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The Current Transcript for March 30, 2022

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

YULIA KLEPETS: She cannot stay in a wheelchair for longer than 30 minutes, and sometimes airstrikes they take longer than an hour or two hours, so that would also cause her suffering.

MATT GALLOWAY: More than four million people have fled Ukraine in the months since Russia invaded. Amongst those who can't leave are Ukrainians with disabilities and those caring for them. In 30 minutes what it's like to be trapped in a war zone and unable to get down to the bomb shelter. Also this morning, masks are coming off, restrictions are ending, but just as people are starting to embrace life as it was. Doctors are already wondering whether we're ready for what's next.

SANDRO GALEA: The pandemic found us as a world sitting ducks. We were an unhealthy world. We particularly in North America. We're living sicker, shorter lives than we should have, and we were ripe then to suffer the consequences that we did.

MG: In an hour, Dr. Sandro Galea on why he believes we need to change how we think about health moving beyond medicine, to incorporate race, class and humility, to be prepared for the next thing coming our way. We start, though, with new targets for a familiar challenge in the climate crisis. Good morning. I'm Matt Galloway and this is The Current.

[Music: Theme]

Canada unveils ‘ambitious and achievable’ new plan to tackle climate change

Guests: Catherine Abreu and Mark Jaccard

JUSTIN TRUDEAU: SOUNDCLIP: [This is no time for excuses. It is the time for even bolder climate action because it is always the right time to face a crisis head on.]

MG: For decades, Canada has set dates for climate targets and for decades the country has missed them all. Now, the government has unveiled a new plan, one that it promises is both bold and detailed. At a speech in Vancouver yesterday, Prime Minister Justin Trudeau described the plan as ambitious and achievable. Is it? Joining me now are two experts on climate policy. Catherine Abreu is founder and executive director of the advocacy group Destination Zero and a member of Canada's Net Zero Advisory Body. And Mark Jaccard is director of the School of Resource and Environmental Management at Simon Fraser University. Good morning to you, both.

BOTH: Good morning.

MG: Catherine, ambitious and achievable, let's start with the first claim. Is this plan ambitious enough to meet Canada's climate commitments, but also to meet the emergency that is in front of us right now?

CATHERINE ABREU: That is, of course, the question of the day. This is definitely the most detailed climate plan that we've seen produced by the Canadian federal government, and that's really good news. So we have more to go on here than we've had in previous plans, whether it's the most ambitious plan. Well, we currently have a target to reduce emissions in Canada between 40 and 45 percent by 2030. This plan models the lower end of that range, so we have emissions reductions modelled in this plan of 40 percent below 2005 levels by 2030. What we don't know is whether all of the measures detailed in this plan add up to those modelled emissions reductions because we didn't get that information. So we have a good roadmap here. It's taking us to... what for Canada, it would be an ambitious goal to achieve, even though it is not our fair share of the global effort. But what we don't know is whether all of the measures that are meant to take us to that goal actually add up to that desired emissions reduction outcome.

MG: We'll take a closer look at some of the twists and turns in that road map in just a moment. Mark, from your perspective... I mean, Canada has never had a problem setting goals. The problem has been meeting those goals. Is this achievable?

MARK JACCARD: Yes, I think it is. It's... My views are similar to Catherine's. It is very ambitious. 2030 is only eight years away and imagine reducing our emissions by 40 percent. They've been rising or steady for the last 15 years or so. That's a real turnaround. And the way you kind of check this is you say, first of all, OK, it's ambitious. Yes. And then you have to have a plan that says, here are the policies that actually do it and those policies, they may include a lot of subsidies, and this one does... a lot of money from government to different people to help them out. But you really have to have a significant and rising carbon tax, price on carbon of some some means or another. And regulations in individual sectors. And I am one of those energy economy modellers who check policies to see what they'll achieve. And much of what is in this plan actually has been promised by this government since even when it ran in the last election. So a lot of us have modeled these measures and they will... you know what we're looking at right here, they should achieve or come close to achieving the kind of major reductions that they're talking about.

MG: Catherine, just to pick up on what Mark said, you've said that the question in some ways is how is this government going to correct its history of watering down and delaying. These are things that have been promised before that have not been met. So why should this time... Why should we believe that this time is going to be any different?

CA: That's right. So, you know, a target is really only as good as its implementation plan. And as you said Matt, Canada's never had a problem with setting climate targets. We've had a problem with implementing and making sure that we meet those goals over the longer term. Our commitments around methane are a great example for that, actually. So back in 2016, when this government was relatively new, they made a commitment to reduce methane emissions in the oil and gas sector by between 40 and 45 percent by 2025. And with the delay and the watering down in those regulations, we'll probably get closer to 29 percent reductions in methane emissions from oil and gas in that same time period. So, you know, if we're going to be meeting these ambitious goals, if we're going to be doing the deep emissions reductions that we need to, to get to those goals, we have to be implementing the policies and the measures outlined in the emissions reduction plan yesterday with as much ambition as possible. And so part of the question here is what's the implementation pathway? Who's responsible for doing what, when? And that has to be distributed better throughout the whole of Canadian government. And the other question is how will they make sure that the inevitable lobbying that they will face from opponents to this kind of climate action doesn't work to increase those delays and the watering down of those policies so that we get the strength and the stringency of the regulations that we need to meet our objectives.

MG: So something like methane, and that's important... Just briefly on that methane has about 80 times the warming power of carbon dioxide as a greenhouse gas. So if you're going to tackle something like methane, you need to do it in an aggressive way. And your concern is that perhaps there could be, again, some wiggle room that appears through lobbying or other means that could water that down.

CA: That's right. So, you know, we have in this emissions reduction plan a commitment to create an entire economy-wide plan to reduce methane emissions, which is great news, as he said, it's a huge climate forcer and we have to tackle it. But are we going to create that plan and follow through with it? Or are we going to drag our heels and take the next four years creating that plan and wind up losing a bunch of time for that early action?

MG: Mark, you talked about the need for a rising price on carbon. This was the subject of great debate during the last election in terms of who should shoulder that price, should it be industry, should it be consumers, where does that mix best fall? What does this plan look at in terms of that approach?

MJ: Well, so first of all it, it holds the course. I mean, we are amongst the global leaders now since the Trudeau government got into power with a strong effort by the federal government to have a rising price on carbon. If you look at other countries that are leading in this Scandinavian countries, that price on carbon is especially on consumers, which is very difficult politically. But you actually need that. And the reason is you need to reduce emissions in... especially in transportation, but in buildings, in the electricity that we end up consuming. And the thing that's hard to explain to people in this, I think, was a bit of an issue between the NDP and the Liberals in the last election is you'll have... we had NDP saying, Oh, well, we're really going to make industry pay for this. But if you're trying to be a leader globally, you have to be really careful how you charge and regulate industry to the extent that they're... Your steel industry, your aluminium industry, your cement industry is competing with the industry from other countries who might not be facing as stringent a policy and therefore whose production costs won't be as high. So this plan has a fair bit of subsidies to try to reduce emissions, but it also has that carbon price and in the end, that carbon price signals to industry as well as consumers.

