Pandemic Planet

Katherine is joined by Jeffrey L. Sturchio, Senior Associate (Non-Resident) with the CSIS Global Health Policy Center and co-author of the new report, The Ending the HIV Epidemic in the U.S. Initiative: An Interim Assessment and Policy Recommendations. The EHE initiative began in 2019 with a goal of reducing new HIV infections by 75% by 2025 and 90% by 2030. However, thanks to limited funding and the diversion of resources during the Covid-19 pandemic, it is not currently on track to meet those ambitious targets. Jeff explains the various factors that could prevent EHE from achieving the 2025 and 2030 goals and shares examples of innovative, person-centered programs in San Francisco, CA and East Baton Rouge, LA that “meet people where they are” and create incentives for people to seek testing and stay on treatment. Jeff and Katherine discuss the importance of adapting lessons from global HIV programs, including PEPFAR, to the domestic epidemic and the opportunity to educate a new cohort of elected officials about EHE as the new Congress takes office in 2023. Jeffrey L. Sturchio a Senior Associate (Non-Resident) with the CSIS Global Health Policy Center, leading the work on the HIV portfolio. He is chairman and former CEO at Rabin Martin, a global health strategy consulting firm, and former president and CEO of the Global Health Council. Before joining the council in 2009, Dr. Sturchio was vice president of corporate responsibility at Merck & Co. Inc. and president of the Merck Company Foundation. He received a BA in history from Princeton University and a PhD in the history and sociology of science from the University of Pennsylvania.

Dr. Heidi Larson, co-founder of the Global Listening Project and founding director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, joins Katherine to discuss the impacts of Covid-19 on global vaccine confidence and the importance of listening closely to people’s stories to better understand how individuals experience and navigate global health threats. Prior to the pandemic, nationally representative surveys suggested that many people accepted routine immunizations, but the explosion of information and misinformation about new Covid-19 vaccines has led more people to question the value of immunization programs, and coverage has gone down. Social cohesion has also been negatively affected by the pandemic, with the World Economic Forum 2022 Risk Report showing a nearly 30% decline since early 2020. Noting that we have all experienced a kind of trauma over the past three years, Heidi argues that it’s essential to enable people to tell their own stories of survival if we want to prepare, as a society, for future shocks and crises. The Global Listening Project aims to capture people’s experiences and develop an index of public readiness that is informed by the public so that future interventions will be more relevant to people’s lives. Dr. Heidi Larson is a Professor of Anthropology, Risk and Decision Science and is the Founding Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. She is the author of STUCK: How Vaccine Rumors Start – and Why They Don’t Go Away.

In this episode, Katherine is joined by Dr. Jeni Miller, Executive Director of the Global Climate and Health Alliance, to discuss the ways in which a changing climate affects health outcomes, as well as the ways in which health professionals can work with those in other sectors to advocate for greater focus on the climate-health nexus. Arguing that a shared interest in health and well-being can unite groups that might otherwise hold opposing views on how to address climate change, Jeni points to progress in raising attention to health within global climate discussions and explains what she expects to see at the upcoming Climate Change Conference (COP27) scheduled to take place in Sharm el-Sheik, Egypt, in November. Dr. Jeni Miller is Executive Director of the Global Climate and Health Alliance, where she coordinates the joint efforts of national, regional and international health organizations addressing climate change. On behalf of the Alliance, Dr. Miller co-chairs the WHO-Civil Society Working Group on Climate and Health. In addition to her work at GCHA, Dr. Miller currently serves as Immediate-Past-Chair of the Environment Section of the American Public Health Association.

In this crossover episode with AIDS' Existential Moment, recorded during the International AIDS Conference in Montreal, Canada, on July 30th, Jeff Sturchio speaks with Dr. Mark Feinberg, president and CEO of the International AIDS Vaccine Initiative (IAVI). In this interview, Dr. Feinberg addresses the continued progress in HIV prevention and treatment seen in recent years and outlines the challenges still faced in translating this progress into meaningful impact on the lives of people affected by HIV/AIDs. Turning the tide against HIV will require a decline in new infections, which highlights the need for an effective HIV vaccine. Dr. Feinberg discusses the exciting and fascinating progress being made in research on broadly neutralizing antibodies and how the lessons learned from failed vaccine efficacy trials have informed new approaches that have considerable promise for enhancing understanding of how to design effective HIV vaccines. He also explains clearly and compellingly some of the basic biology that makes HIV such a wily and difficult adversary due to its genetic diversity compared to such other pathogens as Ebola and SARS-COV-2. New tools in such areas as mRNA delivery and computational biology are being brought to bear in the search for an HIV vaccine. Dr. Feinberg concludes by expressing his hope that the scientific challenges of HIV will continue to attract the next generation of creative young scientists. Mark Feinberg leads a global team at IAVI working to advance the development of vaccines and other biomedical innovations to protect against infection with HIV, TB, and other infectious diseases that have a disproportionate impact on low-income countries. Prior to joining IAVI in late 2015, Feinberg served as chief public health and science officer with Merck Vaccines. Dr. Feinberg holds an M.D. and a Ph.D. from Stanford University, and a B.A. degree from the University of Pennsylvania.

