01/01/21 01/01/21 [captioning made possible amy: from new york, this is democracy now! >>e need a vaccine that everyone can have free of charge, no matter where you live or whether you are rich or you're poor. we need companies to share all their search so we can make enough safe vaccines for everyone. we need a vaccine owned by all of us. amy: while the united states, britain,

and other wealthy nations race to vaccinate their populations, a new report finds as many as nine out of 10 pele in dozens of poorer countries could miss out on the vaccine until at least 2022, because wealthy countries have hoarded enough doses to vaccinate their entire populations between three and five times over. we'll look at the growing movement to develop a people's vaccine. then we speak to one of the world's leading infectious disease doctors, paul farmer, the co-founder of partners in health. >> we are facing the consequences of decades and decades of underinvestment in public health and of centuries of misallocation of funds away from those who need that help most. amy: dr. paul farmer will ta about the pandemic, healthcare and equality, and his new book "fevers, feuds and diamonds:

ebola and the ravages of history." all that and more, coming up. this is democracy now!, democracynow.org, the quarantine report. i am amy goodman. as the united states, britain, and other nations begin unprecedented mass vaccination campaigns to combat the covid-19 pandemic, other parts of the world may not have access to vaccines for months -- if not years. a new report finds as many as nine out of 10 people in dozens of poorer countries could miss out on the coronavirus vaccine until at least 2022 because wealthy countries, including the united states, have hoarded enough doses to vaccinate their entire populations between three and five times over. the report was issued by the people's vaccine alliance, which includes amnesty international, frontline aids,

global justice now, and oxfam. this is winifred byanyima, executive director of unaids, in a video produced by the people's vaccine alliance. >> huge pharmaceutical companies are keeping the vaccine research a secret. they're deciding how many vaccines get made, how much to charge for them, and who gets vaccinated. this will no doubt leave billions of peopleehind. pharma companies are putting profit, not people, first. yet billions of dollars of taxpayers' money is funding their work. we cannot let the ceo's of a handful of pharmaceutical companies decide our future. we need a vaccine that everyone can have free of charge,

no matter where you live or whether you are rich or you're poor. we need companies to share all their search so we can make enough safe vaccines for everyone. we need a vaccine owned by all of us. to end this covid-19 pandemic, we need to pull together once more. amy: that was the unaids executive director winifred byanyima part of the people's vaccine alliance. the world health organization has also warned about the inequitable distribution of the vaccine. this is who director-general tedros adhanom ghebreyesus. >> we simply cannot accept a world in which the poor and marginalized are trampled by theich and powerful in the stampede for vaccines. this is a global crisis, and the solutions must be shared

equitably as global public goods, not as private commodities that widen inequalities. amy: in early december, democracy now!'s juan gonzalez and i spoke to two guests about the calls for a people's vaccine' dr. mohga kamal-yanni joined us from oxford. she is policy adviser to the people's vaccine alliance. she has worked for decades on access to medicines and healthcare in developing countries. achal prabhala joined us from bangalore, india where he is coordinator of the accessibsa project, which campaigns for access to medicines in india, brazil, and south africa. he recently co-authored an op-ed published in "the new york times" headlined "want vaccines fast? suspend intellectual property rights." i asked dr. mohga kamal-yanni to talk about the call for a people's vaccine.

>> well, the people's vaccine is a coalition of organizations like amnesty, frontline aids, glob justice, oxfam. it's co-led by oxfam and unaids. and it has so many people, you know, academics, health activists, health experts, ngos, patient groups, from all over the world, united for one aim, which has a people's vaccine, not a profit vaccine. so we want aaccine -- basically, we're calling for vaccination that is available for all people at risk, and then for everybody once we have enough des, t not the way it's happening now, where if you happen to bborn in a riccountry, you get the vaccine. if you happen to be born in a poor country, you don't. and yesterday in the u.k., they started vaccinating older people,

and there was some clapping. and, you know, it was a lot of joy. and, of course, it's brilliant, you ow, that there is hope that this problem that we're all suffering from will be -- you know, the's a ght at the end of the tunnel. wever, that joy is oy mited to people living here. i've g friends and relatives and people that i work with in other countries, in developing countries, who are saying, "yeah, and what out us?" and yeah, what about them? so this is really a big problem. there's just smany -- it's nd of dividing the world between those who have and can pay and those who don't and can't pay. and therefore while you can stand in the back on the queue. we don't know when you can get the vaccine. and that is just not right. it's not right on moral grounds. it's not right on public health grounds because everybody is saying, "nobody is safe until everybody is safe." yeah, ok.

