Paul Farmer, Global Health Leader, Dies At 62

JOHN DANKOSKY: This is Science Friday. I’m John Dankosky, in for Ira Flatow.

Like the rest of you, we’re watching closely as Russian troops continue their invasion of Ukraine. Scientists in both countries have organized protests and written open letters against the incursion, as they are increasingly concerned about threats to their lives, livelihoods, and global stability. We’ll continue to watch what’s happening, and bring you news in the coming weeks. We’ll also send out our thoughts to those in harm’s way, including the journalists covering this invasion.

The world of science suffered another blow earlier this week. The world lost a giant in medicine, Dr. Paul Farmer. A physician and co-founder of the humanitarian medical group Partners in Health, Dr. Farmer died unexpectedly this week in Rwanda, at the age of 62.

I wanted to start with a clip from Dr. Farmer on Science Friday, back in 1999. Here he is talking with NPR’S Joanne Silberner about treating tuberculosis in Haiti. It’s a window into the way he thought about public health.

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– In our program in Haiti, when we offered patients financial aid during the course of their therapy– and this, frankly, is done widely, although sometimes people seem a little bit sheepish to discuss it– but we were very proud to offer financial aid to our patients– and initially, we did that, and telling them that you’ve got to buy food with this. Because our patients in Haiti were malnourished, right? It’s a very different kind of setting than in New York, where you had a lot of patients whose co-morbid problems were, say, substance abuse. Well, in Haiti, it was really malnutrition, and subsequently, to some degree, HIV.

But when we gave them the money initially, we said, buy food with it. Well, they didn’t buy food. They’d buy shoes for their children or schoolbooks or tin for their roof. But the impact on the family was always beneficial. I mean, the patients would do better no matter what they did with it. If they used the money to help their children to buy school supplies, it still had a beneficial impact.

And at the same time that we got to meet these families through the person with active tuberculosis disease, we also got to offer, again, the children preventive therapy. It was a way of getting inside what Peggy just called those concentric circles, and really having an impact on, we hope, on the incidence of the disease in the region.

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JOHN DANKOSKY: Here to help me remember Dr. Farmer, and also talk about some of the other stories from the week in science, is Sarah Zhang, staff writer at The Atlantic.

Welcome back to Science Friday, Sarah.

SARAH ZHANG: Thank you for having me, John.

JOHN DANKOSKY: So how will you remember Paul Farmer?

SARAH ZHANG: Oh, gosh. So I’ve talked to a lot of public health experts over the past couple of years because of the pandemic. And it was just so striking, this past week, to see almost everyone talk about how Paul Farmer was an inspiration, or even influenced them, to go into the field of public health. As you say, he was just such a giant. I don’t think there’s anyone in public health who’s not been touched or influenced by his work in some way.

And in the clip that we heard, where he talks about treating tuberculosis in Haiti, we heard him talk about not just giving people medicine but also giving them money. I think this is also a really influential idea– the social determinants of health, which is that health is not just about access to pills or access to having a surgery. It’s about how you live your daily life. And if you are poor and you get sick, you’re sometimes forced into these terrible trade-offs, where, can you still feed or clothe your children? Can you still keep a roof over your head?

And what he’s promulgated is just, in some way, so simple but so revolutionary, that if you just give people some money– not that much money by American standards– they can be not forced into making these terrible trade-offs, but actually doing things that will make them healthier in the long run. Health is not just about medicine.

JOHN DANKOSKY: Yeah. And of course, at this time, during the pandemic– and you’re talking to so many health experts– his voice is a very relevant voice at a time like this.

SARAH ZHANG: Yes, absolutely. I think we can see this both globally and here in the US. The people who have died of COVID, it is just so disproportionately among people who are poor and working class, people who had to work in the pandemic, who could not work at home.