In this crossover episode with AIDS' Existential Moment, recorded during the International AIDS Conference in Montreal, Canada, on July 30th, Jeff Sturchio speaks with Solange Baptiste, Executive Director of the International Treatment Preparedness Coalition (ITPC). This is one in a series of podcasts in which we explore what needs to be done to end the AIDS pandemic, both globally and domestically. In this wide-ranging interview, Ms. Baptiste addresses the issues that are still creating barriers to equitable access to HIV treatment around the world. She contrasts the excitement at new developments like long-acting prevention tools with the persistent challenge of inequities in HIV care and treatment, especially in middle-income countries. She speaks eloquently of access as a human right and the importance of educating and empowering affected communities to take the lead in creating new solutions. Ms. Baptiste makes a strong case that the world won’t achieve access for all unless we tackle structural barriers and power imbalances – and redesign systems to address the needs of people living with or at risk of HIV infection. Solange Baptiste assumed her current role as Executive Director of ITPC in 2016. She leads community activists and allies across the globe to deliver ITPC’s mission to enable people in need to gain access to optimal and affordable HIV treatment through treatment education, demand creation, community-based monitoring, and interventions to make medicines more affordable. She earned her Bachelor of Science in Biology from Tuskegee University and her Master of Science in Population and International Health from the Harvard School of Public Health. Solange is committed to ensuring that the voice of affected communities contributes to and influences the decisions and policies that affect their lives.

In this crossover episode with AIDS’ Existential Moment, recorded during the International AIDS Conference in Montreal, Katherine speaks with Phelister Abdalla, of KESWA, the Kenya Sex Work Association, and Ruth Morgan Thomas, of the Global Network of Sex Work Projects (NSPW), about the intersection of sex work, HIV/AIDS, and the Covid-19 pandemic. Phelister and Ruth argue that sex workers’ livelihoods have been uniquely disrupted by recurring curfews and lockdowns, noting that this often-stigmatized community has not benefitted from the social protection programs many countries established to support workers in the formal sector from loss of jobs or income during the early phases of the pandemic. They highlight how sex workers have instead been at the forefront of community-led initiatives that deliver antiretroviral medications, food, and other essential health commodities to each other, and consider how the integration of HIV/AIDS response into pandemic preparedness and response may affect sex workers and the community people living with HIV. Over the years and across many international AIDS conferences, sex workers have fought for their experiences to be taken into account and for their voices to be heard within the meetings’ focus on policy and research agendas. Phelister Abdalla is the National Coordinator of the Kenya Sex Workers Alliance (KESWA) and the President of the Global Network of Sex Work Projects (NSPW), based in Nairobi. She is a single mother of three, and an active sex worker living with HIV for the last 11 years. Ruth Morgan Thomas is the Global Coordinator, Global Network of Sex Work Projects (NSPW). She has been involved in the sex industry for more than 30 years, including as a sex worker, an academic researcher at Edinburgh University, and a sex workers’ rights advocate.

In this crossover episode with AIDS' Existential Moment, recorded during the International AIDS Conference in Montreal, Canada, on July 31st, Jeff Sturchio speaks with Professor Alan Whiteside, Centre for International Governance Innovation Chair emeritus in Global Health Policy at the Balsillie School of International Affairs. Professor Whiteside begins with a discussion of new treatments and prevention tools for HIV/AIDS that offer the opportunity for those who have access to enjoy longer and healthier lives. But there are still barriers and challenges related to the social determinants of health that lead to persistent inequalities and make it difficult for some population groups (especially African women) to benefit. He calls for a focus on the “real issues that real people face” and for understanding the ways that power relationships and marginalization affect the health of people living with and at risk of HIV infection. He also discusses the interactions of the HIV and Covid-19 epidemics in recent years and the additional strains this has placed on health systems and the economics of the global HIV response. Professor Whiteside concludes with observations on the need for leadership and the power of communities in fashioning sustained responses to the impact of HIV/AIDS. Born in Kenya but raised in Swaziland (now Eswatini), Alan Whiteside is an internationally recognized academic and AIDS researcher. He was the founding executive director of the Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal and is also professor emeritus in the Wilfrid Laurier University School of International Policy and Governance in Waterloo, Ontario and editor-in-chief of the African Journal of AIDS Research. His most recent book is HIV & AIDS: A Very Short Introduction, second edition (Oxford University Press 2016).

