Good afternoon everyone, it is now officially 12.04 p.m. which is the official start time for noon conferences. My name is Peter Angelos for those of you who I don't know, it's a pleasure for me to welcome you to this first of the 42nd annual interdisciplinary lecture series of the McLean Center. This is something that my predecessor as the director of the McLean Center, Dr. Mark Siegler, started, as I said, 42 years ago and so this is now, you know, multiple iterations. I want to express thanks to the Bucksbaum Institute for Clinical Excellence that helped support the lunch today, which I hope you're enjoying, just fair disclosure, there won't be a lunch every Wednesday and so it'll be selectively during the course of the year. We will have a full lineup of speakers throughout the year and hopefully we'll be getting the entire series out to you soon, but just a special note to that next Wednesday the speaker will be Dr. Jim Weinstein who's the senior vice president for Microsoft Health who will be speaking about the ethics of AI, moral implications for society. So today it really is a true pleasure for me to welcome and introduce my friend and colleague, Dr. Shola Olapati. A couple words of introduction for those of you who don't know Dr. Olapati. He is a professor of medicine and dean for academic affairs in the biological sciences and Pritzker. Dr. Olapati completed medical school at the University of Ibadan, Nigeria, residency at Cook County Hospital in Chicago, and a fellowship training in pulmonary critical care and sleep medicine at the Mayo Clinic. Dr. Olapati rose to tenured professor at the University of Illinois where he directed clinical research in the section of pulmonary and critical care and sleep medicine for 19 years. He joined the faculty here at the University of Chicago in 2009 to provide leadership in the department of a global health program which has been successful and expanded from a department of medicine-based program to a university-based program. And he completed his clinical ethics fellowship training at the McLean Center in 2011. He's focused his research on global research ethics, the responsible conduct of research. Dr. Olapati is an environmental scientist who early on recognized the potential health risk of exposure to household air pollution, which was an under-recognized global health issue. His scientific research in Nigeria from 2012 to 2015 was the first to explore the potential health benefits of transitioning pregnant women from cooking with polluting fuels to clean fuels. And I'm sure he will share that and other important things with us today. Dr. Olapati's talk today is developing a global state of mind, a journey from the lungs to the placenta and early childhood development. So join me in virtually welcoming Dr. Olapati, who unfortunately can be with us due to illness. Sholan, thank you. Thank you so much for that generous introduction. I'm going to share my screen if I could make this work. Yeah, good afternoon, everyone. I was so looking forward to being able to do this in person. While I was heading home yesterday, I wasn't sure whether my allergies were acting up or whether I had a cold. Knowing that we live in COVID times, I just said, why don't I just check it? And it was positive, so that's why I'm home and doing this, but I actually feel okay. So what I'm going to be talking about, like Peter said, is looking at what I've done over the past 20 years and put it in context of the training that I got at McLean Center. And so that I don't forget to thank the people who have been generous in funding this work. I got this out of the way up front, Richard and Suzanne Kipat, Family Foundation, the United Nations, and then all the NIA for the multiple grants that have supported this work. And I know that Suzanne Kipat was supposed to be in attendance. She might be online. I can't thank her enough. She and her family for the generosity to my research program and also to the Global Health Program at the University of Chicago. What I'm going to try to accomplish today is to make sure that we, people who don't know yet, understand one of the most underestimated threats to human health and life expectancy and to also understand the unlimited possibilities of a global state of mind. And what I'm going to try to do through this presentation is to weave it through privilege, altruism, serendipity or log, equity, autonomy, justice, and utilitarianism, which is an idea that tries to maximize common good, which is what I've tried to do with my career consistently. You know, I've, those who went to medical school in this country know that post graduation, you have tons and tons of loans. I was privileged, just like for me, who is in the upper corner here. We were classmates in medical school before we came to the United States. We went to this wonderful institution for free. We didn't pay anything. We had no loans. So that has given us an incredible opportunity to do, to be in a good position. And since our young faculty days, we've always looked for opportunity to give back. So this might be the major driver of why global health has been such an important component of our academic areas for the past two decades. When I was a young kid, I grew up in a setting where I learned that charity begins at home. As a young faculty at the University of Illinois on the south side of Chicago, where my clinical and research work at that time focused on, on asthma. I was intrigued by the fact that on the south side of Chicago, a lot of African American patients that I saw had terrible asthma, whereas in reflecting on my education in medical school, we didn't see that much asthma. So based on that and the idea that I got a free ride from that medical school, wanted to go to Nigeria to test the hygiene hypothesis, its relationship to asthma. This was way before everybody started talking about the microbiome and the hygiene hypothesis for those who may not know presupposes that if you grow up in a setting where you are exposed to clean environment, you get vaccines, everything is clean. There's little for your immune system to do because there's no infection to fight. So that is usually simplistically an over expression of your TH2 phenotype, which is more allergic. And that pretty much if you do a skin test, you'll see that individuals who have that kind of clean existence are the ones who are going to develop asthma or any other atopy related conditions. By contrast, kids who grew up in settings, similar to what I where I grew up, where we played in the sand, if you are eating on your food drops, you picked it up and you edit. You didn't even give it any 30 seconds. You picked it up and edit. And I remember also in school when we were in lower school, they would come to school and periodically give us some of these deworming pills. Everybody took it. They just gave it to everybody that was in school because helminthic infections were very, very prevalent at that time. And it's a very potent stimulation of the immune system and the TH2, which you would expect to be an allergic phenotype. But if you do the allergy test and you'll find out that these kids would be seropositive for allergens, but then they would not develop much by way of allergic diseases. As a religious person, the way I looked at it is people have life that's bad enough with helminthic infection. Why would the good Lord punish them with asthma or allergic diseases? And if you look at it, this blockage here, there are many factors, but IL-10 seems to just block the expression of some of this allergic phenotype. So I was curious that that would be that was what was happening. So we went in there, we collected blood samples. We extracted DNA, looked at biomarkers of inflammation, CRP, did everything we could do and also went inside some of the homes to collect those samples to identify some of the environmental allergens that may be at play with the manifestation of asthma. The long and short of it was we did find out that hygiene hypothesis really does exist. If you get exposed to a dirty environment or even in this side of the world, if you get exposed to farm settings, we can see we know that that kind of early exposure sorts of prevents or reduces the risk of developing asthma. But the slide that I'm putting up here just reflects the potential opportunities to do global health, because little did I know at that time that the DNA that I extracted from my asthmatics in Nigeria would be the default DNA for the Kappa Consortium, which is a consortium trying to look for the gene for asthma in people of African ancestry. So the DNA from the Nigerian asthmatics was compared to African Americans in the US, different countries, I mean, different states from West Indies, from Brazil and from wherever every black people who are taking for slave trade. And you can see that it's been very, very impressive because a lot of these publications are in nature communications and nature genetics. But I'm just going to flag this particular this is what happens when I'm going to flag this particular this particular assembly of pan genome from deep sequencing of 910 humans of African descent. This study showed that the DNA from people of African descent that was the default had 10 percent more DNA than any