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Brian Lehrer: Brian Lehrer on WNYC. When I first got vaccinated earlier this year, I briefly mentioned it on the show as I was making a point about COVID safety precautions at my local pharmacy where I got the shot. Now, I will mention, probably just this once, that I have now gotten a booster. The reason I mentioned it today is that there are several stories in the news right now, yesterday, and someone very recently indicating that as a talk show host, I'm apparently in a high-risk profession. At least it's high risk for those who go on the air and boast about not being vaccinated. Here's the newest story. This is from yesterday. This is the CNN version. It's all over the place.

Their headline is, Christian Television Network Founder and Preacher Marcus Lamb, Who Discourage Vaccinations, Dies After Being Hospitalized for COVID-19. That announcement came from his family. It says, "Lamb founded Christian Television Network, Daystar Television Network in 1997. He never talked about his diabetes," said his wife, "but he had diabetes. He kept it in check. He was very healthy. He ate healthy, kept his weight down, but with trying to treat COVID and pneumonia, the different protocols that are used, including many of the protocols we talked about here on Daystar, and we use those, and I use them and breeze through COVID," et cetera, et cetera.

Then it says, "Marcus Lamb often spoke out against the COVID-19 vaccines on his show. In an episode earlier this year, featuring anti-vaccine activists, Lamb said the COVID-19 vaccine was not really a vaccine but an experimental shot that was dangerous. Marcus Lamb alleged that people were dying or having neurological disorders from the vaccine." Well, he's now dead.

Here's another one. That's very sad, right? Even if the family is diluted or purposely spreading disinformation, I don't know which it is, but I certainly don't wish illness or death on anyone, but it turns out that COVID victim talk show host in that case was only the tip of the iceberg. Then I saw this story in The Boston Globe. Actually, it's a column to be precise by their columnist, Kevin Cullen, and the headline is, In the Last Three Months, Five Conservative Talk Show Hosts Have Died from COVID.

It goes on to tell some of the stories. Bob Enyart, the Denver-based host of the hilariously titled Real Science Radio show, made his bad-boy reputation by advocating for the death penalty for women who have abortions and like to read on the air the obituaries of those who died from AIDS, accompanied by the soundtrack of Queen's Another One Bites the Dust. Enyart was fond of telling his listeners, many of whom are opposed to abortion, that the COVID vaccines are made from cells harvested from aborted fetuses. "It wasn't true," writes Kevin Cullen, but that didn't stop Enyart from peddling misinformation, endangering thousands.

Enyart died of COVID in September at the age of 62. Then it goes on. Marc Bernier, talk show host from Daytona Beach who built himself as "Mr. Anti-Vax," died of COVID in late August. He was 65. Another Florida Bay talk show host, Dick Farrel, 65, who had also had a show on Newsmax TV, called the pandemic a "scamdemic" and described vaccines as poison. He died from COVID in early August. Within days of each other, Phil Valentine, a talk show host in Nashville who trivialized vaccines, and Jimmy DeYoung Sr., another conservative radio host from Tennessee, who bogusly claimed the Pfizer vaccine made women sterile, died from COVID.

If you're a talk show host making your living on denying the science behind the vaccines, you are apparently creating an underlying condition that will leave you at high risk of severe disease or death. A little media epidemiology that maybe other disinformation spreaders will take note of and protect themselves and their audiences. I hope so. Maybe that would even help protect the health of Republican Senator Ron Johnson of Wisconsin, who chose yesterday, World AIDS Day, to say this about Dr. Anthony Fauci.

Senator Ron Johnson: Fauci did the exact same thing with AIDS. He overhyped it. He created all kinds of fear saying it could affect the entire population when it couldn't. He's using the exact same playbook for COVID, ignoring therapy, pushing a vaccine.

Brian: Senator Ron Johnson on the podcast to Fox News host Brian Kilmeade. Happy World AIDS Day to you too. According to the United Nations, 36.3 million people have died of AIDS-related illnesses since the start of that epidemic. Another 37 million approximately are living with HIV today. According to the World Health Organization, 5,215,000 people who had COVID have so far died. It's around 1,000 people per day right now in the United States. I guess that's Senator Johnson's definition of hype.

With us now, someone with expertise in several of the relevant areas here. She is Dr. Wafaa El-Sadr from the Mailman School of Public Health. Sorry, I have her full ID here. She started out researching and responding to the HIV epidemic in the '80s at Harlem Hospital. In 2003, she founded the International Center for AIDS Care and Treatment Program or ICAP.