In this crossover episode with AIDS’ Existential Moment, recorded during the International AIDS Conference in Montreal, Katherine speaks with Dr. Adeeba Kamarulzaman, immediate past president of IAS and the International Co-Chair of AIDS 2022, about the themes of this year’s conference, “Re-engage and follow the science.” Four years since the last International AIDS Conference took place in Amsterdam, Adeeba discusses the importance of bringing the HIV research, advocacy, and policy communities back together in a hybrid in person/virtual setting to rejuvenate the fight to end the AIDS pandemic. Katherine and Adeeba discuss the exciting new scientific breakthroughs announced at the conference, technical innovations during Covid-19 that that can be successfully applied to HIV programs, and the uncertain future of funding for global HIV/AIDS activities in a period when conflict, food insecurity, climate change, and pandemic preparedness efforts require increased financial investments, as well. Dr. Adeeba Kamarulzaman is former Dean of the Faculty of Medicine and Professor of Medicine and Infectious Diseases at the University of Malaya in Kuala Lumpur, Malaysia.

In this crossover episode with AIDS' Existential Moment, recorded during the International AIDS Conference in Montreal, Canada, on July 31st, Jeff Sturchio speaks with Dr. Michel Kazatchkine, Professor of Medicine at the Universite Rene Descartes in Paris, Special Advisor to UNAIDS for Eastern Europe and Central Asia, and a Senior Fellow with the Global Health Centre of the Graduate Institute of International and Development Studies in Geneva. Professor Kazatachkine reviews the interactions of structural determinants of health, stigma and discrimination, and punitive laws that affect people living with HIV and at-risk populations throughout Eastern Europe and Central Asia. He also discusses the remarkable resilience of people in Ukraine in response to the Russian invasion and outlines the health impacts of reconstruction both in Ukraine and among migrant and refugee populations in surrounding countries. Professor Kazatchkine reminds us that health and human rights involve political choices – and also offer political opportunities. If we hope to achieve an end to AIDS as a public health problem by 2030, we need to work with key populations and communities to deliver solutions that they need. Finally, Jeff and Michel discuss the prospects for long-term financing of the HIV response. We need to think differently about how to sustain programs in a multipolar world, particularly to address the needs of middle-income countries. Professor Michel Kazatchkine has dedicated more than 30 years to fighting AIDS and promoting global health as a physician, research, advocate, policy maker, diplomat, and administrator. Among his many other roles, he has directed the French National Research Agency (ANRS), the world’s second largest AIDS research programs; served as France’s global ambassador for HIV/AID and transmissible diseases; led the Global Fund to Fight AIDS, TB, and Malaria; and served as the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia.

In this crossover episode with AIDS Existential Moment, recorded during the International AIDS Conference in Montreal, Katherine Bliss speaks with Eamonn Murphy, Deputy Executive Director of Programmes at UNAIDS, the Joint UN Program on HIV and AIDS, about the agency’s latest report, “In Danger.” Sounding the alarm regarding faltering progress in HIV prevention and treatment over the course of the pandemic, the report calls for greater attention to implementing legal protections for vulnerable populations and highlights the particular challenges girls and young women have faced in preventing infections and accessing testing and treatment. Katherine and Eamonn also discuss the lessons that can be learned from countries that have managed to make progress despite pandemic-related challenges, and what opportunities the greater uptake of self-testing and use of digital communications technologies during the pandemic may mean for HIV services. Eamonn Murphy, Deputy Executive Director of Programmes, leads UNAIDS’ efforts in promoting an expanded and integrated United Nations system response to HIV at the country, regional, and global levels. Previously he was Regional Director for Asia and the Pacific, where he supported countries across the region in achieving the goals outlined in the United Nations Political Declaration on Ending AIDS as well as the Global AIDS Strategy.