MG: I guess for consumers, they may be wondering what this is going to cost them, in part because the parliamentary budget officer put out a report last week saying that most households in Alberta, Saskatchewan, Manitoba and Ontario will see a net loss when it comes to carbon pricing by 2030. Gas is already really expensive, life is really expensive, and you can imagine outside of the politics, you can imagine that people will wonder if it's going to cost them more. What is your answer to that?

MJ: Well, well, actually, I not.... And that's why the government's plan does have a lot of money that goes to help people with the transition. But you even mentioned gasoline, so the price of oil and the cost of gasoline as an example of the cost for consumers. And it's really important to point out that there's an increasing number of Canadians who are not affected by that rising price of oil because they've already started to make the transition to electric vehicles to the more use of biofuel, to more use of zero emission opportunities. And so this plan says, yeah, transition. And as you get to something like 2030, less and less people are affected by even the carbon price because they've moved with the help of government and provincial as well as federal and municipal, they've moved to technologies, energy forms. And, you know, in places of living that are not impacted by those policies that make polluting more expensive.

MG: Catherine, let me ask you about transportation to pick up on that. Transportation is the second largest emitter. We have through this plan a goal of 100 percent of new light vehicles sold would be zero emission by 2035. That number is very... I mean, yes, there are more people who are driving electric vehicles now, but it's still comparatively very low. Is that possible to make that switch by that time? That seems incredibly ambitious given where we're at right now.

CA: I was scrolling Twitter recently and came across one of those rare good news stories on Twitter, and a person that I follow was proclaiming about their new electric vehicle that they just purchased. And they said it really is like making the switch from a flip phone to a smartphone. And I'm sure you've heard this before. I think we really have to think about this technology transition as being similar to some of the transitions that we've seen in our digital technologies. It will happen fast and it is already happening. That momentum is already being generated. There are plans in many countries around the world, not just in Canada, to transition away from internal combustion engines. So I do see it happening and it was good to get more detail to not just have that longer term 2035 target for Canada, but to see, OK, well, what's I going to look like in 2026? It's going to look like 20 percent of vehicles being zero emissions in 2030. It's going to look like 60 percent being zero emissions vehicles. So. That stepwise approach was actually really useful, you know, to pick up on this question of cost and rising energy prices. Number one, important to point out that this plan actually tries to set out some benchmarks for success that go beyond emissions reductions. And I think it'll be interesting to see if those get trapped over time, and one of them is energy affordability. So they're thinking about that. And as Mark said they've got some measures outlined in here to try and mitigate any potential burden that this could place on Canadians. But the other thing to keep in mind is that there is a huge cost associated with us not taking action on climate change. The costs from climate impacts in Canada are really mounting. And you know, we're seeing billions go out the door year after year, so. So climate change is also costing Canadians.

MG: Mark, let's talk about oil and gas. The top emitter of greenhouse gases in this country is the oil and gas industry. The plan calls for the sector to cut its emissions by 42 percent of 2019 levels. Does that mean less production or what exactly does that mean when you say you're going to cut emissions by 42 percent?

MJ: Oh, that's an excellent question, because there are people who say what we need to do is phase out the production side of oil and even gas, natural gas. But in fact, that could be one way that you achieve those kinds of emission reductions. You simply produce less. But in this plan, the government says, Well, we're not going to predetermine that outcome. We're going to say to that industry, your emissions need to go down. We're going to put in some kind of a regulated cap that's going to go down. And we're also going to again try to help industry with some support when it goes to processes like capturing carbon and burying it underground. And therefore, it could well be that Canadian oil production and gas production, who knows, is slightly rising for a while, is stable or is declining. So you don't predetermine ahead of time just as the same with your steel industry or your cement or your aluminium. But what you do do is, as you said, Matt, it's such a large emitter you're not going to meet any plan if you're not reducing emissions in that sector. And in fact, that's one of the big things here is when we've seen governments fail in the past in Canada, it's because they've had these ambitious plans. They've gone after some sectors of the economy, but they've left other sectors relatively unscathed, like oil and gas. And this one says no, regulations coming there. And that's as Catherine said earlier, though, will... that's going to be the proof in the pudding. We need to see something pretty quickly there.

MG: Is carbon capture proven at scale. I mean that technology of capturing the carbon at source and, as you say, burying it underground. If so much is being banked on when it comes to that, is that proven at this scale?

MJ: Yeah. So the three components separating out gases so that you can get CO2 while you convert a fossil fuel to hydrogen or electricity or some other synthetic fuel separating the carbon is something we've known how to do for over 100 years at commercial scale. Transporting it CO2 in pipelines we've done for over 50 years at commercial scale and then burying it underground. We've had acid gas injection sites for three or four decades, some of which are 90 percent carbon dioxide. So this is something when I've worked on the Intergovernmental Panel with other experts and special reports. We've always had to explain to people, carbon capture and storage is something that can be done at scale. Now, should you? Should you bank on that and say, Oh, don't worry, we can just keep burning gasoline in cars and natural gas in our furnaces, and we'll just capture CO2. You can't bank on it as being the great saviour. So most of this involves moving to renewable energy. You know, but you will have some carbon capture and storage as the leading countries are, and there's nothing wrong with that.

MG: Catherine, there is war in Europe right now, and one of the things that Canada has pledged to do is increase oil and gas exports in light of sanctions on Russia to help get Europe off of Russian oil and gas. What do you make of that? We've heard this argument made here on this program that that is something that Canada should do in this global crisis.

CA: So in fact, what we're seeing with Russia's war in Ukraine is the risk of instability that over dependence on fossil fuels can bring to an energy system. So rather than trying to address that instability in European energy systems by flooding it with more fossil fuels, the best thing that a country like Canada can be doing is thinking about how we support Europe. And how we are part of providing the capacity, the financing and the technology to help Europe and other countries move to energy efficiency and renewable energy. This idea that Canadian oil and gas is somehow going to become one of the main providers for Europe in the long term is, in my opinion, really unfounded because that entails building a whole bunch of new infrastructure in Canada, for instance, to increase production and send those fossil fuels over to Europe. And we're at a time where we don't want to be building more of that fossil fuel infrastructure because we are trying to transition away from fossil fuel dependence. And I think it was actually very bold of Canada's Environment and Climate Change Minister last week to come out and say, Hey, maybe in the very short term, we're going to increase incrementally some of our exports to Europe. But in the longer term, Canadian fossil fuels are not the answer for energy security in that part of the world.

