Author: Nicholas Skoda

[00:00:02] Narrator Globalization, geopolitical conflicts, climate change and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses and more, we’ll explore what it means to protect public health, and how preparedness today can lead to a safer tomorrow. Throughout this season, we’ve spoken with experts from around the world about a wide range of public health threats, from vector-borne diseases and zoonotic spillover to biothreats and orthopoxviruses. Across all these challenges, a larger overarching threat looms, one that has the power to intensify nearly every threat we’ve discussed, global warming and its effects on our climate system. The effects of climate change touch communities around the world. In this episode, we look at how climate change is shaping public health today and how it will continue to test our health systems in years ahead and what we can do to be prepared. Kristie L. Ebi, PhD, MPH, is a professor of global health at the University of Washington. She has been conducting research and practice on the health risks of climate variability and change for more than 30 years. Kristie provides an overview of all the ways that climate change will affect the globe over the coming decades, such as rising temperatures and increased levels of CO2.

[00:01:44] Kristie L. Ebi Going to be characterized by some major challenges, because of climate change, because of biodiversity loss. One of them is food security. That comes from two major sets of changes. One is increasing temperature, changing precipitation patterns because of climate change. That is looking in vulnerable parts of the world, parts of sub-Saharan Africa, parts of Asia. Many crops are growing on the thermal edge of their tolerance. The second part of that is also worker productivity. That is as temperatures go up, there’s many places where it’s extremely hot, and particularly if there’s humidity. And it’s difficult for outdoor workers to be as productive. There’s estimates of how much worker productivity could be reduced under different amounts of climate change. And all of them are significant and will affect the places, of course, they have challenges today. The second major category is from carbon dioxide itself. Carbon dioxide affects our plants. And under those conditions, the protein content of wheat and rice goes down about 10 percent, B vitamins go down about 30 percent, and through another mechanism, the micronutrient content declines as well. I didn’t look at the latest numbers from the Food and Agriculture Organization, but I think it’s around 700 million people in the world are food insecure, about two billion have micronutrient deficiencies. So any decline in these micronutrients puts a lot more people at risk. When speaking of micronutrients, you can think, for example, of iron. About 1.5 billion women and girls are affected by iron deficiency anemia around the world, including in high-income countries. So large interactions with carbon dioxide and what that means for food security, and then on top of it, changes in crop yields. All projections indicate that as we go into the century, food security is going to be a major challenge, particularly around tropical regions, but it’s going to be affecting all regions.

[00:04:08] Narrator Eloise Todd is the executive director and founder of Resilience Action Network International, a network of over 400 organizations from all around the world dedicated to working on health and pandemics, climate finance, and biosecurity. Eloise also outlines some of the challenges we are facing, such as desertification and the process of land becoming unsuitable for agricultural uses.

[00:04:31] Eloise Todd  The impact of climate change on health is better understood now than it was before. And it’s good news that there is more recognition of the health impacts of climate change. What there needs to be is a much bigger focus on the impact of the climate change on health systems. We did some work a few years ago to show what the impact of climate on pandemic preparedness and pandemic response would be. And just very simple things that were not taken into account, such as 16 percent of hospitals are near to areas that would be overtaken by rising sea levels. So when we’re thinking about how to make health systems more resilient, there’s the perhaps obvious pieces such as, let’s make them carbon neutral, let’s think about the disease threats that are going to break out. But there are so many more challenges to think about with pandemics and climate and that intersection. And we know that there are different diseases that are going to come through. Zoonotic spillover is going to get, become more and more frequent. And with desertification and the proximity of humans to animals, that’s going to mean that there are more chances to get that crossover of diseases from animals to humans, which is where 75 percent of pandemics come from. So there really is this interconnection as the temperatures rise, disease is more likely, there’s more zoonotic spillover, there’s more destruction of natural habitats and the cycle goes on.

[00:06:13] Narrator As Kristie and Eloise have outlined, the intersection of climate change with other health challenges is both broad and complex, and as our understanding deepens, one issue is emerging as an especially urgent concern, heat.

[00:06:27] Kristie L. Ebi Almost everywhere in the world has been affected by heat waves recently, and they affect us strongly. It depends on our underlying physiology. It depends on our activities, but ultimately what we’re concerned about is our core body temperature. Our core body needs to stay within a pretty narrow range to protect our cells and our organs. When we go throughout our day, our core body temperature goes up and down. We’re more physically active, our core body temperature goes up. We relax, we find a shady place, our core temperature comes down. But over hours, if we have a higher core body temperature and that heat continues to build up, it does then start affecting our organs. We know from studies of heat waves that about half of the excess deaths in a heat wave are from cardiovascular causes. This indicates our heart is pretty sensitive to those higher temperatures. We also know from the extensive studies of heat waves that almost all heat-related deaths are preventable. And there’s a big focus on trying to prevent all of these adverse deaths, all of the hospitalizations that result from heat waves. There are well-known, particularly vulnerable groups, children, adults over the age of 65, outdoor workers, of course, people who engage in sports during periods that are quite warm. There are other vulnerable groups. We can think of, for example, pregnant women. There’s lots of research showing that pregnant women exposed to high temperatures during pregnancy more often have low birth weight babies. And that can have lifelong consequences for the baby. People who have chronic diseases, that would make them more susceptible to higher temperature, people who take certain prescription drugs that reduce the ability of the body to sweat. As you can see, it’s a very long list of people. And those are just the physiological characteristics.

[00:08:47] Narrator Melissa Furlong, Ph.D., is an environmental epidemiologist who studies the chronic health effects of environmental contaminants that result from extreme heat.

[00:08:58] Melissa Furlong There are different risks associated with heat waves and with wildfires, but if we’re thinking about populations that are uniquely at risk for heat waves, we have to consider the unhoused people who might live in their homes but either don’t have access to regular air conditioning or are unwilling to use their air conditioning for cost purposes. And again, populations that spend a lot of time outside. So either people who have to spend a lot of time walking to work or working outdoors, or just walking outside. So those people are at highest risk from heat waves. And then when we’re thinking about wildfires, so anybody who lives in an area where that isn’t generally affected by wildfires, those people are going to be at higher risk and in populations that have some health susceptibilities, right? Like obviously if you have asthma or respiratory problems, then you’ll be at increased risk from wildfire smoke, but also pregnant women and the elderly are at uniquely high risks from wild fire smoke exposure. And so there’s been some evidence that has been produced over the last 10 years that shows that women who have exposure to more heat waves during pregnancy that they are more likely to have babies who are born pre-term. So that means before 37 weeks of gestation, which could submit risk for lots of other health conditions. And also, they’re more likely to be born with low birth weight, which again is associated with several different health conditions in childhood and throughout life. And heat waves probably are also associated with several different other health outcomes for the baby, for the infant, and for the child.

[00:10:46] Narrator  Cities and communities are beginning to develop heat action plans in order to address this growing threat. Kristie details some strategies she has seen implemented.

[00:10:58] Kristie L. Ebi There is something called the urban heat island, which basically says that urban areas are hotter than the surrounding rural areas because of what our cities are built from. The materials, the asphalt, the cement absorb heat during the day, they release it slowly at night. And so urban areas can be many, many degrees warmer than the surrounding rural areas. On top of that, if people have window air conditioners, for example, those dump heat into the environment. And so looking at all of the ways that our urban environment can be modified to make it more comfortable in a warmer climate. Tree planting programs, having access to blue spaces, of thinking about the different kinds of structures, the different kinds of building materials, the different kinds of orientation of buildings. They’re not directly facing the sun, for example. There’s a long list of urban design elements that can be put in place. And the sooner that communities start thinking about this, the more they can put it into their regular planning, that this is not an extra expense that has to be paid today, but this is, oh, we’re going to be doing X. And so let’s build these actions into that, into our planning. I personally live in Seattle. Seattle is a sea of cranes. There’s constantly building. And so there’s lots of opportunity to think about how to structure our urban environment, which then of course will reduce the overall risks combined with a heat wave early warning and response system can really make a difference.

[00:12:47] Narrator Wildfires present another concern.

[00:12:49] Kristie L. Ebi There is robust evidence that wildfire smoke is much more toxic than what comes out of tailpipes. And so don’t use the same scales that people use for whether air quality is acceptable or not. If it’s wildfire smoke, it’s three to 10 times more toxic. And so to take that into account for trying to protect people who’ve got any kind of lung condition, anybody who’s vulnerable to those high concentrations of wildfire smoke. One of the many increasing challenges for health systems is, of course, that hazards are not appearing one at a time and to prepare for what we call compounding and cascading risks. Pacific Northwest, lots of heat waves, lots of wildfires, they of course happen basically around the same time that the wildfires start when it’s particularly hot. And how to approach then addressing these multiple simultaneous challenges.

[00:13:57] Melissa Furlong So firefighters are obviously at increased health risk from wildfires just because they are the frontline responders. Most of what I do about with firefighters is on municipal fire exposures, so structural rates of, like, in town, but, and then a little bit on wildland. So we know that firefighters are at increased risk for several different types of cancers. The International Agency for Research on Cancer actually, designated the occupation of firefighting as a class 1 carcinogen in 2022, but we don’t know the specific exposures that are contributing and we don’t know the biological mechanisms and we also don’t know, like, what we have an idea of what firefighters can do to protect themselves, but they don’t have a comprehensive picture of how firefighters can protect themselves. But part of the issue with wildland firefighting is that it’s really difficult. Very hard. It’s also very different from municipal firefighting, structural firefighting. And PPE is not routinely used in wildland firefighting so the firefighters are exposed to very high levels of heat and really high levels of air pollution and wildfire smoke during the wildland fire. And the other thing about wildland fires is that they often go on for weeks at a time. So, like, for a municipal fire, a structural fire, right, you know, the firefighter goes and it’s out maybe in a couple of hours. But for the wildland fires, the firefighters are out basically camping out for weeks fighting these wildfires. And so we have really high levels of exposure.

[00:15:32] Narrator While immediate threats like heat and wildfires are near-term concerns, it’s important that potential long-term effects of climate change are also considered and planned for.

[00:15:42] Eloise Todd  How should we be planning our health systems? What do truly resilient supply chains look like? Where should we even be building primary health care facilities, factories? Where will the workers be living in 10, 20 years because of climate change and some of the inevitable migratory effects that happen? What will happen with food systems and what does that mean for populations’ urbanization? The subject is fascinating. It’s also a glimpse into the future that people sometimes feel uncomfortable looking at. But if we really want to plan and understand how we’re going to deliver the kind of countermeasures we need and the kind of preventive measures we need in order to tackle the threats that are coming down the line, we need to have an honest look at where the science is taking us and plan around that. When it comes to climate and health and climate resilient health systems, there has been a decent amount of talk around the issue, but it has tended to land on very specific, tangible outcomes. Everybody likes to have a manageable goal as something that they feel is achievable, to say, oh, well, there’s one slice of the problem and here’s how we can tackle it. And that’s also quite something that governments want to do. It’s something that businesses want to do and also philanthropy. But because of where we are with climate change, it’s really important that we do look at the whole picture systemically. And I think there’s a changing appetite and a changing readiness to want to look at that and be ready to look at that, but it’s taken quite a lot of hard work to get people there.

[00:17:29] Narrator Eloise notes just how important it is that this is a global effort.

[00:17:33] Eloise Todd  The challenge with that is that it mainly focused on high income countries around the world. And so we need that kind of effort when we look at low-middle-income countries as well, and to see if they can implement technologies that leapfrog some of the things that were put into place in high income countries and sort of get to where we need to be more quickly. Low-middle-income countries are certainly much more at risk from climate change. Many of them are in a much hotter zone, not all of them, but many, which means they will have very harsh conditions to deal with as the temperatures rise. Many countries are starting from health systems that are quite rudimentary and need to have a lot more investment. However, that also means there’s a big opportunity, an opportunity to work with communities to deliver the kind of services in a community way that will have more buy-in from local populations. So there’s a mutual learning curve between people trying to deliver services and also those on the ground. There’s also the opportunity to leapfrog technologies and really get to where we need to be a lot more quickly.

[00:18:55] Narrator While there are many issues requiring a unified approach, Kristie, who has worked in the field for decades, highlights where things are moving in the right direction.

[00:19:04] Kristie L. Ebi I’m in the privileged situation of having worked on climate change and health for several decades. I started at a time when there was very, very few people in the field. A good colleague likes to say that in the beginning we all could have met in a phone booth. It is an exaggeration, but it’s not as much of one as it should be. And what really gives me hope is how many people are now paying attention. The young people are really interested in climate change in general more are coming into climate change and health. They understand the risks. They really want to make a difference. That increased awareness, that increased engagement means that there is a momentum to move forward and ensuring we do increase resilience to a changing climate because we have people who are energetic, enthusiastic. And as young people always are, and they hate being called young people, but as they engage in their careers, they are committed to moving the situation from where we are today to a future that is more resilient and more sustainable. And that gives me a lot of hope.

[00:20:26] Eloise Todd  When we talk about sustainable and resilient health systems, we just have to think back to the COVID pandemic to understand how important community relationships and information and the right information and trusted sources are. This was a challenge that faced people everywhere from the UK, where I grew up, to different countries across Africa, all around the world, every single corner of the world. We know certain things for sure. We know that people trust their peers, their trusted community figures, their leaders. You trust your good friends. This is universal. These rules are universal. And so in order to tap into those networks, it’s so important that the local authorities, the governments, the civil society organizations, the people that want to make change happen, everybody’s on the same page. There’s a networked approach to getting the right information, to understanding what the right information is, that it’s verified, and then everybody can walk forward together, spreading the right information and also doing enough in advance to kind of form an inoculation, if you pardon the pun. The disinformation if and when it comes. At Resilience Action Network International we believe there is a lot of work to do still to define what it will take to build truly resilient climate resilient health systems across low- and middle-income countries and also frankly across the whole world. While we salute the initiatives that exist already and are ongoing, we truly believe that there needs to be a much more wholesale, holistic approach to this issue, where we’re willing to say, what is it going to take to design a system that is flexible and agile enough, that responds to where people will be living, that will respond to where people will able to inhabit, and what kinds of diseases and challenges that they will face in the future. So we’re not just designing for now, for the mid-20s, but we’re designing for 2030, 2040, 2050. And we need to take that leap, and that’s the piece that we think is vital.

[00:23:03] Narrator As we’ve heard throughout this episode, climate change touches every corner of public health, from the immediate dangers of health and wildfire smoke to long-term pressures on food security, health systems, and communities around the world. But we’ve also heard something else, a growing sense of momentum towards solutions that could help turn the tide on the climate crisis. As Kristie reminds us, only a few decades ago, the field of climate and health was so small it could fit in a phone booth. Today is filled with researchers, practitioners, young professionals and community leaders who understand the risks and are determined to build a more resilient future. That energy and commitment is a powerful source of hope. And as Eloise emphasizes, building climate-resistant health systems will require a holistic global effort, one that looks decades ahead, strengthens community trust, and treats resilience not as a cost, but as an investment in our collective future. Climate change is reshaping the world we live in, but with attention, innovation, flexibility, and collaboration, we can shape how our health systems respond. Thank you for joining us for this episode and for this season, as we’ve explored the threats and opportunities shaping global health today. The views and opinions expressed by the guests are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates. Guests are not representatives or spokespersons for Emergent BioSolutions, and their appearance on this podcast is not an endorsement.

[00:00:01] Narrator Globalization, geopolitical conflicts, climate change, and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses, and more. We’ll explore what it means to protect public health and how preparedness today can lead to a safer tomorrow. In this episode, we return to the opioid crisis and the progress being made in access to naloxone, one of the key factors in reducing opioid overdose deaths. In 2023, the FDA approved NARCAN® Nasal Spray, a four milligram naloxone product for over-the-counter sale in the United States, marking a turning point in the opioid crisis. Once available only by prescription or through community programs, this medication is now more accessible than ever before. Experts point to expanded access as a critical factor in recent declines in opioid overdose deaths. But the crisis is far from over. Some communities continue to experience devastating losses, especially in rural regions and among marginalized populations. And stigma remains a barrier to widespread adoption. This episode explores naloxone accessibility through three perspectives. A recovery advocate who has lived through the crisis, a mother whose son survived an overdose because naloxone was available, and a public health researcher focused on overdose prevention and equitable access. We begin with Zac Clark, founder and CEO of Release Recovery and the Release Recovery Foundation. Zac, who is featured on the reality television series, The Bachelor, is also in long term recovery himself after years of opioid use. 

[00:01:59] Zac Clark So much of my expertise lends or relies on my personal experience. And so when I think about the opioid crisis, for me, it really looks at the three phases. So back in the 90s, we had big pharma pushing these kind of really high-powered pharmaceuticals into the marketplace, and folks began to get addicted. I’m someone who’s in long-term recovery. I just celebrated 14 years. I was an IV heroin user. I say that very openly to try and defeat some of the stigma that we talk about. And so for me, I was really in that second phase of the opioid crisis. I was using heroin, I was injecting it, and then really the third phase was fentanyl. And when fentanyl came into the market or into the scene, 2013, 14, 15, I was sober where I probably wouldn’t be speaking to folks right now as I am on this show. It did something that I don’t think we ever could have predicted. Fentanyl is obviously, it’s a synthetic opioid, it’s manufactured, it’s a lot cheaper to manufacture, so obviously very attractive to drug dealers, people that are selling drugs illegally and it’s also 50 times stronger than most of the other opioids that we had seen out there in the marketplace. So when this third wave came, the biggest thing for me, and I try to keep it really simple because there’s a lot of things we can go back and forth on when it comes to the opioid. But as someone who experienced drug use, what happened was someone like me who was using heroin starts using fentanyl without knowledge, and we start to see the overdose numbers really climb. And so for me, going back to the question, this is a long way of saying for many, many years, heroin was a dirty word. And in a lot of ways, it still is. It’s one of the reasons I speak so freely about, you know, my experience, so that people can see me hopefully and say, Oh, it’s a pretty normal guy, and he’s a heroin addict. That’s kind of the thread that I try to keep going. When people started to pass away, obviously it was very jarring. And what we are seeing now in the year 2025 around the conversation for me. So I’ve been in this space for a while now. This thing does not discriminate. So more and more people are being affected. More and more people have lost individuals in their lives very close to them. We have lost people, humans who are freshmen in college who show up on a college campus and think they’re trying cocaine or smoking pot for the first time and it’s laced with fentanyl and we’re we’re losing common folk who are experimenting for the first time and so that has really brightened the light being shined and what it has done is it is, you know, families it’s almost like a grassroots effort the conversation is starting to shift to it’s important to understand this it’s important to understand that we’re losing over 100,000 people a year to accidental overdoses, and it’s important to understand that there are things that we can do to help limit those which when you talk about a drug like naloxone which reverses overdoses and some of the other more like preventative methods and educations available. There is some hope, but it’s still bad. You know, it’s still very bad in terms of the conversation. 

[00:05:48] Narrator As illicitly manufactured fentanyl, a powerful and synthetic opioid, has flooded the drug market. The effect of the opioid crisis becomes even clearer. This shift has made the role of naloxone even clearer. We now turn to Amy McCormick, a nurse, mother, and grandmother, whose son Owen nearly lost his life to an overdose. Owen grew up like many kids in the US, skateboarding, hanging out with friends. He began taking opioids at a fairly young age, struggling for several years with his addiction. He spent time in and out of rehabilitation centers in his late teens and early 20s, and eventually experienced an overdose at age 23. 