The global health center works to monitor, prevent, and treat infectious diseases like HIV in 30 countries, including parts of Southern Africa. She's leaned on her experience fighting HIV to address the coronavirus response here and the city and globally with Columbia World Projects as she is a professor of epidemiology at Columbia University's Mailman School of Public Health. Dr. El-Sadr, thanks so much for joining us. Welcome back to WNYC.

Dr. Wafaa El-Sadr: Thank you very much, Brian. It's a pleasure to join you again.

Brian: Have you also been overhyping COVID and HIV for a living, Dr. El-Sadr, like Dr. Fauci?

Dr. El-Sadr: It is actually quite distressing to hear these statements. I think for someone like myself who have been engaged in the HIV epidemic from the very beginning and have witnessed the devastation that it has caused both in our own country and around the world, it is very painful to hear the statements that you just read. I think at the same time, it's also as well to hear some of the same statements being made regarding the new pandemic.

Now, we have two pandemics at the same time globally regarding COVID-19 is equally distressing and alarming. The statements really fail to recognize the data that are available, the information that's widely available, and also people's personal experiences when they look around them and they've known somebody who's had HIV, they know somebody who's had COVID-19. To be able to ignore the evidence, to ignore this palpable impact on communities and families, in all honesty, it's just very difficult to understand.

Brian: Those AIDS and HIV numbers that I just gave, do those sound right to you? They'll probably surprise a lot of listeners with HIV and AIDS not so much in the news in recent years, but I want to acknowledge this because of World AIDS Day as well as because of what Senator Johnson brought up. 36 million have died in the 40 years or so of that virus and just as many people have it today?

Dr. El-Sadr: Yes, I think it's unfortunate that there's this misperception that the HIV epidemic is something of the past. It is not. As you said, more than 35 million people living with HIV globally. Still to this day, many of them may be unaware that they have HIV and, therefore, also may not have access to life-saving treatments we have now available.

Even in terms of new infections, we know just this past year, there were about 1.5 million new infections that have been identified globally. We still continue to have transmission in our own country as well as globally. This highlights, of course, the importance of continuing to highlight the fact that the risk from HIV and the available protective measures that we have now to make sure that people do not get HIV-infected.

In the United States, for example, of course, we've had remain and continue to have a huge impact of HIV, particularly amongst men who have sex with men of color, and also disproportionate in talking about women of color as well. In World AIDS Day, I think very importantly, we recognize the need to also focus on some of the disparities and access to HIV-related services, similar to what we're experiencing in terms of disparities and access to COVID-related testing and COVID-related vaccines and care as well.

Brian: I want to get into COVID in some detail with all these new developments in the last few days. The stat I saw on treatment for people with HIV is that of the 37 million or so people with HIV today, only 28 million on the life-saving antivirals that really changed the course of that epidemic. Does that mean that the rest don't have access to them or why that gap?

Dr. El-Sadr: It's a combination of factors. In reality, also some people are living with HIV, but they have not been tested. They're really unaware of their HIV infection. That's the beginning of what we call the cascade of treatment. You obviously have to first be get tested and recognize that you do have HIV, and then you need to, of course, access the services and, hopefully, the kinds of high-quality services that offer treatment and engage the population in ongoing treatment because we know that treatment for HIV is a lifetime treatment. People need to stay on treatment.

The efforts that are ongoing now are multifaceted. First, we need to get people who may not be aware that at risk for HIV may not have get tested for HIV because of fear of stigma and denial. They need to get tested and then they need to be guided and navigated to the kinds of programs that are really shaped and tailored to their unique needs and where they can get the treatment they need and where they also can get some of the other often supportive service that they need to start treatment and, importantly, to stay on treatment. This remains a challenging part of our country as well as globally.

Brian: Let me transition to COVID questions through the antivirals, that topic. So, so vital to allowing people with HIV to live long, productive, healthy, happy lives, a miracle when those came about really through medical research a few decades ago now. On the other hand, we now have approval recommended by an FDA advisory panel for the antiviral treatment from Merck for COVID.

With great ambivalence, even among most of those who voted "Yes," it only saves 30% of the recipients from severe illness or a death in the clinical trials and can cause genetic mutations that they're afraid could cause cancer or birth defects in some people or launch whole new mutations of COVID, and yet saving 30% of those treated could be a lot of lives saved. How do you see this Merck pill and would you have voted to approve it?

Dr. El-Sadr: Yes, I think the advisor committee genuinely struggled with this decision. I think for one important reason is that there's a desperate need for an oral medication that can ameliorate the effects of COVID-19. Just that you're aware that now we do have some treatments, but they require infusion. That makes it much more complicated to be available to people to take in their homes as well as potentially--

Brian: Right, that is the monoclonal antibodies that people have heard of as a pretty effective treatment for a lot of folks that's in the hospital. The Merck treatment is just a pill that you take.