how do you make everybody safe? so a vaccine nationalism will not get you to everybo safe. and also, on economic ground you're not going to get the economy growing at just 1 -- or back to normal, if one country vaccinate its population and the rest of the world isn't. you can't trade with people who arsick or people who have a high level of infections. so, you know, it just doesn't make sense at all. the other important point is that this is not kind of fact of life that, oh, we have limited amount of vaccines. actually, that's nothe case. there are other options that will enable the world to produce more vaccines, and therefore, vaccinate more people. basicay what ihappening now, if you can imagine that we have a small pie -- so that's one vaccine, a small pie. and so, basically, the rich can have the bigger share of it, and then we'll have just crumbs left for developing countries.

well, the idea is that, why don't we increase supply so everybody can have a decent share of it, rather than fighting on a little one? juan: well, dr. kamal-yanni, i wanted to ask you about the astrazeneca-ford vaccine and how access to that vaccine may be more equitable at this stage. could you talk about some of the agreements that the astrazeneca has reached with the coaliti for epidemic preparedness innovations and gavi, thvaccine alliance? >> well, basically, i mean, this vaccine has been developed by oxford university. oxford university has a standard on managing intellectual property. and it actually talks about en license. however, when they did the deal or the contract withstrazeneca, it became exclusive license for astrazeneca. but they managed to put some contions in the contract

about making the vaccine accessible to developing countries. so astrazeneca went to one of the big vaccine producers in india, the sem institute, and made an agreement to produce 1 billion doses, so that's vaccinating 500 million people. half of them will be in ina. so it's a good way -- you know, good start to make more vaccis availae. th also -- astrazeneca also has some agreements with other counies, like with argentina and brazil, so that may cover a number of people in latin america. but what about the rest of the population? there are some other deals with countries, but not production as such. you know, you can't leave -- you know, so, astrazeneca, compared to others, yes, they've done good things and also fixing the price as -- well, astrazeneca said $4 per dose and serum said $3 per dose.

for developing countries, it will be probably $3 per dose, so $6 per urse or r person but the thing is, you can't leave -- this is the whole -- you can't leave the decision on supply, price, which country, which patient, to companies. that's not their job. their job is to produce. and the job of governments is to make more production, so you have to enable other producers. like in india, there's other producers. other counies would have other producers. so if you allow technology transfer, so sharing technology -- which the technology byhe way, a lot of it has en deloped by public money, including from the u.s. and the u.k. and europe and otr countries. so allowing the sharing of technology and removing the intellectual property barrier, so npatenton vaccines, then other companies can pduce the vaccine d we have more.

and just like astrazeneca did this contract with serum, that includes, presumably, technology transfer or some technology transfer, that can be done on a multilateral level, on a bigger level for more companies. because all these deals, by the way, they're all secret. you don't know what's in it except what they announce, rather than if you have a multilateral agreement, you don't -- you know, the negotiation happens in closed doors but then once they agree a license, then it's public. then you see what's good and what's bad about it. amy: i wanted to bring achal prabhala into the conversation, again, coordinato of accessibsa project, which campaigns to access medicines for india, brazil, south africa. this piece you recently wrote in "the new york times," "want vaccines fast? suspend intellectual property rights." you're joining us from bangalore, india.

can you talk about what that would mean if you suspended intellectual property rights? talk about trade secrets. talk about patents. talk about government subsidies of these private companies. and how does what's happening now, the development of this vaccine, compare to people's access, for example, to the flu vaccine, how that was developed and financed? >> thank you, amy, firstly. it's great to be here. and thank you for having me. the piece that we wrote in "the new york times" was geared around an event that's unfolding this week and the next. it doesn't look like it will get resolved anytime soon or successfully, but that event is a proposal that south africa and india made at the wto, at the world trade organization, to temporarily suspend a trade rule called trips, which is an agreement on trade-related aspects

of intellectual property, the supergovernance of intellectual property worldwide, which the wto takes up. and the reason india and south africa suggested that all member countries of the wto should be exempted from provisions of trips is so that everything that we require to survive the pandemic -- the masks, the test kits, but now especially the vaccines -- should be free to be made in as much capacity as possible to get them faster and cheaper to as many people as we can around the world. there is an overwhelming support from developing countries for this proposal, but the wto works on consensus, which means that even if five or six very rich countries oppose the proposal, it actually won't pass. and that's exactly what's happening. the u.s., the eu, the u.k. and a few other rich countries, as well as, inexplicably, brazil,

