my name is where harmon and i'm the executive director of town hall seattle on behalf of our staff our friends at the institute for systems biology and our friends at third place

books. it's a pleasure to welcome you to tonight's presentation of video krishnan and amber payne. as we get underway, i want to acknowledge that our institution stands on the unceded traditional territory of the coast salish people in particularly the duwamish we thank them for our continuing use of the natural resources of their ancestral homeland. and we thank you for joining us for tonight's event presentation will run around 60 minutes including q&a to submit your questions for the q&a portion. please meet i'm sorry, please enter meet dot ps forward slash krishnan. that's kri s h a n. i'm sorry nan or scan the qr code right now on the screen with your smartphone. that's much more reliable than my terrible spelling. we'll drop this link in the chat as well and you can submit your question at any time. we'll try to get to as many as possible and as a reminder if you want to view the program with closed captions, click the cc button in the bottom right corner of your video player town hall adds new events and podcasts seemingly every day

upcoming programs include charlotte cote discussing indigenous food sovereignty here in the northwest david haskell describing the evolution of sound alongside all the living things on earth and just announced blaze where arthas and melanie mitchell discussing ai as it is as it was envisioned and as it will be for better for worse visit our website to enjoy to join our email list and get the latest updates as more programs are added throughout the season. town hall's work is made possible through your support and the support of our sponsors our arnog matulski science lecture series is supported by microsoft. but as you've heard me say countless times before town hall is underneath it all a member supported organization. i want to thank all of our members joining us tonight if you share their goal of a community energized and empowered by questions of politics science and culture. we hope you'll consider joining us as a member as well. finally, you'll certainly want to go deeper into tonight's topic by purchasing your own copy of video.

krishnan's new book, please use the link in the chat below to pick up yours at third place books one of our many terrific independent and local book sellers. with that beginning her career at the pioneer india's second oldest english language newspaper vidya, krishna and has built a 20 year career and that same word twice in one sentence my bad reporting on medicine and science including recently extensive reporting about india's response to covid-19. she's written for the atlantic the la times the hindu as their health and science editor and for the british medical journal christian is recipient of numerous awards and fellowships including a nieman fellowship from harvard studying the impact of behavioral economics on antibiotic use and international health media fellowships award global health journalism fellowship from oxford and the national press foundation fellowship. among others. amber payne is co-editary in chief of the emancipator at boston globe media. she's also an even fellow and formerly served as managing

editor of bet.com bet.com and as executive producer of both team vogue and them krishnan's new book phantom plague how tuberculosis shaped history is the subject. the discussion this evening. please join me in welcoming amber payne and vidya krishnan. thank you so much. we're for that introduction and video. it's great to see you again virtually across the world. thank you for having me. i will say i have a slightly unstable connection here in goa, but we will see how this goes. we'll see how this goes. and as i said when in doubt i'm just gonna start reading chapter one if we if we lose if we have technical difficulties, but, you know video we we got to know each other we met as nieman fellows at harvard last year and you're always talking about tb. you were always talking about tuberculosis and and we knew that you were working on this

book. we didn't really we didn't really get it. we didn't really get the full scope and kind of through the year as we got to know you and know more about your background as a journalist as a health and science and medical journalist and reporter investigative reporter it started to come together, but it really didn't come together for me until i i read your read your book and it's it's incredible, but can you just set the scene for for those here with us today? who? don't know you what really led you to this this very deep dive, you know, this definitive social history of tuberculosis. well, thank you, and i apologize for just spamming everyone. i know with the unnecessary tuberculosis information. i kind of i've been obsessed with this subject with this packaging which i thought i have to write a biography about because it just these ideas have been buzzing in my head for like a decade and they just came in

and never left and it also came in the pathogen itself to me had like a unique personality and it was so individual and i just can never stop talking about it and my closest friend at some point ask me to stop talking and start writing which is what i did and i'm glad i tried to put in as much pop culture into the book to kind of get other people interested in tuberculosis, and i kind of see jack starting with dr. that's a paying is i will say although the readers have to judge that. yeah, well, let's let's talk about dracula and and what does dracula have to do with tuberculosis? this would actually be a good time for you to read a passage from your book just to set the scene for everybody. yeah take thank you for i thought you'd never ask.