DNA that's in any library that we know about. This kind of opportunity opens up possibilities to find found mutations that may be of interest to understanding other diseases, because I know in some parts of Africa, people have very, very strong bones. For example, we have a lot of problems with osteoporosis here. Similarly, people who live in the desert there, they have significant adaptation in the sodium chloride channel. So there's plenty of opportunity to actually find my incredible scholarly output from being open minded to doing work globally. And one of the observations from the Kappa Consortium, this is a work that's actually under review is that we've been able to identify using nasa epithelium. We've been able to look at identify sites of dysregulation for asthma risk that drives increase in TH2 inflammation, which is what atop is decreased capacity for wound healing and impaired drug response. And this may play a very important role in the understanding of asthma within African diaspora. And I'm sure if Fumi were here sitting here doing her own presentation, she could say the same thing for the incredible work that she's done in Nigeria and in Africa, looking at breast cancer in people of African ancestry and comparing them to African Americans on the south side of Chicago. So this opportunity to just think globally has been very, very important and influential in some of the work that I've done over the past two decades. So in doing the hygienic hypothesis work and trying to get inside the homes to collect just samples, this was the site that we found. You can see the people cooking in what one might even consider primitive ways with firewood. And you could see the walls, the walls are just black. And with a lot of pollution inside the homes. And you can imagine as a pulmonary person, I was just alarmed. And the question was, I went in there looking for atopy. The question was, is it really atopy? Asked, could this just be oxidative stress from being exposed and inhaling all of these toxic pollutants? So I came back because I had no idea how bad that kind of site was. And in looking at the global burden of disease, the shocker was when you look at ambient particulate exposure and household air pollution exposure, he accounted for number four and number five causes of the global burden of disease in 1990 ranking. By 2015, actually, after I started doing this work, you can see that ambient air pollution is still number five. With household air pollution still holding a significant number ten. I had no idea it was this bad when I was in Nigeria. But this observation has been the poking the road that's driven my academic career while still doing the asthma work. And I'm going to share some of this work today, thinking about it from the equity and justice perspective. If you look at exposure to air pollution, ambient air pollution, this accounts for at least three million preventable deaths every year. And if you add to the mortality or disability related to exposure indoors, it accounts for which accounts for another 2.9 million preventable mortality every year. That's about seven million premature deaths every year. And I had no idea it was that bad. And I don't know how many of you are tuned into the challenges of pollution related exposure. But I caught my attention. And if you look at places where this is the biggest problem, if you look at India, it accounts for about 920,000 deaths every year. The ambient exposure, if you add the indoor component, another 590,000 preventable mortality. Look at China. It's almost two million people, both from the indoor and the ambient exposure. This was something that was really difficult to walk away from. And if you look at Africa or the most affected countries in the world, if you look at Nigeria right here, about 125 million people, 75 percent of the population cook with on clean foil. And this accounts for 70,000 premature deaths every year in Ghana. It's about 10,000 every year Guatemala, 5,000. These are preventable deaths. And the common string for a lot of this bottom billion population is that they have energy poverty and don't have access to clean cooking foil. You can just turn on the light and it goes on just like we do here. And this is data from a colleague in the business school or the Milken Institute. You can see here, PM related mortality. When you look at life, yes, lost. It's about 2.3 years relative to tobacco. And all I want you to also pay attention to some of the more topical diseases. I don't want to play their importance, but if you look at HIV or safe water and sanitation, even alcohol, they pale next to the mortality and the mortality associated with particulate matter exposure. And what was most bothersome to me is that women and children who are less than five years of age, they have the brunt of the mortality related to the endopollution from cooking with unclean fuel inside their homes. If you look at the energy ladder or what I call the energy poverty in terms of what people actually cook with, if you look at high income countries, you can see we have access to electricity, gas, LPG, ethanol and methanol. I want you to look at the extreme, the value of low income. They cook with crop waste. Any dry crop waste is and don't is what people cook with low income. It's a combination of that wood and charcoal. I didn't know what cooking with don't was until I went to Bangladesh with one of our colleagues here, Habib in public health sciences.  Sometimes they put it on the back of trees so that when it dries up, this is what people cook with. And it's so disturbing in that they say, why is the exposure so dangerous to women and children? They say, picture is worth more than a million words. You can see the intimate proximity while cooking with these little guys in the backs of their moms. So little, so this makes it very clear why women and little children are the most susceptible to the mortality and mobility related to exposure to household air pollution because of energy poverty. And it doesn't matter whether you go to India or Bangladesh, poor people all over the world, they have the same pattern. And if we don't know about it, if we don't bring it to anybody's attention, nobody would know because we are so far removed from all of these challenges through the privilege that we all enjoy. So and when they talk about autonomy or community engagement and participatory research, haven't been alarmed by that observation. I wanted to work in one of the semi-o-ban or rural setting in Nigeria. And the first thing that I did was, you know, went to some of these communities. You can still I see had here on my head at that time, just to talk to them about some of these challenges and to let them know that we were interested in coming to explore how bad it is and whether we could walk together to protect them. And they were all alarmed because they had no idea. I mean, women were just there doing what women do for their families, cooking meals to keep their family alive and well. Little did they know that it was causing so much of the health problems that they had. And I recommend community engagement and participatory research for anyone because not only did they come up with ideas that made doing our work in this community very, very successful. They also participated in the research willingly. And each time we had to go back, they welcome us gladly because they know that we have their interest at heart because if we're not there paying attention to it, nobody was doing it. So at that time, the American College of Chess Physicians, they started this humanitarian award, of course. They wanted to fund people who had ideas of what to do with $25,000. And of course, I showed up and they gave me $25,000 to go and look into this problem that I just identified. On the right side is the rocket stove. I think at that time, before people knew how important this was, this problem was. This was about a $5 stove. And it's a stove that is lined with ceramic so that people could still hook with the firewood that they usually cook with. And because it's lined with ceramic, it can heat to such high temperatures and theoretically reduce the pollutants coming from it. What I'm showing here on the left side is we looked at particulate matter levels at baseline before people started cooking and one hour into the peak of cooking. And when you look on this side, this is $5,000, PM 2.5, $5,000. And the WHO standard is supposed to be less than 25. In fact, it's getting closer to 10 for someone to get a benefit from it. And what I want to point your attention to is that even before they start cooking, the PM level is already above the WHO standard, meaning that the circulation in those homes are so terrible that their stagnation and perpetuation of the indoor exposure, even when they're not cooking. And this was what we did at the peak of cooking. And then when I introduced this stove for them, it created near complete combustion. But you can see that there was a significant improvement in the indoor air quality. But with the mean still above 125, that's more than five times the WHO standard. It was still unacceptable, even though we had improved the indoor air quality. On this side is the carbon monoxide level. It gives you