[00:06:28] Amy McCormick Owen ended up overdosing in California and he was saved by naloxone. And that was August, it will be seven years this year from when he had overdosed. And luckily rescue was called and he was saved because they did have naloxone. 

[00:06:46] Narrator For Amy, naloxone is not abstract policy. It is the reason her son is alive today. Her family’s story illustrates why access must go beyond pharmacies and into the hands of bystanders and communities. And researchers like Olivia Sugarman, PhD, MPH at Johns Hopkins, who studies how policies can promote access to high-quality health services for historically marginalized people, specifically people who use drugs, are asking the same question. Why? If the naloxone is simple, safe, and effective, are there still barriers to getting it? 

[00:07:22] Olivia Sugarman It’s easy to use. It’s relatively cheap. There aren’t many things controlling whether or not you can get it. It’s more just is it where it needs to be at the time that it should be. So why are people still having barriers to getting it when this crisis continues to be a thing? 

[00:07:38] Narrator Naloxone has been credited with reversing tens of thousands of overdoses each year. For Zac, the evidence of its impact isn’t in reports or numbers. It’s in the clients who arrive at his recovery center alive because someone had naloxone on hand. 

[00:07:53] Zac Clark So the impact that I’m seeing since naloxone has been made available over the counter is fascinating. And I’m seeing it in a couple of different areas. One, at Release Recovery, the program that I run, we are seeing clients and patients show up in our care who at one point had an overdose reversed with naloxone. So those are data points that I’m seeing in real time of someone who is alive where they would not be otherwise, because this drug is available. So I think of common sense. You walk into any house in America, you’re gonna find a fire extinguisher. It is way more likely that you are gonna need to use naloxone at some point than to use that fire extinguisher. And so that’s common sense. And I’m here to tell you that I am seeing people show up in my care who are alive. And so it’s working. I get the opportunity to go out to college campuses and do some tabling, which means basically we’re out there talking to people about naloxone, just being curious. You know, do you know what this is? Do you know what it does? And five years ago, I would say very few students, the young people, I think young people always provide us with more information than probably we’ve realized the young people didn’t know what naloxone was. In my most recent experience, I would say there were only a couple of students who weren’t aware. So that tells me that we are making progress, that the benefits of naloxone are out there. If you’re listening to this and you don’t know what naloxone is or does, the thing that I’m gonna tell you is that there are very little, there’s very little downside other than saving someone’s life, to having naloxone present. We are seeing progress, especially with the young people. 

[00:09:55] Narrator Naloxone can reverse an opioid poisoning, but barriers remain to accessing it. Amy has seen how stigma keeps families and communities from carrying it, even when it could save lives. 

[00:10:08] Amy McCormick Community is like the biggest part of this and decreasing the stigma is making sure everyone knows this can happen to anybody. This can happen to the richest of people, the poorest of people, socioeconomic has no boundaries, you know, with addiction. So I think it’s really, really important that we continue. I think stigma is still a huge part of this. And even in the corporate world, you know, if the numbers show this is where people are overdosing, you know, some of the highest places, they need to be trained and it needs to be present. It is such a high safety profile with such a low cost to save a life. Like now is not the time. Like I said, some funding should not be decreasing at this time. This is where we should still be ramping up, even though we’ve seen a decrease in overdose, it should still be ramping up. You know, make gains in the gym and then decide to stop. Like, we keep going. We keep going harder, harder, harder until this isn’t a factor. And I think there’s so many areas that we can still put naloxone in place, you know, in the communities and educate kids through college and healthcare workers as well, too. There’s just too much opportunity that we have missed that still can be, you know, touched in a lot of regulations. 

[00:11:26] Narrator Naloxone can be obtained in various ways. Olivia Sugarman highlights the most common distribution methods. 

[00:11:34] Olivia Sugarman There’s this really great document from, I think it’s the Reagan-Udall Foundation, but they did, it’s kind of, I think it’s called a naloxone economic overview, but they got a bunch of data around who gets naloxone. And by who gets naloxone, I mean like what kind of companies get naloxone or give it out. And they have this great bar chart of here’s CBOs, so community-based organizations, and here’s pharmacies. And by and large, most naloxone was distributed through community-based organizations. So pharmacies are a great way for people who are bystanders or who are willing to take the cost of purchasing an naloxone kit to access it. But CBOs large and above are probably the major outreach point. 

[00:12:19] Narrator Naloxone’s effectiveness depends not only on the drug itself, but on whether people can afford it, find it, and feel comfortable carrying it. As distribution expands, the conversation turns to equity. Which communities are still being left behind? Despite nationwide declines in opioid overdoses, communities continue to struggle and disparities have become more visible. Olivia emphasizes that the crisis now disproportionately impacts communities of color and minoritized populations. 

[00:12:48] Olivia Sugarman So thinking about equitable ways to distribute naloxone. So we’ve seen a disproportionately high rate of overdoses in communities of color and minoritized populations, which is alarming. But I also think that speaks to more general inequities in harm reduction services or health services in general. And that’s not a new story. I think we’re just seeing a symptom of a story that’s been the case for a long time. That said, now that we know that that’s the case, there is an opportunity to say overdose rates are happening more often in these communities. These are the tools that we know work or can work or that we can tailor to work to be specific for people who either haven’t been engaged in naloxone distribution before, people who may not know about naloxone, perceive their risk to be lower for overdose, or people who have wanted naloxone for a long time but have never had the opportunity to get it because it’s just not available. So I think we’re at a really key moment where I think the imperative really needs to be paying attention to the data. It’s there. It’s in our faces. It’s just about acting on it. 

[00:13:54] Narrator For Zac, equity is also about defeating stigma. He says the opioid crisis has reached so many communities now that attitudes are shifting. 

[00:14:04] Zac Clark When I think about and in talking about the stigma associated with naloxone, I do believe we are making progress. We have to be, you know, I have to believe that. I mean, I’m just this is my work. This is my life. This is one of the things that I care most about after my family and, you know, friends and whatever else we live for. So I have to believe that. And I have to know that. And the reason is the longer this world spins, the more people are going to be affected by an overdose. And when all rows lead back to that, more and more people are going to be exposed to this thing, which means more and more people are going to understand the vital nature of naloxone. And, you know, for a long time I had my big three, right? Keys, wallet, cell phone. It’s now the big four, you know, because naloxone is in that mix, and I just wouldn’t want to be in a position where I’m out in the world, and someone’s overdosing, and I’m not there to help. I think that the area where there’s probably some improvement is just making sure that it is in every deli and in every restaurant and in every place of employment. Because a lot of these organizations assume that while they’ve heard the stories, it’ll never happen to them. Just like a family member. It’ll never happen to them. And that’s where I think we’re misguided. For me, I would much rather be ahead of the curve and have it available. And so the stigma’s real. I mean, anytime you’re talking about street drugs and something that makes people feel like they are less than if they are associated with, there’s gonna be stigma, and someone might refuse to carry naloxone because of what they think other people might say about them. And that’s just the reality of the world we live in. 

[00:16:10] Narrator As naloxone becomes more common, strategies for reaching people where they are become increasingly important. Olivia says that some of the most promising efforts involve non-traditional distribution, vending machines, libraries, and even barbershops.

[00:16:27] Olivia Sugarman  So public health vending machines are basically almost kind of what they sound like. So they’re basically a different version of a candy vending machine. And it has all kinds of different supplies in it. So sometimes it’s things like a naloxone box. It can be a wound care kit or underwear or condoms, or I’m trying to think of an example. There’s actually one down the street from you right now. A Sharps box, like a small sterile sharps container for disposing of your syringes. It’s anonymous. You go up to it. It’s available anytime you want, as long as it’s in stock. Put in a pin. Usually it’s some anonymous pin, and you get whatever you need. I think it’s a great tool. I can’t speak to whether or not they’re deployed specifically in my minoritized communities, but they’re a great tool. A similar tool that takes this kind of static approach when you need it is something called a nalox-box. I think it’s truly just like a box that’s hung up on a wall or in some public area. You take it when you need it. I’ve also heard of radio ads talking about the importance of naloxone, the utility of naloxone on predominantly black radio stations or radio shows that have predominantly black audiences. Churches are now getting involved in the effort. So having congregations do naloxone trainings, having naloxone on site. Some libraries are also now carrying a lot of them, which I think is really cool. 

[00:18:03] Narrator Despite the progress we’ve made, the opioid crisis continues to be a major public health issue in North America and beyond. Naloxone is only one part of the potential solution to this public health emergency, but it is a critical tool for keeping people alive in the face of opioid poisoning. The voices of Zac, Amy, and Olivia remind us that progress is possible through lived experience, through community, and through policy. Expanding access, reducing stigma, and ensuring affordability will determine how far we go in saving lives. As the opioid crisis continues to evolve, naloxone remains a symbol of both urgency and hope. If this subject resonates with you, please revisit seasons one and two of Countermeasures, where we explored the roots of the opioid crisis in depth. Thank you for listening to Countermeasures. If you found this episode meaningful, please consider leaving us a rating or review. The views and opinions expressed by the guests are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates. Guests are not representatives or spokespersons for Emergent BioSolutions, and their appearance on this podcast is not an endorsement. 

[00:00:00] Narrator Globalization, geopolitical conflicts, climate change, and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses, and more, we’ll explore what it means to protect public health and how preparedness today can lead to a safer tomorrow. In recent years, outbreaks of avian influenza, commonly known as bird flu, have raised alarm around the world. Infections in wild birds and poultry are nothing new. But as the virus spreads into new species, including mammals, and as the pace of zoonotic spillover accelerates, experts warn the risk of human-to-human transmission is growing. At the same time, the world is still grappling with lessons from COVID-19. How do we prepare for the next outbreak? How do we detect it early enough to stop it from spreading? And how do we build resilience across human, animal, and environmental health systems? We begin with Dr. Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security. His career has been devoted to infectious disease and health security. Here he explains what drew him to the field and why avian influenza has long been on his radar.

[00:01:28] Dr. Amesh Adalja I sort of always loved infectious disease. I was the son of two physicians, so I was brought up around medicine. And within medicine, I think infectious disease as a career, especially when you’re thinking about health security, pandemic preparedness, emerging infectious disease, which is the focus of my work at the Center for Health Security, it really tries and to meld all of that together. There’s the medicine healthcare side of it, then there’s the national security aspects of it, then there’s the anthropology, the epidemiology. So it really keeps you kind of in touch with everything going on in the planet with respect to infectious disease and threats, because infectious disease is the only branch of medicine that affect impacts everyone and touches every aspect of life, as we saw during the COVID-19 pandemic. In the field of emerging infectious disease, it’s always something new that’s coming up, something coming down. It’s very dynamic. And there’s not always one that people keep an eye on. Try to keep an eye on the entire field and try to understand what might become a bigger infectious disease threats, if not the biggest that the human species has ever faced. I think that one is always going to be at the top of most people’s lists. And then all of the zoonotic infections that might be occurring and kind of each time they jump into humans, they might get a little bit further but then burn out.

[00:02:44] Narrator But what do emerging diseases such as avian influenza look like on the ground today? And why are scientists more concerned now than in the past? For that, we turn to Lindsey Shields, Deputy Director of PATH’s Epidemic Preparedness and Response Initiative.

[00:03:00] Lindsey Shields PATH is an international NGO that supports local organizations, government institutions, and international partners to achieve health equity and public health solutions for all. So I’ve been with PATH now for about six years, and our program really focuses on infectious disease surveillance programs. So, how do we ensure that we are capturing infectious disease outbreaks when they happen? How do we help country governments and local partners to respond to those disease outbreaks in a timely fashion? Hopefully to improve health for all. So most of our work is in sub-Saharan Africa and Southeast Asia.

[00:03:32] Narrator From Lindsey’s perspective, two factors are driving this increased concern.

[00:03:38] Lindsey Shields Think about them in two buckets. One is sort of geography buckets where we’re looking at land use changes that are bringing humans and animals into closer contact. We have a globalized world and society. You can get from one side of the world to the other now in less than 24 hours. And that brings people closer together and also pathogens closer together. We also see viral evolution. And so you’re seeing over time, especially with influenza viruses, they’re able to change and mutate quickly, where that allows them to adapt to different species. So they’re able to test positive for strains of different types of viruses, including avian influenza. And what that means is every time they’re jumping into a new population, that virus is learning how to do a better job at infecting that other group, other species, other location. And so I think these two things together are really driving a lot of the escalation. And as we’re seeing transmission amongst mammals, certainly that’s something that we’re keeping an eye on and worrying about. Human-to-human transmission is always the thing that public health professionals are keeping the closest eye on when we think about emerging infectious diseases. And actually, history has shown us that oftentimes these viruses, especially those that are zoonotic in nature, will make an initial jump from an animal population to a human population, but they won’t have figured out how to transmit from human to another human. And so when you look at the history of these viruses, they are learning over time to adapt, to be better spreaders, to be better at infecting a human. And so once we start seeing that sustained human-to-human transmission in an emerging disease, that’s when we start to get really, really worried. With H5N1, for example, even influenza, we’re seeing that that is happening in more and more species, which means that virus is adapting and more and more likely to have sustained human-to-human transmission.

[00:05:17] Narrator Bird flu is evolving, but how do we even know when it’s happening? The key is surveillance, the early detection systems for diseases, similar to how smoke alarms warn of a fire. Dr. Jennifer Nuzzo, epidemiologist and director of the Pandemic Center at Brown University, explains why.

[00:05:37] Dr. Jennifer Nuzzo Early detection is absolutely critical. The single biggest thing we could do to be ready for future events is to have systems in place that detect them as soon as they happen, or in some cases, perhaps anticipate that they could happen so that we can just snap into action quickly and prevent the, you know, the disease, for instance, if we’re talking about an outbreak from really taking off and spreading, you know, beyond our abilities to control it. That the idea of being able to detect it early and to swiftly respond and contain it at its source is really, really key. That said, as important as early detection, early warning are, it’s not the only form of disease surveillance we need. We need the surveillance that enables us to make good decisions about what to do about the events that we detect. And that’s I think a piece where we really need to, you know, put some more emphasis and do some more work. During this last pandemic, the COVID-19 pandemic, there are a lot of questions about what to do and what strategies were the right ones and how we could best, you know, mitigate the spread and prevent people from becoming severely ill and dying. And so having better surveillance systems and better data collection efforts to answer those questions are just as important, I think, as early detection.

[00:06:50] Narrator Avian influenza doesn’t just require monitoring birds. Surveillance requires monitoring across species, from wild waterfowl to poultry to mammals, and finally to humans.

[00:07:02] Dr. Amesh Adalja Surveillance for avian influenza is very scattered and it’s kind of disparate because it’s not just one thing. It’s not just looking at human infections, it’s looking at infections in avian species. It’s looking at infections in mammals, it’s looking at infections in certain poultry species. And part of that’s going to involve a lot of work with the agriculture side and the veterinary side of this to see what’s making animals sick, surveying flu viruses that are constantly circulating in waterfowl or constantly circulating in swine. And then when we think about human infections, making sure, particularly with severe infections or infections in individuals who have epidemiological exposures of certain animals, that we’re trying to figure out what type of influenza A is it? Is it something novel? Being able to run that down. And oftentimes I find that our healthcare system, the ability to run down an infectious disease to a very specific diagnosis is really lacking. It doesn’t happen very often. People will stop at influenza A versus influenza B, or maybe they figure out it’s an H1N1 versus an H3N2 influenza, but there’s not much incentive to go further. And I think that’s one of the areas where when you think about avian influenza, our surveillance needs to be better. We need to be looking, I think a lot deeper to try and understand how frequently these viruses are jumping into humans and how frequently we’re missing them when they do. Because I think when there is an avian influenza pandemic, these first cases are likely to be missed. They’re likely to be mixed in with other respiratory viruses, other influenza cases. And so I think that the surveillance is something that’s been really lacking. It’s been lacking for a long time, and it’s and it continues to lack. Not because we don’t have technological solutions. It’s just that it’s not set up in a way that we’re able to do this in a really proactive manner.

[00:08:46] Narrator As Amesh mentioned, proper surveillance requires an integrated system between agriculture, animal health, and human medicine. Spillover can happen outside of isolated environments like laboratories. It can happen in common environments like farms, markets, and even within households. Lindsey describes what those spillover points can look like and why they matter.

[00:09:10] Lindsey Shields Vietnam, we took some of these participants to a few areas and had them sort of think about where are the interactions between these different species, wildlife, humans, and livestock. And the first was a farm area, right? A beautiful farm. They were raising, I think, chickens and ducks. But it was outside farming, right? And so that meant that we also were seeing wild birds coming in and grazing in the same lands that these ducks were grazing. And that that creates that spillover potential between the wild, the wild birds that host many of these avian influenza viruses and the livestock that are then in very close contact with people. We also took them to live animal market. These are extremely common all around the world. And it is a wonderful place for potential viral spread and spillover because you have animals in close conditions. Many times these animals are stressed and or immunocompromised. And when we see that happening in animals, they’re more likely to be shedding viruses, they’re more likely to get sick. And you’re also exposing people to animal processing in some places where they may be slaughtering the animals there. And again, that’s another place where you’ll see that potential for spillover. Literature reviews and research has definitely shown that the most common spillover from animals to humans often happens in that butchering step when you are most risk, most at risk for perhaps cutting the animal and then accidentally cutting your own skin and really injecting yourself with something. And that can all be managed through appropriate biosecurity measures. Are you washing your hands? Are you handling the knives correctly and safely? Do you have veterinarians present supporting slaughterhouse evaluations so that you can identify those potentially ill animals? And so I think there is really a need, especially for zoonotic spillover events to have strong collaboration between your human health sector, which is maybe going to be the first responders to see some of these novel diseases in human populations and the animal health specialists who are going to be able to recognize what they’re seeing in the animal populations.

[00:11:09] Narrator Farms, markets, and slaughterhouses are front lines for potential outbreaks. The information generated by surveillance or the information we fail to generate helps determine how fast we can respond. Dr. Nuzzo explains why disease surveillance gaps are not just national problems, but global ones.

[00:11:28] Dr. Jennifer Nuzzo Surveillance has changed a lot since I got into this field, you know, several decades ago. I think there have been some really key improvements, but there’s also a lot of challenges. So when we’re talking about surveillance, we are largely talking about what happens at the national level, right? Countries are ultimately responsible for what happens within their borders. They are people who are elected to run countries, they’re responsible to the people who elect them. So we talk about national surveillance. Now, in a place like the United States, national surveillance may be deeply dependent on and frankly contingent on there being state and local surveillance because we are a federal country, the constitutional responsibility for public health rests with states. So states conduct surveillance and we roll that information up to the national level. When we talk about global surveillance, what we’re really talking about is countries deciding to share information so that we can get a global picture of what is happening. And that’s really, really key, particularly when you’re dealing with something that’s global in nature, like a pandemic. You need to know not just what’s happening in your own country, but possibly what’s happening in the countries that neighbor you or in countries where your citizens may be traveling to and from. So global surveillance is also important. But, you know, national surveillance can’t happen without local surveillance. Global surveillance can’t happen with national surveillance. So we need strong capacities at the local level and the national level. And there is still a lot of work that needs to be done in countries all over the world in terms of being able to do that.

