:52:59.694 --> 00:53:03.934 So what's the way forward if people are so conditioned around their incentives? 00:53:04.034 --> 00:53:06.114 So, so can you, can you sketch that way forward? 00:53:13.759 --> 00:53:22.819 Well, perhaps it's easier to start with places where there's conditionality 00:53:22.819 --> 00:53:25.579 or these conditions aren't already cemented. 00:53:25.959 --> 00:53:32.719 And I say that where across Africa, for example, people are really tired of 00:53:32.719 --> 00:53:34.119 looking to the West for solutions. 00:53:34.299 --> 00:53:38.379 And we see this hypocrisy where Gates, on the one hand, forces, 00:53:38.559 --> 00:53:43.099 you know, Oxford University, which are providing the only open source vaccine 00:53:43.099 --> 00:53:47.119 to partner with AstraZeneca, which, hello, has never produced a vaccine before. 00:53:47.519 --> 00:53:51.639 And, you know, because Gates actually perceives IP as the lifeblood of the universe, 00:53:51.759 --> 00:53:54.479 which of course is nonsense and is toxic and is, 00:53:54.619 --> 00:53:58.499 and then, you know, by contributing also to COVAX, you know, 00:53:58.539 --> 00:54:04.039 the, you know, the, you know, which is aiming to supply the world that doesn't 00:54:04.039 --> 00:54:04.879 have access to vaccines. 00:54:05.179 --> 00:54:07.499 And that's just hypocrisy of the first order. 00:54:08.819 --> 00:54:12.759 Meanwhile Boris of course withdraws 95% of 00:54:12.759 --> 00:54:16.259 development on developmental aid which so 00:54:16.259 --> 00:54:19.999 much to Africa including 100% 00:54:19.999 --> 00:54:24.299 of family planning because of course the US's attitude and the global gag rule 00:54:24.299 --> 00:54:32.359 but then says but we will put a billion into vaccines this is nonsense and there's 00:54:32.359 --> 00:54:36.359 no accountability of these kind of pledges but meanwhile Africans are. 00:54:37.539 --> 00:54:42.819 At that point where I think, okay, let's start here where we can divest ourselves 00:54:42.819 --> 00:54:49.779 of this Western, the West being addicted to developing us, as it were. 00:54:49.979 --> 00:54:53.679 There's enough, I think, across Africa, there's enough innovators, 00:54:54.259 --> 00:54:57.199 enough tech, enough people, enough, 00:54:57.339 --> 00:55:03.499 there's a rising middle class and wealth that means they can invest in their 00:55:03.499 --> 00:55:09.499 own health without having to go down that Western model of a biomedical model 00:55:09.499 --> 00:55:11.159 and putting the disease first. 00:55:11.299 --> 00:55:15.339 I think they can see much more clearly that the only way to actually stamp out 00:55:15.339 --> 00:55:17.159 these diseases is by making people healthier. 00:55:17.519 --> 00:55:20.879 And that starts with the actual conditions in which people live. 00:55:21.119 --> 00:55:24.619 And it starts with exploring, you know, I mean, it's not that there aren't, 00:55:24.619 --> 00:55:30.119 you know, there are certain tools which we think could make people a whole lot healthier. 00:55:30.339 --> 00:55:33.279 You know, we know that fecal transplants are 00:55:33.279 --> 00:55:36.279 incredibly successful for making our biome healthier and protecting us 00:55:36.279 --> 00:55:39.459 from all sorts of diseases we know that viruses are responsible 00:55:39.459 --> 00:55:42.739 for at least 25 of all of our cancers so how 00:55:42.739 --> 00:55:46.839 about we invest in more live vaccines you know which we use anyway like you 00:55:46.839 --> 00:55:51.559 know bcg measles oral polio you know which we're all familiar with and you know 00:55:51.559 --> 00:55:55.959 and especially are well used across africa and southeast asia as tools which 00:55:55.959 --> 00:56:00.899 might actually protect us against a lot of these uh expensive diseases so we 00:56:00.899 --> 00:56:02.039 don't and get them in the first place. 00:56:03.199 --> 00:56:06.919 So I think that, you know, we suffer from a global failure of imagination. 