I think globally, as well, Paul Farmer was also just a great advocate for the equality for vaccines around the world. And we’re in the moment where, in the US and in Europe, we’re getting third and fourth shots, and there are still lots and lots of people in the world who haven’t gotten a single shot.

JOHN DANKOSKY: There is some other big public health news this week. You pointed out a story to us about a case of polio in Malawi. Why is this so significant?

SARAH ZHANG: Yeah, this is a big deal, because the world has actually gotten really, really close to eradicating polio from the Earth, which would be a great thing to do if we could accomplish it. So for the past few years, the only two places in the world where wild polio has been circulating have been Pakistan and Afghanistan. In Africa, there hasn’t been a polio case in years. And in Malawi in particular, there hasn’t been a polio case in decades.

So what’s really concerning about this one case is that it’s probably just the tip of the iceberg. It kind of came to attention because a young girl was paralyzed by polio. And actually, most polio cases are asymptomatic. You don’t get really sick at all. And even if you do, it might just kind of be fever and headaches. It’s really only in 1% of cases that patients actually become paralyzed.

So if we have this one such case, there are possibly hundreds of cases out there. But according to the genetic sequence of this virus, it seems like it’s quite similar to something that was circulating in Pakistan a few years ago. So it’s kind of a big question of how this virus traveled thousands of miles to Malawi. So there’s going to be a lot of work ahead to try to eradicate polio again in Malawi.

JOHN DANKOSKY: Mm-hmm. We have an update now to one more medical story, something that you’ve been following. A few weeks ago we talked about a study of military members that had a pretty convincing association between the Epstein-Barr virus and then later developing multiple sclerosis. You say there’s some new research out on this. Tell us about it.

SARAH ZHANG: Yeah, that’s right. So that study you mentioned in military members was just kind of a really incredible study, using tens of millions of records, finding a really clear correlation that getting infected with this really common and in some ways fascinating virus called Epstein-Barr increases your risk of multiple sclerosis. Now we have a second paper, which actually gives us maybe some causation to what this relationship is. So a second paper out of Stanford finds that people with multiple sclerosis, they have antibodies that bind to the virus. But these same antibodies also bind to a protein in their brains.

Multiple sclerosis is an autoimmune disease, where the immune systems mistakenly attacks the nervous system. So this idea that there’s an antibody that binds to both the virus and the brain has just been theorized for a really long time. But this is the first time it’s really been found and identified. It might not explain every single case. Multiple sclerosis is really a complex illness, and the immune system is really, really complicated. But it really might explain a subset and really tell us why we are seeing this association.

JOHN DANKOSKY: Would this make it more difficult to just vaccinate against Epstein-Barr? I mean, what does this mean as far as treatment?

SARAH ZHANG: Yeah, that’s a great question. So on one hand, maybe there are ways to think about targeting this antibody that is somehow maybe getting the immune system to mistakenly attack the nervous system. The other big question, as you ask, is vaccination. Just to talk a little bit about Epstein-Barr for a minute. It’s a virus that actually infects almost all of us– 95% of us– so statistically speaking, you and I probably have had this virus. And it doesn’t really make you very sick.

Usually what happens is you get it as a kid and you probably don’t even know that you got it. If you get as a teenager, though, it can sometimes give you mono, which is sometimes called the kissing disease. We don’t really know why there’s this age gradient, but there is.

So there have been efforts to develop a vaccine to Epstein-Barr before. But they found that, while it can prevent mono, it can’t really prevent infection in general. So now we have this question of well, OK, if we have a vaccine that does not prevent infection, can it still prevent multiple sclerosis? And there are reasons to think that it might. We don’t know the definitive answer.

The good news is that, just recently, two new clinical trials for the vaccine to Epstein-Barr just launched, one of them from Moderna, the company that also makes the mRNA vaccines for COVID, so this is an mRNA vaccine for Epstein-Barr, and another group at the NIH. So these are really early stage clinical trials, but there are some real viable vaccine candidates down the road.