[00:12:58] Narrator Some communities may face higher risk of spillover because of factors such as geography, farming practices, or weaker health systems. Other places may lack the resources to detect and respond quickly. Lindsey says this is why the idea of One Health, linking human, animal, and environmental health systems, has become so important.

[00:13:18] Lindsey Shields I love the question about what is One Health because depending on who you talk to, it can mean a whole lot of different things. I think the classic way that One Health has been interpreted is often related to zoonotic diseases, right? And it’s really like animal and human health, and how do we work together across those two sectors to make it better? And that really neglects the third piece of this. It’s really animal, human, and environmental health because all three of those sectors are intricately intertwined. You affect the health of one of those three areas and it will have impacts on the other two. We see this often with climate change, with the changing patterns of climate in various locations. You end up having different types of diseases emerging. You have different types of challenges emerging. We’re seeing higher rates of diseases associated with pollution, we’re seeing higher rates of arboviral diseases with increases in the mosquito population. And so I think infectious diseases is a great example of how One Health is used, but One Health itself is really understanding that human environmental and animal health is intricately intertwined and that you must be taking into account the health of each of them in order to address the health overall.

[00:14:28] Narrator But establishing a One Health approach means addressing barriers both formal and informal to collaboration. Lindsey says progress is happening, but that it can be uneven.

[00:14:40] Lindsey Shields The barriers to integration and collaboration between human and animal health. There’s sort of the formal barriers and then there’s the informal barriers. The formal barriers are often, you know, there’s some need to have a formal standard operating procedure or a plan for how you’re going to connect. There’s in some countries, that means there’s a national One Health platform set up so that you start having routine meetings and the sharing of data happens more naturally. Sometimes that means, you know, joint response activities. So in some countries, there are actually One Health rapid response teams that when a zoonotic disease outbreak has occurred, they will actually send representatives from both animal health and human health to that location to be able to respond to it. That’s sort of the formal barriers. And I think countries are really starting to put more time and effort into that. You’re seeing national One Health action plans being prepared, you’re seeing One Health woven into their national health security plans as well. Then I think there’s the informal barriers, and that’s the one that I think is most interesting to see coming around over time. And that’s especially in a local setting. If you have the if you have figured out ways to lower the barriers for communication. Just to pick up the phone and call the animal health person. If you’re aware of, hey, we just had a case of anthrax come into our hospital. Let me just call up my friend who’s not now, you know, this formal communication mechanism and give them a heads up that something is happening. I think this removal of those barriers for informal communication can be really helpful. We’ve seen that happen in some places where, you know, there’s a fora that happens, either a community of practice around One Health that brings together people from different sectors once a month, once a quarter. And in those areas, we just see a lot more willingness to kind of share information and share data, even in an informal setting, because there’s that personal relationship.

[00:16:26] Narrator Breaking down silos is one part of the preparedness equation. Another is resources. Lindsey warns that without equity and surveillance and preparedness, global health security will remain fragile.

[00:16:39] Lindsey Shields I think there’s been a lot of progress over the last decade or so on surveillance systems, whether it’s a high-income country, a low-income country, or a global or regional initiative. A couple that come to mind that have been around for quite some time is called GOARN, which is the Global Outbreak Alert and Response Network. This is a really great human health focused organization that helps to identify disease outbreaks and and respond in a coordinated fashion. On the animal health side, there is also GLEWS, which is the Global Early Warning System. And that also allows capture of infectious disease outbreaks in the animal population.

[00:17:15] Narrator The COVID-19 pandemic exposed many of these gaps. Lindsey reflects on what preparedness looks like today and why preparedness projects can often lose funding between crises.

[00:17:28] Lindsey Shields We often have a hard time getting funding for preparedness because it’s much easier to be responsive to something. Outbreak response, it’s very clear we have an outbreak, we need to respond to it. It’s really hard to track, categorize, and understand the impact of the work that we do in preparedness because you don’t have the outbreak that occurs as a result. And so I think it’s really critical that investment in preparedness is increased and sustained over time. Historically, what we see in preparedness investments is very much cyclical. You’ll see an outbreak of a major disease happening, you’ll see an influx of substantial funding to address that disease that then transitions into recovery and then preparedness. And then over time that kind of peters out. And then all of a sudden you have the next outbreak, and everyone goes, didn’t we do this a year ago? Didn’t we plan for this? And so the preparedness piece is really, really critical. And I think a lot can be done to leverage the One Health approach in order to be prepared for pandemics or for emerging diseases in general.

[00:18:26] Narrator For Jennifer, the lesson is not only about funding, but about trust and communication.

[00:18:34] Dr. Jennifer Nuzzo So, I mean, first of all, trust isn’t built in the midst of an emergency. You have to build trust in advance of an emergency. And part of making sure that people trust government or trust, you know, the recommendations being made is about showing up in people’s lives in a meaningful and productive and welcome way in advance of an emergency. One of the kind of things that really stuck with me during the COVID-19 pandemic, and I, you know, was fortunate to be able to talk to really hundreds of maybe even more people from all walks of life, you know, all sorts of people during the COVID-19 pandemic and learn a lot from those conversations. But at the beginning, you know, I was hearing a lot from people. They would ask all these really thoughtful questions and they’d be really distressed. And, you know, very frequently I would hear them say to me, oh, I just don’t know who to trust.

[00:19:23] Narrator Lindsey highlights some of the scientific advances and global initiatives that could make a difference for the next outbreak.

[00:19:32] Lindsey Shields In order to be prepared for pandemics or for emerging diseases in general. I think one of the things that came out of the COVID-19 pandemic that I think is really positive is the 100 days mission. You know, CEPI is really driving the charge on this, but the 100 days mission is basically saying we want to get vaccine to disease outbreaks of novel viruses sooner. So there’s a lot of learning going on right now of how do we decrease the barriers from you’ve identified a new novel disease to we are rolling out a new vaccine that can actually address it. And I think COVID-19 put a ton of pressure globally on people to think more strategically. We had massive advances in rapid diagnostic testing. We had rapid advances in the types and styles of vaccines available. And I think those learnings need to be utilized as we start preparing for the next one. Yeah, I think public health, especially after the COVID-19 pandemic, we learned a lot about how we need to be better communicators. People in public health tend to be very technical in nature. We love talking about epidemiology and getting really into the weeds about all these different things. But the general public needs clear messaging and they need to be able to understand how it relates to them. And so as we’re thinking about messaging around public health, One Health, and pandemic threats, I think we need to do a better job of being able to tell a story that is directly applicable or relatable to the general public.

[00:20:55] Narrator And for Lindsey, there is an optimism in how the scientific community continues to adapt to get ahead of outbreaks.

[00:21:04] Lindsey Shields The Vietnam work, I think, was really exciting because we were looking at how to improve community-based surveillance. So people who are maybe community health workers, they may not actually have access to diagnostic tools, etc., but they were trained on specific events that would trigger a response or trigger an outbreak investigation. Historically, that had only include human health signals, right? Somebody’s got a weird fever or somebody’s really sick, or a school has a bunch of kids that are out sick suddenly. And what we did was we actually incorporated training for also understanding when to notify on animal health events that might have really strong impacts, right? A sudden illness in a flock of birds or, you know, cow found dead, right? These would be some other examples of things that would trigger a response. Now, especially at the community level, people have very differing levels of education. They may not actually have, you know, to that point about technical people being very technical. We utilized a combination of brief trainings that were rolled out at subnational level, but also images that were not required to have very that didn’t require a lot of words and require people to know how to read. So you would see the image and you would understand, okay, this is the type of event that I would need to report on. And so I think looking at modifying our communication methods to be more responsive to where the community is really critical. And that allowed then, you know, rural communities in Vietnam to start reporting suspected cases of illness that could be anything ranging from anthrax to avian influenza to something else that could be both a threat to that livestock population, but also a critical threat to the human population in the community.

[00:22:46] Narrator As we’ve heard, surveillance, One Health, preparedness, and communication are not luxuries. They are necessities. The expertise of Amesh, Lindsey, and Jennifer show us that science and systems matter, but so do relationships, trust, and persistence. We can’t predict exactly where the next spillover will occur, or which virus will trigger the next pandemic. But we can prepare. And the more we invest in preparedness today, the better chance we have of tackling the next public health threat. Thank you for listening to this episode of Countermeasures. If you enjoyed this episode, please consider leaving a rating or review.

[00:00:02] Narrator Globalization, geopolitical conflicts, climate change, and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world. Brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses, and more. We’ll explore what it means to protect public health and how preparedness today can lead to a safer tomorrow.

Whether naturally occurring or man-made, the next biological threat may already be taking shape. The COVID-19 pandemic demonstrated how fast an outbreak can ripple across borders, and how our health systems can struggle to keep up. The impact of biothreats stretches beyond health, shaping economies, national security, and public trust. In this episode, we explore what it means to be prepared for a biological threat, how governments and industry are working to protect people, and what could happen if we don’t get it right. We’ll hear from Wolfgang Philipp, Principal Advisor and Chief Science Officer at the Health Emergency Preparedness and Response Authority, also known as HERA. And Christopher Frech, Senior Vice President for Global Government Affairs at Emergent BioSolutions and Chairman for the Alliance of Biosecurity. Together, they offer perspectives from both sides of the Atlantic on how to strengthen biodefense, build public-private partnerships, and prepare for future threats. We begin with Christopher Frech, who explains what qualifies as a bio threat and how governments decide which threats demand the greatest attention. 

[00:01:50] Christopher Frech So, what qualifies as a bio threat? The Department of Homeland Security reviews threats to the public or to the warfighter, and it makes what’s called a material threat determination regarding those threats. The list is known as a material threat list, and then that drives scenarios, which drives requirements, and then the development and the procurement of medical countermeasures, vaccines or therapeutics, to protect the public. The Public Health Emergency Medical Countermeasures Enterprise is the interagency advisory board that advances national health security to coordinate that research and development against those threats. 

[00:02:34] Narrator Biothreats can materialize in different ways. Some emerge naturally, others may be caused by human actions, accidental or intentional. While distinguishing between these is important, the need to be prepared to act quickly doesn’t change. 

[00:02:48] Christopher Frech Distinguishing between naturally occurring outbreaks or intentional acts like bioterrorism is really driven in part and personal by the source of the threat itself. So naturally occurring. If we looked at a map around the world, anthrax is ubiquitous in the soil. And in many cases, you’ll have cases of subcutaneous or cutaneous anthrax exposure, the skin, often in animals that’s then connected to humans, or in the case of man-made, where it’s a deliberate attack. We think back to the 2001 anthrax attacks on Capitol Hill, where someone put anthrax in an envelope and sent it to Capitol Hill offices, and then people are exposed. Often, the man made attacks are very targeted, or they’re having great magnitudes because they’re trying to have a really large impact. So weapons of mass destruction versus someone coming across and digging up anthrax in the soil. 

[00:03:53] Narrator The 2001 anthrax attacks reshaped U.S. preparedness. The attacks revealed how few vaccines and therapeutics were available to be rapidly distributed in the event of an emergency, and prompted the creation of modern biodefense programs. 

[00:04:07] Christopher Frech That question around investing in stockpiles and vaccines and treatments, I think has been one that’s a really important one. And really, those 2001 anthrax attacks kind of brought to light the fact that the government didn’t have U.S. government, in this case, didn’t have all of the vaccines and therapeutics to protect the public against these threats. And it realized that it also needed these products before they occurred, so that they were available to use them when it occurred. And the U.S. then, through Project BioShield in 2004, 2005, put forward a bunch of policies and programs that would act as an incentive to the development and procurement of these products going forward. I think a really great example of recent on how that’s worked really effectively is the recent series of outbreaks to mpox. Even though mpox wasn’t listed as a material threat per se, it is an orthopox family of viruses. And because the U.S. had been focusing on smallpox, we had products that were stockpiled and developed, and in this case, even licensed, that were available to respond going forward in that case. Botulism is another example of how it’s worked really good because it’s a bioterrorism threat, yet on an annual basis, there’s endemic cases of botulism that occur every day where those products are used to protect the public against that illness. 

[00:05:46] Narrator Stockpiles can save lives, but they’re only as strong as the systems that sustain them. In Europe, building such a system has been a recent focus. The Health Emergency Preparedness and Response Authority, or HERA, was created by the European Commission in 2021 after the COVID-19 pandemic exposed vulnerabilities in health systems across the continent. Wolfgang Philipp, who was part of leading the creation of HERA and is currently principal advisor and chief science officer of HERA, talks a little bit about the mission and some of the early initiatives HERA has identified to help prepare for future threats. 

[00:06:23] Wolfgang Philipp The basic mission is to make sure that medical countermeasures in Europe are available and accessible, in particular when it comes to pandemic preparedness, also to outbreaks, to epidemics, and also to biological threats, including other threats that could further develop. So it’s an end-to-end organization. We have functions across the whole value chain that starts basically with ways of early detection. We have threat assessments. We work on intelligence function, epidemic intelligence function. We support research and development into new medical countermeasures. And when I talk about medical countermeasures, that means things like vaccines, therapeutics, drugs like antibiotics or antivirals in particular, but also other things like diagnostics for rapid diagnostics or even materials for better PPE. All of this goes into preparedness and response to biological threats, but also chemical threats, not just naturally occurring, but also man-made. It also goes down further to functions like procurement and stockpiling, as well as deployment of many countermeasures. We have a kind of a setup like BARDA, the U.S. agency. That was the initial thought to set up an agency or to set up an entity that functions a little bit like BARDA, making sure that medical countermeasures against biothreats and other threats are coming to the market. Here we’re talking about materials or medical countermeasures that not necessarily have a real economic basis, which means not for the rollout in the larger market, but require specific investments, in particular with the public. HERA is doing this with a large budget, or we are investing this into development and research and development, into stockpiling, into late stage development as well. So our main job is really end to end making sure that medical countermeasures are available to member states, because that is relatively complicated. Member states act on their own, but the ultimate goal is to work in complementarity, aligned and in a coordinated way. On top of that, we have been coming up, at least the commission has been coming up, with a proposal for a preparedness union. And that is in in the implementation now, that’s of 2025. We have been recently coming up with a new medical countermeasures strategy and a stock stockpiling strategy for a deeper implementation of measures to deal with biothreats in the future. 

[00:09:10] Narrator Whether it’s the U.S. Strategic National Stockpile or the EU’s HERA, both efforts share the same goal to be ready before the next emergency, not after it begins. Biothreat preparedness doesn’t just depend on governments. Many vaccines and countermeasures exist because of collaboration between public and private sectors. Christopher explains why industry must be at the table long before an outbreak starts. 

[00:09:37] Christopher Frech The role of private industry, I think, is a really important one because going back in time, the government realized that industry wasn’t able to do this on their own, or government wasn’t able to do this on their own. And industry needed a level of clarity and certainty, and in fact, in some cases, incentives to have them respond to meet the needs of government to protect against the public, particularly given that many of these products don’t have a natural commercial market, right? They’re not going to be commercially available. They’re actually products that you hope to never use but you know you need. And so that role of industry plays a vital one because without industry, government’s not going to have these products. And without government, industry is not going to make these products along the way. So it comes down to really communication and coordination and having industry at the table early on so that they can understand what it is that the government’s concerned about, and then what those products need to look like in terms of developing and characteristics to be able to respond to meet that need and thus have them available to respond should that threat occur. 

[00:10:52] Narrator Strong public-private partnerships require trust, communication, and sustained investment over time. Christopher says that commitment is often tested by a cycle called crisis to complacency. 

[00:11:04] Christopher Frech Often in this space, you see movements of crisis to complacency occur. We have an event that occurs, we throw a lot of money at it, and then we forget about it, and we take that money away and we move on to something else. In 2006, 2007, 2008, we saw an Ebola crisis occur. We saw a knee-jerk reaction from the government on an emergency supplemental. Then we saw the Zika crisis occur, and they said, okay, forget about Ebola, pivot to Zika, and that resources went there. As we think about it from a perspective of what are those top policy priorities to improve readiness over the next five years. And certainly, I think starts with communication coordination and alignment between government, governments, and industry. As we talked about that earlier, right, there’s that public private partnership, the operative word in that statement is partnership. Partnership requires you to do things differently. It’s not a transaction. It requires you to communicate what are your concerns and what are those realities that may exist to be able to respond to meet those concerns. I think it also means that you need to have robust, consistent, and sustainable funding, recognizing that you’re preparing for something that’s in the future that may or may not occur. 

[00:12:30] Narrator While the United States works to sustain partnerships through programs like Project BioShield, Europe is developing its own models for cooperation. Wolfgang describes how HERA has built new alliances across sectors and across borders. 

[00:12:45] Wolfgang Philipp Surge-ready manufacturing capacities is difficult to answer. The question is always what is the end point? What is affordable and also what is feasible? So we have a couple of samples that show that we are working towards that goal. We are working with our international partners, we are working with industry on matchmaking, we are working on supply chain resilience through the diversification of sources of materials that you need for development of critical medical countermeasures and also to reduce our dependency of, in particular, non-EU suppliers, is here a key focus. But for many of the things that’s not feasible, we have been working with the U.S. as well and some other countries into this direction. The second example, and that’s more practical, we have created a network of ever warm production capacities for vaccines, which is known as EU FAB. And that’s a network actually designed to maintain state-of-the-art facilities in a state of readiness, capable of rapidly transitioning and producing vaccines in the event of a health crisis. So EU FAB is one of these elements that was that even started basically a concept creation started even before HERA was created. We are also investing in biomedical research and in innovative platforms that would support more flexible manufacturing capacities and technologies. And then what I mentioned already before, in terms of vaccine readiness, we have created the European Vaccines Hub, and that is including an end-to-end approach, including scalable manufacturing of vaccines. So that the idea is here really to work with industry, but also with other funders to cover all relevant aspects of vaccine development, but also of large scale production. And for this, there’s many things that can be done. 

[00:14:40] Narrator In addition to preparedness between EU member states, Wolfgang says that international cooperation is the cornerstone of any effective preparedness system. 

[00:14:49] Wolfgang Philipp That needs to be organized at an international, ideally global level with the partners we can trust or we trust. And that’s what we’re doing. We have been setting up memorandum of understanding agreements basically on how to cooperate with like-minded partners in multiple countries, agencies like the US BARDA, in Japan, SCARDA or AMED, and Canada, the newly created Emergency Response Canada, but also with the Africa CDC or agencies like WHO and others, philanthropies like the Bill & Melinda Gates Foundation, and so on and so forth. And cooperation here really is always targeted in specific areas that could be medical countermeasures developments, that could be alignment of of ideas, that could be exchange of information, but it could also be setting up new systems like, for example, a global wastewater system. So the point is we are doing this not just through paper, but also through financing of projects and programs, like for example, in Africa, where the EU is heavily engaged through programs that we finance for WHO and many others, like programs that we finance also with EU member states to increase the manufacturing capacities for vaccines in Africa through a program that’s called MAV+ and many other things. 

[00:16:14] Narrator Misinformation is not just a European concern. In the United States, Christopher says that rebuilding public trust is now a core part of national preparedness. 