00:56:07.319 --> 00:56:10.659 And when we, you know, it's going to be very hard to get people to detach from 00:56:10.659 --> 00:56:13.379 our addiction to this biomedical model. I fully agree. 00:56:13.579 --> 00:56:15.719 So I think it's easier to start where it's possible. 00:56:16.459 --> 00:56:21.719 So, but then before we go for the final few questions, I would like to go back 00:56:21.719 --> 00:56:25.379 to your involvement in the Olympics that are running right now, 00:56:26.359 --> 00:56:29.299 where overall the situation is not great, right? 00:56:29.299 --> 00:56:32.499 There's also lots of debate about the actual quarantine measures taken, 00:56:32.699 --> 00:56:34.139 about the testing and so on. 00:56:34.279 --> 00:56:40.199 So you wrote a paper and published in May where you were urging also the International 00:56:40.199 --> 00:56:46.539 Olympic Committee and the local organizers in Japan to rethink the measures they took. 00:56:46.719 --> 00:56:54.139 So in that sense, that's also an invitation for a collaborative effort to find the best way forward. 00:56:55.159 --> 00:56:57.519 So did your paper have that impact? 00:57:01.206 --> 00:57:05.806 No. Okay. And why not? Because they don't want to collaborate. 00:57:05.986 --> 00:57:07.706 And that was very clear right from the beginning. 00:57:08.406 --> 00:57:12.506 You know, obviously the natural people to collaborate with are the athletes 00:57:12.506 --> 00:57:14.306 or the athletes' associations themselves. 00:57:14.826 --> 00:57:17.106 They're the ones who have gained all the wealth of knowledge, 00:57:17.186 --> 00:57:20.346 of expertise, best practice over the last year and a half. 00:57:20.806 --> 00:57:26.286 And I say that as somebody who was involved in, you know, counselling the Women's 00:57:26.286 --> 00:57:30.146 National Basketball Association, you know, last year. and they had a really 00:57:30.146 --> 00:57:33.546 successful season, 87 games without a single positive COVID case. 00:57:34.106 --> 00:57:38.586 But instead of actually inviting the people who know what they're talking about, 00:57:38.706 --> 00:57:42.906 the World Players Associations, for example, and the experts that, 00:57:43.066 --> 00:57:48.986 you know, like, I mean, I am not an expert around sport. 00:57:49.506 --> 00:57:55.666 I've known people who are far more informed than I am, but I know who to ask. 00:57:55.666 --> 00:57:58.406 Task and it's like the center of support and human 00:57:58.406 --> 00:58:01.666 rights is full of experts where you think okay why don't 00:58:01.666 --> 00:58:06.926 we just find out where the experts are and ask them but instead there's this 00:58:06.926 --> 00:58:12.946 ethos of hand-picking experts who the IOC know will tow the party line and there's 00:58:12.946 --> 00:58:17.386 also a fear that if they step out of line they'll be excommunicated and even 00:58:17.386 --> 00:58:20.186 though we were myself and Mike Osterholm home, 00:58:20.206 --> 00:58:22.986 who was such an amazing man, 00:58:23.146 --> 00:58:30.746 an American public health heavyweight who has no fear and is such an expert. 00:58:33.309 --> 00:58:35.809 Instead of actually really listening to what we're talking about, 00:58:36.749 --> 00:58:39.469 they're just really paying lip service. And we can see that. 00:58:44.769 --> 00:58:49.629 Relying on vaccination is a nonsense strategy when you could already see vaccine breakthrough. 00:58:50.189 --> 00:58:56.009 And we know that vaccines were fundamentally just, their primary purpose is 00:58:56.009 --> 00:58:58.509 to stop severe disease. It's not to stop spread. 00:58:58.889 --> 00:59:02.609 So instead of taking a science-based approach or a risk-based approach, 00:59:03.309 --> 00:59:10.309 they sort of created this charade and then how can we be surprised when it doesn't work out? 00:59:11.709 --> 00:59:19.229 So, I mean, the good thing is that because of that paper, we have raised the stakes, 00:59:19.569 --> 00:59:25.569 you know, to a much higher level and created a lot more awareness about what's 00:59:25.569 --> 00:59:27.709 really going on because there's a huge lack of transparency. 