have opposed this proposal and are stalling it, which means that it's unlikely to go through without a fight. now, the irony of the fight having to take place this week is there's really good news out of the u.k. there's also really good news out of science. and personally for me, sitting in india, i wish i could share in that good news with the same spirit of cheer and celebration. i saw a moving interview with a 91-year-old called martin kenyon in london, who called his hospital, said, "hey, i heard you had vaccines." they said, "yes, come on over and get one." he walked over and he got a pfizer vaccine, the first dose of a pfizer vaccine. and he's looking forward to hugging his grandchildren this christmas. and it's a beautiful, touching story. the problem with that, that pfizer vaccine, over 90% of its supplies, untithe end 2021 --

so that means for the next 13 months -- have been sold out to a handful of rich countries, to the u.s., to the eu, and to the u.k. there's actually no way that anyone in india or anyone anywhere outside these rich countries is going to get their hands on one of these vaccines for love or for money. they just don't exist outside of very few number of rich countries. that's kind of amazing to live through in 2020. i've been campaigning for access to medicines for a long time. but my father had covid. he's 87 years old. my mother is 72 years old. i definitely would like them to have a vaccine and get one fairly quickly. the prospect of these vaccines being unrolled without any possibility of a majority of the world getting them is genuinely heartbreaking. and that's the anger that partly prompted that piece.

the irony, of course, is that this is such a dramatically different situation from the 1950's when the flu vaccine was developed by jonas salk, who, of course, famously said, when asked by ed morrow about whether he was going to patent his invention -- he said, "ha ha ha, can you patent the sun?" and it's a heartbreak -- it's a beautiful moment. it's a really beautiful moment. and -- amy: and that was about the polio vaccine. >> i'm sorry, that was about the polio vaccine. that's exactly right. and that's about the polio vaccine. the tradition of jonas salk, however, does continue with the flu vaccine that we all take. that flu vaccine is developed at a unit of the who, which it's called informally the flu network, and formally the global influenza surveillance and research systems. it's a collaborative infrastructure

that they've set up at the who that involves 110 different countries, 130 different laboratories, which pool information on what strains of influenza are circulating in their countries. that information is collated. and every year, for two different flu seasons, in the northern hemisphere and the southern hemisphere, the who then releases what would be called the formula for the flu vaccine, which then anyone anywhere can produce because it's completely free of any proprietary intellectual property or monopoly, which means that billions of people have taken it since the 1970's based on this cooperative, shared system of pooling knowledge, as well as finances. and that's created a very robust infrastructure for the production and consumption of these flu vaccines. and it's a great success. it is, unfortunately, exactly the kind of thing that's not being replicated with the coronavirus vaccines.

juan: well, achal prabhala, i wanted to ask you, in terms of the refusal of these handful of rich countries to allow the suspension of intellectual property rights at the wto, what is their argument? given the enormous worldwide crisis that we're functioning, how do they defend this? and what could possibly be done to overcome this resistance? >> i wish, actually, sometimes that people would be honest and upfront and say, "look, we actually care about these corporations more than global human life. we're actually fine with a certain number of usually poor people dying for a lack of access to these vaccines as long as the companies and the industry that makes them survives." i'd be willing to listen to that argument because it at least would be honest. what happens instead is that the arguments that are advanced are, a, that it's not a problem.

to say that it's not a problem ignores 20 years of human history, where millions of people died because of lack of access to monopoly drugs for aids and then did so again for lack of access to drugs for cancer and then did so again for lack of access to hepatitis c drugs -- and, by the y, are doing today in the united states for lack of access to insulin, which is, again, patented, for lack of access to prep for aids, or for a lack of access to cystic fibrosis drugs in the u.k. so it's to deny reality. but the logic that's advanced is that the innovation system requires these monopolies to exist in order to reward private pharmaceutical corporations for taking big risks with private money -- except for the fact that that's not what's happening here. it's never happened, but it's never happened as starkly as it is not happening in the pandemic. moderna, which is just one of the vaccines that posted successful results a couple of weeks ago,

has admitted, by its own -- in its own financial reports, that 100% of its vaccine development project was funded by barda, by warp speed and the u.s. government, u.s. taxpayer money. on top of that, it's been given preorders of another 1.5illion from the united states and another substantial amount of money, nearing about a billion, from the european union. every other vaccine, from pfizer to astrazeneca, also has substantial government money. german taxpayer money of up to $445 million went into the pfizer vaccine. astrazeneca received huge subsidies through public money from the united kingdom through its early development at oxford university. all of these vaccines have, on top of that, received these very lucrative, very large preorders. now, you can't have it all ways.