[00:16:25] Christopher Frech Misinformation and public skepticism has certainly been something that has undermined responses in the past and is  certainly a current challenge in the current public health paradigm, and certainly one that kind of we saw the ups and downs throughout the COVID years of how people responded to the information. I think there has to be, first and foremost, a bit of transparency in our public health officials and our government officials. That challenge, I think, becomes difficult at times. And as we saw in the past, it changed from one day or one week to the next. I also think that there is value in practice and making people better aware. 

[00:17:13] Wolfgang Philipp When we talk about response capacities, so public trust, not just into the acceptance of the use of medical countermeasures, but also on any kind of guidance like public health guidance or other guidance that would need that would be provided in a bio threat emergency, in a complex situation, in a pandemic, in certain phases to react. So it is very critical that requires definitely credible but also proactive communication by credible people and organizations. Not to react all the time, to run misinformation. Really, we need to come up with more professional, proactive means of communication. And that should lead to better belief in science, better belief in capacities of authorities like health or security structures. But all of this needs a constant push through the channels that actually reach the different social groups, not just those that might be the most difficult to reach, but the broad population. 

[00:18:16] Narrator Trust, transparency, and coordination determine whether preparedness plans translate into real-world action. Wolfgang says that Europe is now taking those lessons to heart, embedding cooperation and flexibility into every new preparedness measure. 

[00:18:35] Wolfgang Philipp So we have a solid plan that has been developed and whether implemented now with member states. With discussion with member states, with experts, and also with our agencies, EU agencies active or relevant in this field, and particularly  Medicines Agencies. Agency, we will have assessed several factors, such as the impact of a medical countermeasures on our response capacity to cross-border air threats, in particular, obviously biothreats, their time critical effectiveness, potential vulnerabilities in supply chains, so for lead times or availability. 

[00:19:11] Narrator Even as the world invests more in preparedness, the landscape of biological threats keeps changing. New technologies are reshaping science. Climate change, population movement, and geopolitics are all adding pressure. 

[00:19:25] Christopher Frech Geopolitical factors, certainly like global conflict have an extraordinary impact on this area and on bioterrorism, biothreats, preparedness and response. Certainly, we start with the uncertainty of the world that we live in and the factors that are there, both either state actors or in some cases, non-state actors or lone wolf actors, and their ability to kind of move forward. The government will look at threats as having two components. One is intent. So I intend to do harm. And the second is capability, the ability to do harm. And certainly with biothreats, there’s a bit of a dual use issue there that they’re not difficult necessarily to acquire, and they’re not difficult to actually execute with regard to a threat. In addition to that, other factors have become really important too, right? The movement of products, supply chain shortages, the uncertainty of the time. All of those factors call into question and raise the challenges of being able to prepare and respond to a threat. In the biodefense world, you’ll often hear a lot of guys will talk about and girls, preparedness equals deterrence. If I’m prepared against a threat, it makes it less likely that threat will occur because, at least in a man-made scenario, my adversaries will look to something else to use in that. And certainly the fact, and we’ve learned this through the experience during COVID, the need to be prepared before you need to be able to respond. 

[00:21:09] Narrator Wolfgang Philipp says preparedness now has to mean being ready for the unexpected. 

[00:21:14] Wolfgang Philipp We are preparing for a range of threats that starts with obviously with respiratory viruses that have a pandemic or epidemic potential. We are also looking into vector-borne diseases accelerated by climate change and also we are stockpiling materials for chemical, biological, radiological and nuclear threats. There’s always gaps in preparedness, response capacities that’s an inherent part of the of our business basically. When it comes to close the gaps in our biodefense capacities, is we should see that the world has changed. I mean, there’s much more pressure now by state actors, by rogue states, which is becoming more and more problematic, in particular when we talk about biothreats that is certainly. That is also partially driven, for example, by tech developments which enable faster and more efficient manipulation of molecules, agents or organisms. We will always have gaps. We still have gaps in the availability of vaccines, in the availability of therapeutics, and that’s still for a large number of prominent threats. We see also still underinvestment in biotech. We might need to invest more into the sector to increase our resilience here. We see uneven biosafety and biosecurity capacities. We see, let’s say, suboptimal MCM readiness in general. We have learned at least a couple of lessons, not just from the COVID pandemic, but also from all of the other pandemics and attacks that we have seen over the past 20 years. So in Europe, not just with the creation of HERA, which has a specific role, but also with strengthened mandates for the European Center for Disease Prevention and Control that goes into better and stronger epidemic intelligence, surveillance, and also risk assessments around certain scenarios, with stronger mandates for the European Medicines agencies, but also on the legislative side, for example, with regulations around how to coordinate response to biothreats, to epidemics, to pandemics, or in general to health emergencies in Europe. 

[00:23:27] Narrator While preparedness must evolve, so must the partnerships that sustain it. 

[00:23:32] Christopher Frech What makes me optimistic about our ability to better prepare for the next bio threat? I think for a long time, certainly I’ve been in this working on these issues for 16 plus years, and I’ve seen an evolution of how people are thinking about this and realizing it. And it really starts with that threat realization and understanding what the threats are and what the consequences are. I think for the world, COVID was a real wake-up call around some of these theories that we were talking about when they became realities. And COVID was an extreme case that the world all saw at the same time. But we saw breakdown of supply chains. We saw the nationalistic views of hoarding products or keeping products and not letting products go across the border. But I think people now think about this as a real thing and realize that this is something that we actually do need to prepare for and we need to continue to respond to, and it’s increased the amount of communication, coordination, and awareness that didn’t exist, pre COVID that now, today is actually providing for greater preparedness and response for a myriad of threats, should they occur down the road.

[00:25:04] Narrator Preparedness is a shared mission. It requires science, trust, and sustained cooperation across every border and every sector. As Wolfgang reminded us, viruses do not stop at borders. And as Christopher explained, preparedness itself is a form of deterrence, a way of ensuring that when the next biological threat emerges, the world isn’t caught unprepared. And though the next threat may look different, the same principles apply. Collaboration, transparency, and a commitment to science-driven results. The real test of preparedness is not how we respond after a crisis begins, but how we choose to build before it happens. 

[00:00:03] Narrator: Globalization, geo-political conflicts, climate change and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures, where we explore health threats impacting communities around the world. Brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From Zoonotic disease to bioweapons, orthopoxviruses, and more, we’ll explore what it means to protect public health, and how preparedness today can lead to a safer tomorrow. According to the World Health Organization, vector-borne diseases (VBDs) like malaria, dengue, West Nile virus and Lyme disease cause more than 700,000 deaths a year and account for more than 17 percent of all infectious diseases. These diseases have catastrophic consequences for individuals and communities, and climate change, urbanization, and global travel are contributing to the resurgence and spread of vector-borne diseases. As disease vectors like mosquitoes and ticks adapt to warmer temperatures and expand into new regions, public health systems face mounting pressure to anticipate and respond to outbreaks. This episode explores the evolving landscape of VBDs, the science of vector control, and how we can prepare for future threats. Dr. Matthew Phillips is a physician scientist at Mass General Brigham. He helps break down what vector-borne diseases are and how they spread.

[00:01:04] Dr. Matthew Phillips So vector-borne diseases refer to infections that are transmitted between humans and other animals by some other organism. It’s what we call a vector. So instead of being spread through the air by coughing or sneezing or on surfaces like some other germs, these are diseases that are spread by insects and other arthropod vectors, like ticks. These vectors are almost always some kind of blood-feeding organism, like a mosquito or tick. And it’s an incredibly diverse category of diseases. There’s numerous vector-borne diseases, really a worldwide issue. Vector-borne diseases are a tremendous global health concern, mostly because of how widespread they are and how prevalent they are as well. So globally, about three out of every four people live at risk of a vector-borne disease. So that’s 6.3 billion people around the world are at risk of getting these diseases. They’re punching above their weight in that category. And then in the US alone, there’s 20 different species of vector-borne diseases. The number of cases of vector-borne diseases increased. It’s doubled in the past couple of decades. Now, it’s over 760,000 cases a year based on numbers by the CDC. So even in the USA, it’s very diverse, very prevalent category of diseases and poses a really big public health concern.

[00:02:18] Narrator Vector-borne diseases pose a threat worldwide and disproportionately affect lower income countries located in climates where vectors thrive. Dr. Pauline Byakika–Kibwika is a Ugandan epidemiologist and a professor of internal medicine and epidemiology. Her focus is largely on malaria.

[00:02:38] Dr. Pauline Byakika–Kibwika Vector-borne diseases are persistent challenges in Uganda and in most parts of Africa, mostly because of the tropical climate, because the climate favors survival of the vectors, especially if we look at malaria. Survival of the vectors, the climate is favorable for survival of the vectors, but also survival of the pathogens within the vectors. So it’s really about the climate, the tropical climate. But also, we have done a lot in terms of prevention. However, we still have a lot of work to do because not everybody can access the preventative measures that are available to stop contact with the vectors and therefore to stop transmission. Mostly because of poverty, people are poor, so some cannot afford the preventative measures. And knowing that the diseases are endemic, they occur throughout the year, it’s quite costly both for the households and the government to be able to supply the preventative measures for everybody all the time. So mostly the climate and two, of course, the level of poverty at household level, these two fuel transmission diseases.

[00:03:58] Narrator Vector-borne diseases impact communities in ways beyond just the health risks and illnesses they present.

[00:04:04] Dr. Matthew Phillips Whenever you have a disease that’s causing a lot of death and illness, it’s gonna have a huge economic impact on that community. So you’ll have people not working and you’ll have people just the healthcare cost of having all these people ill will affect the community as well. You can actually kind of quantify the economic impact of these diseases by looking at the impact of interventions we’ve done to help prevent some of these diseases. So there’s a kind of a natural experiment done by Malaria No More and Oxford Economics. They went and looked at from between 2003 and 2023, so two decades, the US distributed about 15 billion dollars for malaria control in Africa. And through the through the Global Fund and the President’s Malaria Initiative. And it’s estimated that this probably prevented about 650 million malaria cases. So when they analyzed this, by averting these malaria cases, the USA contributed to over 90 billion dollars in GDP across these countries. To put another way, for 20 years of US investment in preventing malaria, it generated 5.8 times the economic return for every dollar spent. Another analysis kind of looking forward suggests that if we reduce malaria by 90 percent in Africa, it could increase Africa’s GDP by about 126 billion dollars. So by preventing these illnesses, you can really help the economic prospects of that community as well. They also contribute to stigma and discrimination. And then in general, vector-borne diseases also act as a disaster multiplier. So when something is already happening to a community, the vector-borne diseases just make it that much worse. So a great example of this came a couple of years ago in Pakistan in 2022. There was a catastrophic flooding, and this led to a five-fold increase in malaria cases across the country. So typically they would have about 500,000, which is what they had in 2021. In 2022, they had 2.6 million cases. And so it adds to the destruction and disruption of natural disasters.

[00:06:03] Narrator As Dr. Byakika–Kibwika mentioned, there is much that can be done to try and prevent vector-borne diseases and their spread. And most of these interventions can be quite straightforward. Mosquito nets are one of the best tools we have for preventing malaria. Rob Mather is founder of the Against Malaria Foundation, the world’s third largest funder of nets. AMF has provided 350 million nets over the past 20 years. According to Rob, that’s roughly 250,000 deaths prevented and 250 million cases of malaria averted. Although simple, nets have a big impact.

[00:06:42] Rob Mather So what makes bed nets such a successful way of preventing malaria are two behavioral aspects of the malaria-carrying mosquito and two fundamental design features of the long lasting insecticidal net. So if we go back to the mosquito, they do two things, got two things on our side. The first is that generally malaria-carrying mosquitoes are nighttime biters. So they bite between ten o’clock at night and two o’clock in the morning. And that means if we can protect people when they sleep at night, we’re getting a long way there. The second thing that mosquitoes do is that they land on a net and migrate to a hole if there is a hole in the net. They don’t do an aerobatics maneuver through a hole. So if we look at the fundamental nature of a net, which as a mechanical barrier, it protects the person sleeping inside from the malaria-carrying mosquito. The mosquito lands on the net, picks up insecticide through its feet, through its legs, and that causes a knockdown. And that goes on, even when you have holes and rips and tears in nets, because of that mechanism of movement, if you like, of the mosquito. So putting the humble bed net over a sleeping space, a double bed is covered by a two dollar net, is incredibly effective at keeping the mosquito away from the person sleeping underneath.

[00:08:06] Narrator Another key prevention method is education, which can lead to important behavioral changes. These play a vital role in communities where misinformation and misconceptions about how VBDs can present and spread are still real concerns.

[00:08:20] Dr. Pauline Byakika–Kibwika In terms of community education, I believe once one, apart from the education that is specific to malaria, the moment one gets attains education in school to a certain level, at least the primary level education, they should be able to prevent malaria. They should be able to understand and be able to do something to prevent malaria. But once somebody hasn’t attended school at all, it is very difficult for them to understand some of these issues affecting health. But also there are quite many populations that still have myths within and amongst the populations that will believe that if somebody has a fever, then the cause is either somebody doing some kind of witchcraft or something that is causing them to have a fever, and that will prevent them from seeking treatment. So education usually makes people move away in terms of thinking, think less about things like witchcraft and think more about the actual causes of disease, and therefore they are more likely to reduce their contacts with vectors and also reduce the transmission of malaria and be able to access treatment earlier. Community engagement and community education is one of the methods, the strategies that the Ministry of Health emphasizes for prevention of diseases. And this is in a way to try and cause behavior change, to try and cause behavior change in terms of reducing contact with the vectors, behavior change, household changes around the households and all those, removing all those factors that favor transmission of malaria. For a long time, we preached or we spread vector control measures, trying to, you know, control the vectors, telling educating the population to avoid having stagnant water around their homes, because that’s where the vectors breed, the mosquitoes breed. So people to slash and cut down bushes and grass around their homes and remove all areas that could hold stagnant water where the mosquitoes breed. But that is not enough. The other methods include preventing the mosquito bites, that is using repellents, insect repellents, but insect repellents are not that cheap, so not everybody can afford to use those. The other method is use of insecticide treated mosquito nets, which have been distributed by the government of Uganda and distributed to majority of the people in the country. But you know these also have a lifespan. If I give you a mosquito net one mosquito net in a year, it may not necessarily, there is wear and tear and they wash them frequently.

[00:11:23] Narrator In communities where the AMF is present, Rob has seen firsthand that education has made a difference.

[00:11:30] Rob Mather By now, given that we are many, many cycles into distributing nets, in most countries we’re sort of four, five, six cycles in, if you imagine a cycle being three years, there is very widespread knowledge of what a long-lasting insecticidal net is and how it is used. When AMF started twenty years ago, one of the innovative ways that villages would communicate why nets were important, because in many circumstances, malaria is contracted by drinking stagnant water, isn’t it? Answer no. But unless you have knowledge of where malaria comes from, that might be the understanding. And so if we go back a number of decades, not today, but go back a number of decades, one of the very amusing but highly effective way of communicating to a village group, you need to use your nets, and that’s how you’re going to stop contracting malaria, is they used to groups within villages often used to do a little skit or a little play, where they’d have a couple of people lying down on a mat in the center of the village, and two people flapping their arms, pretending to be mosquitoes, would come next to them and and and sort of dip down and make as though they were biting them, and then fly away and the people would roll around on the ground and not feeling very well. A net would then be put over those two people, and the mosquitoes, the people, mosquitoes would come back and do the same thing, touch the net, roll over on the ground as a dead mosquito with legs and arms in the air waving around, and everybody would be falling over with laughter because it was a very funny scene. Communicating through humor, a very serious message about the use of a net. We’re beyond that now. And the education that is done now is much more sophisticated about it does cover things like removing areas of stagnant water where mosquitoes breed, use of the nets, sowing up holes if there are holes in nets, that sort of thing. But broadly, educationally, the knowledge of nets and what they do and how they should be used is pretty well understood.
[00:13:34] Narrator Another barrier to prevention and treatment is that for people in rural communities, healthcare can simply be difficult to access.

[00:13:41] Dr. Pauline Byakika–Kibwika So, to bring these health centers closer to the communities, but there are still homesteads that are very far from the health facilities. So that is a barrier. Usually, people will have to either walk these long distances or wait for public transport, which public transport also is not very, very accessible. And therefore, that creates a big barrier to access. And that delays diagnosis because people then take several hours to get there. It delays access to diagnostics and therefore delays access to treatment as well. Now, vaccines, we haven’t had vaccines for malaria for so for since time immemorial. But recently the WHO approved two vaccines for malaria, and our our government was able to bring in some vaccines, and therefore these have been rolled out for especially for children below five years of age. But regarding access, it’s still not highly accessible because the number of doses are still quite few, and therefore, not everybody who needs the vaccine will be able to get the vaccine. So same to the treatments. The treatments are more available than the vaccine. The vaccines are a new modality on the block. The treatments we have had antimalarials for many years, and these are more widely available. But still, some patients will take several hours to get to the health facility, and therefore they may not necessarily get the treatment.

[00:15:25] Narrator Not only are vaccines difficult to deploy due to logistics, but it’s also been difficult to develop vaccines for many vector-borne diseases in the first place.

[00:15:35] Dr. Matthew Phillips Yeah, so there are a variety of reasons why it’s been difficult to develop vaccines for vector-borne diseases. Some of the reasons have to do with the disease itself. So, for example, dengue, it’s been challenging to make a vaccine because of kind of the underlying biology of the virus. So there are four different types of dengue that are all capable of causing kind of similar clinical syndromes. Once you get infected by one, you are immune to that specific type of dengue, and you have temporary immunity to some of the other ones, but not lifelong. And so when you’re developing a vaccine for dengue, you want to make sure that you’re covering all four of these strains. Because if for some reason one of the strains isn’t covered enough, you could be predisposing people to getting a more serious form of this disease. And so currently, there’s only one approved dengue vaccine in the United States. Malaria is another case where the biology of the disease has made it really challenging to find a vaccine. Malaria is not a bacteria or a virus. And so a lot of its underlying machinery, its biological machinery is similar to ours. We’re both eukaryotic organisms. And so it also has other ways of hiding in the body, whether it’s hiding in our cells or kind of shifting what it presents to the body on the outside of the parasite. And so it has all these mechanisms that we have to kind of compete with. And so it’s been really hard to develop a robust malaria vaccine. That said, in the past couple of years, there has been some progress. There are now two malaria vaccines that are approved by the World Health Organization. The first was approved in October of 2021, specifically for children in sub-Saharan Africa or in areas that have a high risk of transmission, had efficacy of about 50 percent, but it kind of waned over time. Specifically, it was geared towards one type of malaria called falciparum. It had better protections for these kinds of strains. More recently, in the past couple of years, in October 2023, WHO approved a second vaccine for prevention of malaria. Again, this is for children living in areas of moderate to high transmission. This one had a fantastic efficacy. It was over 75 percent. That said, it hasn’t been around long enough for us to know how durable this protection is.