00:59:27.769 --> 00:59:31.429 I mean, how do we know what's going on? How do we know what their real testing protocols are? 00:59:31.429 --> 00:59:34.449 How do we know you know um how people 00:59:34.449 --> 00:59:37.649 are living eating sleeping i mean the athletes themselves that 00:59:37.649 --> 00:59:40.949 we did the mental health they have a hotline paul 00:59:40.949 --> 00:59:45.249 they have a hotline for mental health and for women or for anyone you know who's 00:59:45.249 --> 00:59:49.369 who gets uh sexually assaulted which which shows you a lot about this approach 00:59:49.369 --> 00:59:52.049 it's like no one is going to report so that's a great way of saying it didn't 00:59:52.049 --> 00:59:56.629 happen who's at the end of the line i'm not you know that's a bit of a uh it's 00:59:56.629 --> 00:59:59.329 not meant to be a a diversion or digression, 00:59:59.389 --> 01:00:04.489 but it sort of epitomizes their whole approach where they're not taking it seriously, 01:00:04.489 --> 01:00:07.349 but they are investing measures that look like they take it seriously. 01:00:07.949 --> 01:00:09.829 And meanwhile, there's this. 01:00:10.677 --> 01:00:14.237 Disregard of athlete, public, and global health movements. 01:00:14.337 --> 01:00:17.197 But there's an interesting aspect to this, right? 01:00:17.257 --> 01:00:21.997 Because there are two ways to interpret the International Olympic Committee's 01:00:21.997 --> 01:00:24.457 response and the Japanese organizers. 01:00:24.757 --> 01:00:29.157 On the one hand, it could be that they have just alternative objectives. 01:00:29.417 --> 01:00:30.577 Their goals are different. 01:00:30.857 --> 01:00:36.617 Their goals are essentially in collision with the ones of public health. 01:00:36.897 --> 01:00:40.537 They're not telling you what these goals are, but that's why they're not listening. 01:00:40.677 --> 01:00:42.357 This is one possible interpretation. 01:00:42.757 --> 01:00:47.097 The other interpretation is it's sort of plain stupidity and mediocrity, 01:00:47.157 --> 01:00:53.757 that people are following in a sort of habitual perspective on how public health 01:00:53.757 --> 01:00:57.337 should be organized, how these kinds of events should be organized. 01:00:57.697 --> 01:01:02.257 And they just march along that habit. it and if you deviate, 01:01:02.357 --> 01:01:06.217 if you challenge them to deviate it is just rejected because the world looks 01:01:06.217 --> 01:01:11.077 just fine from their habitual world model. 01:01:11.837 --> 01:01:16.877 So which of the two sides would you take as your interpretation of this lack of response? 01:01:18.557 --> 01:01:24.457 You're right. It's one of the most frightening things is colleagues that I respect 01:01:24.457 --> 01:01:29.477 deeply who are utterly convinced or who have been up until the game started that, 01:01:30.037 --> 01:01:34.557 Everything was absolutely fine, that we were drama queens who were banging on 01:01:34.557 --> 01:01:38.297 about nothing, that vaccination would protect everyone, and it's not a big deal. 01:01:38.437 --> 01:01:40.737 And you think, wow, I'm not sure where you're standing. 01:01:41.497 --> 01:01:46.377 The world looks very different to me and to my colleagues. 01:01:46.377 --> 01:01:51.837 But I agree that there is this combination, this fairly lethal combination of 01:01:51.837 --> 01:01:59.437 mediocrity and complacency, where we have forgotten the importance of public health. 01:02:00.797 --> 01:02:09.037 And we have had the pandemics of the 21st century before, SARS and H1N1, 01:02:09.137 --> 01:02:13.637 which should have been dress rehearsals for this, have been really interpreted 01:02:13.637 --> 01:02:15.677 as that, oh, well, it's never going to get that bad. 01:02:16.517 --> 01:02:21.157 And, you know, the last century, we, you know, people talked about the death 01:02:21.157 --> 01:02:25.117 of infectious diseases, which is, of course, is deeply arrogant. 