MG: Just in the last couple of minutes that we have. You hear of targets like this and a plan like this, and for people who aren't dialled in paying as close of attention as you both are and both experts on this, it can seem a bit abstract and they can seem like it's out there. How do you think people's lives will change with more ambition placed on reaching those goals and the goals are there but actually driving hard to get to those goals, Mark?

MJ: Yeah, I don't think they'll change that much. In fact, I've had to make that case for a few decades now. So often when I've seen in the media where someone says our lives must change profoundly to get our emissions down, that this economy is somehow dramatically different. It's not actually. It's not like we'll stop using cars. We'll stop living in the same kind of house. We'll stop having similar types of jobs. And in fact, the jobs you need for this energy transition are in many ways very similar. If we're using... If we're doing electricity generation, but we're doing it more with renewables and we're needing storage and batteries, there will be mining jobs, there will be all the jobs you had in refineries. All of those same kinds of jobs and then retrofitting all of our buildings, all of the skilled trades that you need. So I don't think people will notice it. It'll happen, even saying it happens over 10 years. That's actually an incremental kind of change. If you think of the rate at which we grew the oilsands and moved people around very different.

MG: Catherine, are we not going to notice this?

CA: I think we will notice it, but when we notice, it will notice how it's making our lives better. I think we've been sold this bill of goods that taking action on climate change requires a bunch of individual sacrifice from ourselves when in fact, what we're talking about here is transformational change happening at the systems level and at that systems level, that change should actually make it easier for us to make the climate safe choice when we're trying to figure out how to get around our neighbourhoods. It should make it easier for us to have better insulated warmer homes with lower energy costs. So I think really a lot of climate action is about making the world a better place, making our air cleaner, making our communities more comfortable to live in and actually helping to reduce and stabilize energy costs, not put them on the rise. And so for me, a big question is, OK, are we creating climate policies that bake in some of those positive benefits? And I do see us moving in that direction in Canada, which is good news.

MG: We are going to dig into the details of these goals and where we need to go to meet those goals coming up in days ahead. In the meantime, it's great to speak with you both this morning. Thank you very much.

MJ: Thank you.

CA: Thanks for having us.

MG: Cathreine Abreu, founder and executive director of the advocacy group Destination Zero, member as well of Canada's Net Zero Advisory Body. Mark Jaccard is director of the School of Resource and Environmental Management at Simon Fraser University. Your thoughts? Welcome. Email us thecurrent@cbc.ca. Coming up after your CBC News, we head to Ukraine and talk about those who cannot flee that country in the face of war. I'm Matt Galloway and this is The Current. Stay with us.

People with disabilities trapped in Ukraine’s war zone

Guests: Yulia Klepets and Yulia Gorbunova

MG: Good morning. I'm Matt Galloway and you're listening to The Current.

[Music: Theme]

MG: Still to come, we are still coping with this pandemic, and we are nowhere near ready for the next one. Lessons from COVID-19 with epidemiologist Dr. Sandro Galea just under 30 minutes, but first stuck in a war zone while living with a disability.

[Music: Theme]

SOUNDCLIP: [Man speaking in Ukrainian, Matt translates below]

MG: I'm very grateful for Sergey's help. He says his team helped the disabled. They bring anything you ask for it like water. It's the sound of a volunteer supply drop at an apartment in Kharkiv, Ukraine. And the voice is an elderly man who's blind, he is one of thousands of Ukrainians with disabilities living in a war zone and relying on volunteers like Sergei for help. Yulia Klepets lives in an apartment in Kyiv. She is there with her 82 year old mother, who uses a wheelchair. Her oldest daughter, Maryna, has autism. We're speaking with Yulia through a translator. Her name is Dana Kohut. She was in Lviv when the war broke out, and she has left Ukraine. Yulia and Dana. Hello?

DANA KOHUT: Hi, Matt. [Yulia says hi in Ukrainian]

MG: How are you doing? And we'll get to what Julie has gone through just in a moment. But Dana, first for you. I mean, how are you doing?

DANA KOHUT: Oh, thank you Matt for asking. Actually, I lost Ukraine also when the war started on the second day of the war. Right now, I'm in Slovakia. I'm here with my twins, nine year old twins and also my sister in law. And yeah, just checking on news, you know, like hoping the war might end.

MG: What is it like for you to watch this from a distance?

DANA KOHUT: You know, we wake up and we would immediately check on the news, right? We are in constant contact with our husbands like I would have like calls throughout the day, right, checking how my husband is doing back home, also my mum. So it's all heartbreaking. But we also realize that, you know, we are... like our relatives, they are staying in the view that it's really close to Polish border. And in that town there haven't been any military activity except of like airstrikes to some critical war infrastructure like oil refinery or some like tank factories. But except for this, the city is, you know, like, safe. So you also realize that throughout the country, like across the country, there are a lot of people who are suffering a lot more, right? So that is all heartbreaking for us, and we are looking forward to, you know, like international solidarity and also asking for military help for the country's right to defend its independence and you know, the right to choose.

MG: I'm glad you're doing OK and I'm glad you're safe.

DANA KOHUT: Thank you. Thank you, Matt.

MG: Yulia, how are you doing?

[Dana translates Matt's question for Yulia]

YULIA KLEPETS: [Dana translates] Not bad. We are trying our best.

MG: Can you describe Yulia, the building that you live in? What does it look like?

YULIA KLEPETS: [Dana translates] So we live in a block of flats on the seventh floor in Kyiv, just a quite spacious apartment that is really close to the main train station. We are right now five women in one apartment. It's Yulia herself, also have 82 year old mom, her cousin and also two of her daughters. One is 17. And another one is 24.

MG: What are you hearing and seeing inside? What does the war sound like from where you are?

YULIA KLEPETS: [Dana translates] So I hear bombings constantly throughout the day. It's at least 10 times a day we hear air siren warning that there is bombing in the city. And also that we can hear them, you know, quite close because all this territory is like towns near Kyiv like [inaudible] are really close to the place where we live. That is happening throughout the day that I can hear the bombing.

MG: When the air raid siren goes off. What do you do?

YULIA KLEPETS: [Dana translates] I don't hear the air siren from the city, right? But I have an app on my phone that actually alerts me that there is air siren in the city. So what will happen? First thing we all like, we leave through our corridor before, like, you know, in the first days of the war, we would not leave and hide immediately when we hear air sirens. But on the second day of war a building really close to us was hit with a rocket. So we got this great fear that this might happen also to our building.

MG: You're living with your mother who is 82 years old. Tell me about her, how is she doing in the midst of all of this?