[00:17:47] Rob Mather If we think about a vaccine, if you could vaccinate against malaria in the way that you know, the classic vaccination program, of course, is polio, hundred percent of the population, a hundred percent effective, one administrative dose, no cold chain logistics. And those first two things, hundred percent effective, a hundred percent of the population talk to how impactful it can be. And the last two, how many administrative doses talk to and cold chain logistics, whether you need to keep the vaccine cool, obviously, refrigerated, and talk to cost. Polio was bullseye. So that was terrific. The work that the scientists in the last well, it’s been over a number of decades now have done to come up in recent times with two malaria vaccines has been absolutely fantastic because it’s the first time we’ve ever had a vaccine, now two against a parasite, because there are a number of malaria parasites. But that’s been a fantastic breakthrough. But we’re not there yet because we don’t have that hundred percent, hundred percent. We have a much lower percent, thirty-five, forty, fifty percent, a portion of the population, four administrative doses, cold chain logistics. You get the idea that it’s not quite there as a vaccine which costs money and so it’s not as cost effective as it we want it to be. But hopefully the scientists will have other scientists stand on their shoulders, metaphorically speaking.

[00:19:11] Narrator Over the past few years, there’s been increasing worry that climate change is expanding the areas where vectors can live.

[00:19:18] Dr. Matthew Phillips So global climate change, driven primarily by greenhouse gasses released into the atmosphere from human activities like burning fossil fuel has a huge impact on all areas of human health, especially infectious diseases. So based on our current understanding and the current literature, over half of all infectious diseases are going to be made worse by climate change. Vector-borne diseases are actually the best studied of these types of infectious diseases just because of how integrated into the environment the transmission of vector-borne diseases is. So these vectors require environment capable of spreading them, the spread of the actual vectors themselves, the range of the animals. You can imagine climate change being this all-encompassing problem, it affects every single aspect of how these diseases are transmitted. And so it’s important to remember that arthropod vectors are cold-blooded, and so they don’t control their internal temperature. And so the ranges of these organisms is heavily dependent on ambient temperature. And so as the global climate warms, you’re seeing a northward expansion of a lot of these vectors, these ticks and mosquitoes that can pass on diseases. You’re also seeing them able to get up to a higher altitude as well. It doesn’t affect climate change doesn’t affect every location in the same way. And so you’ll see some areas getting wetter as well, and certain organisms do better in more wet conditions. So you
think about like mosquitoes able to breed in standing water. And so increasing rain, increasing catastrophic flooding and storms in certain areas, will help kind of the breeding of mosquitoes. So you do see this expanding range of vector-borne diseases. Climate change also affects the seasonality of these viruses, of these diseases, vector-borne diseases. So the with warmer weather, you get longer summers and shorter, milder winters. And so it’s been estimated that by 2050, the amount of time per year that mosquitoes, like the Aedes mosquito, the one that transmits yellow fever and chikungunya, the range that they’ll be able to be active, expands by one or two months by 2050. You’re also getting larger populations.

[00:21:18] Narrator In Uganda, where malaria is endemic, climate change can make the problem worse. Although the healthcare system is better equipped to deal with these challenges than in many locations that are not used to seeing malaria cases.

[00:21:32] Dr. Pauline Byakika–Kibwika The transmission of malaria is favored by the climate in which we live, the tropical climate. And of course, I’m sure you have heard of climate change. Climate change affects so many aspects of life, including health, including the transmission of malaria. So in some months, we get the effects of changes in the climate. And these will have an effect on the transmission of malaria. So some days, some some months we get some years, some years we get outbreaks of malaria. But because we are all very aware with a high index of suspicion for malaria in the environment that we live in, these are usually detected quite fast and interventions are put in place. So our outbreak investigation and control systems as a country are very highly developed and are very very sensitive so that they will be able to detect these and come in timely to try and and and fight the outbreak. But as I said, malaria is transmitted throughout the year here in Uganda with peak seasons during the two rainy seasons. We get two rainy seasons in the year, mid year and towards the end of the year. So usually immediately after the the the rainy season, we have a peak of malaria transmission. And we have to work harder because the the prevention has to be strengthened.

[00:23:10] Narrator There are developments on the horizon that show promise in both prevention and treatment.

[00:23:15] Dr. Pauline Byakika–Kibwika An individual is given malaria, antimalarials that are meant to treat, but can be used to prevent as well, taken as preventative measures. So chemoprophylaxis is being used for certain populations, especially the high-risk populations, can take chemoprophylaxis to prevent.

[00:23:37] Rob Mather When I look at the future for malaria control, I’m absolutely hopeful. I’ve been at this for twenty years, but I think there are a number of things that make me hopeful, the first is the nature of people. My experience over the last twenty years is that is that I have come across a very, very large number of incredibly generous people who care. And that I think in some ways is sits at the heart of how we make progress with anything. We’ve got a lot of people who care about something. I think people also care about results, which is really important. And so if you can deliver results, then you can continue to be backed. And so that’s a sort of fundamental aspect of why I think in the coming years we’re going to make inroads into malaria and drive it further and further down. I think allied to that, and I guess I’m touching on this this point about accountability, or I have touched on this point about accountability and of aid delivery. If we can use data and be ruthlessly true transparent with what you do, and I think that leads to excellence and outstanding behavior that achieves better results. And I think the third thing that makes me hopeful is scientific breakthroughs. You know, we’ve touched on malaria vaccines and gene drive technology. Some years away, but not so many years away that we potentially can’t see it in in the near to medium term. And I think therefore I would say that bringing malaria under control is a question of when, not if. And if more people were to support interventions with strong track records of impact, and fighting malaria with distributing nets is certainly one of them, we’re gonna get there faster.

[00:25:17] Narrator Vector-borne diseases remain one of the world’s greatest public health challenges, driven by climate change, poverty, and barriers to prevention and treatment. Yet, as we’ve heard, there is also real progress from bed nets saving millions of lives to education changing behaviors to new vaccines and treatments offering hope for the future. Thank you to our guests for taking the time to share their insights. If you found this episode insightful, please share it with colleagues and friends. And don’t forget to subscribe so you don’t miss future conversations on global health. Thanks for listening to Countermeasures. If the content of this episode resonated with you, we recommend subscribing so you never miss an episode. You can find more about Countermeasures and Emergent BioSolutions at emergentbiosolutions.com. The views and opinions expressed by guests on this podcast are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates.

Narrator: [00:00:00] Globalization geopolitical conflicts, climate change and advancements in technology are making the biological threat landscape more complex than ever before. This is Countermeasures where we explore health threats impacting communities around the world, brought to you by Emergent, a leading public health company that delivers protective and life-saving solutions to communities around the world. From zoonotic disease to bioweapons, orthopoxviruses and more, we’ll explore what it means to protect public health and how preparedness today can lead to a safer tomorrow.

In 1980, the World Health Assembly officially declared smallpox eradicated, following a decades long global effort involving mass vaccination and containment strategies before vaccines. An estimated 30% of people who contracted had died, and survivors were left with life altering scars. It was one of the deadliest diseases in human history, and its eradication is considered one of society’s greatest achievements. Unfortunately, smallpox is only one disease in a larger family of orthopoxviruses, which also includes diseases such as cowpox and mpox. These diseases which are  now monitored, still pose a significant health risk. Health threats are always changing. In this episode, we look at orthopoxviruses exploring their history, how they spread, and the challenges they continue to pose from the legacy of smallpox and declining herd immunity to modern outbreaks. We’ll examine what these viruses mean for global health to understand orthopoxviruses. Today we begin with smallpox, a disease that haunted humanity for millennia before its eradication. Dr. Renee Nara, director of Public Health and History of Vaccines at the College of Physicians of Philadelphia explains what we know about its origins.[00:02:00]

Dr Rene: So there’s two, two clues, two big clues. The first one comes from the mummies in Egypt, they have the mummify bodies. You can see sort of what happened through them throughout their lifetime, some of them have some scars on their face and skin that they give us a clue that maybe they had smallpox during their life. And so they have the scarring on their face, on their arms, on their body. But you know, the scientists more recently have a way of telling the changes in the DNA of an organism, in this case, the virus, and they call it a genetic clock. The genetic clock for smallpox is about 4,000 years.

Narrator: Smallpox was a deadly and life-altering illness in the time before modern medicine.

Dr Rene: Yeah. So you would begin with a flu-like illness. You felt feverish and tired. And over the course of a couple of days, you’d start developing little pustules. And if you remember, many people will remember chickenpox. You, you got these pustules all over your face and your, and your arms and, [00:03:00] and, but smallpox was everywhere. Smallpox was all over your, your trunk, your legs, your arms, inside your mouth. Sometimes in the eyes and it would cause blindness. And then yeah, the, the scarring, chickenpox for the most part, you might have a pockmark here and there, especially if your parents were really good about keeping you from scratching yourself as mine were. But if, if with smallpox, it’s almost impossible because the, the actual virus itself just destroys that area.

Narrator: For centuries, societies had no idea what caused smallpox, though they knew it was contagious. Over time, methods like quarantine and later variolation offered some protection.

Dr Rene: Somewhere in China, there were some physicians who started taking the smallpox scabs from people who had smallpox. And once they were healed or they were on their way to healing, they would take the scabs and dry them out in the sun, and then they would ground up the scabs and give them to people through a, a straw and through the nose. And so they, they noticed that when [00:04:00] somebody, somebody took smallpox that way, that they would get a, a slighter course of the disease and they would develop immunity against smallpox. So this was called variolation. It was, uh, very, you know, controversial throughout its whole history because you were giving people the disease.

Narrator: Eventually, the smallpox vaccine was developed a milestone that changed the course of human health and paved the way for eradication. Dr. Martin Muchangi of Amref Health Africa explains what made smallpox eradication possible and what lessons we must carry forward.

Dr Martin: Yes. So major victory was attained in the 1980s when the WHO was able to declare they were smallpox free. This was of a couple of efforts, some of them, which was more or less around going to the field, engaging with the communities, and making sure that work is done and done diligently. Then the second thing [00:05:00] was around group of solidarity, ensuring that everyone comes together to solve a common problem, and that was coupled with very targeted community engagement, making sure that the corners are involved, communities are engaged, and of course, deploying very novel public health tools. Ensuring containment and above all, ensuring that there is, uh, vaccination and vaccination, which is not just mass vaccination, but targeted vaccination to the most vulnerable and Ines above all. Uh, coupling that was the issues. To do it in data, using data for decision making. Evidence for logistics and ensuring that data actually informs the investment that went on. So I would want to say that the eradication of smallpox set stage for the current systems [00:06:00] that are addressing the current pandemics.

Narrator: The eradication of smallpox showed the power of global solidarity and targeted vaccination. But today Martin warns that the world faces new vulnerabilities, especially for populations born after the 1980s.

Dr Martin: The very fact that we are no longer vaccinating population against smallpox is a danger. I would want to say that those ones who actually received the smallpox vaccination were covered and we were able to attain some sort of hand immunity up to some level. But you can imagine since the 1980s, there’s a whole vulnerable population that are like 45 years old. And so those are vulnerable populations and room to say that any other other pox virus. Could pose some sort of vulnerabilities to population. So at this point, we are at a risk. Of course, those [00:07:00] who are vaccinated are safe, and it’s okay that it’s an indicated disease, but so far there are major of vulnerabilities, especially for those who are not, uh, vaccinated. So we just need to remain alert that while we are celebrating that there’s no more smallpox, it was eradicated. Then there are major vulnerabilities. Should, should, such kind of a virus, heat, or a virus, which is very close, the genetic linkage with it. Then the wound will be at a mental risk

Narrator: Because of this orthopoxviruses are still a major threat to global health, especially in places with high population density. With waning vaccination rates among younger generations, mpox has emerged as an orthopoxvirus threat. Dr. Martin explains the complexity of mpox transmission, and while one size fits all, response won’t work.

Dr Martin: The epidemiology of folks is a little bit complex. There is [00:08:00] urban mix, rural mix. There’s actually the mix that also takes the social among graphic kind of profiles. And so it is distributed not evenly. So if you look at the populations that are living in urban areas, you realize that. Most of them are actually getting it through intimate contacts. And then when you’re looking at the rural communities, like mostly in Central Africa and rural Africa, the transitional pattern is actually emerging as the main transmission route whereby. You. You have people who are living in small communities and they’re living in congested areas, so you realize that the contact kind of transmission is the one which is predominant. And more specifically, we also see kind of zoonotic bureau of us. And so for that case, I want to say that the epidemiology of mpox transmission is mixed. We need to actually be very [00:09:00] cautious and very targeted in terms of like addressing the problem. Not to generalize how we are dealing with this. We need to consider geographies. We need to consider socio demographics. We need to consider urban rural mix and actually try to understand the sociocultural context of individuals and that’s how we can come up with the proper interventions moving forward.

Narrator: The recent emergence of mpox reminds us that preparedness doesn’t end with eradication. It requires being proactive and vigilant access to the necessary medicines and the ability to act fast. Eric Balsley, director of product management at Emergent BioSolutions describes how the world has thought about readiness in smallpox.

Eric: One of the things to keep in mind about mpox as an orthopoxvirus. The reason today we see mpox outbreaks happening around the globe in, and not say in the [00:10:00] 1980s, 1990s as much is because the way the world responded to smallpox was a goal of eradicating smallpox as a, as a virus. And they were, we were successful in doing that, and success was through a vaccination of large numbers of people to prevent the spread of small pocket. Now one of the, one of the benefits of mass vaccination against smallpox is that smallpox vaccines used to eradicate smallpox are also protective against mpox. So for, for many, many decades, the world has benefited from a large amount of the population having been vaccinated against smallpox and therefore also having immunity against mpox as the population is aging and younger people are, are making up a larger percentage of the population. You have more and more people who are not [00:11:00] protected against mpox because they’ve never been vaccinated against smallpox. And unlike, unlike smallpox, mpox has a natural reservoir in, in various animals. So because of that you can see how outbreaks occur. So there’s always a, an animal source for mpox to, to find its way into, into a human. And then that pro provides an opportunity for mpox to spread within communities.

Narrator: Stockpiled vaccines and medicines as well as disease surveillance remain essential, but as Martin points out, equity and response is still a global challenge.

Dr Martin: One of the most important thing to point out is that when you look at when EM impacts broke out, there was major campaigns around vaccination. So like if you pick the US itself, there was very quick movement of vaccination around [00:12:00] 1.2 million doses were administered. That is very good. And of course when you’re looking at the other countries, like the ones which are in Africa, there was some gap in terms of like the supply chains. When you’re looking at the quantity in systems and when you’re looking at the reach and the ones who actually required. Those who needed the vaccine most were somehow not covered. But I would say that. Just looking at the transitions between the previous struggles of smallpox and how mpox was actually handled, there’s a major improvement in terms of the way these outbreak has been handled. Group awareness, group of solidarity, putting science into perspective. Bringing people together and, you know, uh, also changing policies in a way that they can accommodate a procured intervention was one of the key things that I would see is positive in terms of the, uh, [00:13:00] impacts.

Narrator: From vaccination campaigns in the US to inequities in Africa, mpox has tested global systems. Eric Balsley reminds us that readiness is not only about supply, but having systems in place to roll out vaccines when they’re needed.

Eric: Readiness to respond, I think goes back to the policies that have been established and the investments that have been made to be able to deal with these, these threats. So I’ll, I’ll go back to the US and if you look back to the early two thousands. At that point in time, the US set a, set a goal of having a smallpox vaccine for every single person in the us And it’s an ambitious goal, and it’s a, it’s a goal that means you’re prepared, right? If you have a vaccine for every single person in the us. Yes, there’s going to be a disruption to day-to-day life, but it is a, it is a situation where you have to roll [00:14:00] out vaccines and be able to respond. And, and there are numerous countries around the globe that do have relatively robust preparedness programs to ensure that if, if something like an orthopoxvirus outbreak. That is becoming more and more of a pandemic and more and more threat to life. Um, they’ll be able to respond. Um, I think, I think what we see today still, if you look at the response in Africa, there is, there is a delay in vaccines being made available. And that’s, you could have debates with people on whether it’s vaccine supply, vaccine pricing, infrastructure. Approval processes, readiness on the ground for, for the vaccines to be administered. Vaccine acceptance within communities. There are a lot of things that, there are a lot of, there are a lot of challenges that you’re going to face when you introduce, when you introduce a new virus into a population, and you have to find ways to educate, deliver, ensure vaccine compliance.[00:15:00]

Narrator: Preparedness is not just about vaccines and warehouses. It’s also about knowing when and where an outbreak is starting. Dr. Martin stresses that surveillance communication and community engagement are as important as stockpiles.

Dr Martin: Yeah, indeed. Stockpiling of vaccines is very necessary, but beyond stockpiling of the vaccines, there are other things which we need to think about critically. The first one is around surveillance and want to emphasize the importance of surveillance, and these integrates the elements of community-based disease surveillance, the elements around genomics. The elements around, uh, community intelligence and, and citizen science that is getting the knowledge of the community, like the way they perceive things. Then the second element is around precision vaccination, because again, to avoid wastefulness and [00:16:00] being targeted from a pap precision vaccination is necessary. Who requires this vaccine? Who is the neediest and when do we begin? When does it end? Then the learned element is around the therapeutics. We need to be very clear about the kind of drugs that we need to use, the most effective drugs, and then proper communication, community engagement that is often ignored, but without that then uptake of the. Therapies, uptake of the vaccination, uptake of the preventive practices normally for forced apart. And we wouldn’t want to have such kind of a thing because when you’re giving a service to a customer, a customer must be able to appreciate that and communication. That communication does that in terms of engaging communities, then, I would want to say that the effort that goes into financing. For this, [00:17:00] for this action needs to be apt. We need to think about how to reinvent some money that can help us to address pandemics without major struggles.

Narrator: Surveillance, therapeutics, vaccines, communication, financing. All of these pillars have to stand together and when outbreaks cross borders, no country can respond alone. Eric Balsley says, global collaboration across governments industry and NGOs is key.

Eric: You would hope. You would hope that you’d be able to get vaccines to people faster. That’s why we see things such as the public health emergency of international concern that was issued for the 2024 outbreak of mpox in Africa. I don’t think the vaccination level is where you’d want to see African countries being right now. I do believe that’s, that’s. High income countries do recognize this, this gap and the need for coordination to be able to be prepared not [00:18:00] only for how they work together in, in general in preparedness, but also in response to outbreaks as again, the example that we can, we can reference here is, is what’s going on in Africa with mpox right now. So I do believe that there is, is a recognized need for better coordination across countries and across. NGOs to make sure that it’s not just the high income countries that benefit from, from preparedness, but rather the globe then benefiting from preparedness. I don’t know if there’s a, a clear answer on how to do that yet, but I think what’s important is that there’s, there’s continuous discussion and alignments with, uh. Industry with governments, with, with nonprofits on how to, on how to approach this. And one of the, one of the examples that I would use from the outbreak that I do think is, is something we should pay attention to is, is [00:19:00] Gavi’s recent announcements around the fact that they’re going to have a global stockpile for mpox vaccines. Right? That’s, I don’t know if that has happened in the past where you have an entity like, like Gavi stepping up and saying, we are going to be the ones who ensure. A stockpile capability for the globe to respond to these outbreaks. And I think that’s going to be an important piece because you, you establish more centralized procurement, more predictability around demand.