Dr. El-Sadr: Yes, an oral pill that people can self-initiate and they can take and so on. That's very important. That's a big advantage. On the other hand, I think there are concerns. The effectiveness is not that high. It decreases the risk of hospitalization, severe illness by about a third, 30%. There's concerns about, as you said, some of the mutations, some risks in terms of mutations of the virus itself or potentially other adverse events, particularly amongst pregnant women who may not be aware that they're pregnant when they take this treatment.

I think this was a very, very tough decision. I'm hopeful that over the next several months, there'll be new antivirals, new treatments. I know that several of them are coming to the FDA that will have a better effectiveness, that worked better, but also they will have a more favorable-- what we call them more favorable profile in terms of not having these potential side effects.

Brian: Dr. El-Sadr, Omicron, the first US case is in a person in San Francisco who had traveled to South Africa and came back last week, double-vaxxed with the Moderna, their case described as mild. Do we learn anything at all from this variant or about vaccine effectiveness from this N of 1?

Dr. El-Sadr: I would say beware of taking any conclusions from an N of 1. It's what we call an anecdote. I just want to step back and remind the listeners that when new variants arrive, there are three things that we're usually concerned about. One is, is it more transmissible? Is it easier to be transmitted from somebody who has COVID to another person? Number two is, does it cause more severe illness? Does it result in more hospitalizations or more deaths?

Number three is whether this new variant actually may compromise the effectiveness of our vaccines or our treatments like the monoclonals, for example, or this new antiviral. That's what we worry about. At this moment in time, we really don't have firm answers on any of those three elements that I just mentioned. We don't have sufficient data to say that this is more transmissible or that it causes more severe illness or that it compromises our vaccines at all or our treatments.

I would say over the next several weeks and probably a couple of months at least, we hopefully will get more data. We will learn much more about the characteristics of this new variant. It's not unusual to get somebody who's vaccinated to get infected. We've known that even before Omicron, but what we already know from the data available is that people who are fully vaccinated, they're much more likely to have a milder illness and less likely to be hospitalized and more likely to survive, of course, and recovered from COVID. We're going to be watching very carefully the evolution of the data over the next several weeks.

Brian: Just know that we can take a few questions for Dr. Wafaa El-Sadr, MD, MPH. That's Master of Public Health, MPA, Master of Public Administration, chair of Global Health and university professor of epidemiology and medicine at the Mailman School of Public Health at Columbia University. 212-433-WNYC, 433-9692, or tweet your question @brianlehrer. This is WNYC-FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are New York and New Jersey Public Radio.

Dr. El-Sadr, President Biden today is announcing some new COVID strategies that's being reported, including requiring negative tests the day of traveling into the US, not the leeway of 72 hours as is the current case. He's also going to require insurance to cover rapid at-home tests. I'm really glad about this. We've covered the affordability question on the show recently. They're like $23 for each two-pack, which is a lot of money for most people if they'll need them regularly for work or school. Is he on the right track today if these reports are accurate?

Dr. El-Sadr: Yes, I think both of these measures are completely appropriate and the timing is good to put them in place. I start first with the rapid test. Absolutely, I think we need to make these tests more widely available. Of course, one of the critical challenges has been the price. I think that would be extremely helpful because then that will allow people to test more frequently and, of course, to test more frequently in the comfort of their home.

I think that's a very good advance. I think the other issue in terms of tightening up some of the requirements for incoming travelers are also reasonable and requiring a test within 24 hours prior to boarding a flight to get back to the United States will at least give some confidence that that individual is not, at that moment, infected.

At present, for vaccinated individuals, they're required to show with this within the past 72 hours, which then may result in a situation where they may be infected, but there's not sufficient virus there to be detected by the test. The closer you get the tests done to the travel itself, the more likely you are to catch an infection at that point in time. All of these are measures that are reasonable and appropriate to ensure, of course, the health of individuals themselves and prevent further transmission.

Brian: You have a lot of experience with HIV and AIDS treatment and prevention in Africa. I see you're originally from the continent from Egypt, right?

Dr. El-Sadr: Yes.

Brian: I heard an official from an African country yesterday say what's happening now is a cruel pattern of behavior by the mostly wealthy countries like in Europe and the US. We don't give them enough vaccines, creating the conditions for new variant like Omicron to emerge there. Then when it does, what do we do? We bar the people from their entry to our countries. Like we're creating this wealthy gated community of safety and then punishing them for the punishment we gave them in the first place of not enough vaccinations. Is that too harsh an analysis in your opinion?