YULIA KLEPETS: [Dana translates] So my mom, she can't walk on her own. She has a disability, she uses a wheelchair, to get to the bathroom or through the kitchen. She can eat herself, like feed herself, but unfortunately she cannot walk. She understands the situation that she lives in the part of the city that is under serious threat of rocket strike. But even, you know the possibility to take her down from her bed and help her, you know, stay on the floor. It's impossible, like 10 times a day, because for me and my children that would be, you know, like, impossible right to or to bring her to a corridor. That is something that we cannot unfortunately do that many times a day.

MG: So what happens then? Because when those bombs are falling, a lot of people will head to a basement, will head to a car park because she can't walk on her own. What happens when those bombs are falling?

YULIA KLEPETS: [Dana translates] Me and my children and my cousins we sleep during the night. We sleep in the corridor to make sure that we don't have to, you know, like run from our room several times a night. What happens with mom? She actually she stays in her bed. She realizes that we cannot help her to get to the corridor 10 times a day. In the first two days of war we would take her in her wheelchair to the bathroom right, the place where we don't have windows, which is considered to be safer. But the thing is that she cannot stay in a wheelchair for longer than 30 minutes. She would have severe pain. And sometimes airstrikes they take longer than an hour or two hours, right? So that would also cause her some suffering. So she has... So she agreed to stay in bed.

MG: That must be really difficult for her.

YULIA KLEPETS: [Dana translates] It's important to understand that my mom. So she has two types of suffering, one is a physical one. And the understanding that there is a serious threat to her life and another one is that she actually she is ethnic Russian right, and she has been living in Ukraine for many years. And she does not understand why Russians come to Ukraine. They bombed the cities is right. They want to kind of liberate us, and there is nothing to liberate us, right, so that they are killing people just for... And Putin's like densification or special operation that is, which is total nonsense, right? Because my mom, who is Russian, she is not oppressed in Ukraine and she does not need Putin, Russians and their troops to come and liberate her.

MG: You're also living with your daughter, who is 25. She has autism. What does she understand about what's happening in this war in and around that apartment?

YULIA KLEPETS: [Dana translates] Maryna my daughter, she perfectly understands what is happening on the first days of war, though she couldn't identify the sound of war. Those were like strange noises outside, you know, when the rocket hit our neighbour, the neighbouring home right next to our building. Actually, I was the one who was panicking and who was shocked while Maryna, my daughter, she was really calm and she would tell me, You know, everything is going to be fine. You know one day war will end, right? But then in a week or two, she will, you know, she would probably sense this like negative energy, right. And also our worries, and she would also become really aggressive. She would be, you know, like kicking, hitting me, her sister, right? So she and she actually needed some different medication so she would take pills. Right. Right now, she's OK, right? She does not need that extra treatment. And she actually plans her future. After war, she talks about her friends in the centre where she had, you know, lots of friends, where she goes for socialisation, and she knew her friends there. She also plans a trip to a resort town near the mountains. So she is, she is like, quite positive right now.

MG: There are many millions of people who have left Ukraine because it's safer to get out of the country than be in the country. Do you think it would be possible for you to leave the country?

YULIA KLEPETS: [Dana translates] So the first day I was actually thinking, seriously, and considering leaving Kyiv. One thing that was stopping me from leaving the city was my mom who is unable to move. There will be no one to take care of her, you know? But I was also thinking about my daughters. One is 17, and you know Maryna is 25. I would go, you know, relative in the western part of Ukraine, where it's safer now in... But the thing is that my car got broken just before the war started and I cannot go by car. Many people, many volunteers, would offer me to go by train. But I know the situation that many people actually flee the city and they, you know, when there is a train from Kyiv to lets say [inaudible] or Lviv there are plenty people get packed on trains and when normally there would be, you know, like in one place, there would be sitting like three people. Now you would have 20 people sleeping on the floor, corridors and I believe that would be a huge challenge for my autisitic daughter. So we've decided to stay as long as possible. We are not leaving the city right now, so we are not sure if that's the right decision. But in this situation, probably there is no one right answer to what we should be doing.

MG: Do you feel trapped in the city?

YULIA KLEPETS: [Dana translates] Yeah, there is such a feeling. So we feel that we have passed... In the last week there were less bombs and air sirens, but in the past four days, you know, the sounds of sirens come off, go off more often. And we understand that the battle, right and the fights are happening, not that far from us. So, yeah there is a bit of that sense of being trapped. You know, during the day, we are busy, we are helping and volunteering. I am volunteering to help. To other families that have relatives with disabilities. I would go to my friends and I would bring them some humanitarian aid right, some food or clothing. The nights are the worst after 10pm. It becomes really scary when you hear the noise of bombing or shooting. That is the time when we have the fear.

MG: What sort of help do you need?

YULIA KLEPETS: [Dana translates] So I don't know what specifically me, I... There's nothing that I would immediately need, right? What I want. What everyone around me needs is we want this nightmare to be over. We want our motherland. We want Ukraine to be free. In the past, unfortunately, we would take for granted right, the freedom and also the ability to move around the city for granted, right? Right now, we really appreciate that. But we want to be free and we want this war to be over.

MG: Yulia, I'm really glad to speak with you and I want you to stay safe, and I wish you and your family the very best in what is a really awful situation.

YULIA KLEPETS: [Dana translates] Thank you. Thank you for your support and really hope that this nightmare will end soon for all of us.

MG: Dana, you've been through a lot as well. So I just want to say thank you to you and I wish you the very best. I hope you're home soon. But in the meantime, I'm glad you're safe.

DANA KOHUT: Thank you. Matt. We are staying strong, and we also hope... we have a big hope that Ukraine will, you know, will regain its territory, its rights and people will be able to go back to normal life. So thank you for spreading the word internationally about the war in Ukraine.

MG: Take care and thanks again, bye bye.

DANA KOHUT: Bye bye.

MG: Yulia Klepets is in Kyiv. Dana, who translated our conversation, has fled Ukraine. She is now in Slovakia. There are an estimated 2.7 million people in Ukraine who live with a disability. Some have managed to leave, but the journey to and across the border has its own obstacles. 30-year-old Oleksandr Nikulin is visually impaired, he's HIV positive and relies on medication. He and his partner fled to the border town of [inaudible].

OLEKSANDR NIKULIN: In [border town] they have a little bit challenges to cross the border because we are men and old man in Ukraine, have a responsibility for Armenia. In fact, we had to dig out the documents that we are excluded from this responsibility, but it was not enough for military guys from the border.

MG: After several more meetings, they were finally able to cross the border into Slovakia. Oleksandr Nikulin is now in Germany, but for him it was a tough decision to leave the war zone.

OLEKSANDR NIKULIN: My parents are still in Ukraine. They don't want to leave, but we have everyday call-ins and my mother said to me, is everything OK. We are OK, we are safe. It was really hard, but I had the standard of only one thing. I can help other people to be safe, to have some humanitarian stuff. I'm with my team of Fight for Right, now providing the evacuation of people with disabilities from Ukraine, and I can be more effective in this point.