i start the book with a very ghastly episode and i'm gonna read a portion which kind of sets the scene for what people do or did before modern science to comprehend things that are just beyond human comprehension. i'm gonna drive right in it is okay. i'm gonna die right? it's no coincidence that my clients like my next thing to come from elsewhere dracula was stiff and all the london because he came from a remote mountainous region of eastern europe. alien to most citizens of england's capital metropolis. it's also not by chance that dracula arrives in late august of september that was also the season and cholera of ebonic plague had historically struck europe like all aliens dracula face the strong anti-indigram sentiment the countess associated with swarms of rocks

and other creatures carrying filth and the vampire brings a terrifying illness the thins the blood and corrupts the race the book decries him as emerging from a whirlpool of races, which is a term stroker. from late victorian debates when it was used to describe the east end of london home to a large number of newly arrived eastern european jewish migrants. could fled the probe programs their burgeoning numbers swelling mainly in the slums were feared to bring moral and physical afflictions to britain. vampires have been a part of ancient folklore long before strokers novel. english writer john william polidory's 18 19 short story the vampire is often credited to kick-starting the genre something stroker may have known as a teenager when he spent hours trolling through the ancient often illustrated text of irish folklore in dublin's marsh library, but in dracula he gave the phenomena or twist worthy of the industrial age

dracula is the son of dracul about that typically means dragon, but can also mean devil strokers devil lived in transylvania and traveled to your london wire ship and then railroad to reach london before he began ravaging the city. both the vampire hunters and the novel john seward and abraham van helsink or doctors as well as experts in vampire laws. they're on a mission to destroy the invader. during this time medical and literary opinions were often reflections of each other. dracula is essentially a collection of victorian era medical anxieties. it's written at a time when outbreaks ravaging british colonial outposts ended up at the doors of the colonizers the most devastating example of this was the color of pandemic of 1817, which began in far away bengal india from india caldwell went to southeast asia the middle east and eastern africa through trade routes. this is the first of several

colorado pandemics to sweep across asia and europe during the 19th and the 20th century the plague that began near calculated travel the world for 20 years killings hundreds of thousands the exact all of the death is mortalities are known but some data is preserved and shows how fast the total number of deaths could have been the british army alone recorded 10,000 deaths. and the indonesian island of java recorded 1 million deaths so to the readers in london the devil came from the east as was customary. through the period of cholera outbreaks. there was an ongoing debate in england about how diseases spread and dracula captured it perfectly when stroker used blood infections as an integral element in his plot. you definitely you start with this origin story of bram stoker's dracula, which i thought was brilliant to make this really clear connection

between the hysteria and the terror of the infectious disease the lengths we've gone to to historic historically to find a cure. um you give me some sympathy for for dracula. he's seems a little misunderstood. but is a bit about that era, you know that that era of medical discovery and how you know this framework you used is still a cultural touch point that extends to present day. um, yeah literature does this bizarre thing where it kind of gives us a mirror? to to understand something that we cannot understand and that's what i found fascinating going into dracula. and who who i have a lot of sympathy for i feel like he the real guy like the impala was just so misunderstood and

jumping off of that one character which was which was known to to evoke horror and and finding writers who combined that with the horror of just pestilence which was very common before modern science is such a nice. it's such a twilight zone to kind of deep into especially because we are back again there. we are again facing the pandemic and we once facing science denialism and there is the tsunami of misinformation which may not be very familiar in the us but in india is it's just the last three years. have i i finished this book six months before the pandemic began and everything that came after the pandemic started has just made me realize how profoundly we need to go back to the original story to look at things

that we just take for granted and science is a gift that we need to value as against take for granted and that's kind of what this book does in using different stories. so through the book. you'll find a russian doll of stories like the stories within stories within stories, and i hope the leader finds it interesting. yeah, definitely. you know you trace the spread of tb from the us and europe in the 19th century, you know to developing countries, and it's flourishing today, but give our give us just a brief rundown, you know a state of tb today and how did mumbai become the epicenter and such an incubator the disease? so we have 10 million 10.4 million infections in 2020.