you cannot have a vaccine project literally contracted out -- i hesitate to say "subsidy," because when it's 100% of the cost, that's not a subsidy, that's ownership. you cannot have a price like a preorder of $6 billion, which is basically what pfizer has awaiting it on successful completion of its trials and approval, and, on top of that, say, "but we also need the intellectual property monopoly because of all this private capital we've risked," which doesn't seem to actually exist. it is very, very strange, but this is the argument that's being advanced and it doesn't hold water. i think we understand that as well. it's just that this argument has a rich history. it's embedded in a particular kind of thinking, a particular branch of economics, which they know that they can ride on and, in effect, lie their way through opposing

what is really a very sensible and unradical proposal made by south africa and india at the wto. juan: i wanted to ask dr. dr. mohga kamal-yanni about the situation with the trump administration had removed united states from the world health organization. president-elect biden is now saying he will return the u.s. to the who. what do you think has been the impact of the united states pulling out of the who in the midst of this pandemic? >> well, i mean, what do you say about such an amazing, really incredible, irresponsie, i'm afraid, decision in the middle of a pandemic to do that? i mean, it's a strange decision even if we're not in a pandemic. so what do you think if we are in the middle of it? it's really, really not very good. my dream, to be honest, as a non-american, about your election, is to retain two things --

one, the american role in advancing global health, under particularly in joining the who, and also, you know, putting science before politics. this has been also very, very problematic from the u.s. it really affected not just decision makers in other countries, but also ordinary people. this ignoring the science behind covid was really, really bad. so we do hope that the new administration -- i mean, they made commitment -- biden made a commitment to join the who. that is fantastic. the sooner, the better, you know? that would be great. but also for the u.s. to join something like or to voice public support for something like this technology access pool that who and other countries co-sponsored to do the facilitation of licensing intellectual property and --

so, managing intellectual property -- yoknow, your previous question -- but also facilitating technology transfer to other companies. so supporting the c-tap would be absolutely fantastic. amy: finally, how exactly, summing up in a minute, if you got around trade secrets, if the companies were forced to release their trade secrets, they did not get patents on this, how would a people's vaccine work? every company all over could just develop the vaccine where it is? what is shocking, president trump signs some executive order, not their how enforceable it is called america first. we have learned if you're altruistic or not, if someone is sick somewhere in the world you are in danger. so everyone is in this together, but what would a people's vaccine -- how would it happen? >> what it requires is, firstly, for companies to say,

"there are two aspects of our monopoly that we'll give up. we will share with you our patents and we'll share with you our trade secrets." trade secrets are the know-how and the technology that's required to make a vaccine. it's a very important part of the process. if they were to say, "look, we'll license this to any company with a reputation and a quality certification that's willing to make this vaccine with us," then let's open it up, and let's have anyone interested do it. and if they did that, they would suddenly find that there are whole avenues of supply that open up around the world. there are over 20 vaccine manufacturs in india, but there are also eight vaccine manufacturers on the continent of africa. and there e a number of ways in which you can do this collaboratively. the one way not to do it is the way that they are, by producing these artificially limited quantities of tse vaccines by sort of keeping it all to themselves. amy:chal prabhala, coordinator of the accessia project speaking to us from bangalore, india.

thanks also to dr. mohga kamal-yanni of the people's vaccine alliance. when we come back, we will speak to one of the world's leading infectious disease doctors, paul farmer.  [music break]

amy: this is democracy now!, democracynow.org, the quarantine report. i'm amy goodman. as we continue our coverage of the covid-19 crisis, we turn now to the rld-renowned infectious diseases doctor and medical anthropologist, dr. paul farmer. he's chair of global health and social medicine at harvard medical school and co-founder of partners in health, an international nonprofit that provides direct healthcare serves to those who are sick and living in poverty. dr. farmer co-founded the group in 1987 to deliver healthcare to people in haiti. in 2014 partners in health was one of the first organizations to respond to the ebola crisis in west africa. dr. farmer's new book is titled "fevers, feuds, and diamonds: ebol and the ravages of history".