01:02:25.257 --> 01:02:29.837 I mean, we are facing, you know, pandemics and climate change and antimicrobial resistance. 01:02:30.337 --> 01:02:33.357 Those are the three global narratives that affect us all. 01:02:33.697 --> 01:02:41.257 You know, and once our antibiotics go, you know, we are really… Well, 01:02:41.357 --> 01:02:46.577 you know, humans have declared victory over many natural phenomena on many occasions 01:02:46.577 --> 01:02:50.097 that can get bitten in their backside very rapidly. 01:02:50.317 --> 01:02:55.837 So the time capsule we're going to send to one of the possible inhabited planets 01:02:55.837 --> 01:02:59.557 in the future will just say, look, we killed this planet out of stupidity. 01:02:59.597 --> 01:03:02.537 This is our main opponent in building collaboration? 01:03:04.421 --> 01:03:05.781 Well, certainly where the IOC 01:03:05.781 --> 01:03:09.321 is concerned, they have a long tradition of rising above the rule of law. 01:03:09.481 --> 01:03:13.141 I think that we can see now that, you know, you can only rise above the laws 01:03:13.141 --> 01:03:17.341 of nature for so long. But, you know, we don't. 01:03:18.081 --> 01:03:23.161 We should take a cue from the virus and understand that we have to, 01:03:23.181 --> 01:03:24.721 this is the opportunity for change. 01:03:25.101 --> 01:03:28.781 And the Olympics work a whole lot better. People perform better, 01:03:28.921 --> 01:03:31.901 you know, higher, faster, stronger together when we actually 01:03:31.901 --> 01:03:35.641 can actually create the best environment and 01:03:35.641 --> 01:03:38.721 it's all you know one that when you 01:03:38.721 --> 01:03:41.641 do that right and when from the right intentions then it's a 01:03:41.641 --> 01:03:45.741 more profitable environment as well then work everybody it's a global win-win 01:03:45.741 --> 01:03:50.581 which is one of the most tragic things because that's where I let's you know 01:03:50.581 --> 01:03:54.881 you know instead of having a you know these bilaterals which are non-transparent 01:03:54.881 --> 01:03:59.981 let's have the kind of conversation where we can all say the advantage right Right, 01:03:59.981 --> 01:04:02.501 but there's another thing that worries me about your paper. 01:04:03.401 --> 01:04:09.741 Look, it's published with some real experts in one of the leading medical journals in the world. 01:04:09.881 --> 01:04:14.741 We have our mouths full continuously about evidence-based medicine. 01:04:14.861 --> 01:04:19.881 Well, here's the evidence delivered in a highly credible, high-authority journal. 01:04:20.741 --> 01:04:27.641 It has absolutely zero impact. So, is it actually just a pretense that evidence 01:04:27.641 --> 01:04:30.841 matters in these debates on global health? 01:04:34.821 --> 01:04:41.261 Well, that is probably the real question, isn't it? 01:04:41.301 --> 01:04:46.141 The evidence from the very beginning of this pandemic has been that it was airborne, 01:04:46.441 --> 01:04:50.121 microscopic, asymptomatic. We could see that right from the beginning where 01:04:50.121 --> 01:04:53.541 the Chinese doctors that were infected were not, you know, were not the ones 01:04:53.541 --> 01:04:55.741 in the ER or the ICU like we saw in SARS. 01:04:56.021 --> 01:04:59.781 It was the family physicians, the ophthalmologists, the elective, 01:04:59.781 --> 01:05:03.201 you know, people on elective surgery wards and the surgeons that were not, 01:05:03.201 --> 01:05:08.101 that showed us that it was being transmitted asymptomatically and it had to be airborne. 01:05:08.841 --> 01:05:13.921 And of course, the Chinese cover up, you know, and governments always cover up epidemics. 01:05:13.961 --> 01:05:19.401 We know that, that is, that's, you know, that's pandemic 101. Public Health 101. 