Narrator: Global collaboration is essential, but it’s not just about moving vaccines and resources. It’s also about moving knowledge, building trust, and sharing data. Dr. Martin says progress is being made, especially in Africa, where local evidence and. Citizen science are driving new approaches.

Dr Martin: Yeah, I would want to say that, uh, that having initiatives that generate evidence is something very positive. And this is for the purpose of contextualizing solutions. So like the study which was conducted in Africa is, is one of the kind of the standards that is an example of how we can use evidence, testing the drugs with the people, making sure that it works actually as defined, making sure that it’s acceptable and above all. Building the capacities of the scientists who are undertaking the standards to do even better in future, and this is part of what I would want to say, couldn’t encourage data sharing, sharing of innovations and evidence. From the group or south from the group or north, building a strong group of solidarity towards answer, addressing these challenges for other  orthopoxviruses. So I want to say that’s a positive thing, like that study which happened here [00:21:00] in Africa and I, I do hope that many more are going to happen in the future

Narrator: Despite the challenges of preparedness. There are reasons for optimism. Dr. Martin explains why he believes the future can be different if the world builds on the lessons of smallpox and impacts.

Dr Martin: But that makes me optimistic that we have a starting point of as where we, we are not starting from zero. Then the, that element is that we’ve picked lessons, uh, all the way from. COVID 19, the one which hit nearly everyone in the world. There was a lot of lessons which were picked and above all I see, group of solidarity and a movement, which is emerging that appreciates that.An epidemic, which is somewhere in Africa, in Asia, in Europe, America. Actually can heat the launch within hours. And within this, everyone can be in problems there.[00:22:00]

Narrator: The end of smallpox didn’t meet the end of ox viruses. The rise of mpox shows us how fragile preparedness can be and how inequities in access to medicines and proactive surveillance can lead to lower trust in health systems and shape outcomes. As we’ve heard from Dr. Rene Najera, Eric Balsley and Dr. Martin Muchangi. The lessons of history, the realities of today and the hopes for the future are all connected. Solidarity, equity, innovation, and one health approach are all factors determining whether we are ready for the next  challenge, the world defeated smallpox. The question now is what will we do with the lessons that left behind?

Thanks for listening to countermeasures. If the content of this. Episode resonated with you. We recommend subscribing so you’d never miss an episode. You can find more about Countermeasures at emergentbiosolutions.com. The views and opinions expressed by guests on this podcast are their own and do not necessarily reflect those of Emergent BioSolutions or its affiliates.

[00:00:00] Maryann Mason We think of grandma baking cookies. But think about it now generationally, these grandmas wore miniskirts and listened to rock and roll and, you know, did recreational drugs. So that stereotype of grandma sitting in a rocking chair doing all those things prevents us from seeing them in their whole totality of how they’ve lived their lives and what social influence and some conditions are under. So sometimes it’s just stops people from asking, could this behavior be substance use related? It’s not even on the table for many people. I think that’s one of the big things. The other is stereotypes of what aging is like, where cognitive decline is expected. And so sometimes people will have that stereotype and not think, could this be due to miss substance misuse? And so they won’t investigate that alley.  

[00:01:07] Narrator This is Countermeasures, brought to you by Emergent, maker of NARCAN^® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is a leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season, we’ll continue to explore some of the communities hit the hardest by the crisis. From prisons and construction sites to schools and elderly care. We will hear from changemakers offering a new way forward. When many of us think of the opioid crisis, we might not think of older adults. Stereotypes of what it means to age can prevent signs and symptoms of opioid misuse and dependency from being caught by medical professionals, friends and family and caregivers. However, older adults are a population that is deeply impacted by the opioid crisis and has historically been under addressed by education, harm reduction and treatment options. Maryann Mason is a sociologist and an associate professor of emergency medicine at Northwestern University. She’s been working in the area of substance and opioid misuse for ten years with a focus on older adults.  

[00:02:27] Maryann Mason There has been an increase in opioid overdose deaths in older adults. Older adults are just like younger adults, but their rates are a little lower, but they have followed the curve of everybody else. So since 1999, which is the reference point, most of us use older adult overdose deaths have increased enormously over a thousand percent. There are certain periods during that 1999 to 2024 where the increase has been steeper. And about 2014, 2013 is when the increase started going steeply up and there have been permutations in the rates, but pretty much upwardly ever since. The major reasons for the increase are the same reasons really behind the overdose increase in general. It began with the overprescription of opioids by physicians, and then it morphed into illicit opioids like heroin. And then when the crack down came in that and it was harder to get heroin, fentanyl made its way into the drug supply and increase things. And now more recently, we have poly substance driving the increases. So people who are using opioids and stimulants and opioids and alcohol, those are the substances behind the increase. And just want to point out something really interesting about older adults. I’ve been looking closely at the most recent data. And overall in the United States, it looks like drug opioid drug overdoses are going down slightly from 2022 to three and then to 24. But that’s not the case for older adults. They’re continuing to climb for older adults.  

[00:04:31] Narrator Mary Nguyen is a Doctor of Pharmacy graduate from the University of Waterloo outside of Toronto. She has worked as a pharmacist in a rural community in Ontario, where she saw the effects of the opioid crisis on older adults in the community. Like Maryann, she says that most people don’t think about the impact of the opioid crisis on older adults and that stereotypes of aging can prevent opioid misuse from being identified.  

[00:04:57] Mary Nguyen It’s surprising how often older adults are affected, even though we don’t typically associate them with opioid misuse. You know, people rarely imagine someone like 80 year old Martha down the street struggling with addiction. But the opioid crisis really started in the 90s with OxyContin. And now that baby boomer generation who were highly prescribed opioids are older. So we’re really seeing that lasting effect. Now, to put it in perspective, one in six older adults have taken opioids. Opioid use disorder among this group tripled from 2013 to 2018. Older adults are actually the largest users of prescription opioids. So when you think about it that way, it’s not as surprising that opioid use disorder is prevalent in the population. Unfortunately, we see a lot of stigma in opioid use or misuse in this population, so it can prevent a lot of diagnosis and treatment.  

[00:05:57] Narrator Mary found that the dangers of developing dependency were not fully understood by patients, especially if they were taking prescription opioids, and that many of these issues were exacerbated by the rural setting.  

[00:06:09] Mary Nguyen The lack of resources, especially for comprehensive care and follow up, really makes it difficult to manage opioid dependency. You know, I’ve seen many of my patients struggle with dependency, whether or not they realize it, mostly because their long term use of opioids is often for legitimate reasons, like for chronic pain management. And they’re not always the most eager to explore safer options, especially when they think that opioids work the best for them. People also don’t realize how easily dependency can develop. You know, it can take as little as a couple of weeks. And then tolerance is a big issue as well. The longer you’re on opioids, the less effective they become, which leads to taking higher doses and a greater risk of dependency. Many assume that because a medication is prescribed, it’s safe. Especially if something they’ve been taking for a long time, they’re less likely to stop because they don’t think it’s an issue. You know, our health care system in Canada is quite strained. Doctors’ offices are overloaded. Sometimes they don’t have time to give proper education or ongoing check-ins for these patients who are on long term medications.  

[00:07:25] Narrator In rural settings, especially, tools like naloxone can be crucial.  

[00:07:32] Mary Nguyen It’s really important to reduce that stigma around naloxone. Many people hesitate to carry naloxone or take it when it’s offered because they think it implies that they’re an addict of some sort. I like to reframe it as a safety tool. It’s like having a fire extinguisher in your kitchen just in case of emergencies. It’s not that we think you’re abusing your medications, but if you were to accidentally take too much or if someone else were to get into your medications, it’s there as a safety net. And I think, you know, with the evolution of injectable naloxone to nasal naloxone kits, people are less hesitant to carry it because it’s a lot easier to use. Most people don’t want to carry around a needle and syringe and have to poke someone in an emergency.  

[00:08:20] Narrator While one way older adults are affected by the opioid crisis is misuse of opioids that were prescribed to them. Some older adults may have a long history of using illicit drugs. The rise of fentanyl has put this population at greater risk.  

[00:08:35] Maryann Mason Older adults, there’s kind of two types of opioid misuse. One, is early onset where people may have a 20, 30, 40, 50 year history of substance misuse. And then late onset, that happens in their older years and that’s mostly prescription oriented. So you kind of have to think about two distinct groups of people, older adults who are using. So the younger onset people, there could be a variety of reasons why they’re they’ve misuse and continue to misuse, including untreated pain, mental health issues, sort of cultural norms, generational cultural norms. And then for the older adults who initiate, it’s more likely to have to do with prescription abuse that builds dependency. The disparities are very stark. So among older adults, it’s the 55 to 64 year olds who are disproportionately affected and then men and then African-American men. And so while there is not a ton of definitive research on this, I think the general thought is that it’s a generational impact, meaning that it’s a group that’s likely had early onset use and maintain their use over decades. And so they’ve I mean, they’re survivors. Right. They’ve been able to survive with substance use for 30, 40, 50 years. But now we’re in a situation where the potency of the drug supply combined with their aging has put them at proportionate risk. So the older adults or the young old, as I like to call this group of African-American men, sort of have a generational legacy in that way, in that if you think back to the 1970s, there was a heroin epidemic. A lot of us don’t think that far back, but that was the population ensnared in that epidemic. And I think this population now, they’re older adults. They have continued to use and are ensnared in the new epidemic with greater risk.  

[00:10:55] Narrator Jessica Liebster is a case manager at West Neighborhood House, a multi-service organization in Toronto that serves the community to address critical issues through personal and social change. A large portion of their programing is targeted at older adults in the community, some of whom have struggled with chronic opioid misuse. One of their programs includes volunteers going into the homes of seniors in the community who might be isolated.  

[00:11:21] Jessica Liebster That program provides volunteer support to connect with participants, so sometimes they will get a weekly call if they would like to just chat and have a connection on a weekly basis. So through that, then we’re able to link up to other support services. So sometimes people don’t identify, they don’t want to ask for services that they think maybe are for other people, right? It’s like people are sometimes very proud or they don’t want to access charity because they don’t see themselves in that light. But we know that all of these social supports most people can benefit from, right? So but some people will then say, yeah, you know, I am kind of lonely. It would be nice to connect with a volunteer. But the volunteer then can identify all kinds of needs and supports. And when things deteriorate as they can, in terms of health or mental health or what have you, then the friendly visitor or the family connection volunteer can say, Hey, this person is struggling a bit and gets some advice or support on how they can refer them to other services. So that piece is, I think, really significant because it captures a lot of folks who wouldn’t necessarily see themselves as needing case management, but there is an element of identifying with some of the needs through that program.  

[00:12:43] Narrator Like both Mary and Maryann, Jessica has seen the intersection of social isolation, poverty and substance misuse.  

[00:12:53] Jessica Liebster Substance use, we’re maybe thinking of a younger population, so there’s less awareness and not always less awareness always leads to like less access to service as well as maybe somebody not identifying their own needs in that regard as they see themselves as different from other substance users that, you know, maybe are kind of sensationalized in the media or what have you. Right? So I think that ensuring that we’re kind of shining a light on substance use with older adults is really important. And I also think to like the older adult population within, you know, homeless or under housed folks is not really acknowledged. You know, we see lots of older adults who are unhoused, maybe living in shelter for a long time or living sleeping outside using substances. And so, you know, that piece, I think can also get missed because we’re looking at the impact of poverty, like severe poverty in addition to aging, in addition to substance use. So there’s some very specific needs there that, you know, require a bit of a nuanced perspective to respond to.  

[00:14:13] Maryann Mason And then specific to the older adult, there’s lots of different things. But key to this group are things like income inequality. So people with lower income tend to have less opportunity for medical insurance to treat pain. And so there’s this idea that people self-medicate when they’re not able to get medical care. There’s also this idea, and it’s well documented, structural racism in the United States where African Americans were actually less likely to be treated for pain with opioids than other populations. And so, again, it leads one to think about the development of illicit views. So you think about those sort of legacy factors, the fact that people don’t have health care, that they’ve experienced lifetimes of racism, that they don’t have access to things like stable housing, which could help them manage these conditions. And the fact that employment and things like that is so racialized in the United States, you can kind of see how this happened.  

[00:15:32] Narrator As a pharmacist, Mary saw the impact of the pandemic on older adults, which augments the social isolation that can contribute to substance use disorder.  

[00:15:41] Mary Nguyen Covid-19 made things much harder during the pandemic. I saw a sharp rise in opioid abuse, with more patients starting medication assisted treatment increased and relapses, more naloxone requests and treatments for other substance use disorders like alcohol use. And I really do think it’s from that isolation increase in the stress and anxiety leading to this substance use. With health care services limited during lockdowns, it’s tough to get the support you need, right? And with the pandemic, it also led to shifts in the opioid prescription regulations in Ontario, because there weren’t as many in office visit and limiting the transmission risks of Covid. They provided at the Ontario government provided looser restrictions on opioid prescription transfers and longer dispensing intervals. But that inadvertently increased the risk of drug diversion. Across Canada, we saw increases in opioid related hospitalizations and fatal overdoses, especially from fentanyl. But from my experience, the elderly patients were the most impacted by opioid disorder because those were the ones often without a strong social support and a challenge that was further exacerbated by the pandemic.  

[00:17:09] Narrator Mary has also seen that the health care profession has a ways to go when it comes to this issue, including in long-term care.  

[00:17:17] Mary Nguyen You know, a lot of times when patients go to long term care homes, the health care they receive is often okay. Is there another problem we need to address? Let’s add on medication. It’s very rarely that a doctor goes in and like, hey, let’s see what we can take away. And it’s a practice that is starting to become more popular, especially as you see so many interactions between the different medications. And, you know, just because someone needed something at one point doesn’t mean they need to be on it forever. And as pharmacists specifically coming more into long term care homes, we are coming in and doing medication reviews to do prescribe to minimize the risks. A big thing with opioid use with the cognitive decline is the fall risk. You know, older adults, if they have a bad fall, I think 50 percent of patients who had a hip fracture aren’t able to return back to their normal independent living anymore after that. So I think it’s a big intervention that pharmacists can play.  

[00:18:31] Narrator Lake Mary, Maryann believes that treatment is not curated to this population.  

[00:18:37] Maryann Mason No, I don’t think there are services tailored to older adults out there for people, or at least in the quantity and the places where people need them. They’re, first of all, there, if you are talking about recovery and treatment, there are some things older adults may need that the general population doesn’t just because of how we age. So they might have transportation or mobility barriers, so they may need a different needs there. They may have hearing or vision issues that necessitate delivering supports and services. There’s been some work done looking at sort of the culture of recovery and how that works and the idea that sort of group therapy, talking about your things in in a group is not in alignment with what many older adults feel is comfortable for them. So there are adaptations that need to be made that way, but also medication assisted recovery, which we know is an effective treatment for opioid use disorder, is less often offered to older adults than younger adults. And so, you know, should that be something people are interested in, They’re not being asked.  

[00:19:59] Narrator Maryann also believes that there is more work to be done to tailor current programs to the needs of older adults.  

[00:20:06] Maryann Mason Older adults have come of age in a time where that wasn’t a thing. It wasn’t an option for them or that you had to go to specialized treatment. So many don’t know you can get substance use disorder treatment at your primary care physicians office. So there’s a couple of things there. One is the education of the older adult community about what’s now available. But to the education of providers to offering things. And then I guess three is how do we adapt things being offered to the needs of older adults? We have a long way to go. If you think about harm reduction, harm reduction are services that can help people who use drugs be safer and less risky. And there’s a whole menu of effective strategies people can use in harm reduction, anything from syringe distribution to test strips so you can test your drug supply to drug checking. All of those things are in the harm reduction menu or bucket. But there’s evidence showing that older adults are less often touched by harm reduction. And there’s again, a couple of theories about why they’re less often reach. But part of it has to do with stigma. And you think about this population generationally. There was this whole, I’m going to use a word we don’t use anymore, but this junkie label for people where there is a quite a bit of shame and personal failing associated with substance use. So people do not want to identify with that. Sometimes for older adults, they may have gone through a period of abstaining for a number of years and then have recently or more recently gone back to use. And so they really don’t want to go out to the mobile van and stand in line for services because they don’t want to self identify as someone who is using again. The other factors transportation and mobility. People aren’t in the places where they used to hang out and use drugs in their older days, so they’re they can’t be reached in those places and stuff. And so I think we’ve got a ton of work to do around strategies to reach this group with those this population, with those strategies.  

[00:22:41] Narrator Older adults are a large, complex and diverse group, and opioid dependency looks different among different populations. However, stereotypes about aging and stigma surrounding opioid misuse can prevent older adults from seeking treatment or for dependency to be caught in the first place. In addition, harm reduction services and supports tailored to older adults are lacking. Increased interest and research into this area will help improve outcomes for everyone. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit www.emergentbiosolutions.com. If this episode resonated with you, consider reading and reviewing Countermeasures on your preferred podcast platform.  

[00:00:02] Bella Grumet I think when you’re directing harm reduction efforts toward college students and students of this generation, I think one of the things that makes us so successful is our peer-to-peer modeling, because we’re the generation of D.A.R.E., where I have been signing drug free pledges since I was in the first grade and didn’t really know what a drug was. So I think people in that generation kind of have a kneejerk reaction to any sort of harm reduction or drug focused efforts because they think they’re being judged and are being told to do something. But we really value kind of meeting people where they are and saying you’re you’re an adult, you’re going to do what you’re going to do, but please listen to us and how to do it safely. 

[00:00:48] Narrator This is Countermeasures, brought to you by Emergent, maker of NARCAN® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is the leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season will continue to explore some of the communities hit the hardest by the crisis, from prisons and construction sites to schools and elderly care, we will hear from changemakers offering a new way forward. At colleges nationwide, each new school year, students eagerly move into dorms and select their classes. For many, college is a time of firsts. The first time living on their own. The first time meeting so many people at once. And for some, the first time they will experiment with illicit substances. Coming from a diverse range of educational backgrounds, when it comes to drugs and alcohol, many students don’t know the dangers of accidental overdose or why accepting a pill to help them study harder or be more social has the potential to end their lives. In this episode, we speak with college students, researchers and educators about how to make campuses safer for everyone. The Carolina Harm Reduction Union, or CHRU, is a peer-to-peer student-run, faculty-monitored harm reduction organization that provides education and harm reduction materials at the University of North Carolina at Chapel Hill. 

[00:02:25] Riley Sullivan My name is Riley Sullivan. I’m the Executive Director and co-founder of the Carolina Harm Reduction Union, and I’m also a senior at the University of North Carolina at Chapel Hill. 

[00:02:37] Bella Grumet My name is Bella Grumet. I’m a senior at the University of North Carolina at Chapel Hill studying neuroscience, and I am the Director of Communications for the Carolina Harm Reduction Union. 

[00:02:47] Kathleen Ready I’m Kathleen Ready. And I’m Director of Education and kind of volunteer coordination with the Carolina Harm Reduction Union. 

[00:02:57] Bella Grumet One of the reasons getting involved in this organization was important to me is I was actually touched by a loss we had due to an accidental opioid poisoning related to a student on our campus and in the past years was three alumni and students overdosing on an opioid related to UNC’s campus. And so I just really saw a need to get education and awareness out to the student population to prevent another tragedy. 

[00:03:24] Narrator Members of CHRU saw the need for education on their campus, as well as the importance of peer-to-peer education. 