i spoke to him in early december. i asked him how it is possible for the united states to have nearly 20% of the world's infections and deaths while having less than 5% of the world's population. >> well, i mean, we are facing the consequences of decades and decades of underinvestment in public health and of centuries of misallocation of funds away from those who need that help most. and, you know, all the social pathologies of our nation come to the fore during epidemics. and during a pandemic like this one, we're going to be showing the rest of the world, warts and all, how -- we have shown the rest of the world how badly we can do. and now we have to rally, use new tools that are coming online, but address some of the older pathologies of our care delivery system and of our country.

i think that's where we are right now. amy: what needs to happen right now in the united states? >> well, first of all, you know, i think that it's a great tragedy that such matters as masking or social distancing or even shutting down parts of the economy that contribute to risk but are -- it's just a shame that that's been politicized. these are not political or partisan actions. they are public health strategies. right now they're all we've got. but even when the vaccine is online or begins to co online, we have no history of seeing a vaccine taken up so rapidly that it would alter the fundamental dynamics of a respiratory illness like this. so we are facing, as president-elect biden said, a long, dark winter.

and if we can make a difference that could spare tens of thousands and perhaps more than 150,000 lives, then we should do that. and whether or not these are called mask mandates or pleading from the president, we need state and cal authorities to come together and underline the nonpartisan and life-saving nature of some of these basic protective measures. we need to invest very heavily in making sure the vaccineoes to those who need itost and those who have been shut out of previous developments like this or shut out for too long. so we have a lot of work ahead of us this winter, but no small amount of it is going to rely on individual families and communities to take up some of these measures rapidly to make sure that the dark winter does not lead to a blighted spring. amy: dr. farmer, can you comment quickly on these vaccines, for people to understand,

the first what's called mrna, messenger rna, vaccines, what they actually do in the human body? do they make you immune, or you can get sick and be a carrier, but you, yourself -- i mean, you can be infected and be a carrier but you, yourself, will not get very sick? explain the choice owho gets the vaccine, also the fact that this has not been studied in children, people under 14, and so what this means for kids. >> well, in general terms, let me just say that in the 30-plus years i've been involved in this work, i've never seen such a rapid development of a novel preventive for a novel vaccine. so there's a lot to celebrate in terms of the global effort to ce together to develop new vaccines. again in general terms, the idea is that instead of having a natural infection --

in this case, breathing in the novel coronavirus and getting sick, which leads to the outcomes that we know -- death or recovery with sequelae -- it also leads probably to immunity. that's what it's like with other viral infections in humans, or almost all of them. so what the vaccine does is introduce something that will trick the body into believing that it's being invaded by the virus -- in this case, it's focused on a particular protein on the outer surface of the virus -- and generate that immune response, which is often robust and enduring, at least with other viruses. now, in the case of any novel pathogen, we don't know for sure how long that immunity lasts, right? i mean, how could you? it hasn't been studied for long. but we know about other viruses and can take some lessons from those.

and in the case of this new vaccine or this new type of vaccines, the mrna vaccine, we're also dealing with that unknown. this is a new kind of vaccination. this is a new approach. it's very exciting, in part because it seems to confer that immunity without significant adverse effects. so, i think, again, on the side of development of a novel technology, the vacces, whether mrna vaccines or others, are great news, right? and maybe they will influence a new generation of vaccines for other pathogens, particularly viral pathogens, which tend to be the worst ones among humans. so that's where we are with the development of new technology. unfortunately, as i said and as you've underlined many times, amy, the old pathologies of our society make it unlikely that the rollout will be smooth and evenly taken up across various communities,

some of them with well-founded fears and mistrust of any kind of public health campaign. so we're in a bit of a pickle. i'm optimisticbout what will happen in this country, but as you pointed out in opening up the hour, a lot of us are concerned with what's going to happen in the global south and among those who might as well be considered living in the global south in wealthy and egalitarian countries like the united states and parts of europe. so it is going to be a rocky winter with some highs and lows. and i hope there are more highs than lows. i hope there's more reason for celebration than for grief. but i think it's going toe a very, very difficult winr. amy:ust before we go to this remarkable book about dealing with ebola and what it meant, i wanted to ask you about property rights, about patents, and about countries like south africa and india