an idea of the tolerance of the human body to tolerate. I don't know that anybody would get exposed to this kind of carbon monoxide and not be dead. But you can see how high the carbon monoxide level was before and after the introduction of this rocket stove. So that made us feel very good at least that we were improving the indoor air quality in these homes. The other thing that we did, excuse me, as a pulmonologist, was we looked at the mothers and children who are older than six years old and did pulmonary functions, pyrometry in them. Nigerian women, most African women don't smoke. And if you look at it in the women, almost 40% of them had mild to moderate obstruction. And in the children, almost about 40% of them also had obstruction because you could see from the picture, they had such intimate exposure to pollutants coming from the cooking with unclean fuel. And if you look at a dose response curve, looking at HAB zone, which is really quite high, and you look at what we were able to accomplish by pulling this down to 125, you can see that we really, really were just at the top of the iceberg because people are still going to be subject to exposure that's going to have significant health consequences. In looking further in Nigeria, where I was going to focus continuation of this work, this is what the map of Nigeria is. And if you look at the prevalence of cooking with unclean fuel, mostly firewood, you can see that most of the northern and northeast Nigeria, that's what 75 to 80% of the population cook with. And they have indoor experience similar to the one that I just showed you. If you looked at the prevalence or incidence of adverse birth outcomes, you can see a near parallel between where people cook with unclean fuel and the high prevalence of adverse birth outcomes, meaning still births premature and low birth weight. So with that in mind, I was curious with respect to what is the mechanism driving this mortality that's so high. And thanks to one of my illustrious colleagues, Gokhan Mutlu, which done exactly the kind of work that I was looking for to understand what was going on. He had an animal lab setting where he was able to expose people to filtered air and particulate matter here. I don't know where he got this from Germany or something, that they sell air from Germany. Anyway, he was able to expose all of these animals to either filtered air and did some elegant studies to demonstrate that exposure to household air pollution creates a pro-thrombotic state. If you look at bleeding time, partial thromboclastin time, and also platelet count, you can see the control exposure to filtered air and to particulate matter. And you can see consistency that exposure to particulate matter was terrible. The other thing that was striking to me was that they looked at time to loss of blood flow in the coronaries. And you can see here that within a short period of time, the pro-thrombotic state was able to compromise blood flow. And unless you think that this is just a laboratory experience experiment, this is a study that was done in Europe. I don't know how they got permission to do this. But they looked at 20 men with stable coronary artery disease, some of them who had actually undergone coronary bypass. And they exposed them to diesel exist to the level of 300 microgram per meter squared of particulate matter and exposed them to filtered air and the diesel exhaust. And then I got them on this, did a stress test. What you're looking at here is during exercise, you expect the heart rate, of course, to go up and look at the ST segment depression during exposure to filtered clean air and to diesel exhaust, suggesting that the exposure to polluted air actually has a more immediate impact. In fact, the cardiovascular sequelae of exposure to household air pollution is a major cause of mortality and mobility. And for those of you who are historian, if you remember what happened to the colon version in the United Kingdom in 1952 about 4,000 people died within about 10 days when the PM 2.5 level rose to almost a thousand. A lot of them were asthmatics, but a significant proportion were cardiovascular related. With this in mind, I wanted to know what it would be like to actually do a randomized control study to transition people from cooking with this firewood or kerosene. Kerosene is a bad foil, but it was also been subsidized by the Nigerian government. So subsidizing on clean foil with adverse health outcome, at least from our hypothesis generation idea and giving them this incredibly nice stimulus still stove with ethanol, which is similar to what people who are rich cook with on their boat. So the idea was we would do this intervention and try to see whether we could look at pregnancy outcome in this group of women. This slide looks complicated, but pretty much what we did was we randomized pregnant women in the 16 to 19th week of pregnancy into either a clean ethanol stove or they continue cooking with either firewood or kerosene. And we did a personal exposure monitoring where they carried this very expensive monitor for about 72 hours. We also had a GPS monitor in there so that we could tell exposure ambient from indoor exposure. And then we did ultrasound six times during the pregnancy so that we could track intrauterine growth. And I did a lot of cytokine and on the data stress biomarkers, including blood pressure monitoring so that we could look at the impact of exposure this intervention on birth outcome. Halfway through the study, we also thought, what a minute, why can't we just look at the cold blood to be able to look at angiogenesis and hypoxia since exposure is supposed to be pro thrombotic. We were interested in looking, taking a quick, a good look at the placenta. That's exactly what we did because of time limitation. We've published all of this work, but higher levels of exposure to PM 2.5 accounted for more preterm significantly more preterm deliveries, miscarriages and stillbirths, reduced gestational age at delivery, smaller newborns, but not statistically significant. More disturbing was the fact that we were able to see histologic evidence of hypoxia in the placenta. And when we looked at biomarkers, we could also see increased level of hypoxia inducing factor, meaning that these children were actually developing in a hypoxic setting with the body trying to generate more oxygen capacity. When we looked at the placenta, we also saw dysregulated placenta angiogenesis where angiogenesis almost persisted towards delivery in an attempt to negate the placenta hypoxia. We were also able to see that TNF alpha was elevated from Dr. Mutlu's work. He found out that IL-6 was a major driver of this and its CNF alpha actually regulates the production of IL-6. So everything was just consistent with some of the observation and the work that Gokkan did in the lab. And more interestingly, the development of gestational hypertension, those that were in the kerosene or firewood group developed hypertension more than those in the control group. And without doing any other intervention with similar levels of blood pressure at enrollment, people in the intervention group actually had a significant drop in dastolic blood pressure. And if you put it in the context of hypotensive changes in pregnancy, this is really another unanticipated benefit. This is just showing here that if you look at people who are cooking with kerosene, 6.4% of them developed hypertension relative to a smaller number in ethanol users. Similarly, kerosene was a major driver of some of these hypertensive changes and preeclampsia being a major, major concern in low to middle income countries. So, because of the work that we, what we found with respect to the placenta, we were really intrigued and trying to figure out what to do. This is just what I'm showing you here. Histologically, when you want to define hypoxia in the placenta, you look for hope by ourselves, chronic vascular density, acetyl nuts. Galena in Fumis lab was very helpful in helping us to look at this histologically in the placenta. Group C here is a group of African-American women, thanks to Dr. Sarosh Reina who had placenta in African-American women that I was interested in comparing to Nigerian women. What you see here is significant increase in acetyl nuts, reflecting placenta hypoxia. This is in the unclean group. This is in the ethanol group. This is in African-American women who ordinarily shouldn't have any reason to have indoor exposure, but I'll tell you later close to the end why people on this outside and African-Americans are also annoyingly causing household air pollution, even though they have access to the cleanest of wealth. So any of the parameters that we looked at, we demonstrated the presence of hypoxia. By looking at some of these sophisticated staining, you can see that the more exposed the mothers were, these are electron microscopic work, we could see increased expression of hypoxia-inducing factor. So I haven't demonstrated the benefit of this intervention. I mean, if we talk about ethics, if people benefit from the intervention, what do you do to the control group? Luckily, we were able to actually ensure that all of the people who were in the control group haven't observed that it was beneficial. We gave