MG: As he mentioned, Oleksandr is now working with an organization called Fight for Right, helping others with disabilities leave Ukraine. Yulia Gorbunova has also been helping people with disabilities. She's a senior researcher for Human Rights Watch, focussing on Ukraine, and today she is in Warsaw, Poland. Yulia. Hello to you!

YULIA GORBUNOVA: Hi.

MG: As you understand it, in a war zone, what are... And we've heard some of them from our guests earlier. What are the main challenges that people living with disabilities are facing right now?

YULIA GORBUNOVA: You know, I've been listening to these heartbreaking accounts, and really I cannot believe that this war has been going on for, I think, thirty four days. And it's just caused unimaginable suffering and thousands of people died and wounded. Close to four million, I think, have been displaced. And you know, in a situation of an armed conflict, you know, where people are forced to flee when violence erupts. People with disabilities are at higher risk of harm, of harm during fighting. And you know, there's certain parts in the areas of Ukraine, certain cities which have been under attack for weeks. Some of them have been siege... under siege for weeks and some of them have been occupied by Russian forces. And I'm talking about places like Kharkiv, like Mariupol [and more]. So, and you know, they... I've interviewed people who either were there and we talked on the phone, people who've left and you know there's enormous obstacles that they have been facing just to survive, but also to flee.

MG: Tell me more about that. What have you heard specifically from people there on the ground living with disabilities in this war zone?

YULIA GORBUNOVA: So basically, the range of disability... the range of obstacles, excuse me that people's disabilities are faced with. You know, some of them have been very vividly described by your previous guests. People with disabilities have a much harder time to flee without assistance and access to assistive devices. For example, I've interviewed a woman in Mariupol, which is one of the hardest hit cities in Ukraine, which has basically been razed to the ground. And you know, it's continued to be razed to the ground. And, you know, people... A woman in a wheelchair was unable to... much like the previous guest she was unable to get to the basement because she has to use a wheelchair. So she cannot... because there's no electricity, she cannot use elevators. So she has no access to the elevator. Or, you know, she's not able to get to the basement. So she stays in her apartment in this incredibly severely shelled part of town and tries to distract herself with doing something when shelling starts. There are other obstacles that people with disabilities have. I mean, people who have hearing disabilities, you know, they do not hear sirens and people that hear it cannot get to them, then they simply may not hear, you know, even if they have a basement to shelter in or any other type of bomb shelter, they may not hear a siren in time to get there. People with intellectual disabilities may not understand what's happening during attacks. And in also quite often, unfortunately, in conflicts people with disabilities that need assistive devices to move, such as wheelchairs or crutches, et cetera. They are sometimes left behind because they may, you know, they're unable to flee or they are unable to... or they, you know, they are concerned that they may make it more difficult for their families to flee...

MG: What would you like to see done? I mean, we know that there are more than four million people who have fled the country and if people are able to get out, that's a whole other challenge when perhaps they're, as you said, trying to leave the country, trying to get across the border, trying to find safe harbour in another country. What would you like to see done to help this population at this point in the war?

YULIA GORBUNOVA: Well, look, I think one thing that we've been continuously pointing out in our reporting at Human Rights Watch is the need to ensure a safe evacuation for all residents and for people with disabilities. So evacuation is very dangerous in Ukraine. It's not just a matter of getting out of the country, it's a matter of getting out of a particular area, a village or town that is being shelled or is in the area of heavy fighting. And we continuously hear reports and we've documented instances of evacuation routes being shelled, and in some cases it's seemingly deliberately shelled, you know, because it's clear that there's civilians that are trying to flee. And those evacuation routes are either attacked or they do not open when you know, the warring parties say they're going to open, so they're things like that make evacuation very, very dangerous. And of course, when people are travelling, who need certain arrangements to travel again, people in wheelchairs, people in need of special medical equipment to even be relegated from place to place, special transportation, all that can be very challenging. So I think it's very important to remind warring parties about their obligations under international humanitarian law, which include ensuring safe evacuation for... specifically for people with disabilities.

MG: Yulia, it's great to speak with you about this. I appreciate you shedding some light on... This is an important part of the war. And so thank you for joining us. Thank you.

YULIA GORBUNOVA: Thank you so much.

MG: Yulia Gorbunova is a senior researcher for Human Rights Watch, focussing on Ukraine, and we reached her this morning in Warsaw. Coming up after your regional update.

SANDRO GALEA: It's like your car. What you really want to do is be able to drive your car and enjoy your car. You do not want to spend too much time in the shop. Well, health care is being in the shop. What we all should be doing is optimising our ability to be healthy and spending as little time as possible in the shop.

MG: The difference between health and health care and why that really matters if we want to be ready, not just for this pandemic, but the next pandemic. My conversation with Dr. Sandro Galea coming up in 90 seconds. My name is Matt Galloway. You're listening to The Current on CBC Radio One. We'll be right back. Stay with us.

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Epidemiologist says addressing inequality is key to navigating next pandemic

Guest: Dr. Sandro Galea

MG: Hi, I'm Matt Galloway. You're listening to The Current most COVID-19 restrictions have now ended. It's a sign of just how far we've come in this pandemic. But it wasn't too long ago that residents in long term care were shut in their rooms at the first sign of an outbreak.

EMILIO GALEA: I get claustrophobic, you know, and it's very, you know, depressing. Thank God, it was 14 days this time. The second day was a period of 22 days. We were locked in. And when I say locked in, I mean locked in.

SANDRO GALEA: We have shown, as have other groups that we have about a threefold increase in depression in the population since COVID has started. So I do think it's worrisome and I think it gets at the start of... We should be thinking about the whole of our health, the whole of our health and our health is not simply being free of virus.

MG: That first voice, you heard, belonged to Emilio Galea. We spoke with him a year ago from his long term care home in Ontario. Residents in that home were just coming out of a 14 day lockdown. We also heard from his son, Dr. Sandro Galea, talking about the mental health effects the lockdown was having on his father and others. Now COVID-19 numbers are down and it's getting easier to see a light at the end of the pandemic tunnel. But in a new book, Dr. Sandro Galea argues that all the things that made us most vulnerable to COVID-19 are actually still with us. Dr. Sandro Galea is a physician, epidemiologist and the Robert A. Knox, professor and dean at the Boston University School of Public Health. He's also the author of this new book called "The Contagion Next Time". Dr. Galea, good morning.

SANDRO GALEA: Morning, Matt. Thank you for having me.

MG: Thanks for being here. What's it like to listen back to your father from a year ago? A very, very different time in this pandemic.