the pandemic actually were made a tv was because of various parts of the world were in lockdown and tb patients could not access care. so things are worse than they've ever been for tb patients last year 1.3 million people died of tv. and there are three myths about tb and all three at this point contribute to spreading it people think it's a disease of the poor and the past. neither of those things are correct people think that it's a disease of one organ which is lungs, which is also not correctly is like cancer in my reporting. i met patients who had db in the eye our tv in their spine in the intestines and the last myth is that tv is curable it used to be curable when we treated antibiotics with respect and use them sparingly, but there is such vast misuse and overuse of

antibiotics, especially with the pandemic that we now have drug. distance chains of tea that just do not respond to the most powerful antibiotics known to medicine. so this i feel like with with yeah. now, i mean you you talk about you know that you tell the stories of many of a few women pia shreya you point to this. there's either lack of treatment overtreatment the wrong treatment i learned about these drug resistant, you know forms of tb, you know, i i wonder how that you know, the question is how is that still happening, but i wanted to reference something you wrote in chapter 5 called antibiotic apocalypse on the move and you wrote when you're talking with these doctors listening to the doctors talk about antibiotic resistance is

like hearing characters in a horror movie as they navigate increasingly limited options one doctor joked. being at that point in the film when you realize the call is coming from inside your own house. connected to this issue. in mumbai in particular is that's how mumbai feels like at this point it it we now know because of the pandemic that a small pathogen in wuhan has just engulfed the world. so the antibiotic apocalypse that's donning in the slums of mumbai for now is tightly a boomerang in that ghetto but we now know from coronavirus that it you know, uses that as a springboard gets more and more vary and then it just spring springboards out and by when that doctor was telling me that it feels like they're stuck in a

horror movie is because they increasingly on a daily basis see patients. who were they you they we are back again at a point in history where all doctors can do is help. physicians die and is a result of misusing medicines either completely not understanding medicine, but also india like the us again has a highly privatized healthcare system. so the doctors are not incentivized to give the best treatment they are intense incentivized to give a treatment that keeps retains the patient as a client or you know, if they're insured doctors are incentivized to extract as much money from each patient and in mumbai in particular all of that has added to what is now mass medical negligence because if you're poor you are treated without dignity and compassion

and you're under treated and if you're rich you over treated to milk that insurance that you have but that's also just bad for the person and between these two because they're just no moderation in tv treatment doctors. i are completely going mad looking at this and that's what that one character was trying to say, which i will say he captured it in a very visual way by comparing it to for a movie. that's where we are at. definitely. it's important point too. i think that you make that it's not just you know, it is mathematical negligence. it's it's a patient killer and it doesn't it doesn't really discriminate between the rich and the poor there's it's it's finding a way but, you know, we can't talk about india without talking about cast and about race and racism you draw parallels even between cast and race and between the system of discrimination and the east and

the west and so i wanted to talk a little bit more about that and how tb and other plagues have fueled have they have been fueled by this deliberate as you call it of unfairness. yeah, thank you for that question. one of the things that's not happened in india as against we are a new post-colonial nation. so what which is why i had to lean on a lot of american literature which has documented in granular retail the health deficits that you see in refugee communities and minority communities in african american neighborhoods and housing projects in chicago are a particular study that i rely on to make this comparison between race and cast which also i find myself in this twilight zone. i live between us and india and it's such a unique.