this $60 stove to everyone and 81% of the participants on their own chose to adopt cooking and to start paying for ethanol. But the reasons they chose to adopt the ethanol had nothing to some of the medical reasons we were doing the research. They did so because this is a stove that made them feel as if they were in a higher socioeconomic class. It would last for about eight years instead of changing their regular stove every year. It also made them smell less of smoke after cooking, in addition to the fact that it allowed some of their children to stay with them while cooking. A shell that gave us the ethanol that we used for this study to my joy decided to do a commercial pilot of clean cook stove and ethanol in Lagos. Meaning that if we demonstrated that this thing was as good as it is to women and to protect developing children, they wanted to see how they could create a business environment in Lagos to make this available to people so that they don't cook with on clean fuel. What does the future hold for these children? I mean, I mean, I'm an adult pulmonologist, but the more I look into some of these challenges, I then found myself in the placenter and also working with young children. What we decided to do is since we had this child cohort, we have followed this same cohort of children, about 200 of them for the past nine years. And what we're currently doing, this is work that's funded by the NIEHS. We are looking at these children, looking at current exposure, whether they're in settings where they're still using pollutant cooking in their household or clean fuel and monitoring their personal exposure outside the, so that they carry this monitor customized for little kids to be able to carry them around. And so that we can have an idea of what they're exposed to. We also have data on indoor exposure and the ambient exposure. And what we decided to do is we were going to look at, we were going to look at cognitive development in early childhood to see whether the in-utero exposure to the hypoxic setting has implications for the growth and development of these children. So what we ended up doing is we're working with some of our colleagues and I need to give Michael himself from the Department of Pediatrics credit and Susan Duncan who are part of my research team. We decided we were going to use the Kaufman assessment battery for children to investigate sequential processing abilities, knowledge, learning ability, and planning ability. And to use the Vinland adaptive behavior skills to test communication, daily living skills, socialization, and motor skills in this cohort of children that we have. And the results are very sobering again too, but motivates us to keep looking for ways of making this problem go away. So in this simple little cohort, this is just looking at preliminary where we are and looking at almost 200 of these children that we've followed now for almost eight years. We have about 132 from households that are using clean stoves and 66 children from households using polluting cook stoves. And peak indoor levels were higher in households with polluting wells as we would expect. And we used a multiple linear regression to look at the differences to association between the exposure and neurocognitive ability while correcting for all of these factors. I'll show you the result which is really very elegant but very disturbing. We found if we retract to the KPC, I'm sure I hope the pediatricians who know more than I do understand the implications of this. A two-fold increase in peak personal PM exposure was associated with a significant 3.9 unit reduction in KBC2. When we looked at the mean PM exposure too, you can see this inverse relationship, meaning that the in-utero exposure and continued exposure of these children means that they're not going to be super smart down the road. And if you look at the other instrument, it's the same thing. If you look at peak indoor level, a two-fold increase was associated with a significant reduction in the VAB score. Similarly, when we look at the peak personal exposure, this one did not reach statistically significant, but the trend is quite obvious. And the message is true that if kids are exposed to this level of pollution early in life, it has implications for their cognitive development. And when we related this to the kind of stove that they were using, you can see that those that were using clean stove had slightly higher score, while those that are polluting little worse. And you have to put this in the context that ambient exposure in Nigeria is also quite high. So even though we're trying the best that we can do indoors, the ambient exposure continues to be a challenge. So our conclusion is that high-pex exposure early in life maybe associated with decrements in child neurocognitive development. And the stove type affects neurocognitive outcome. And this is the first study to look at this in a really rigorous manner. But then what next? Are we just going to fold our arms and publish and then walk away? No, we have another RO1 that's allowing us to look at an implementation science strategy working with the Lagos state government in about 32 local government communities to use an implementation science approach to look at exploration, preparation, implementation and sustainment to see how we can actually create an ecosystem where people can come in and create a business around making ethanol available or making some of these clean cook stoves available. And we are in the second year of working this program. And the idea is that hopefully we can encourage as many of these unfortunate households to be able to have access to clean cooking technology. Lest we think this is a problem out there, which is the problem that most of us have when we think about pollution. I'm sure most of us remember in the summer when the fires from Canada brought real high levels of pollution to the United States. I just focused on this particular day that was a particular day that it was much, much higher. So lest we think it's a problem out there, we need to start thinking seriously because everybody is at risk. And lest you think we're insulated, this is the result of another study that was done in six United States cities. It's called the six city Harvard study. This was published in 1993 where they followed people from Portage, Stubenville, St. Louis for 14 years to look at life expectancy. And to put it in context, the PM 2.5 level in the most polluted city, which is Stubenville, Ohio, was just about 40, much, much lower than what I just showed you when we had this problem in the summer.  So I just included this to let you know that all of us are at risk. And this is also work from the Milton Friedman Center here, looking at potential gains in life expectancy in some of the 10 most populated countries that includes the United States. And you can look at India, average life expectancy gain if only we can wrap our hands around ensuring that people are not exposed to pollutania. If you go to New Delhi, daily PM exposure level is in the 300, 400 range every day. If you look at potential gains based on all of this economic model, there's a lot we can do collaboratively to change the trajectory of our lives of people who are less privileged than we are. And the same thing in Africa, where a lot of the energy poverty continues to be an issue. Again, we have pollution threat to health and the tools to combat it remain on equally distributed worldwide. Central and West Africa is a growing pollution hotbed. South Asia continues as global epidemic for pollution and most Latin Americans are breathing air that I exceed the WHO guidelines. So all of us are potentially at risk. I'm going to tease you with this particular notion that being on the south side of Chicago is also just as bad as being in Nigeria. This was in 2018, where we actually because of the ability for us to look at indoor exposure, we can currently put indoor monitors in households in Woodlawn, Washington Park, Roseland, Orgette, Austin and in Nigeria. I think we did the same thing for Bangladesh. What I want to point your attention to is H3, which is Roseland. You know, even though they smoke, look at the level indoor exposure for PM 2.5, 1500, even higher than some of the households in Nigeria where people were cooking with. And you might wonder, why is the indoor air quality on the south side of Chicago 153, 111, 35 so bad. We live in a cold climate and poor people learn from their grandmothers that when it's cold and you have cold baths entering your household, you should turn on your gas range and as a way to supplement heat. So a lot of our African American colleagues, even though they work and have access to the thermostat, when it gets cold, what do they do? They are turning on their gas range to supplement heat. And if you look at the south side of Chicago, the Matala mortality rate and infant mortality rate is also one of the highest in the United States. So I just wanted to use this as the pattern slide to underscore that global health is also local health and anything that we've learned globally can be very applicable even on the south side of Chicago. In terms of strategies for the future, I have some of these parting questions for all of us. Will self-interest prepare us to engage meaningfully to protect ourselves from the predictable worsening of our environment and adverse consequences? Do we have a moral imperative to look out for the least privileged among us even when they are so far away from us? And is there room for an environmental justice mindset to protect everyone regardless of race, color, country of origin or income? This kind of work takes a village. I have collaborators here at the University of Chicago. I want to thank for me who convinced me to come to the University of Chicago to be part of developing the Global Health Program. It's a real outstanding colleagues from the University of Nevada. This extensive list of young people and a colleague from Michigan State University. Again, this is just want to thank all of them. This is just what the team looks like when we go to the field. Serious looking people. I'll stop here and take any questions that you guys might have.  