SANDRO GALEA: Yeah, it was interesting listening to it. My father is… and my mother, they're doing well. They're obviously in a much better place, I think as we all are around COVID. But I also think that they continue to live with the long term consequences of COVID, as do many of us. And I think it reminds me and I think reminds us of why COVID was what it was, which is fundamentally about deeper underlying challenges that we have to face in Canada and the U.S. and globally.

MG: As you say, there will be... There already are a number of books about COVID. Why did you want to write this book now?

SANDRO GALEA: I fully expected there to be many books about COVID, and I think there should be. And I expected, as has happened, there will be many books about how we can be better at developing vaccines, how we can be better at stockpiling, how we can be better at developing testing and tracing systems, how we can be better at medications and treatment. And I think all of that is important. But fundamentally, I think what COVID has taught us is that unless we tend to the underlying conditions, the underlying social structures, economic structures that really are the substrate on which a pandemic happens, none of these other measures are enough. So I wanted to have a book out there that said the impact of a pandemic reflects the underlying challenges that existed before the pandemic, and I would like us to temper those underlying challenges before the next pandemic.

MG: Tell me about the title "The Contagion next time", which people will realise is a nod to James Baldwin's classic "The Fire Next Time".

SANDRO GALEA: Yeah, so it seems, Bolden wrote "The Fire Next Time", which is really one of the strongest, most searing indictment of racism in America. And his language actually is a reflection of an African-American spiritual, a hymn to a song in many churches were talking about the fire next time. And he used that term to reflect the deep seated consequences of what today we have come to call structural racism. Now the book, "The Contagion Next Time", is not just about racism, but certainly racism is one of the core forces that I talk about. I talk about racism. I talk about inequities in housing and wealth and employment and stability of employment and underlying health, all of which predates the pandemic by decades and centuries. The pandemic found us as a world, as sitting ducks. We were an unhealthy world. We, particularly in North America, and the US in particular, we were living sicker, shorter lives than we should have. And when a pandemic hits were, the people who are most vulnerable are those who are sicker to begin with. We were ripe then to suffer the consequences that we did, and I don't want us to forget that. I worry that as we move beyond the pandemic, we will now move to thinking if only we can invest in more vaccines that will solve the problem next time, because it will not, it will not unless we tend to these underlying issues.

MG: You go back to the SARS outbreak in 2003 and talk about what in some ways we should have learnt that we did not apply. Knowing what you know now about COVID, when you look back at SARS, what goes through your mind?

SANDRO GALEA: I think one thing that goes through my mind is that we as a continent, let's talk that way, got lucky in SARS. Now Toronto did not get lucky in SARS, Toronto was hit by SARS quite hard. And there were these enormous shutdowns of hospitals and all that, but SARS spread relatively little in North America. And I think what happened to us is we thought, well, we dealt with that, that was OK, but of course, the only reason SARS did not spread is we got lucky. The viral dynamics were not such that SARS spread all over Canada and all over North America. When SARS hit, we saw some of the things that we're seeing now with COVID for example, we documented the increase in poor mental health, the increase in depression, anxiety disorders. What we are seeing in COVID is exactly what we saw in SARS only just on a larger scale. When SARS hit, we saw the real shortfall in clinical care services, so clinical care services were not able to scale up to deal with the demand. We saw it happening in SARS, in Toronto, and now we saw it happening over Canada and over the US. So SARS was a small foretaste of what happened in COVID. Now we're seeing it in COVID, and I hope we do not forget it in COVID the way we forgot it during SARS.

MG: Forgetting it is an interesting way of framing it. I mean, there were roadmaps that were put together coming out of SARS to help us navigate through something like this. What happened to those roadmaps?

SANDRO GALEA: We struggle, I think with this challenge to balance between the urgent and the important, and we deal... We as a society deal with urgency. So we deal with things that are pressing that we have to deal with now. But we forget the important and important, of course, is the long term building to create a resilient society that is resilient to these stressors that will happen in the future. Now notice, I say, will happen. I did not say may happen because we do know that other pandemics, other stressors, other large scale traumas will happen. The only thing we don't know is exactly when they will happen.

MG: What are the foundational forces of public health?

SANDRO GALEA: Public health is about the world around us. Yours and my health Matt, principally comes from the air we breathe, the water we drink, the food we eat, where we live, where we work, where we play. Whether we have stable housing, whether we have a liveable wage, whether we have a right to make self work and recreation, whether we are in danger of being shot in our neighbourhoods, whether we are safe in our homes and our place of work. Those are the forces that fundamentally drive our health. Those are the forces that we as a world intended to fix starting in the mid-19th century. And as a result, we doubled global life expectancy. Our global life expectancy went from being in the high 30s to about 40, throughout the entirety of human existence until about 1850. From 1850 on we've gone from about 40 to about 80, an extraordinary achievement. And that achievement was because we tended to occupational hazards, to community safety, to safe air, lower pollution, safe food, safe water, social connections, dealing with issues of loneliness and depression. So we know we can do it, but we keep falling short. We're not fully realizing the potential and that is what I would like to see us do.

MG: How do you think those forces came to impact our vulnerability to this virus when it appeared?

SANDRO GALEA: I think in two ways. Number one is that the risk of exposure to the virus was patterned by our social and economic circumstances. So let me give you one concrete example. When the virus hit in March of 2020, it really hit North America hard. We all knew that one of the things that had to be done was we needed to lock ourselves inside, get away from other people so that we do not transmit. And we were not at risk of transmitting the virus. Well, we did not all have that option. In fact, the majority of people in North America did not have that option, majority people do not have the option of working from home. And as a result, their risk of exposure to virus was higher. Now, that majority were people who were in lower wage jobs, particularly people of colour. Number two, we've known right from February of 2020 that those who are most at risk of severity of disease. So a severe potentially fatal case of COVID are those with underlying health conditions, those with diabetes, those with high blood pressure, those with congestive heart failure. Well, the patterns of distribution of those conditions in our society is uneven. It is those who have fewer resources, people of colour, those who are immigrants. That's where the disproportionate weight of those underlying conditions exists. And those groups were the groups that were most affected by COVID, had more severe COVID, had higher mortality rates. So our social and economic opportunities are structured both a risk of getting COVID, and they structured our underlying risk of disease, which then resulted in an underlying risk of death. So that's why you saw, for example, in the United States Black Americans had twice the rate of death than white Americans. It's not because the virus differentially affects people based on skin colour, not at all. It's because the social conditions that people who are minorities in the United States have lived in for decades and centuries have structured economic opportunities and have resulted in underlying illnesses that makes them much more likely to get sick if they get COVID.

MG: Which is a very different way of looking at health. I mean, in many ways, this is a book about the pandemic, but it's also a book that seems to offer a different conception of how we think about health.