JOHN DANKOSKY: And just to be clear– and we talked about this a few weeks ago when we covered this initial research– if this is correct, what we’re saying, this wouldn’t account for every case of MS that we have, right?

SARAH ZHANG: MS, like all autoimmune diseases, is such a complicated disease. It may have lots of different factors that go into it. It sort of runs in families in some ways, so there may be some genetic component. The other part of it is, of course, as I said, almost all of us have been infected with this virus. Most people will not get multiple sclerosis.

So there’s also just a question of, well, this virus could be a triggering factor, but maybe there also need to be other factors. And we don’t exactly know what those are yet.

JOHN DANKOSKY: We’re going to go to another story that’s a bit of a downer. It’s not quite an update. Last week, we talked about recent research that shows that climate change was increasing the risk of flooding around the world, and also that extreme drought was occurring more frequently around the world.

This week, a new report– and it says there’s more fire in the world. Oh, my goodness, Sarah. What’s new now?

SARAH ZHANG: Yeah. Well, in some ways, if you’ve been living for the past few years, this is probably not surprising, right? There’s been so many wildfires in the American West and in Canada and Australia, even the Arctic. So a new report from the UN lays out that the risk of highly devastating wildfires might go up by 57% because of climate change.

And I think, in some ways, why this has happened is a little bit intuitive, right? If there is less rain, it’s going to be drier. If it’s really hot, it’s also going to be drier, because the moisture inside fuel is going to evaporate. So what you have is just basically a lot more fuel that is ready to go up at any sort of spark. And unfortunately, we’ve been seeing that already, and it will probably happen some more.

The really scary thing is not just that places that have historically dealt with wildfires might have to continue to deal with them, but that they may be happening in places that historically haven’t, like the Arctic, for example, which a couple of years ago was also on fire. So I think the risk of wildfire is not just going to get bigger in some places, but it’s going to change, and we’ll have to adapt to that.

JOHN DANKOSKY: We’ll wait and see what other scary study comes out next week about global climate change.

We’re going to finish with one last update. A few weeks ago we mentioned the case of space junk that will soon impact the moon. And at the time, Sarah, we said that it appeared to be part of a SpaceX booster, but there’s actually new news here– a bit of a mystery.

SARAH ZHANG: Yeah. So we still don’t know exactly what it is. So we have a better idea. So originally, a group of independent astronomers thought that it was a piece of a SpaceX booster. Some more analysis by astronomers at Harvard and NASA says it’s actually maybe a piece of a Chinese rocket booster. This is part of a Chinese rocket that launched in 2014.

Usually rocket boosters, they kind of just fall into the atmosphere and kind of burn up. Somehow, in this case, it did not happen. The Chinese, however, are saying that it is not their booster, that theirs actually burned up. So someone is clearly mistaken here. But in any case, this booster is on its way towards the moon and is still going to crash into it by March 4th.

JOHN DANKOSKY: It’s so interesting that we just don’t know who owns this piece of space junk. Is anyone keeping track of all this stuff that’s up there?

SARAH ZHANG: No. That’s the problem, right? So the US Space Force does keep track of everything that’s around the Earth. So everything that’s kind of close to us and might be a problem for satellites close to the Earth. But when you get a little bit further out, when you get out to around the moon, no one is really tracking it. Part of the problem is that the moon is really, really bright. So if you’re looking at a small piece of space junk, it’s like this tiny little black speck against something that’s really bright. And that’s just hard to see or hard to identify.

Space Force, I think, did recently give a little bit of money to astronomers to try to come up with better ways to track this lunar space junk. But yeah, this is a kind of problem that no one is really responsible for.

JOHN DANKOSKY: All right, we’ll see if we have any more updates. It’s fascinating stuff.

Sarah Zhang is staff writer at The Atlantic Thanks so much, Sarah, for being with us this week.

SARAH ZHANG: Thank you. Good to talk.

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