You know, unmute. So now I can't even unmute myself in person. So that was wonderful. Thank you very much. And I know that there may be questions here. I'm going to start just by asking you one question, Shola, which is, you know, it seemed to me that the research insights that showed that this exposure to particulate pollution indoors had this impact on health and why not. I'm just curious about it seems to me that there was an additional, maybe you could tell us a little bit about once you identify there is this health issue, how do you then affect the policies locally to make the changes that happen? Because it seems like so frequently we see there's a realization that there is a public health risk. But then it seems like the change in policy takes decades before their substantive change, whereas it seems like changes that you were showing it seemed to happen more rapidly. Yeah, that's a great question, Peter. Because this study was in Nigeria and what people in Nigeria do is just what people all over the world do. So there's ongoing effort at the WHO level to extend some of these observations and the work that we do to all of these countries. But you have to understand that low to middle income countries, where the bottom billion people live, they have dysfunctional leadership. I guess I say that with Tongan chick because even here in the United States, I don't know that we are any better than them. But for Nigeria, especially where kerosene was being subsidized, I made a strong effort to share some of this report with some of my colleagues. I mean, we played cricket together, they were commissioners to try and see whether they could influence policy to take away the subsidy on kerosene and make sure people don't cook with it anymore. There's still kerosene available. They're still cooking with it. In India, for example, they've done a much better job. They have what they call this Ujwala program where they've decided to just go to some of these poor communities and replace their firewood with LPGs. They've done a fantastic job with this, but then they negate it because they have this festival of light where they burn everything and the PM levels again go above 1,000. So as they're trying to improve it, they have some of these traditions that make things. But seriously, the Kling Cooking Alliance through the United Nations, they're creating entrepreneurship around Kling Cooking to also have carbon credits available for households that actually adopt Kling Cooking technology. You get paid about $20 every year and in settings where people are living on $1 to $2 a day, that's substantial. So there's ongoing effort to look at carbon trade to create a small business enterprise. That's why I'm actually quite excited with the new R01 that we have, which is using an implementation science approach to distribute, work with communities to let them look at willingness to pay, willingness to adopt Kling technology. But the challenges are still quite high. And on our backside, actually started a similar project on the south side of Chicago to actually look at to replicate what we did in Nigeria. But then we ran into COVID at that time because I was trying to just show on the south side of Chicago that the habit of turning on the gas rain during the summer winter months, it's a major contributor and that would be very amenable to public service announcement. Because if we could show that some of these adverse bad outcomes are season log in winter relative to summer, then we could just go and tell people, we don't need to actually still do that. Now that people are sensitized that maybe the gas that we cook with inside has nitric dioxide, even without privilege, everybody is worried about NO2 in gas. So the indoor environment is a very, very important area of investigation that even those of us who are privileged now and have access to LPG, we're worried about the impact of NO2 on cognitive development and hypertension development and all of that. So yeah, we hope that policy and some of this, in fact, the one that gets me the most, it's the trajectory of some of these young people.  So they're not going to be economically great participants in economy, but I'm hoping that at least the pediatricians who know more than I do can do a lot more to rehab and make some of these young people have more fruitful and productive lives. Yes, Umi. The best. And yet, by the time patients come to us, it's all right in the future.  So to answer your question here, the policy begins when you go and community engaged work, sit in a ivory tower and expect our new people to help appreciate what's happening. So I'm glad that I'm focusing on such that we're just playing around in a real play as a hospital. But today, by talking to my homologous, I realized that in preventive oncology, we can't go out to the community to the community engaged work. And I think it's a moral obligation environment that we may not do any research at the University of Chicago without engaging our community. And I'm really grateful that the Auburn Health Initiative, a lot of work that the ITN is doing, all of us really think here about all of us beyond the terrarium. So you're going to get the data, or beyond getting the data we have on socially active in our communities to change our communities. And I think as the University of Chicago, we have to change the world. So for those of you who are going to the community, I'm putting it on the top of which, but again, it's really, I don't think we can go out and see this. Thank you. Other questions? All right. So that was truly wonderful. We're going to ask if you have just a few minutes to stick around to talk with the fellows. It'll be a little bit different, but we'll see if we can get this to work. But thank you all for coming and look forward to seeing you at future noon conferences. Happy to wait.


Hello everybody! This video is about recovering deleted photos or videos from an Android device. Dear friends, if you need to recover deleted data, use utilities by Headman Software. Follow the link in the description to visit our website, download a utility for free, and install it. Then start disk analysis. When the process is over, it will show the files available for recovery, and you will be able to bring them back. Our blog features quick guides to solve all kinds of problems faced by Windows users. Our channeling blog offers solutions for any issues from installing the operating system to remote administration and connecting mobile devices. Our specialists will be glad to answer your questions in comments to videos and articles. Nowadays, most Android gadgets come equipped with cameras capable of taking quite good pictures and filming videos. The capacity of smartphone internal memory or memory cards used to extend it have long exceeded the humble 16 GB. Now, a gadget with such memory size can store quite a lot of important data. In this video, we will have a look at how to recover lost or deleted photographs or videos from an Android device. There are many reasons why photos or videos can be lost from an Android device. Deliberate or accidental formatting the memory card, a virus attack, malfunctioning programs, system failures or hard cleaning of the memory in the struggle for more free space. By the way, we recommend watching a special video about cleaning the memory of your Android smartphone or tablet PC from junk files and unnecessary programs in a correct way. You will find the link in the description. Here is the first and the simplest way of restoring photos and videos deleted from an Android device, in case they were stored on a memory card. If they disappeared, take the memory card out of a gadget and connect it to a computer or a laptop using a card reader. In some cases, you can use the smartphone or tablet connected with a cable as a device to work with the memory card, but remember that data recovery software doesn't always see a memory card connected to the computer in such a way. And there are certain reasons why. As you can see, the memory card appeared in this PC folder. After that, download, install and launch Hetman Partition Recovery. Find the download link in the description. Click on this memory card in the left pane of the program window. During the analysis time, if you have deleted the file recently, fast scan will