SANDRO GALEA: Yeah, I suppose I see the book as a book that uses the pandemic to help us think about health differently. And I'm intrigued that you say it's a very different way of thinking about health, I tend to think it is. You know, I have two different reactions to the book. One reaction is the one like you had and the other reaction is, well, everything you're saying is obvious. And I suppose the truth is probably somewhere in the middle, because I actually do think that what I'm saying is obvious and I'm pleased when people think it's obvious. And I want this to be obvious so that we can all orient how we think about health so we can move forward. Because I don't think I'm saying anything that's counterintuitive. I think it simply requires a, as you say Matt, a bit of a rethink, a bit of a refocus and to say doctors and medicines and nurses, these all matter. This is not an argument against clinical care. Not at all. I want the best doctor and the best nurse to look after me and my parents. You had my dad on your show a year ago. I want to be sure that they're well looked after in their nursing home. But as we had discussed a year ago around those circumstances, that is not enough. Fundamentally, we want to create a world where we each, all of us need less care. We want to have care available to us if we need it. But we want to live in a world where we need less care.

MG: I guess one of the reasons why people might say that it's a different way of looking at it is because you talk explicitly about moving beyond medicine. What do you mean by that?

SANDRO GALEA: I have written about this conflation that we have between health and health care. I sometimes challenge people to say, you know, when having a dinner party in your house, bring up the topic of health. Just use the word health and see how long it takes for somebody in the dinner party to use the word health care interchangeably with health. And it really just takes a few minutes because we use the word health care and health interchangeably. And that's a mistake. Health care is medicine and treatment that looks after us when we were already sick. Health is keeping us from being sick to begin with. To use another metaphor it's like your car. What you really want to do is be able to drive your car, enjoy your car. You do not want to spend too much time in the shop. Well, health care is being in the shop. And what we all should be doing is optimising our ability to be healthy and spending as little time as possible in the shop. Now, what does it take to keep your car to shop? Well, what it takes is having roads that don't have potholes in them, having rules for safe driving so that you're not in an accident. Now if you have an accident, you want to have a good mechanic. That's the metaphor. We want to create a world where the roads are such that we can keep living our lives. If we are sick we want an excellent doctor, excellent nurse, excellent hospital. But those should be recourses that we use less and less.

MG: And so there are things that you say we should be focussing on in addition to medicine. One, we'll talk about race in a moment because you've raised that already, but one is housing. They're connected in some ways, but tell me about housing and the connection between housing and health.

SANDRO GALEA: You know, housing one can be [inaudible] and say, housing is medicine. Just use that terminology. So let's be concrete about it. In the context of a pandemic the science has shown very clearly that houses where there were more people per homes were more likely to have greater viral transmission. Now why were there houses with multiple per house? Typically, these are people with lower income, less wealth, and typically these are less safe houses. That, of course, is directly linked to economic opportunity, which is directly linked to historical disadvantage. So housing in and of itself is a way to make sure that we are healthy, of course. On the other extreme, if you're homeless, you have even less recourse to the safety of housing. You know, one of the things that we've done... And I'm at Boston University and Boston Medical Centre, which is the affiliated hospital. For example, it started an experiment a few years ago where it invested millions of dollars in buying housing to be able to provide affordable housing for people who are recurrent users of the emergency department, largely because of homelessness. And what Boston Medical Centre was able to show is that by investing in housing, it reduced visits to the emergency department, reduced emergency department costs and, more importantly, improved health. So an investment in housing resulted in improvement in health that repeat visits to the emergency department wasn't able to do.

MG: Housing is often connected with race, and we talked about this briefly. But how did you see race play out as the pandemic unfolded in terms of not just different outcomes, but speaking to the larger issue of a holistic view of health?

SANDRO GALEA: Yeah, I use in the book an American example of if I may. You know, the United States about one hundred years ago developed the program through the Homeowners Loan Corporation to encourage homeownership. It was an effort by the federal government to say homeownership is good for our society and the Homeowners Loan Corporation would encourage banks to lend money for mortgages. Now, in so doing, they would take maps and it would colour maps in green for areas where they would say these are good bets for lending people mortgage money and red where they were not good maps. That's where the term redlining comes from. These banks, the Homeowners Loan Corporation would colour in parts of maps as red. And of course, what areas did they colour in as red? Well, those were areas where African-Americans lived as a result. African-Americans were less likely to become homeowners over the course of the past century. As a result, they accumulated less wealth and wealth, of course, transmitted across generations, much of it transmitted through property ownership. Fast forward one hundred years. You now have a situation where you have these segregated cities in United States, areas where in many cities have sort of straight line roads. On the one side, you have white American families and of Black American families, difference in housing stock, difference in wealth in these families, difference in the burden of underlying disease and COVID hits. And that becomes a difference in the manifestation of different risk of getting COVID and different morbidity and severity of COVID once you get COVID. And that is directly traceable to policies a hundred years ago, that were clearly discriminatory policies.

MG: Which and that's what you mean when you say that in some ways, America has a health gap consistent with the history of the United States of America.

SANDRO GALEA: The COVID health gap and the racial patterning of COVID in America is that there's nothing new about it. It reflects the underlying health gap that existed before COVID, and it reflects the underlying health inequities by education, for example, reflects underlying health inequity by income, reflects underlying health inequity by race. I mean, let's talk about education for a second. There have been studies that have shown very clearly that within each racial group, within Black Americans, within white Americans and Asian Americans, there is a clear relationship that the more education you have, the less likely you were to get COVID, the less likely you are to get sick of COVID. So immigrants, immigrants of colour tend to have less education, less access to wealth be a greater risk. So all of these things go together, and we as a society, I think, have an overriding responsibility to recognise that.

MG: You point to obesity as a microcosm in some ways of how structural forces shape health conditions that might appear to be under one's own control. What do you mean by that?

SANDRO GALEA: Yeah. So obesity is a good example because the biggest driver of obesity and the obesity epidemic more broadly is the greater availability of calorie dense nutrient products things like, I mean, just to put it casually, things like potato chips. You can say, Well, of course, I can control how many potato chips I eat. One, yes you can, but you're able to control it depending on what access to other foods you have. And we have abundant evidence that shows that you can be in areas in United States and this is all over. And this has also been shown in Canada, by the way, where the food you have available to you is units for unit, much more calorie dense, much more nutrient poor. So it doesn't matter how good your choices are, you are choosing from a choice set that is already putting you on the path to unhealthy eating. So you can choose within that, but you've already been strained into a less healthy path, which is going to make it much more likely you are going to get obese. And we know there have been some excellent reports have been published that obesity perhaps is one of the sentinel risk factors to risk of getting severe COVID. So that sentinel risk factor to getting severe COVID has been pattern by availability of food, which is itself pattern by availability of economic opportunity in neighbourhoods, which is itself patterned by a history of marginalisation of particular groups in particular neighbourhoods. So, you know, I suppose one can listen to this and say, I'm saying, well, everything is connected and also historically connected. And my answer to that is it is and that's OK. I think it's OK for us to recognize that. And what I'm trying to do is to get us to have that conversation.