01:05:20.201 --> 01:05:25.561 But, you know, the problem for... 01:05:26.999 --> 01:05:31.999 The World Health Organization is that the countries, because they all adopt 01:05:31.999 --> 01:05:37.299 this stance of you're not going to come in and cross our boundaries or interfere 01:05:37.299 --> 01:05:38.719 with our sovereignty unless we say so. 01:05:38.799 --> 01:05:40.039 They have no independent ability 01:05:40.039 --> 01:05:44.619 or financial clout to be able to figure out what's really going on. 01:05:45.599 --> 01:05:52.059 And so despite the obvious airborne and the evidence, and a lot of the scientists 01:05:52.059 --> 01:05:54.479 put a lot of serious effort into getting this out there. 01:05:54.479 --> 01:06:00.659 It took an enormous amount of time for both the CDC and the WHO to update their 01:06:00.659 --> 01:06:02.419 priors, and we didn't see that till May this year. 01:06:02.699 --> 01:06:07.259 And you think, wow, I mean, this comes back to the importance of communications. 01:06:07.639 --> 01:06:10.799 And even well before evidence, that's the precautionary principle. 01:06:10.859 --> 01:06:13.359 After all, it's like, this is what the evidence looks like. 01:06:13.639 --> 01:06:20.919 And we know that for a disease that's operating like this, let's adopt airborne precautions. 01:06:21.139 --> 01:06:24.059 Let's mask up. Let's look to our ventilation. Let's look to air filtration. 01:06:24.479 --> 01:06:29.859 Let's figure out. And we can see that that is part of the problem now. 01:06:29.919 --> 01:06:34.219 We didn't do that. People haven't been honest about saying, okay, we screwed up here. 01:06:34.979 --> 01:06:37.579 You know what I mean? Fauci himself said, I'm sorry, I got it wrong. 01:06:37.759 --> 01:06:40.999 It makes it much easier then to listen to him the next time around. 01:06:41.999 --> 01:06:46.099 There's a real issue here, right? Because if you put in this effort to write 01:06:46.099 --> 01:06:49.599 this paper, put all the arguments together, together, and there's subsequently 01:06:49.599 --> 01:06:54.499 no response from your target audience, the IOC and the Japanese organizers, 01:06:54.899 --> 01:06:59.019 it erodes trust in public health measures. 01:06:59.119 --> 01:07:02.639 It erodes trust in the science behind it because the general public says, 01:07:02.719 --> 01:07:06.339 well, these people make all this noise, but the guys in power are not impressed. 01:07:06.839 --> 01:07:11.699 So are you now obliged to keep on hammering on this message until they give 01:07:11.699 --> 01:07:15.239 in just to safeguard the trust in medical knowledge? 01:07:19.119 --> 01:07:26.799 Well, certainly I'm not going to give up my position or my importance of evidence or my standpoint. 01:07:27.079 --> 01:07:32.199 And when I say that there's no impact, I mean, I'm probably saying far too binary. 01:07:32.459 --> 01:07:35.359 You know, it certainly has created a... 01:07:36.784 --> 01:07:43.264 You know, a much more potential even moving forward to hold the IOC accountable 01:07:43.264 --> 01:07:45.424 for this five-star fiasco. 01:07:45.544 --> 01:07:49.004 And that's super important because this cannot be the global standard going forward. 01:07:49.224 --> 01:07:53.804 You know, I mean, and that's, you know, we have the opportunity at a moment 01:07:53.804 --> 01:07:56.484 in time where we can actually see the importance of science. 01:07:57.564 --> 01:08:00.384 And, you know, then let's hold on to that ribbon. 01:08:00.444 --> 01:08:03.704 Let's hold on to that quality and hold that line and use it to inform, 01:08:03.944 --> 01:08:10.204 you know, our events, whether it's the Olympics or the football or the Beijing 01:08:10.204 --> 01:08:14.904 or the World Cups going forward or the Dubai Expo or whatever it is, 01:08:15.044 --> 01:08:16.184 you know, going and getting back to school. 01:08:16.324 --> 01:08:20.544 I mean, let's use that evidence and let's hold the line on the quality and the rigour that we know. 01:08:20.704 --> 01:08:24.404 And let's, you know, it is important to actually, you know, stop, 01:08:24.524 --> 01:08:25.944 you know, call a spade a spade. 