pushing for a temporary suspension of intellectual property rights and patents so that covid-19 vaccines and medications become more accessible, particularly in the global south. >> well, i'd just like to say something we've had a chance to discuss before in previous years. you know, when you look at what happened around hiv, which by 1995, 1996, those of us in the infectious disease world understood that this would be a life-saving suppressive therapy -- like as with diates requiring insulin, you'd have to keep taking it, but this would save millions of lives and maybe even more and prevent transmission of mother to child -- the same debates about intellectual property of course came up then. the average wholesale price for a three-drug regimen in the years immediately after the discovery of these new agents was $15,000,

sometimes $20,000, per person per year. so if you split your time between harvard and haiti, as i had and do, you would imagine, if you couldn't have an imagination beyond conventional property rights discussion, that the majority of the world would be shut out of access to ts therapy. and, of course, that made the most difference in continent level in africa, where the majority of people living with hiv and dyinwith hiv were at the time. and what happened later was the production of generic versions of these drugs, often in india or china or even south africa -- right? so that a much lower cost could be tied to the same agents. and when i say "much lower," i mean a reduction, rely even within those early years, from $15,000 to $20,000, to about $300 per peon per year.

and with groups like the clinton foundation getting involved, those prices dropped even further. and right now you can get a really good three-drug regimen, even with some pediatric formulations for children, for about $60 per patient per year. so you could say that took a long time, but it didn't take a long time in terms of the impact that it cod have. millions and millions of lives, maybe even 16 to 20 million lives, are being saved by these drugs. but in some places, like rwanda, where i've spent 10 years, you saw the virtual eradication of aids among children because if mom is on therapy, the transmission to babies in utero, or through breastfeeding probably, really doenot occur. and this is not a hypothetical development. this has already hapned in rwanda, which is a very poor country with a very robust public health

and care delivery system. amy: dr. paul farmer. we will return to our interview in moment and talk about his new book "fevers, feuds, and diamonds: ebola and the ravages of history."  [music break]

amy: this is democracy now!, democracynow.org. i am amy goodman. as we contin our conversation with dr. paul farmer,

infectious disease doctor and renowned medical anthropologist. cofounder and chief strategist of partners in health. author of the new book "fevers, feuds, and diamonds: ebola and the ravages of history." between 2014 and 2016, ebola killed more than 11,000 people, most in sierra leone, guinea and liberia. i asked dr. farmer to talk about his new book and his work in west africa during the ebola crisis. >> well, you know, i wrote the book, a lot of it, in sierra leone. and as chance would have it -- and i think we talked about this in 2014 -- i was in sierra leone in june of 2014, but for an unrelated matter. i was there for a surgical conference, which i was involved in pt, in organizing. and i remember folks coming to the conference saying, "you know, there's already ebola in the neighboring countries. should we really have it?

is it a safe venue?" and my response was that you don't get ebol through medical conferences but through caregiving -- that is, nursing the sick and burying the dead -- and that we would be ok. shortly after that, i left, went back home to rwan. and as youill recall, my colleag, humarr khan, sierra leone's leading infectious disease doctor, died of the disease on july 29. and i began lobbying my own friends and co-workers to join in on the fight. and so, i will add, amy, that we were very tardy to get there, in my view, and arrived in october. and what i saw then, in both liberia and sierra leone, was just terrifying. it's not like there's a terror with a respiratory virus that's invisible. that terror comes when someone is sickened and fell ill. but there in the midst of this clinical desert,

there were times when we saw people collapse in the street and knew that it was likely or possibly from ebola and, with some shame, you know, waited for those fully masked and gowned to come and help people. now, that was not during the time which would follow in a couple of weeks in the ebola treatment units and community care centers and abandoned public hospitals. we're still doing a lot of that work today. but the reason i wrote the book was i got to know a mber ofatients quite well. and as they recovered, we became, very often, friends, that initial group that i met in october and some that i met in ebola treatment units in the course of the worst weeks of the epidemic. and one of them, a young man named ibrahim, on the night that i met him, told me that he had lost more than 20 members of his family to ebola anasked me to inteiew him.