be enough. If you do it after formatting or a system failure, full analysis is much better. As you can see, the program has found the FAT partition of the card and all of the files, both existing and deleted. Now let's move to the folder from where the files were lost and see that the program has found them as well. If you can't see your photos or videos here, you can find them in Content Aware Analysis folder. They will be sorted into folders by extension. To recover your files, select them and click Recovery. Specify the directory and folder where to save the files and click Recovery button. Now the files have been recovered. Recovering photos or videos from internal memory of an Android device is no easy task. It's because gadgets with Android versions earlier than 5 could be connected to the computer as a USB drive. In this case, recovering data from the device memory would be easy, just as shown before with Hetman Partition Recovery. Beginning with Android 5, devices are connected by default as a media player via MTP protocol, and this is something you can't change. Now, recovering photos or videos from internal memory of an Android device will require Android super user rights or root rights, as well as active developers tools required to enable USB debugging. At the moment, I won't stop to tell about rooting an Android device. This is a huge topic for a special video. So if you need to recover photos or videos from the internal memory of your smartphone on Tablet PC, and this device is rooted, you can use such apps as Wondershare Dr. Phone for Android, Android Data Recovery or iSkysoft Toolbox for Android. It's not advertising. In fact, there are lots of such programs. So let's begin. In one of the programs, they are all based on similar principles. Enable USB debugging on your Android device Connected to the computer. As you can see, the program recognized at once. Choose the data type to be recovered and click Next. After scanning, the program will show photos or videos which it can recover. Select the ones you need and click Recover. If you don't have the opportunity to connect the smartphone to a computer, you can also restore your files using the smartphone itself. There are plenty of apps to do it on Play Market. However, all of them need root rights to work properly. Some of them offer the chance to recover data from a device without super-user rights, but the quality of their work will be much worse. As an example, let's have a look at an application called DiskDigger. After you start the program, there will be two ways of scanning the device. Click Scan without root and full scan, root required. Choose the scan type and the app will run it. You will see all files detected by the program. And you can start them by clicking on the cogwheel symbol. View properties of any file. And recover the selected files by marking them and tapping the Recover button. Select the recovery type and save the files. As you can see, it is not easy to recover photos and videos from Android devices. That is why it's better to prevent them from being lost. It can be done with special Android apps that work like RecycleBeans. There are many such apps and there is little to show about them. For example, let's take Dumpster. The principle of its work is very simple. Just install it, and all the photos, videos and other files or apps deleted from the device will be sent to the RecycleBean of this application. They can always be recovered from there. Talking of save storage for photos and videos in Android devices, we can't miss such service as Google Photos. This app will help you to set up automatic or manual synchronization of photos and videos from your smartphone or tablet PC with the cloud storage. They will always be stored there even after they are deleted from your device or memory card or even after you lose your device. You can access your pictures from the computer as well. When saving photos and videos in high quality, the storage size is not limited. If you save them in the original quality, the storage size will be limited to the size of your Google Drive to which this app is connected. Now the conclusions. Recovering photos or videos from internal memory of an Android device is no easy task. Android itself doesn't have this function, and that's why there are so many difficulties. You need to route the device and enable USB debugging, which is carefully hidden by the software developers. Android recovery programs often fail to restore everything from the devices in your memory. Things are completely different with recovering data from memory cards. For such tools as Hetman Partition Recovery, restoring data from any removable media is the primary function. That is all for now. Hit the Like button and subscribe to our channel. Leave comments to ask questions. Thank you for watching. Good luck.


Hello, everyone. My name is Bob Trug. I'm the director of the Center for Bioethics here at Harvard Medical School. I'm here today to interview Professor Arthur Kleinman, psychiatrist, anthropologist, Professor at Harvard University and Harvard Medical School, and to talk with him about his book, What Really Matters? Living a Moral Life Amidst Uncertainty and Danger. In this book, you tell stories about people who have faced danger and uncertainty with moral courage. So I thought we might begin by asking, what prompted you to write this book, and what did you hope the people would take away from reading it? Well, thank you, Professor Trug. Actually, can we just call each other Arthur and Bob? Yeah, sure. What prompted me in writing this was that my own life I had encountered experiences that I felt were about ethics in action or values in action. And I was looking for ways of thinking about that in terms of people's real lives that reset the terminology of ethics. And the way I came to think about that was that ethics was something we aspire to and that we use the great work of ethicists to help us understand. It was a search or quest for the universal or something broader than the local. But in the local worlds we lived in, clinics, wards, in our own communities, that this was something different. It was about the enactment of values, whether we were conscious of them or not, that occurred in part of groups. And in those groups, we might concur with or usually silently disagree with what the flow of values were. And then we would have dissonance between our own sense of what was right and what we were expected to participate in. And that's what I was really interested in. And that went back to the Vietnam War, where I was secunded by the NIH to a medical research unit in Taiwan and sort of disagreed profoundly with what I saw going on there in that unit and didn't feel I had much of a space for it. It also went back to my own training, both at Yale in internal medicine and at the Mass General in psychiatry, in which I felt that there was no space at that time for ethical issues. And that's one reason why, in spite of the fact that periodically I've critiqued bioethics, I really appreciate the central role of bioethics to legitimate a space to talk about, especially the moral. So the moral for me is the enactment of our values in our work and in our lives. So the title of the book is What Really Matters? But towards the end of the book, you reframe this as a question. You ask, what should really matter? And you talk a bit about that. And if I understood you, you're suggesting that what should really matter is facing up to our existential condition. And I wondered if you might say a little bit more about that. Yeah, so what really matters is my way of talking about people's sense of what's at stake for them in their local lives. And at the end, I felt, well, I should say, kind of what's at stake for me. And it is, I think, facing up to the reality of our world. So on the one hand, in American society, we have a Disney-esque sort of a dream world that we induct children into and we slowly grow out of. That's romantic and has happy endings and the like. And then most of life has lived not in that romantic dream world, but in the gray zone of everyday life, where you're not ever quite sure whether you're meeting up with an ethical challenge or resistance, just as some idea based on emotion or personality. And you're not always sure where you stand, I think. And so here I tried to argue that really at the end, as we emerge maturely in the world as full adults, we should cultivate a sense of what really matters to us in our lives. And maybe it takes a whole life in a sense to do that. And I've discovered in my own life that what really matters is being honest about human conditions. And the human conditions, I think, are on the one hand quite uncertain. We live in a world that's increasingly uncertain. Just look at the explosion of biomedical knowledge and our inability to negotiate this, even if we have an MD degree, let alone people who don't have that privilege. But also that there are dangers that we don't like to talk about. So you and I as physicians know that if we sat down right now, we could write out a thousand ways that people could die. And in fact, the great Scottish physician, Thomas Brown, said several centuries ago, I who have seen a thousand deaths, thank my God, I