position to be in a someone who writes about social injustice because you see mirrors of these two completely different systems of discrimination race is mostly it just simply because it's based on color and it's easily identifiable cost in a country like india where everyone looks the same is so much more insidious, but the effects of it are the same minority communities are ghettoised into poorer neighborhoods, and then there was poor sanitation and the municipal services do not work in those neighborhoods the way they work in posh neighborhoods of mumbai and all of this leads to more infectious diseases, but also more crime and then there is this way of talking about neighborhoods the way like you attribute the characters of the bad neighborhoods to the people who live there. so, you know, the the neighborhood is filled with criminals. that's a very common thing to

stay in in india where you talk about poor neighborhoods that way and i feel like it it was my privilege to be able to make this between the cast and race and come down to the same point because no matter how different these systems of discrimination are this calculated injustice has the exact same precise impact on minority communities. they don't get health care. they are ghettoised in some human housing and every time they are up against the health system. they are made to lose their dignity and i use i used to instances in the book the 1992 los angeles riots is something i talk about to make a comparison to indian neighborhoods, but i also talk about the tuskegee trials where the entire country was being treated for syphilis. whereas a certain population was, you know, denied over and over again, and i kind of want

you to talk about medical apartheid because you can't talk about infections disease without bringing in race and cast and gender. yeah how i mean that's the section on tuskegee. i you know, i i feel like i i learned a lot there as well. it's a study. i feel like we know it. we've hurt we hear about it. of course, we don't get to really learn about it in school in unfortunately, but you know, i was interested in how that fit into your exploration and you also went into you know hiv and you know, that struggle across the board and you drew these these parallels in medical history that i think are really important and really really relatable for for all audience's, but i want to get you know going to the drugs. to squash this global health epidemic tb start with tb. there are other there are other

issues. what did you learn, you know kind of what did you can you give a couple of give an example of something that you felt was important to really dive into in the book and i want to get to just the question of how do we how do we reform the drug industry, but talk let's talk about these drugs and the issue. i again i live between us and india and i i've been held support of so long and india is the pharmacy of the world. but what we now do what we what are generic industry now does is basically manufactures drug addiction of a cost for american pharmaceutical companies. so for example, fisa will make a will outsource the drug making to india make it at a fraction of a car cost. the drugs will be exported back to the us where they slap charges on it, which are just

not justifiable anymore and one of the one of the things that i hope it's a conversation the book forces. is that the global drug pricing conversation cannot be had in silos cancer patients of fighting for access to cancer drugs. our tb patients are the same now with covid technologies, and we keep having the same conversation disease after disease. whereas it's one conversation the patent monopolies that are enforced on data enforced on the rest of the world because when these laws were drawn up the colonies, which is the global south the developing nations the g77. we're not a part of this there was we were not invited to the negotiating table and the one of the things we cannot talk about drug pricing without calling into question the model the the

morality that guides it because we keep having i i keep reading literature where it says that oh, this is not a cost. active intervention so my country is a low resource country where you have you need medicines that don't depend on say cold chain or because we don't have a robust health system. anyway my it's it's a long winding way of saying that who decided to have a conversation about right to help in economic frame? i don't know who decided at what point that it's okay to let people die. unless someone or some company can turn a profit essentially the moral reasoning underlying this economic framework is that they're not say black and brown people unless it's profitable for them. so we in health we keep talking about cost effective measures as against effective measures.

right, and there is just like how i'm just yeah, it's just unjust it's unfair and it is racist and there is no way of beating around the bush. so one of the things is book does is be centered this conversation of medicine as a knowledge monopoly to the point of view of black and brown nations, and that's not being done before and i was very very conscious of using tb as an example, but the same thing applies this book was written before the pandemic began and i didn't have to change a single thing what we now see the trips weaver and pattern monopolies everything that right in the last few chapters with book has come to pass and it's been very frustrating to watch that. yeah. it's it's prophetic because you draw this direct line too between colonialism and and patents of these pharmaceutical