[00:03:32] Kathleen Ready We do a lot of different educational presentations as well as actual distribution and handing out of naloxone and fentanyl testing strips. And one of the great things about at least UNC and just like the general community is, there are so many different groups of people with different interests and different background knowledge. It’s like we’ve presented two groups of people that are EMTs and we’ve also presented to Greek life in different cultural groups, and each of them have different interests and kind of baseline knowledge. So we create tailor presentations that are tailored to what they think is important for whoever is in the organization to learn about. So do we do a lot of that and working with groups of students and people in the community and as well as distribute naloxone. So every week we have we put a table on campus for a couple of hours and hand out naloxone and Fentanyl testing strips and train the kids who come to the table how to use these resources and how to spot an overdose and what to do if you’re ever put in that situation. Just generally raise awareness on campus. 

[00:04:40] Narrator Administrators are key in supporting students. Alexis Drakatos at the University of Oregon, oversees substance misuse prevention services. She says the student perspective, like the one brought by Riley, Bella and Kathleen, is crucial. 

[00:04:56] Alexis Drakatos The student perspective of our work is really important, and we do have I’d say our efforts are primarily student led or student inspired. And so within my team, I do have a staff, a staff of students. We have about five or six, I’d say, that are peer, we call them substance abuse prevention peer educators. And so their role is really helping develop education and leading a lot of our workshops, doing outreach and things of that sort. So it’s really important to us to bring in students and have them be that, be that face. And also they’re the ones that are amongst their peers. They know they’re on the ground seeing what’s happening, seeing the types of questions. And so that allows us to really involve students, one, because their perspective is so important, but also when it comes to the actual moments where we’re educating a group of students, having that peer to peer model we find just allows to meet students where they’re at. But I think it also allows for just a comfort as being able to ask questions that they may be less willing to ask if I’m in the room or other professional staff are in the room. And so I think it really allows for a healthy balance. 

[00:06:08] Narrator Cori Hammond is the Director of Prevention Services at Partnership to End Addiction, a national nonprofit with a mission to transform how addiction is addressed by empowering families, advancing effective care, shaping public policy, and trying to help change the culture. Cori says that most overdoses in the college age demographic occur because people don’t realize they are taking an opioid. 

[00:06:32] Cori Hammond The risk factors for this college age group, the risks are similar to what we see in adolescents, in some ways. The the prefrontal cortex of the brain, which is that part of the brain that’s responsible for critical thinking and risk management that’s not fully developed in the late teens and early 20s. And so because of this college age people are more likely to take risks just in general. Sensation seeking, like, in males peaks at age 19, which is conveniently freshman year for most of them. But that’s common risk factors for all substances, specifically for opioid overdoses. We think about unintentional overdoses due to mostly fake pills for this age. So the overwhelming majority of young people who have a fentanyl or an opioid overdose, they didn’t mean to take fentanyl. They, you know, the overwhelming majority of them are not addicted to opioids. They thought they were taking a legitimate pharmaceutical pill that they bought from a pal or they’re taking a bump of cocaine, not realizing that fentanyl or any of these other ultra potent synthetic opioids were present in what they were taking. So that’s the main risk on college campuses. And, you know, college students are under a lot of pressure, you know, pressure to make good grades, attend class, be social, be involved and figure out their life plan, which is all part of the whole experience of college. But it’s really stressful. So it’s understandable that they could be tempted by a lot of different substances to help cope with all of that, you know, things like amphetamines that they think are going to help them stay up to study, you know, cocaine or MDMA that they think is going to make them social or fun at this party, Xanax, that they think is going to help them relax when they’re anxious. And, you know, they may be getting these substances from someone that they trust completely, but who is that person getting substances from? So we know that the illicit drug market is not safe and these fake pills can be like they can’t be identified just by looking at them. And so these are the situations that we know put college students at risk for an accidental overdose. 

[00:08:58] Narrator At the University of Oregon, incoming students are required to complete online training that includes education about fake pills. 

[00:09:07] Alexis Drakatos We do have students from all over the world. And so it is important to recognize that the education that our students may be coming in with specific to alcohol and other drugs is going to look really different just depending on the state, the country that they’re coming from, even the community and then even the individual school and what their K-12 education might have looked like. So we want to try to have a baseline education for all our students to educate them on specific campus policies, state policies, and maybe even in some cases, federal regulations. So the baseline education for incoming students is we utilize the so online prevention, especially knowing that we have such a large incoming class of students. And so our students, during their first term or quarter on campus, they’re required to complete some online modules that focus on alcohol, cannabis, prescription medication. And then we also focus on Title IX and some other sexual assault, consent and consent education. And so all students are required to complete those modules. We also do require students when they come for orientation, freshman or first year student orientation. We have them go through an in-person workshop that’s led by students. 

[00:10:28] Narrator Certain groups of students are at higher risk of substance misuse. And Alexis emphasizes the importance of reaching and educating these groups. 

[00:10:37] Alexis Drakatos How we go about educating specific communities or assessing maybe trends or levels of risk within specific communities on campus. I think areas that we do spend a great deal of our time in the three that come to mind immediately would be fraternity and sorority life. And so we recognize that their data shows and I think even anecdotally you will see that I think students that are engaged in fraternities where you guys might be at utilize substances at greater rates than non-fraternity and sorority life peers. They’re also at greater risk for other other harmful behaviors as well. And so that’s a really important group for us to be working with and having targeted education towards. And we also like to focus on athletics and so working broadly with our athletic teams. And then I think the other I’d say is working with incoming or first freshman year students as well. And so what that education might look like as much as possible is involving students from those populations and that education. So, for example, a fraternity sorority life, part of my role is overseeing we call it the Safety Wellness Board here on campus. And so it’s we have members that are all in fraternities and sororities that lead this board. And so we have staff that are working with these students that are peer leaders. And then those are the students that are leading education to the greater fraternity sorority life community. So again, it’s that model of having student leaders involved saying, okay, what do we need to talk about? What are the trends you’re seeing? What do we need to do to address these things? And so having that support to help them tailor education for those students. 

[00:12:24] Cori Hammond In general, we know students are at a higher risk of substance use disorders during college if they binge drink, if their peers use if they’re a member of a fraternity or sorority, and if they kind of believe that substances are super harmful. We also know that female students are more than twice as likely as male peers to seek out stimulants for non-medical use, which puts them at higher risk of coming into contact with laced or fake pills. Bisexual women, for instance, are at an increased risk for opioid misuse and opioid use disorder. We know in general that students who are struggling with low GPAs or have difficulty in socializing are more likely to use opioids than their peers. Prescription opioid misuse is highest among students who report psychological distress or depression or suicidal thoughts. 

[00:13:22] Narrator As you’ve heard, conversations about prevention for college students are changing. Students are calling for open, nonjudgmental conversations rather than scare tactics. 

[00:13:33] Bella Grumet So I think when you’re directing harm reduction efforts towards college students and students of this generation, it’s really I think one of the things that makes us so successful is our peer-to-peer modeling, because we’re the generation of D.A.R.E. where I was signing drug free pledges since I was in the first grade and didn’t really know what a drug was. So I think people in that generation kind of have a kneejerk reaction to any sort of harm reduction or drug focused efforts because they think they’re being judged and they think they’re being told to do something. But we really value kind of meeting people where they are and saying, you’re like, you’re an adult. You’re going to do what you’re going to do, but please listen to us and how to do it safely. And I’ve gotten a lot of feedback from people on how they’re so much more open and willing to listen to a peer talk to them because they know they’re not being judged. They know it’s not some message being forced at them. It’s someone on their in their circle, on their level, like meeting them where they are, that’s coming from a place of just wanting to help and not to judge. 

[00:14:39] Riley Sullivan I won the D.A.R.E. essay contest in fifth grade and reflecting on that curriculum that I’ve had to go through my entire childhood and to college it’s largely corny and you make everything seem like the worst thing in the world. And even recall a video of like some dude dressed up as Mario saying, if you do drugs, you go to hell before you die. And it kind of brings us to this point where it’s almost like The Boy Who Cried Wolf, when there’s something that is actually incredibly harmful, we’re less likely to listen because we’ve been programed to kind of ignore some of that messaging. 

[00:15:24] Narrator Another important element in this shifting conversation has been about dispelling the myth that it’s normal to use substances in college. 

[00:15:33] Cori Hammond The conversation around prevention has changed a lot. You know, we’re doing a lot of work to try to dispel some of the myths and misconceptions about substance use in young adults and adolescents. A big one is this idea that substance use as a teen or a young adult is an inevitable part of life, that it’s a rite of passage. It’s something that everyone does, and that’s something that we know is just not true. For high schoolers, for instance, the number of total abstainers, those who have never used any substances at all is increasing year after year. Like last year, 30 percent of high school seniors said that they had never used any substance before, and that’s including alcohol and nicotine. For 18 to 20 year olds, which is a big subset of the college population, only about 35 percent said that they had used any illegal substance in the past year. And there was a recent systematic review of all of these different studies that found the prevalence of prescription opioid misuse on college campuses is generally below 10 percent. So this is certainly not something that everyone is doing. And talking about substance use, like everyone’s doing, it just really normalizes it unnecessarily. So instead of focusing so much on the negatives, like don’t do this, it’s bad for you. Prevention is really trying to focus on the positives, like this idea that most of your peers aren’t using substances. We’re definitely moving away from that just say no approach. And it’s been a slow shift. Like over over the last century, we’ve had a shift in the way that the medical community in the scientific community thinks about addiction. So first we had what could be called like a moral model, this idea that people believed drug addiction was a moral failing. And if you just have enough willpower, you can overcome it. And then we kind of moved to something that would be called like a biomedical model, where we realized the role that genetics and biology play in substance use and addiction, learning how addiction is a progressive brain disease. And finally, we realized that even that was kind of too reductive. And it’s not just biology. And so we landed on a much more comprehensive model, which most would call the bio psychosocial model. So taking into account biology, psychology, the socio economics and all of these cultural factors contribute to someone’s risk and should be taken into account for both prevention and treatment. And so that shift in understanding mirrored the way that we have shifted in prevention too. So first we used scare tactics meant to terrify kids, to not try drugs, and then we moved into kind of just psycho education. And if we just teach them the facts, then they’ll be able to say no. And it wasn’t until the 90s or so that we saw a significant shift towards evidence-based programs. And then finally later, a shift in this more comprehensive approach took hold. And so once we’re thinking comprehensively about someone’s risk landscape, their biology, psychology, socioeconomic status, culture, it becomes really obvious why just teaching kids to say no is not enough. 

[00:19:13] Narrator The CHRU team has seen that students are very responsive to open and honest conversations about prevention and harm reduction. 

[00:19:21] Bella Grumet I’ve actually been really moved by how positive the response has been. I have people coming up to me and public being like, it’s the naloxone girl. And then that kind of sparks conversation of them, asking more questions, asking for more resources, asking for us to come back and present to their new members of their organizations. And I think what’s been really important to me is it’s generated a conversation around the naloxone and around opioid overdoses that has been absent. And the absence of that conversation was causing people to die. Because I think in college, there’s kind of a you can sweep it off mentality to a lot of things that go on. And I think getting this conversation started has made people take a critical lens to what’s going on in their lives. And the hope is that if there is ever an emergency situation, instead of hoping someone will sleep it off. They’ll know the signs, they’ll know the symptoms, they’ll know to call 911, which has been what has been missing in the cause of some of the recent deaths we’ve experienced in our campus network. 

[00:20:26] Kathleen Ready And to kind of add on to that, not only are students super receptive and excited to get the resources themselves and have us present. There also as the person who’s in charge of volunteers, very excited to become involved themselves. Like I trained two kids this morning and I have like ten more than I’m going to train this weekend. Everyone on campus is excited about it and they too want to help spread the word and communicate to the people they know. 

[00:20:54] Riley Sullivan I’m like constantly surprised with the things that happen around our work with CHRU. And like our first couple of weeks trying to start this thing out. It’s as somebody pointed us in the right direction to get mass quantities in naloxone, which I didn’t even know would be a possibility. And then we get offered to go on like NPR, and then people are listening to us. And it’s obviously been incredible to watch and see people like Bella come on and Kathleen. 

[00:21:29] Narrator Another important element of modern harm reduction and prevention is understanding the intersection of substance use and other factors like mental health. This is taken into account on the University of Oregon campus. 

[00:21:41] Alexis Drakatos In general, substances are can be used as a way to cope with whether it’s stress, if it’s stress of academics and trying to get everything done and managing things. And so maybe we know prescription stimulant misuse on college campuses in particular is, you know, as a as a as an issue that we see on campuses. And so whether it’s stress of just try academic performance and trying to do as many as much as possible and perform well. But then also on the other side, we know that our most college campuses, I would say, are seeing increased rates of students feeling, having anxiety, having depression. And so and I think that using substances to cope is not something we just on campuses, but I think in society those things coexist. And so recognizing that those things are real, that these intersections are real and we know that they’re happening, that’s something that I think a lot of our work and collaborations on campus really target, is how can we help students identify maybe when they are when maybe substance use isn’t something they’re just doing recreationally, but it is turning into more of a crutch or a tool to help them cope. So offering trainings and information, just normalizing that it’s okay to be stressed, it’s normal to be stressed, it’s normal, you know, mental health and all these things are normal. But then how can you and also asking and seeking support is normal and really important as well. And so resources that that are available on our campus and I would imagine other campuses have similar might look different, but there’s lots of similarities. 

[00:23:19] Narrator While progress has been made, stigma still plays a role in conversations about substance use. 

[00:23:25] Cori Hammond As much progress as we’ve made in normalizing talking about addiction and mental health disorders, they are still stigmatized. A huge part of what we call secondary prevention is learning to get help when you need it before things get worse. And it’s understandably hard for young people to say, I have a problem and I need help. It’s tough to admit that you’re having difficulty with substances or difficulties with your mental health and opening yourself up to judgment from adults or your peers. You know, in college age students, they’re probably wondering like, what are what are my professors going to think? What will my parents think when I have to drop out? When in actuality we know how common this is and that there is effective support and treatment out there. And stigma in harm reduction is still a massive problem. You know, many people take an abstinence only approach to drug use, thinking, you know, my child’s never going to use drugs. Why would I ever have a discussion with them about how to use them safely. Which is very reminiscent of my child’s never going to have sex, so why would I ever talk to them about contraception, which is problematic in so many ways. And so we really need to break through that way of thinking. You know, young people are are dying and we have access to tools that can save them. We want adolescence and college to be a time where kids can make risky decisions and learn and grow from them. And in today’s world, we need harm reduction to do that. The alternative is that a young person can make one poor decision and their life is over. 

[00:25:19] Narrator While there is still lots of room to grow, conversations about prevention and harm reduction on college campuses have come a long way. Student led initiatives like the CHRU administrators like Alexis and educators and researchers like Cori are all doing their part to prevent accidental overdose on campuses and educate college students about the risks associated with substances. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit www.emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform. 

[00:00:00] Lorraine Martin I’ll give a little story here that is firsthand for me because it’s one of my reports. Her son-in-law was at work. He hurt his knee doing whatever physical activity he does. His buddy says, I’ve got my prescription in my pocket, my painkiller here. This will help you get you through your shift. This was not someone who had a substance use disorder. They were trying to get through their shift. Their buddy gave them something they’d gotten over the Internet. It had fentanyl. The son-in-law of my employee was blue and dead in their bed that night. Thankfully, their spouse somehow woke up, was able to call 911. They got naloxone into their place. The gentleman was able to live. But this was just an employee trying to get through their shift. And what happened to him, I would call a poisoning. He took something he didn’t know what he was taking, and it caused him to potentially lose his life. Those kinds of stories when you can can bring it home either through a workplace related incident like that or a family member situation, or telling a story about someone who just was recently working for the White House and had been in recovery and had been saved several times. 

[00:01:06] Narrator This is Countermeasures brought to you by Emergent, maker of NARCAN® Nasal Spray. Join us as we explore the shifting complex world of the opioid crisis. Today, opioid overdose is a leading cause of accidental death for so many families, loved ones and friends behind these lives lost. This season will continue to explore some of the communities hit the hardest by the crisis, from prisons and construction sites to schools and elderly care. We will hear from changemakers offering a new way forward. Overdose can happen anytime, anywhere, including at work. According to the CDC, workplace deaths due to accidental overdose increased by 500 percent from 2012 to 2020. Some workplaces have a higher risk than others, notably in industries where employees perform difficult or dangerous work, such as construction, extraction and hunting and fishing. However, accidental opioid overdose can happen in any workplace. There are also countless people in recovery who are reentering the workforce, maybe for the first time in years. Some workplaces have started to provide naloxone and training to employees to help them be prepared to act in the event of an opioid emergency. But there are still gaps to address when it comes to employers’ responses to the opioid crisis. Lorraine Martin is the CEO of the National Safety Council, a nonprofit safety advocate founded in 1913. They help workplaces navigate important safety issues that could be impacting employees. 

[00:02:44] Lorraine Martin Our mission statement is to save lives from the workplace to any place. So we look at those things that are preventable, things that we can take action around and make sure that we create a culture of people being safe in their workplace beyond, in their communities. So literally, we can all live our fullest lives. We have more than 13,000 members that are members of the National Safety Council, including federal agencies, and that represents about 41,000 work sites around the nation. And what we do is we tackle the big issues. We look at the data, what’s causing people to get injured or to lose their life, and what can we do about it. So back in 1962, we led the National Educational Campaign about seatbelt use, and then two years later really campaigned the issue of how to drive defensively. And in the 70s, we advocated for the formation of OSHA, which is our government agency that helps make sure workplaces know what’s safe. So we’ve been looking at all of the issues and the dangers that we face in our daily lives, and they change. So today we are looking at the data and informing workplaces about the dangers of opioid overdoses and really advocating for lawmakers to pass legislation. 

[00:03:53] Narrator Something the National Safety Council emphasizes is building a strong safety culture at work that includes having lifesaving tools like naloxone on job sites. 

[00:04:03] Lorraine Martin So we often talk about building a strong safety culture and having your safety culture be truly of value, not a priority, because priorities can change day to day in your life, in your workplace. So really understanding that safety is the top value, that everyone has to go home safe at night or whenever their shift ends and understanding that we all play a role in making not only ourselves safe, but those around us, and that every employee feels safe not only to do their work, but to raise concerns and bring their voice. And that’s where you get to the culture issue, that you really have an environment where leaders value employees input. They respond proactively to the issues that might be putting them at risk. And there’s never any kind of blame or punitive actions. It’s all about making sure that everybody gets to live their fullest life, whatever that might be. 

[00:04:53] Narrator Desiree Voshefsky is a community impact manager at Community Medical Services for Eastern Arizona. In her role, she hands out naloxone to local businesses and says that many businesses want to have the power to keep employees and community members safe. 