Katherine is joined by Ann Keeling, Senior Fellow with Women in Global Health and lead author of WGH’s new policy brief, Subsidizing Global Health: Women’s Unpaid Work in Health Systems. Neglecting to pay women appropriately for their contributions to the global health workforce is not new. In 2015, the Lancet Commission on Women and Health estimated that women contribute $3 trillion to global health activities every year but that at least half of that labor is unpaid, with negative implications for women’s professional opportunities in the long term. Katherine and Ann discuss why women take on more underpaid or unpaid positions than men; how the stresses of the pandemic have created even greater challenges for this cadre of unpaid workers; and how making greater investments in female health workers could positively impact the quality of care they are able to provide. What happens when women in the global health workforce aren’t paid or supported appropriately? And what key indicators can be used to ensure progress is being made in making the global health workforce more gender equitable? Ann Keeling, WGH Senior Fellow, is a British citizen whose 40-year career in global health and social development has included posts in Pakistan, Papua New Guinea, Indonesia, the Caribbean, Belgium, the USA, and her home country, the UK. She held the post of Head of Gender Equality Policy with the UK Government and is currently the Chair of the NGO Age International.

Ted Chaiban, Global Lead Coordinator for UNICEF’s Covid-19 Vaccine Delivery Partnership (CoVDP), joins Katherine to discuss the state of Covid-19 vaccine coverage across the world; why some countries continue to struggle with low coverage, even as vaccine supplies have improved; and what steps need to be taken to ensure vaccines reach the most vulnerable. Out of the 34 countries that in January 2022 had Covid-19 vaccination coverage of below 10%, 23 have now surpassed 10% and 8 now have coverage above 20%. But while there has been impressive progress, continuing to support countries’ efforts to deliver the shots remains vital. How does CoVDP support in country Covid-19 vaccination programs and tailor approaches to their specific needs? What strategies work best to reach populations living in conflict-affected areas? And how can reaching people with Covid-19 vaccines help provide them with access to a broader suite of health and social services, as well? Ted Chaiban is the Global Lead Coordinator for COVID-19 Vaccine Delivery at UNICEF’s COVID-19 Vaccine Delivery Partnership. Most recently he served as the Regional Director for the Middle East and North Africa at UNICEF.

In this episode, Katherine speaks with John-Arne Røttingen, Ambassador for Global Health at the Ministry of Foreign Affairs, Norway. Whether it’s continuing to fight against Covid-19 through increasing equitable access to vaccines and therapies; understanding how the Financial Intermediary Fund fits into the global health funding framework; what the global response to Monkeypox tells us about the state of international cooperation on health; or addressing the threat of AMR, Ambassador Røttingen reminds us that investing in health security and pandemic preparedness is investing in a global public good. But what do global health public goods look like exactly? And what lessons can we draw from our experiences in managing Covid-19 that can inform the response to emerging challenges such as Monkeypox and AMR? John-Arne Røttingen is Ambassador for Global Health at the Ministry of Foreign Affairs, Norway. He is Adjunct Scientific Director at the Norwegian Institute of Public Health and Visiting Fellow of Practice at Blavatnik School of Government, Oxford University, and was the founding interim Chief Executive Officer of CEPI – Coalition for Epidemic Preparedness Innovations.

Katherine is joined by Doug Mercado, head of the area office with the World Food Program in Romania, which is managing the delivery and distribution of food supplies to vulnerable communities in neighboring Ukraine. The impacts of Russia’s invasion of Ukraine are felt internally, regionally, and globally, with agricultural production disrupted and access to food supplies limited because of damage to infrastructure and markets. At the same time, both Ukraine and Russia produce wheat and corn for the global market, but the conflict, along with sanctions on Russia, are limiting the distribution of grain globally and driving up prices. Doug's mission day to day? Bring food assistance to 6 million people inside Ukraine. This requires an expanding presence within Ukraine, establishing critical relationships with key institutions, ongoing support from donors, and negotiating with armed forces on the ground. Douglas Mercado is the Head of the Area Office with the World Food Program in Romania, and a guest lecturer at Princeton University’s Woodrow Wilson School of Public and International Affairs.

Two years later, Dr. Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations rejoins Steve for the second iteration of our Live From Munich mini-series. Dr. Hatchett reminds us that having just had a pandemic does not prevent outbreak from another, and that pandemic preparedness needs to be “viewed as a security challenge, not as a health challenge, not as a development challenge”. He points to lessons in vaccine manufacturing and financing arrangements that incentivize disease surveillance that can better prepare us for the next pandemic. “Many of the high-income countries see the value from a geopolitical and security perspective in making these investments. The challenge for the long term, obviously, will be whether these facilities can be successful, sustainable and be sustained.” Richard J. Hatchett, MD, is Chief Executive Officer of the Coalition for Epidemic Preparedness Innovations (CEPI).