can die but once. And it seems to me that without attempting to induce hysteria or fear, I just want people to be honest about how dangerous our world is. And it's dangerous at the macro level, politically, economically. But it's also dangerous at the local level. Every time I, I used to have two offices at Harvard, one here at the medical school and one in arts and sciences. And when I was younger and chairing the department of what is now global health and social medicine was then social medicine, but was also in the anthropology department, I just had a zip back and forth. And it always struck me how dangerous it was to zip back and forth in Boston. Now Boston may be notoriously dangerous in this regard because of the lack of courtesy among the Bostonians when they're on driving and when they like to scatter the pedestrians. And it seems to me that if we're honest about how dangerous the world is, then it leads to a different formulation of things. Then we get away from rosy endings. Then we get away from sentimentality. Then we say, well, okay, Disney for small kids, but let's not propagate the myth later. Let's look at how tough it is to live a life and how courageous people are. And I think I agree fully with your use of the term in characterizing my book about moral courage. I think it takes courage to face up to one's condition, to be honest about the world we live in and yet not to be afraid of it.  I don't want people to read the book and be afraid of life. Quite the contrary, everything I've learned teaches me this wisdom, maybe with a small W, that if you face up to things, honestly, life becomes not only more tolerable, but more enjoyable and you feel more comfortable in life. You feel like you're not pretending, you're not denying things, but you're living in the world as a mature adult.  That's a, you know, a reality that 99.9% of Americans never have to deal with. And thank goodness in a way, that we have professionals who take that on. But I don't mean to make people feel paralyzed by this idea. I think that being aware of the dangers, being honest about them, and also about the uncertainty, leads to a kind of wisdom in the art of living. And that's what I want to do. I want to contribute to the art of living. And in this regard, I think ethics are enormously important because the medical ethics and ethics generally validate our quest for something beyond the local that we recognize no matter how fine an institution we're in and you and I are fortunate to be in a great institution. Nonetheless, on a constant basis, we feel frustrated and we disagree with perhaps with the flow of consensus et cetera on things. And we're privileged in our society and in our institutions to be able to step back and say, well, you know, I really disagree with this. And then I think it's a matter of being able to step forward and say, yeah, this is why I disagree. Speaking for all of us who were a part of your visit, it was so wonderful to have you for the public forum and also for the discussions that we had with the students. But I kind of wish you could have been a fly on the wall for the discussion that we had about your book before you came, because we went through each of the stories that you have and each one of them had moral lessons, you know, that we were deriving from them. So I would say to people who were out there who haven't read the book that the stories are fascinating in terms of the challenges that the protagonists face and the courage that they show in getting through them. And so we thank you for that. I also know that you have another book coming out shortly and I wonder if you might say a word or two about that. Yes, I have a book with Penguin books, which is a popular book called The Soul of Care, or at least that's the working title right now, which is about caregiving. Because when I look back across my professional life and my personal life, I see that caregiving has been a theme that's almost like a golden thread that is the spine of who I am and what I've done. And I think it's true of many people. And I feel that there is an undervaluation of the significance of caregiving. And that this is really one of the great examples of the moral glue that holds a society together and holds families together. It actually holds individuals together as we feel fragmented. One of the things that keeps us going and maybe even allows us in a small way to transcend our circumstances is the giving of care. I also realize that care is very difficult and time consuming, economically burdensome, and highly threatened today. Threatened not just in medicine, but literally in the rest of society. And so this book is about that, about the centrality of care, about the fear that we may be losing care, professionally certainly, but also in our everyday lives. And about what it would mean to revitalize care. Revitalize it in medicine, in medical education, in bioethics, making it more central to all of our themes. And I think that's something that since I'm 76 years of age and who knows how long I'll keep going on. If I have to go now, this would be the theme I'd like to go with. Oh, that's great. We're looking forward to that book. We're looking forward to reading it. And hopefully the opportunity to have you come back and talk with us about that as well. Thank you so much, Bob. Thank you so much, Arthur.


Hi, I'm Dr Mary Carr, Chief Veterinary Officer of South Australia. Farm Biosecurity is all the little things that producers do every day that prevent the transmission of disease onto properties and also disease spreading around properties. It's also a range of things that provide some assurance to trading partners that we know what diseases look like, we know how to report them and we have response policies in place. So, Australia's first line of defence is our border control. It's about preventing pathogens entering Australia. Unfortunately, this is never going to be 100% effective. We're always going to have to have a second line of defence and that's on-farm biosecurity. On-farm biosecurity was developed in partnership with industry, in particular LifeSoCSA. It's an online risk management program that helps producers manage, improve and promote their on-farm biosecurity practices. One of the biggest benefits from on-farm biosecurity is about having a productive and profitable industry. One biosecurity enables better informed purchasing decisions with buyers able to access credible and transparent checks for on-farm biosecurity practices and animal health management before and at the point of purchase. By showing we have really good biosecurity and data around what practices our producers undertake, we have a really good platform for providing assurances for market access. The other aspect of that is that it provides producers a risk management tool for preventing diseases coming onto their properties. It gives them a platform to actually think about the risk and to help make decisions about what they bring onto their property and also how to manage those diseases on-farm. Through stronger on-farm biosecurity, one biosecurity can make the industry less vulnerable to uncontrolled disease spread. So the online portal has two main components. One is a biosecurity planning component, the other is a disease risk rating. So for the biosecurity planning component, that will meet your LPA, your livestock production assurance requirements and the disease risk rating is a tool that allows you to describe your disease status for your individual property. The important thing about on-farm biosecurity is that we all get in there and work together on it. We need producers to work together, work with their agents and work with their processes to make sure we create a culture of engagement around biosecurity that will secure our future for the livestock industry going forward. Biosecurity is everybody's business. Let's work together to improve on-farm biosecurity. Sign up for one biosecurity online or talk to your local animal health officer.


Collegative properties have a lot of practical applications. One application that I want us to discuss is that of antifreeze. Antifreeze is something that you put in your car radiator to keep the water in the radiator from freezing in the wintertime. And to test your antifreeze, you use a little tester. This tester is calibrated in Fahrenheit, and if one ball floats, it says your antifreeze is safe to plus 20 degrees.   What we're going to do is to use a tester and test some sample radiators. And if you look at these, you think you may have enough antifreeze, but we need to test to see how safe it is. So let's start with this one. And what I'm doing is just pulling some of the solution up into this container right here.   So even though this is green, this radiator is not safe. In this one, one ball floats.


This paper analyzes international coal financing from commercial banks and institutional investors, revealing that financial institutions from the United States, Europe, and Japan play a significant role in financing coal plants globally, with some countries accounting for a larger share of coal emissions than under the commonly used territorial approach. This article was authored by Nicola Manic, Jan Christof Stechel and Michael Jacob.