MG: This speaks to the idea of health as a public good. When did that become controversial? That idea of health as a public good?

SANDRO GALEA: That's an excellent question, because you're suggesting that it wasn't always controversial, but there has been a real shift in the western world conversation on health since about the late sixties. And that there was an excellent surgeon general's report in United States that came out just at the tail end of the Trump administration, which looked at the trajectory of our conversation on health. And it showed very convincingly that for decades, in the first half plus of the 20th century, we tended to talk of health as a public good. We tended to talk of health as being the product of these forces that you and I are talking about. Then there was the rise of medicine and the rise of biomedical, specifically in the late 60s, early 70s. And much of that was a very deliberate and intentional rise of medicine fuelled by the medical profession and then redoubled by the biomedical research establishment. And that tipped the scale, and we started talking much more about medicine, then we started to talk about health. And that moved us away from this notion of health as a public good to an idealised notion that you and I have full control over our own health. Now I'm not saying that this was a negative intent of anybody in biomedicine or of medicine. I'm simply saying that we as a society slipped our conversation and that is hurting us. I mean, that was hurting us long before COVID. In the United States, we have lived sicker, shorter lives than all other high income countries, including Canada, for the past 40 years really since the 80s. And that is a direct consequence of the fact that we changed our conversation, that we started thinking that there would be a pill that I can take and Matt, that you can take that will take care of everything. And of course, that's simply false. And I hope that a listener to this conversation will step back and say, Yeah, when I think about it, you're right that I need all these other forces around me to make me healthy. That is actually not really smart to think that's going to be a pill to solve everything. But that's sort of how we think, that's sort of our thing and that's sort of how our politics thinks.

MG: Politics in your country. Is it possible for health to be a public and a collective good in a society where there still isn't a universal health care system where people have to worry about how they're going to pay, not just for the treatment, but for the preventative treatment that might keep them out of the hospital, for example.

SANDRO GALEA: Yeah. The question of the universal health care system is a tricky one. There is no question that it is a stain on the United States soul that it does not have a universal health care system. Everybody should have access to health care when they need it and that should be a right of citizenship. It's also, I think, sometimes misleading because in this country, the conversation tends to drift. Well if we had universal health care that's going to solve these things that we're talking about. And the answer is it's not. They're in many respects, separate issues. We want universal health care because we all want to be able to see a nurse, a doctor in a hospital when we're sick, but we would prefer not to be sick to begin with. So there are two different axes of action needed.

MG: When we talk about the next contagion, you say it's not if, but when the next thing arrives as we still make our way through this thing that we're living in right now, one of the things you say is that humility is an essential tool for building a healthier world. What can humility give us?

SANDRO GALEA: Humility can give us an honest appraisal of what we know and what we do not know. And it avoids us making the mistakes of being overly dispositive in prescriptions that then lose trust and confidence of the general public. One of the things that we have seen in the context of COVID have been these enormous societal divisions, and those divisions have been driven by many forces. But I think one of them has been by a lack of trust in what science and the health establishment has had to offer and a lack of trust that's built over decades of over-promising. And this over promise over decades has an effect. If we keep telling the population, we are soon going to get to a place where we can actually scan your genome and treat you of all cancers, we see that not happening time and time again. It does not seem to be unreasonable that all of a sudden there's a pandemic, and we're told by the health establishment, Oh look, there's a vaccine that will fix it all, don't worry about it, just take the vaccine. For a certain proportion of population to say, Well, I'm not so sure I believe that. You know, I've been asked by many colleagues in the media in the context of the COVID vaccine to say what should we do now to build trust? My answer to that is absolutely nothing. I don't think you can build trust in a crisis. Trust needs to be built in between crises.

MG: Do you worry about a lack of humility now in this moment when cases are starting to rise again, despite... We're in this moment where a lot of people say they're done with COVID. You have leaders who are saying you are done with COVID and you don't need to wear the mask, you don't need to adhere by the guidelines that we had over the last several years and COVID is not done with us. Do you worry about a lack of humility in that moment?

SANDRO GALEA: I think anybody who even browse a social media should be worried about lack of humility. We as a world, are grappling with a newly emergent, algorithmically mediated public square, which prizes certitude and disputation and leaves no space for uncertainty and complex thinking. And I think that's a problem for all of us. And I don't see this in a luddite way. In no way do I say that we shouldn't have social media at all. I just think we need to get better at learning how to think clearly and communicate clearly using media that are new to us. We've never lived through a global crisis where the public square is mediated and is very democratising force of social media before, and I think we have stumbled through it in much the same way. For example, when 9/11 and the wars in Iraq and Afghanistan happened in the early aughts was mediated 24-7 news, we as a world, we're trying to figure out how to have those conversations through that medium. I think similarly, we need to learn how to use this medium to have the kind of difficult, challenging, thoughtful conversations that need to be had that are not easily reducible to simple answers. Right now, we're in the war of competing simple explanations. Frankly, none of which are correct.

MG: Just finally, what gives you the optimism that everything that you've spoken about in terms of how we need to think differently about health, that that will be employed to protect us from the contagion next time?

SANDRO GALEA: Well, to quote a Canadian scholar, optimism is a form of political resistance. We, as a world, as I mentioned earlier, doubled our life expectancy over a 150 year period. We as a world developed two vaccines, not just one within eight months of COVID, first being diagnosed. They were more than 90 percent effective. We as a world had hospitals that did really well. In hospitals we did very well in terms of caring for people with COVID. So we've done some really good things, and I think this shows the potential of what we can do. And I, you know, I suppose I like any of us, I'm shaped by my own life experiences. And as... I think immigrants by definition, lean into optimism because one is aspiring to a better world and I think we can get there.

MG: It's a fascinating book, and I'm really glad to have the chance to talk to you. Thanks again. My best to your family as well. I'm glad that they are in a better place than when we spoke a year ago.

SANDRO GALEA: Thank you. I really appreciate that.

MG: Dr. Sandro Galea as a physician, epidemiologist and the Robert A. Knox, professor and dean at the Boston University School of Public Health. He's also the author of "The Contagion Next Time". That is The Current for this Wednesday. Coming up next on CBC Radio One, it's Q. At the heart for many years of Tom Petty and the Heartbreakers was the guitarist Mike Campbell. He was the engine in many ways of that group. It's been five years or so since Tom Petty died. Mike Campbell is now back on stage with his own band, and he will join Tom Power coming up in a few moments to talk about that band The Dirty Knobs, probably some Tom Petty stories thrown in there as well. Mike Campbell coming up in just a moment on CBC Radio One. I'm Matt Galloway. Thank you for listening to The Current. We'll talk to you tomorrow.

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