and even though, as you point out, i'm an anthropologist as well as a physician, that was a very unusual kind of experience to have someone who just experienced such loss and was still covering to make such a request. and that kind of convinced me that these stories from west africa and the history of the place would be an important thing for me to learn about. and that was the genesis of the book. amy: ando talk about ebola. the outbreak and then how it was contained. you talk about it as the "caregivers' disease." >> well, ebola, like the coronavirus, is an rna virus. and also, likely, both are zoonoses. that is, they come from other species, animal species, and then leap into humans. and if you look, stand back and look, a lot of the diseases that cause the highest number of deaths among humans have these zoonotic roots.

and ebola is one of those. its natural host is still disputed. it may be a bat. you know, that seems plausible. but in the midst of all that, its origins, in what species it came from, was not really the task at hand. the task at hand there was stopping transmission from person to person because once introduced into the human family, eba spreads easily through contact. and the two main sources of exposure are caregiving -- first, you know, nursing the sick, cleaning up after them, and, second, the last act of caregiving, in most parts of the world and in most religious traditions, is burying the dead. and those were causing the transmission. now, the problem there, unlike the united states, is that there were not professional caregivers and there were not professional undertakers or morticians.

so of course, family members and traditional healers had to fill in that gap. and that's why so many people got sick and so many traditional healers got sick. and then, of course, the professional caregivers also experienced enormous risk. it wasn't just dr. khan. it was thousands and thousands of nurses, laboratory technicians, ambulance drivers, and doctors. and of the thousand or so that got sick during that time, probably more than half of them died. so that, again, is another huge loss for any country. but if you're livg in a medical desert and don't have a lot of physicians and nurses and lab techs and ambulance drivers, it's really something. going back to the u.n. secretary-general's comments about covid, the effects of that will be felt for years and decades if we don't step in and work to build those health systems again. amy: certainly -- >> i don't know if that's a -- amy: certainly, as we've learned,

dealing with health, with epidemics, with pandemics, if people have any questions about whether altruism is a motivation, we just understand we are all connected. you, dr. farmer, talk in your book about colonization, the slave trade, the catastrophic consequences on african nations. talk about -- though this is not usually talked about in health terms, you put the two together. >> yeah. well, let me just start, amy, by saying th during the epidemic, the great majority of our attention, and certainly mine, was on the clinical response -- that is, trying to make sure that ebola treatment units, at least the ones with which we were affiliated, were not only places for isolation, but places for care. and care for ebola is not rocket science, even without what are called specific therapies, like an antiviral, like remdesivir,

for example, for covid. even without specific therapies, the interventions that are required to save the lives of the majority of ebola patients are to replace the fluids that they've lost through nausea, vomiting, diarrhea, sweating, right? the torrid heat of the area. all those losses of fluids and electrolytes are what really imperil the lives of those sickened with ebola in the short-term. and we have therapies for that. they have been around for 100 years. they've been improved over time. you know, these oral rehydration salts, what you probably call pedialyte, are important. and for those who cannot take oral medications because they're nauseated or vomiting or in a coma, there are iv solutions that can save lives in that manner. and even that was not happening across the region. and there were reasons for that, right? people were frightened.

and anything that involved a sharp -- that is a needle to put in an iv, for example, or a blood draw -- poses some risk to healthcare workers, right? but it would have been better just to say, "hey, we're frightened," because anyone in their right mind would be frightened. but instead, we started having arguments about what kind care was the apprriate care. and the arguments, i mean, especially within what are called the international actors -- which doesn't mean academy award-winning actors, but the ngo's and humanitarian groups that had flooded this region after the civil wars that afflicted it for some time and then returned, obviously sometimes a different cast of characters, including ones that we know well, like the cdc -- came back, just a decade after this conflict ended, to be involved in the ebola response. and i made the argument in the book that the response was hampered

by the fact that the attention was largely to containment, not to care. and, of course, this generated very painful echoes from colonial rule, which in that part of the world was largely a 20th century phenomenon. this is not remote history, as you know. so in order tomprove the quality of containment efforts, we should ha focused more on the quality of care. and, you know, we're going to face that when the next epidemic of ebola comes along. amy: your description of people, the life histories of the ebola survivors, is deeply moving. can you talk about ibrahim kamara and yabom koroma, some of the people that you dedicate this book to? >> well, you know, it's not always been easy to talk about them because they endured such losses and they were not easy to hear about.