Dr. Heidi Larson, founder of the London School of Hygiene & Tropical Medicine’s Vaccine Confidence Project™ and co-chair of the CSIS-LSHTM High-Level Panel on Vaccine Confidence and Misinformation, joins Katherine for this episode. The national security threats associated with low confidence in vaccines have changed in the wake of the Covid-19 pandemic, and we’ve seen growing polarization on regarding vaccine mandates, increased aggression towards scientists, the circulation of rumors and disinformation about vaccines on social media, and social instability. Groups that oppose vaccination requirements invoke terms such as “freedom” and “liberty” to emphasize the importance of individual choice when it comes to being vaccinated. But what happens when one person’s freedom harms the larger community? Larson explains that trust in vaccines is tied to trust in government and that a low level of trust in government is one of the greatest obstacles to improving the uptake of Covid-19 vaccines worldwide. Dr. Heidi Larson is a Professor of Anthropology, Risk and Decision Science and is the Founding Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. She is the author of STUCK: How Vaccine Rumors Start – and Why They Don’t Go Away.

In the fourth episode of our Live From Munich Mini-Series, Steve is joined by Tom Bollyky, the Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations. Mr. Bollyky attended the Munich Security Conference “to keep the conversation about the response to the COVID crisis still on the national security agenda”. National security and global health have been historically linked, as exemplified with the birth of PEPFAR. Could the war in Ukraine lead to a similar program for Covid-19? And what are the major obstacles in creating pandemic preparedness policy? Tom Bollyky is the Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program at the Council on Foreign Relations.

Two years ago, Dr. Jeremy Farrar joined Steve for the first iteration of Live From Munich, when the Covid-19 Pandemic was just emerging. Today, for the third installment of this Live From Munich mini-series, he returns to discuss this murky transition into the next stage of the pandemic. Dr. Farrar predicts that “political interest will wane from the pandemic because other events take over.” Politics are turning towards an exhausted, frustrated, even sometimes violent public. “We all feel fed up with this pandemic. But our emotional state doesn't determine the outcome of the pandemic.” We must be prepared for all scenarios, not just the ones we prefer. Dr. Farrar takes a lesson from the Munich Security Conference: “The truth is that the security community does this all the time. They think of a central scenario that is the most likely and they put most of their planning around it, but they do not ignore the other scenarios.” Dr. Jeremy Farrar is the Director of Wellcome Trust.

In episode #124, the second episode of our Live From Munich mini-series, Steve is joined by Seth Berkely, CEO of Gavi, The Vaccine Alliance, “the largest purchaser of vaccines in the world”. He speaks on strengthening health security: “Do we prepare for our hopeful future? Or do we prepare for reality?” “The right thing to do is to continue to prepare for worsening variants, worsening disease. And the best way to do that is to make sure high-risk people all over the world are as protected as they can be.” We are only as safe as our neighbors. Longterm, "it hurts the world if new variants appear, get the chance to circulate, and then jump out again, as we’ve seen.” Different vaccines have different advantages for various levels of infrastructure, and “we want to get countries to a place where they can say we have the right vaccine, in the right place, at the right time to meet the needs of our population.” “We’re fools if we don’t keep in mind that we have to protect everyone in the world.” Seth Berkely is the CEO of GAVI, The Vaccine Alliance.

Dr. Nkengasong, Director of the Africa CDC and soon to be head of PEPFAR joined us for this 123rd episode, and the first episode of our Live From Munich mini-series, a collection of episodes recorded at the Munich Security Conference. He is a leader in the initiative to incorporate global health in security discussions like the Munich Security Conference. “We have seen how an outbreak of a disease can truly be a health security matter, and also human security, as well as even going as far as a national security threat.” The Covid-19 pandemic has shown us “the need for us to look at the security from a human perspective”, that “we are more connected as humanity”, and “the inequalities that we thought existed are more profound within countries between countries and between region than we thought”. As North America and Europe begin this murky transition to the next stage of the pandemic, Dr. Nkengasong is concerned that we will “begin to refer to COVID as a disease that will soon be over in the US. And then of course, because of that, it becomes one of the neglected tropical diseases where we now have to rely on foundations or charity to take care of.” He recently called for a pause in vaccine donations: “we're saying that we have a lot of vaccines in the country. Now our problem is vaccination”. “I'm a big believer in that we should always pause to evaluate where we are in respond, and then make corrective actions”. How will Africa overcome its major challenge of vaccine hesitancy? “I think every good public health practice as you and I know is local. The concepts are global, but in practice is local, which means Africa must take his own socio-cultural context and deal with it and then find the touch points” Dr. John Nkengasong is the Director of the Africa Centers for Disease Control and Prevention, and has been nominated by President Biden to be the next head of the Office of the Global AIDS Coordinator in charge of PEPFAR, the President’s Emergency Plan for AIDS Relief.