The COVID pandemic has been pretty miserable for almost everyone, but one sector of society who definitely made the best of it a big farmer. This is an industry which was famous for price gouging during the AIDS crisis and getting millions of Americans hooked on opioids. It's now associated with the one tool capable of getting us out of the worst public health crisis in a century. COVID-19 vaccines. Companies like Pfizer and Moderna of course are not only doing this for PR to be associated with vaccines that rescue us from this pandemic, they're also making tidy profits from the sale of them. And it looks as if those profits are only going to keep on rising. That's because as the FT report both firms have this summer jacked up their prices. So the paper reports that Pfizer raised the price of its COVID-19 vaccine by more than a quarter and Moderna by more than a tenth in the latest EU supply contracts as Europe battled supply disruptions and concerns about side effects from rival products. Groups are set to generate tens of billions of dollars in revenue this year as they sign new deals with countries anxious to secure supplies for potential booster shots in the face of the spread of the highly infectious Delta coronavirus. They go on to write the new prize for a Pfizer shot was 1950 euros against 1550 previously according to portions of the contracts seen by the Financial Times. The price of a Moderna jab was $25.50 a dose. The contract show up from what people familiar with the matter said was about 19 euros which is $22.60 in the first procurement deal but lower than a previously agreed $28.50 because the order had grown according to one official close to negotiation. So it's that Moderna vaccine which is the most expensive but Pfizer well still expensive and only getting more so. The companies are able to command such high prices because they are the only two mRNA vaccines currently on the market and it's those mRNA vaccines that have proven to be the most desirable technology for the countries that can afford them in a few experiments or a few studies they've been shown to be more effective than the other vaccines on the market and having fewer side effects. You'll know all about AstraZeneca and that problem with blood clots for younger recipients of it obviously very very rare. We can see here the effect of that desirability of the mRNA vaccine in terms of revenue forecast for 2022. The FT is suggesting that those mRNA vaccines are expected to have a revenue of $85 billion of course they're more expensive so that doesn't necessarily mean more vaccines in total in contrast the viral vector vaccine so that includes AstraZeneca Johnson and Johnson and Sputnik are expected to generate $30 billion in revenue during 2022. Of course when it comes to countries like the UK when it comes to regions such as the EU or the USA governments are more than happy to pay these prices basically because lockdowns cost a hell of a lot more than $85 billion the bigger problem here I mean actually I shouldn't say that's not a big problem because we did fund them through public investment we are paying twice for them that's kind of annoying but it's manageable it's a much bigger problem for poor nations who can't afford them essentially they're not getting they can't afford those prices. What Pfizer say in response is they say look these high prices we charge these are actually only for those rich countries that afford them in fact because we charge these high prices in the west we're able to charge lower prices in the developing world and the chief executive of Pfizer told the FT that they would be providing jabs to middle-income countries at half price and to the developing world or to poorer countries low-income countries at cost that might sound good that might sound reassuring until you realise they aren't selling any vaccines to those low-income countries or not very many at all again we've got another graphic from the Financial Times you can see here that to high-income countries where they're selling vaccines at full price Pfizer have sold over $2 billion and to low income countries you see Pfizer here is that sort of royal blue to low income countries Pfizer have sold less than 200 million so say oh it's so generous we'll sell them at cost to the developing world we'll sell them at full price to the rich world but then they only sell them to the rich world so they only sell them at full price I say only obviously they are selling some to low-income countries but not very many. Ash this is a pretty neat trick isn't it you say don't worry we're going to charge low prices to poor people and then you don't sell any to poor people I mean look it's a way of managing some of the political fallout particularly around this issue of well I'll try that again particularly around this issue of intellectual property rights whilst also not having to do very much which is going to at the end of the day harm your profit margin and what this is resulting in is in some areas of the world dangerously low levels of vaccine coverage so when you look at the amount of vaccine bought up by North America by wealthy European countries you've got enough to cover the population you know not just once over but one and a bit times over so it's like 114 percent for Europe and I think maybe even 120 percent for North America you start comparing that to poorer countries to certain regions in Africa and it's as low as two three four five six percent right so you have this huge difference in available vaccine for those populations and look one the argument against that is that it's just inhumane profit shouldn't be put above people's lives the fact that intellectual property rights have been maintained at the expense of countries poorer countries being able to manufacture generic versions of this vaccine technology is of course a complete abomination right it is offensive to the notion of human dignity and that there are some things which are more important than making money but two if you have unvaccinated spots in the world well you increase the likelihood of the emergence of variants which ultimately endanger the efforts to lift lockdown restrictions over here in a rich country like ours so no matter what way you look at it even if it's from a purely selfish and self-centred perspective this is stupid it's not something which has got a long term or even medium term of view in mind but ultimately companies like Pfizer are able to behave in this way because of the relative weakness of governments if Pfizer if we wanted Pfizer to behave differently it would make it much more difficult for them to price gouge and restrict sales to poorer countries but we don't and I think what's what's become really really apparent over the past few months especially because at the beginning of the year when lots of people were saying we need to release the patents I think you should release the patents anyway but there was an argument to say that wouldn't solve the problem because the problem is actually the capacity that the world currently has there aren't that many factories which are currently going idle and so even if you release the patents they wouldn't necessarily be the capacity to make that many more vaccines on a very short time frame I think what the last few months have shown is that even if opening the patents wouldn't allow that many new vaccines to be created on a really short time frame even if it was in an 18 month time frame like there are many countries given the amount of boosters we're having given the amount of problems that different vaccine production outlets are having what this pandemic has shown once and for all is that telling developing countries to rely on the goodwill of the west and to rely on the goodwill of big pharma is completely for the birds Africa has been told we're going to provide you this many millions of vaccines via COVAX and none of them have arrived right some of them arrived but very few of them have arrived and that's because the factory which is in in India understandably they've said we're going to use all of those vaccines in India because we've got you know such a big problem and then Pfizer only want to sell their vaccines to to the countries where they can charge super high prices and AstraZeneca have had its own problems but basically what you need is you need to have an infrastructure in these countries so that they can rely on themselves because relying on the west is just not it's not working at this point in time obviously we should you know that takes a while we should just be giving billions and billions of vaccines to all the countries in the world but this idea that sort of like the liberal ruling class will will save sub-Saharan Africa has just been proven false in this situation now I mean I mean look you're completely right and not only is it a load of bollocks it also I think shows the model of crisis management that we're going to see as the climate emergency deepens so what we're seeing is that there is a thin veneer of western philanthropy which fits with our idea of what our place in the world is of oh look at you you poor abject melanated people we'll give you some scraps off of our table and our you know huge big pharma conglomerates you know our governments could feel really good about themselves and say we're doing enough to help these you know poor unfortunate souls whereas actually what's going on is that the reason why we're so relatively well insulated when it comes to vaccines is because it's built on a model of exploitation price gouging and also moving intellectual property and advances in technology which were developed in the public sector into private hands so actually you can't separate off the relative level of privilege though but also does mean a certain amount of vulnerability to predatory pricing mechanisms imposed by private companies but you can't really separate that from what's going on in the rest of the world now if countries like ours were to push forward with say with socializing lots of this technology and saying we're obviously going to put distribution and manufacturing over and above the ability to generate a profit while not only would it be cheaper for our government so it would also be better for the rest of the world but there's an ideological opposition to doing that so what we're seeing is a form of vaccine nationalism of course you know buy up all the stuff for richer countries and then we'll just give the crumbs off the table to the poorer ones and it is precisely this kind of model I think that we're going to see with the climate emergency which is we insulate ourselves through technology through our ability to fund infrastructure very quickly and for the rest of the world not only will we neglect our duty in terms of our contribution to emissions through outsourcing emissions right through buying from countries which aren't decarbonizing at the same rate as our country is but when dealing and looking at the kind of human cost of that particular kind of emergency we'll go well there's not much we can do to help you beyond this kind of quite you know flimsy and insulting level of philanthropy so what we'll do is we'll put our borders up and I think that it's you know we've talked a lot about borders on the show Michael and I'm with you I don't think that it's reasonable to have a full open borders approach to pandemic management you do have to restrict some levels of travel from hotspots to populations which have got low case rates however I think that looking at it also as a way of dealing with an inequality that a rich country has had a hand in shaping that's obviously not the politics that either of us would subscribe to but also it's immoral and it's deeply wrong but I think it is also something we're going to see as the climate emergency deepens we cause the problem we make it harder for poor countries to fix the problem and then our solution to the movements of people and human suffering is to put the borders up