of course, having been involved in their care, i thought i knew something about eir losses, but it turns out there were many more. and i had an epiphany, whici'm barrassed to share. but, of course, it wasn't long before we understood that every adult patient that we cared for who survived ebola -- or didn't -- had also survived a brutal civil war. and when i started talking with ibrahim, who is the very man i mentioned earlier, who's the person, really, in a way, who inspired me to write this book, i couldn't believe the details, and spent many, many months -- and in the case of yabom, years -- interviewing and learning about them. and, of course, this happens over time. but yabom's story was different. if i could just go back and say, ibrahim was probably 26 when he fell ill with ebola and did not have children of his own.

his most grievous losses were his mother, his siblings, family members, grandparents, aunts, uncles. yabom, on the other hand, was 39 and she lost, in addition to her husband, some of her children, her mother also, and other family members. and what i learned about these two was that they moved between villages and the capital city during the war, after the war, and even during the epidemic because, very often, they were called to perform those caregiving services for afflicted members of their family. and again, in the case of those who perish, who was going to bury them at the time that they fell ill? and this was in august of 2014. so they faced these impossible choices -- another reason it was difficult and painful

to write about them -- choices that 've never faced, like do we respect our mother's dying wish to be buried in her home village? and, of course, that was also against the recommendations of public health authorities. but there wasn't enough in the way of assistance with caregiving or with respectful burial of the dead until later in the epidemic. and so their compassion led to their own infections and to infections amg other members of their families. now, i will add, amy, that, of course, i still am friends with these people and they've recovered to varying extents. yabom almost lost her eyesight, as well, because, as i think we discussed when we were together inugust of 2014 to talk about ebola, one of the complications is a blinding inflamtion that can be readily treated with steroids and eye drops

that cost pennies or a dollar to save someone's vision. so there were lots of complications, to say nothing of grief and psychological and emotional complications. there were lots of complications that ended in the months after the epidemic was declared brought under control. amy: dr. farmer, you write that every american and most europeans who fell ill with ebola in west africa survived. "different mortality outcomes emerged from the same strain of ebola, depending on care that was or wasn't available depending on your country of origin." if you can explain this and then expand that to what we are seeing today in this country, for example, also on the issue of racial differentials and disparities? >> well, you know, this is something that i encourage my students to grapple with

or our trainees in clinical medicine, you know, ich is case fatality rate. because case fatality rate is a report card on the quality of the medical system, right? and there are many parts to that -- referral to a clinical facility able to manage complications. and we're going to be facing the same challenge in the coming weeks. if hospitals become saturated, if we don't flatten the curve, then they become overwhelmed. and not only do they perform more poorly in terms of caring for those sickened by the the pandemic -- or in the case of ebola, the epidemic -- they also fail to provide the services that people need for other problems, other illnesses and injuries. and we saw a lot of that during ebola, but we've also seen it in the united states once our hospitals in new england and new york became overwhelmed. and that's, of course, exactly what happened in west africa, as well.

it just happened earlier and more devastatingly. but that's just the first part of the equation. you know, case fatality rate is a marker, a report card, onhat ppens after you get infected, right? we also have racial disparities and other social disparities, as you've noted, in risk of infection. so all along that noxious path, we have to make interventions that lessen the risk for infection, but also that lessen the risk for a bad outcome once infected. and i think that is the goal before us with covid-19, just as it was a goal during ebola. now, why am i bringing this up as a controversial matter? because if the report card is only about disease control -- that is, stopping the epidemic -- and not about survival once infected, why is it that people would go to an ebola treatment unit to be isolated if they fear they will not receive care? and the answer is, they won't.

right? and this was not new. treatment centers and treatment units that were really isolation and quarantine facilities proliferated across the continent of africa during -- under colonial rule and remained a feature there even after the end of colonial rule. and that pathology of focusing on disease control over care, i think, really weakened the epidemic. amy: dr. paul farmer, author of the new book "fevers, feuds, and diamonds: ebola and the ravages of history." he is chair of global health and social medicine at harvard medical schl, co-founder and chief strategist of partners in health, also featured in the documentary "bending the arc." that does it for today's show. democracy now! is looking for feedback from people who appreciate the closed captioning. e-mail your comments to outreach@democracynow.org

or mail them to democracy now! p.o. box 693 new york, new york 10013. [captioning made possible

sami yaffa: for thousands of years it was a place separated from the beliefs and influence of the outside world. after the second world war, western influence hit it like a tsunami. but walking here today, you can still sense the shroud of the past over everything, especially culture and customs. where else can you get an overdose of both history and blade runner-like futurism? and blade runner-like futurism? or both spiritualism and