Dr. El-Sadr: I don't think it's too harsh at all. Many of us have been saying this for several months now, is that we have to take very seriously our responsibility as wealthy countries with the resources we have in hand. We have to take responsibility for making vaccines available to less resource settings, to countries in Africa and elsewhere that cannot, at this point, secure their own vaccine doses. This is a moral responsibility, first and foremost, but it's also an issue of self-interest.

We know that wherever there's ongoing transmission, that's exactly the right situation where you're going to get the evolution of new variants, including Omicron, for example. It's the right thing to do, but it's also the right thing to do from the point of view of self-interest. I think, in many ways, these countries have been in a very difficult situation. The wealthy countries, what they did is once they knew these vaccines were coming out, they essentially were able to reserve a huge number of doses of these vaccines a priority.

It is very difficult for other countries to compete for access to large numbers of doses they need. We need to support these countries by providing enough doses now for their people. We also need to support them to get the doses into people's arms to get people vaccinated, to provide the healthcare workers with the training, with the resources to have their transportation systems, and so on.

Brian: Right, because that is a part of it, right? I have heard it said that lack of vaccination in Africa is not mostly from lack of supply, so don't feel guilty about getting your booster, but from lack of ability to get shots into arms with the medical infrastructure in many of the countries on the continent and maybe other related reasons. Sounds like you agree with that to some degree?

Dr. El-Sadr: I think we should be very cautious. These are the kinds of statements that we used to hear about the scaling up of treatments in Africa that somehow it's going to be difficult to get the medicines there. People are not going to come in to get treated. The healthcare workers don't know how to do it. We heard that before and we've proven them wrong again and again. I think we need to focus on both.

Certainly, there isn't enough supply. There aren't enough doses of the vaccine. At the same time, we also need to acknowledge that supply is required, but it's not sufficient, that there also needs to be the investments in providing the technical assistance, the sharing of expertise, of experience to enable these countries once they get sufficient supply of vaccines to enable them to get these vaccines to the people who need them urgently.

Brian: Let me get one question in for you from a listener before we run out of time. Nel in Manhattan is going to get that honor. Nel, you're on WNYC with Dr. Wafaa El-Sadr from Columbia's Mailman School.

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Brian: Nel is listening on delay, so I think now Doug in the Bronx is going to get that honor. Doug, you're on WNYC. Real quick.

Doug: Okay, thank you very much. My question relates to before the vaccines came into existence even and now. The vast majority of people never get infected no matter what their lifestyle. Also, even of those who show positiveness or are infected supposedly, the vast majority of them or at least the majority of them do not have any symptoms, do not get sick. What's the explanation if there is one?

Dr. El-Sadr: I think what we've noted, and this has been noticed for quite a while, is that when people get infected, the manifestation of this infection can vary substantially. You're right that what's unique about this virus is maybe about half of people who get infected do quite well. They don't have symptoms and they do well.

However, that doesn't mean that we should all not worry about an infection because we know at the same time that in certain populations like older individuals, people who have other conditions like cancer or hypertension or diabetes or heart disease, whatever their age might be, and people who have lung disease and obesity as other examples, that such individuals are much more likely to get very sick from COVID-19. That's really why it's important to prevent and to suppress as much as possible the spread of the infection in a community in order to do so.

Brian: I don't know if this is where the caller was going ultimately or what he was implying in this case, but this is one of my favorite anti-COVID propaganda disinformation, junkie myths to bust. People have called the show and said, "You know, only 1% of people who get COVID die from it, so why are we turning our world upside down?" My answer and then you give me your answer because you're really in this field for a living and then we'll be out of time.

My answer is yes, but it's so widespread. 100,000 people are being diagnosed with COVID every day in this country right now. Yes, 1% of them, only 1% of them die. What does that mean? That means 1,000 Americans are dying every single day from COVID because the percentage is small, but the number of cases is so huge. You're going to minimize COVID over that stat when that stat is so misleading. Anyway, that's me on my high horse. Dr. El-Sadr, say anything you want as we wrap up this segment.

Dr. El-Sadr: I agree with you completely. 1% is quite high actually. As you dissected it, you can see the impact because the large numbers of people who are getting infected. We know that vaccines also not only protect the individuals getting vaccinated, but we have evidence that the vaccines actually may decrease the potential of transmission of the virus from somebody who is infected to their loved ones. I think there's benefit to the individual that's been proven beyond a shadow of a doubt from vaccination and there's also benefit to their loved ones and to their community from them getting vaccinated.

Brian: Dr. Wafaa El-Sadr, professor of epidemiology and medicine and chair of Global Health at the Mailman School of Public Health at Columbia University. Thank you as always.

Dr. El-Sadr: Thank you.

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