[00:05:07] Desiree Voshefsky I think it’s important for businesses to be trained on how to use naloxone because you never know if somebody, whether it’s in the workplace or outside of the workplace is going to overdose you. You honestly just don’t know. It could be a fake pill that they thought was something else or, you know, anything like that that can happen. Again, anything could happen. As far as having that medication on hand, I think is the first step and not being afraid to have it on hand either, because I do see that a lot. We went out with the Tucson Fire Department. A lot of the businesses were grateful that we came around and handed out. We did, you know, hit some stake in my own with some people that were kind of like, why are you doing this? I’m not going to use this, that kind of thing. And, you know, just insuring them that there’s limited liability that comes around with it, that they’re able to administer it and it doesn’t have an adverse effect if somebody is not in an overdose. And just continuing with the message that it’s better to have it and not need it and need it and not have it. 

[00:06:07] Narrator Cal Beyer, the senior director for SAFE Workplaces at SAFE Project, a nonprofit dedicated to helping overcome the addiction epidemic in the United States. As part of their SAFE Workplaces program, they provide employers and employees with the tools and resources necessary to address issues of behavioral health and achieve emotional well-being in the workplace. Like Lorraine, Cal believes that the culture at an organization is key to employee safety. For Cal, this begins with having open conversations about mental health. At SAFE Project, they encourage employers to create a wellness culture. 

[00:06:43] Cal Beyer There’s a lot of stigma associated with mental health, and especially when you think about substance use disorder or suicide prevention. You hit barriers when you talk about mental health, suicide prevention, overdose prevention in the workplace. So this concept of building a wellness culture is a gateway, a best practice to avoid that stigma of mental health. I encourage organizations to focus on the intersection of physical health and emotional well-being, and this requires leadership support to build a caring culture, so break down that stigma. But to build that culture requires really intentional effort. It requires a strategy. It requires data from various sources. Thinking about your success with recruiting and retaining staff. And then really being intentional about building an inclusive and respectful workplace culture. I think the biggest challenge that I’ve seen and the outcomes that are driven when organizations are intentional about building in positive employee experience to give a concierge approach to the employee, to let them know that they’re seen, heard and understood in the workplace, give affirmation, give recognition. And doing that by recruiting people intentionally who are going to align with the vision and values of your organization and then take time to adequately orient a new hire and onboard them, giving them career path opportunities for future development. And if you go a step further and go to wellbeing, you’ll combine physical health, nutrition, hydration, sleep along with emotional well-being, things like resilience, mindfulness, teaching people, stress management. That’s how this becomes holistic and that’s how organizations are going to have more success driving positive outcomes. 

[00:08:49] Narrator Part of a robust safety or wellness culture includes having resources for people who are in recovery or who struggle with opioid dependency. These issues don’t disappear when someone clocks in. As someone in recovery, Desiree knows what could make a workplace recovery friendly. She says it’s often about the basic things that many of us take for granted. 

[00:09:09] Desiree Voshefsky I do think the stigma does affect the person that is seeking employment. A lot of it is a lot of self-doubt. You know what’s going to happen if, again, in an argument or what happens if, you know, there’s a lot that goes into it. I think when a person is coming into the workforce that’s new to recovery and things like that, there’s a lot of self doubt. There is a lot of this may be the first time in ten years that they’re looking for a job. This is the first time that they’re having to deal with other people in the workplace that may not be in recovery themselves. So it’s kind of assimilating back into normal society, as you would call it. And that can be a challenge. And there’s a lot that somebody kind of has to go through because if you think about somebody that’s been using substances since they’re 14 and they’re now 32 and they’re just starting into the workforce, there’s a lot of things that need to be backtracked on what we need to prepare them for and prepare them to do, and that could be simplest things like sending an email, writing a resume, the how to answer the phone professionally, all that kind of stuff. We’re having to kind of step back and pretty much start at the basics. 

[00:10:19] Narrator Naloxone is an important tool to help prevent opioid overdose deaths in the workplace. However, both Lorraine and Cal have seen pushbacks from business leaders, sometimes due to stigma and also due to uncertainty about the legal implications of naloxone at their workplace. 

[00:10:35] Lorraine Martin So what we ask workplaces to do to be ready is to make sure they get education, that they have training on what the opioid crisis is all about, and then the naloxone is a mitigating tool for you. Now you get your training. And we provide free training at nsc.org for using naloxone and having a program in your workplace, and then make sure they’re making sure that you have naloxone at your workplace as you do any other emergency response. And companies have responded well to understanding that they don’t know what they don’t know. Many businesses truly they listen. They hear me out, but they have no idea unless it’s happened to them, that this is happening at workplaces. We also know that on this issue of substance use disorders, fentanyl and opioids and the harm they cause, there’s still a lot of stigma around that issue. And then helping business leaders really understand that we’re really talking about something that could impact anyone and in many cases has already impacted someone they know. And if they understand that it impacted someone in their life outside of work, to be able to translate that to it could impact someone also at work that you’re there to take care of, just like you are for any other kind of safety risk that might be about them. So they often bring up when I had no idea that the data was that much, we lose 200 people a day, 200 people a day in our country to an unattended overdose emergency that they lose their life and we can do something about it. So the first thing is education. And I will tell you, there’s a big gap. The second is giving them the tools. Once they understand, okay, I need to lean into this. The next question is always, well, I need to get my legal counsel involved to make sure I know that I’m not going to have any kind of implications if I lean into this. We have lots of resources there as well. We’ve gotten a law firm to help us with a legal brief to address the issues of Good Samaritan laws in each of our states. But they worry about that and as they should. And truthfully, when they were asked about defibrillators and putting AEDs in their workplaces, they had those same questions. Right. But we got through them. And we now understand that having that emergency response in our workplace is an imperative. Just like I am hoping naloxone will be in the same situation going forward. Quite a few are starting to stock naloxone, which is great. Very soon we’ll be able to have a list of companies that are willing to be those first leaders and have us talk about them. So we’re just getting really close to that. And about 50 percent of employees in a recent survey that we did indicated that having naloxone onsite was something that they were interested in doing it about. Only 20 percent of worksites actually have really leaned into this. So there’s a lot of work for us to do and a lot of lives that we can still save. 

[00:13:22] Cal Beyer Have I seen resistance or pushback to having naloxone in the workplace? Yes, candidly. And I understand from a risk management perspective, the entirety of my career, there was a lot of emphasis around drug testing programs, drug free workplace policies, and there was a lot of concern that maybe the perception that the presence of naloxone on a job site could encourage active drug use. But the reality is there are many ways of an overdose. So there were many dynamics that we just need to recognize. The risk is real. The Bureau of Labor Statistics has identified 10 years in a row the number of occupational fatalities attributable to an unintentional overdose is increased, and it’s now 9.5 percent of all occupational fatalities in the workplace. So in an industry like construction that has the highest rate of overdose among all other industries, we’re more likely to need naloxone on a job site to help revive an individual than we are possibly to use an AED. So we need to normalize this conversation. We need to recognize that this is part of being a prepared workplace building in naloxone training and stocking of naloxone on job sites to be able to respond appropriately to in a medical emergency and a risk management approach would show this makes good business sense. And it’s not only the right thing to do. It’s the humane thing to do. It’s the moral thing to do, but it’s the right business thing to do as well. So this should be an area of alignment. We should start seeing a lot less stigma as we educate more people about the reality and the risks and break down the myths and the disinformation or misinformation that’s been provided, and to just acknowledge let’s save lives. That’s what this is all about. 

[00:15:29] Narrator Another element of preventing overdoses in the workplace is the role of government. In Ontario, Canada’s most populous province, the government has been making efforts to ensure naloxone is in the workplace. Dr. Joel Moody is the chief prevention officer and assistant deputy minister for the Ontario Ministry of Labor, Immigration, Training and Skills Development. 

[00:15:51] Dr. Joel Moody June of 2023, the Ontario Occupational Health and Safety Act was modified and it required that naloxone be available in some of those workplaces where a worker has an opioid overdose or have risk to have an opioid overdose. So for employers to understand that they must provide that kit on site, an employer becomes aware or ought recently be aware, that’s the way it’s written in the legislation. They had to understand these tests. You know, first, that there to be a risk of worker opioid overdose in the workplace. Second, that the risk that the worker overdoses while in the workplace where they perform the work is for that employer. And then the work risk posed by the worker is also performed by the worker for the employer. So it provides a test that if all of those criteria are present, then the employer must comply with those Occupational Health and Safety Act requirements to provide naloxone in the workplace. So within the Ontario context, we’ve been very fortunate to work with some great members and stakeholders. So I’ll give you a little background. So the Workplace Naloxone program was launched in December of 2022. And for two years, the government provided free naloxone kits, nasal naloxone to businesses that were at high risk for opioid overdoses. It provided free training that was incorporated for their staff to equip them with the tools, the knowledge, the experience about how to respond to an opioid overdose. And the program has been very successful. If I could, you know, tell you about some of the numbers within that period of time, over 6000 workplaces participated, and that resulted in over 5600 workers being trained and delivering of over 5100 kits to workplaces. We still have a lot to do. The opioid epidemic is still very much still happening. But we want to find ways that we make a difference by reducing the stigma of individuals that may have a substance misuse problem as well as how do we ensure that in Ontario and maybe other jurisdictions, but definitely within Ontario we have both the healthy safe workforce because that does add to the productivity within the province as well. 

[00:18:40] Narrator Some industries are higher risk than others for a wide variety of reasons. A major factor is manual labor. In physically demanding professions, the risk of workplace injury and a subsequent prescription for an opioid is higher. 

[00:18:53] Dr. Joel Moody The profile for workplaces by risk is not the same. So when we look at the evidence or look at the data, one of the research groups that’s here in Ontario has done some work, and that is coming from the Institute for Work in Health, or IWH, they recently released a study that looked at injured workers that were found on construction sites, materials handling and processing applications. And their work, they identified that these were high risk sectors in which you saw opioid poisonings were three times higher for formerly injured construction workers compared to the general population. Another research that has also been done here in Ontario took data from Public Health Ontario, the Ontario Drug Policy Research Network, the Office of the Chief Coroner, in which they looked at data from 2018 to 2020, construction, retail trades, the transportation and warehousing sectors. And that work also identified that those were the top occupation groups among individuals who had died from an opioid poisoning. So some of the work that we’re doing is we’re taking those data and understanding better. So, for example, we know that about 1 in 13 opioid related deaths in Ontario between 2018 and 2020 occurred among construction workers. And so our Ontario Workplace Naloxone program saw the highest participation from that sector construction, and that was about 25 percent of those workplaces, 14 percent were from health care and social services, and another 12 percent were from the manufacturing sector when we ran the program December 22 to March 24. We also know that when we understand the data and understand the epidemiology, that most opioid related deaths involve a combination of opioids with other drugs and alcohol, and this is possibly reflecting upon the reliance of nonprescription opioids to manage unresolved pain. And you can see what that’s an item within the construction sector where sometimes the workplace culture, lack of job security can lead to underreporting of injuries and also wanting to get individuals back to work sooner. 

[00:21:31] Cal Beyer There’s a couple of reasons why the construction industry has stood out as well as the extraction industry, but it’s been heavy, hard manual labor that does lead to an increased number of musculoskeletal injuries. And evidence shows the more likely users of opioids were individuals with those musculoskeletal injuries. And the frequency of opioid prescriptions increased with multiple repetitive musculoskeletal disorder. So that’s a really important issue. To me, that first dose prevention strategy starts with safety and injury prevention, injury reporting, injury management, and then educating employees about the risks of opioids. What I think is also important to recognize is we need to do more about workplace design and human factors engineering to reduce the repetitive motions, especially to shoulders, necks, knees and backs, using more material handling equipment on job sites to reduce repetitive lifting, lowering, twisting, turning and carrying of heavy loads. Those are some of the strategies for injury prevention that many companies are being more intentional about. 

[00:22:58] Narrator Despite many of these compelling arguments, Lorraine has met with business leaders who feel that opioid use and overdose is not a workplace issue or not something that employers should be concerned with. 

[00:23:09] Lorraine Martin So one of the things when I talk to leaders and I bring them the data and I start to help them understand that this is happening at workplaces is they’ll often say, well, not our employees. You know, we hire a different kind of employee. And I will say there’s also a bridge you have to get past when they may have had a situation, but it was a contractor, not one of their employees, that perhaps had this emergency. And there is all kinds of stigma wrapped into all of that regarding who this is really affecting. Give a little story here that that is firsthand for me because it’s one of my reports. Her son-in-law was at work. He hurt his knee doing whatever physical activity he does. His body says, I’ve got my prescription in my pocket, my painkiller here. This will help me get you through your shift. This was not someone who had a substance use disorder. They were trying to get through their shift. Their buddy gave them something they’d gotten over the Internet. It had fentanyl in it that the son-in-law of my employee was blue and dead in their bed that night. Thankfully, their spouse somehow woke up, was able to call 911, got naloxone into their place. The gentleman was able to live, but this was just an employee trying to get through their shift. And what happened to him? I would call a poisoning. He took something he didn’t know what he was taking, and it caused him to potentially lose his life. Those kinds of stories, when you can can bring it home either through a workplace related incident like that or a family member situation, or telling a story about someone who just was recently working for the White House and had been in recovery and had been saved several times herself. And now as a lawyer, you got to bring it home that this can hit anybody. This can hit anybody. And you don’t know what your employees are wrestling with, whether it’s, you know, an injury at work and someone gives them something that poisons them or having a substance use disorder that needs to be addressed. So stigma plays a big issue. And again, it’s about education, it’s about awareness, it’s about storytelling, and it’s about understanding that if that emergency is happening in front of you, there is no response other than having on hand the thing that can save that person’s life, period, end of story. No judgment belongs in that equation in any way, shape or form. 

[00:25:26] Narrator The fact that opioid use disorder and overdose is a workplace issue is clear from some of the examples that came out of Ontario’s program. Because of the training provided, employees were able to save lives. 

[00:25:38] Dr. Joel Moody Happy to to share a story that was conveyed to us as we have gone through both the program. We’re in the process of evaluating the effectiveness of that program. But a story that came to us was in the Greater Toronto area, which is what we refer to as the GTA. Within about a nine day window, there was a grocery store happen about March of 2022, two situations where naloxone training and the kits provided under the workplace naloxone program were used to save a life. And the first incident, an employee found their colleague unresponsive in a washroom. The second incident occurred at the exterior of a building. In both cases, the worker was able to, number one, identify the signs of the opioid poisoning. Number two, being able to access the naloxone that were in the kits. Number three, administer the naloxone, and they also had to provide CPR to her to revive one of the employees. And both cases, they prevented a fatality. 

[00:26:50] Narrator Desiree emphasizes that people in recovery can hold jobs and are in the workforce. Like in many places touched by the opioid crisis, stigma creates barriers. 

[00:27:01] Desiree Voshefsky I think a lot of it has to do with stigma, just personal, people not knowing what substance use disorder is, what opioid use disorder is, and not seeing it as a way that people that have these substance use disorders maybe still be able to hold a job. People in a recovery can still hold a job. We know people that are even actually using and call it functional substance use, they can actually have a job, too. So it can be a variety of ways and there’s different levels to substance misuse. It could be somebody that is taking prescription pain medication that kind of gets stuck and is become dependent on them now. So there’s kind of all levels to it. And I think that the more that we don’t talk about it, the more that we’re hurting the person that’s either seeking the job has a job or may need some help to continue doing their job. 

[00:27:52] Narrator Cal also emphasizes that beyond providing naloxone, workplaces can become recovery friendly. Many people in recovery are still going to work or are looking for employment. Lowering barriers to being in the workplace while in recovery is good for everyone. 

[00:28:07] Cal Beyer The idea of a recovery, friendly or recovery ready workplace is going to continue to expand. This has been a really positive movement. Individuals in recovery and there’s at least 21 million based on data that are in recovery. And there is evidence 70 percent of individuals with substance use disorder are in the workplace. So what a recovery-friendly workplace will do is create fewer barriers for employment, reduce the discrimination, create new career paths and give people a fresh start at a career. There is evidence that shows recovery ready workplaces are going to be more productive. They’re going to have less turnover. They’re going to have reduced health care costs. So in every angle, there’s a lot of evidence why this is important. I was one of the individuals selected by the Legislative Analysis and Public Policy Association to partner on building a model recovery ready workplace statute. There’s great information about the power of building recovery allies. And so that’s something that we’re very supportive of. But the hallmarks of a recovery ready workplace are going to be acceptance and affirmation, reducing that stigma and then the need for some flexible policies, especially around leads as individuals may need time for doctors and therapy and for ongoing recovery support. Those organizations that see the value in that flexible leave policy are going to get the benefit of more engaged workers. And then another hallmark has been peer to peer support and mentoring programs. And that even includes on site recovery meetings. But the biggest part, and it’ll be the most challenging, is going to be providing training on an ongoing basis to all employees to let them know as well people in their life may benefit from recovery, giving people a pathway to learning more, sharing resources so they can support family members or even start a recovery journey themselves. That’s what I’m excited about, this idea of recovery ready workplaces. 

[00:30:34] Narrator Lorraine believes that many workplaces and members of the public have gotten to a place where overdose is seen as an emergency like any other. And just like other emergencies, like a heart attack, the tools to save someone’s life should be close by. 

[00:30:48] Lorraine Martin So being trained to address it, just like we all went through our CPR training or other kinds of emergency response, I think is the place to start. And the fun or really exciting thing about any skill that you give an employee is they take it with them, right? Whether that’s how to drive safely or do CPR or be able to respond to an overdose. They take that with them. They take it with them when they’re on the battlefield, when they’re in their communities, and they save lives truthfully for those skills that you give them. And it’s traumatizing, truthfully, when someone around you as an emergency and you can’t you can’t do anything about it. We have workplace incidents like that all the time. And it’s not just the person in their family, which is traumatic and horrible. It’s everybody around that witnessed it, that knew that person, maybe didn’t know that person, but is in the organization where that valuable team member is no longer here. It’s a ripple effect. So knowing how to have this very simple tool and training is something that I hope everyone will lean into so that when that emergency happens, you can really be the person who saves a life. And the difference between saving that life and having someone perish in front of you because you didn’t have the skills or the tools is really just momentous. 

[00:32:02] Narrator Through his work, Cal has worked with numerous people and groups who are making an impact on this important issue. You can learn more about them in the description of this episode. He’s generally encouraged the conversations about overdose, opioid use disorder and mental health are becoming more common in workplaces. 

[00:32:20] Cal Beyer This idea of help seeking and help accepting starts with help offering. When coworkers identify that someone is not well and asks, Do you need support? How can I help you? It goes a long way to a person saying I’m going to be accepted for who I am. And this idea of no shame is filtering through many industries, many more organizations, and people are getting more help. So I’m especially encouraged by the example of the construction industry. There’s probably 40 different organizations that have provided tokens, chips that have 90 day information in the logo of organizations to say we stand in support and we’re going to support the efforts around the mental health suicide prevention crisis line. I’m just excited about more conversations becoming more natural and being more at the peer to peer level and people worrying less about the privacy confidentiality barrier that didn’t let people seek help in the past. 

[00:33:29] Narrator Opioid use disorder is something that affects every aspect of someone’s life, including work. To keep everyone safe, workplaces should be providing naloxone and the training on how to administer it to employees. Additionally, creating workplaces that encourage holistic wellness and that are supportive of recovery is good for everyone at the workplace, employers included. To learn more about the work being done by the National Safety Council, SAFE Project and the Government of Ontario, please visit the episode description. We’ll also find resources for free training and information for employees and employers alike. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit www.emergentbiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.