01:08:25.984 --> 01:08:29.084 Like all the big winners of this pandemic have been the tech guys who, 01:08:29.164 --> 01:08:33.844 you know, continue to churn out these, you know, but ridiculous contact tracing 01:08:33.844 --> 01:08:39.044 apps that do nothing, haven't shifted the level, the dial one iota, 01:08:39.664 --> 01:08:43.104 and yet there's all this pretense and lack of evidence that they do. 01:08:43.764 --> 01:08:48.984 It's like there's no app for public health. It's not easy. You have to go out there and do the work. 01:08:49.604 --> 01:08:53.124 And it is work, and it is harder in the face of all of this. 01:08:54.684 --> 01:08:57.424 People's addiction to easy wins. 01:08:57.804 --> 01:09:02.544 But achieving is just that, and it's not even a win, But with an opportunity 01:09:02.544 --> 01:09:06.384 to actually put people first, we have to do that. 01:09:06.484 --> 01:09:10.284 And we know what that looks like. It's not rocket science. We have to invest in it. 01:09:10.684 --> 01:09:16.244 Otherwise, we don't. So, Annie, my last two questions. So, on the one hand…, 01:09:16.864 --> 01:09:18.004 You're not demanding, are you, Paul? 01:09:18.444 --> 01:09:20.584 No, not at all. I love the questions. Okay. 01:09:21.544 --> 01:09:29.424 So, look, do you believe humans will ever succeed in building sustainable collaborations, 01:09:29.944 --> 01:09:31.404 in this domain of global health? 01:09:31.504 --> 01:09:34.044 Is it even possible? Will we be able to? 01:09:35.484 --> 01:09:39.924 Yes, I do. Okay. That is my experience from the pandemic. 01:09:40.104 --> 01:09:47.284 I do believe, I mean, I look around and I see all these different connections 01:09:47.284 --> 01:09:49.004 and I'm grateful to them all. 01:09:49.064 --> 01:09:56.004 All these new colleagues and collaborations that have enabled, 01:09:56.004 --> 01:10:03.904 mood certainly have enabled me to try and do my best to help advance, to take part, 01:10:05.324 --> 01:10:08.704 in this endeavor. So I think it is possible. 01:10:10.244 --> 01:10:16.504 And maybe I am condemned by hope. But now, if you could change one thing in 01:10:16.504 --> 01:10:22.184 humans, let's say we give you the most advanced technology, you can change one trait of humans. 01:10:22.344 --> 01:10:26.124 What would it be so that they could achieve sustainable and sustainable collaboration. 01:10:44.839 --> 01:10:52.539 Well, I think this is the collision of homo economicus and, you know, 01:10:53.219 --> 01:10:54.599 very fundamental, you know. 01:10:56.019 --> 01:11:05.359 What is the other, you know, the human beings that can, 01:11:06.339 --> 01:11:11.179 that are able to cooperate and to overcome these global challenges is have to 01:11:11.179 --> 01:11:13.939 be able to put people before profit. 01:11:14.059 --> 01:11:18.879 So we have to give up our addiction to this money. 01:11:19.799 --> 01:11:25.439 I mean, recognising that there's a limit to capitalism and to this model of 01:11:25.439 --> 01:11:29.079 home economics, that means we can go so far down this model. 01:11:29.159 --> 01:11:31.399 If you carry that model to the natural end, well, then I'm sorry, 01:11:31.499 --> 01:11:34.299 you're going to kill so many people that you're not going to be able to make those profits anymore. 01:11:35.379 --> 01:11:37.519 We're not going to see big pharma 01:11:37.519 --> 01:11:41.119 change because drugs are the most profitable industry on the planet. 01:11:42.279 --> 01:11:49.779 So that's maybe why that's one trait that I think has to change if I could actually change anything. 01:11:50.259 --> 01:11:53.659 Okay. Annie Sparrow, thank you very much for this conversation. 01:11:55.239 --> 01:11:57.959 It's a pleasure. That was a pretty tough conversation, Paul. 01:11:58.139 --> 01:12:00.099 You're pretty demanding. 01:12:00.819 --> 01:12:05.939 Hi. You listened to one of our podcasts in the series on collaboration produced 01:12:06.179 --> 01:12:08.919 by the Ernst Trommel Forum and the Convergent Science Network. 01:12:09.579 --> 01:12:12.519 You can find more episodes on our website.