drugs and technology. so i wanted you to sketch that out for spend a great. part of that, you know great chapter really explaining the issue with the patents. so what is the can you sum up the issue with patents and tv drugs? yeah, so hi this again came from this frustration of being an indian reporter and all we make drugs for the world. and while we are constantly told by western pharmaceutical companies that the quality of drugs in african and asian countries if they're manufactured is not good and we can't trust it, but they can totally trust it when they outsource all their clinical trials to black and brown nations and which is why which is why i felt like writing a book kind of gives me the scale to deep dive into the story of the origin of intellectual property law which began with the english and the french

empire in 1883 when there was a scramble for territories in africa and asia and the empires wanted to regulate trade and what we see as trips strips is a 21st century legal inheritor of these laws and india again as the crown jewel of the biola had an intellectual property law long before most european nations. we had one in 1856 and all of this kind of comes from a very unset. global south where they can only manufacture raw material and exported but they cannot ever demand equality and the trip's laws as well as the laws. the frame then the late 19th century warframe with the intention to load the dice in favor of the empires. and they currently load the dice

in favor of multinational cooperation. intellectual property a historically has been a tool to promote trade interests of the developed nations in developing countries. so when india was invaded we were manufacturing we made textiles and ships and all of these silk and spices but the minute british empire came in. he reduced us to raw draw, you know raw material. british textile industry could but back to the roots of this saying this is all these being racist. it's not just suddenly racism now and i i hope i mean, it's not a coincidence that most people from the pandemic are dying and black and brown nation. this is now a preventable infectious disease coronavirus. we have 12 and in my country you

can't get a booster shot as yet, so wow, it's maddening and we're going to start to take some audience questions. please everyone feel free to continue to submit questions, but i do need to ask about bill gates and the gates foundation, you know huge nonprofit. they've given out 60 billion in grants since they began last year alone. they they funded work in 134 countries their revered in this space of health equity research development funding but to quote you you write that bill gates has and i quote the mind of a genius and the morals of a thug. let's talk about it. thank you for that question. so india is the largest laboratory for the gates

foundation and my entire career as a health reporter. i've been hearing i've interviewed mr. gates quite a few times and i've been hearing my entire career that mr. gates wants to solve malaria. we here's a disease with coronavirus that mr. gates cancel, but what he did was the the oxford university funded vaccine, which is funded by taxpayers. he handed it to an indian company the serum institute as a patent monopoly. so only one company in india could manufacture the drug for the rest of the world and i mean, it doesn't take a genius to point out the flaw in concentrated supply for the world and the kind of burden it places on india. i i don't know if you remember the devastating second wave that india had six months ago and that that joke the vaccine

supplied to 91 developing countries and all of this is because mr. gates is one of the champions of knowledge monopolies and my for the life of me i cannot trap my head around how they keep talking about these complicated ways to get vaccines to poorer countries when the simplest and the most direct way is to transfer technology and let these nations manufacture it for ourselves as against manufacturing it and exporting it to them. and i'm going to call i do quote nigerian poet and author gen. see the vocalist charity is the opium of the ridge and that's the crux of what the gates foundations again the moral underpinning of this whole way of making healthcare available is philanthropy cannot fund

healthcare. and again, it comes from a completely unsettling view of the developing world. i do feel that the west is just incapable of looking at the world without giving itself the rule of the savior and we keep coming back to we saw this during hiv where are drugs. do not get to africa, which is where the most deaths were because the minute you make the minute you elevate charity to some high principle of justice what you're not talking about is the it's you the companies are turning and the gates foundation needs to come under scrutiny. i believe mostly because their charities toxic kindness what they come what they get from that charity is this position of superiority where they dictate the terms at this point gates is

the gates foundation is the largest donor to who gates foundation also hires ceos of pharma companies on its board and there's too much clash of interest and this is a man who's not a elected to public office. he's not a scientist. he's not a doctor yet. he has so much power and no one questioning it and that's again kind of something. i wanted to complicate in the book. thankfully. i did have publishers who were okay printing sentence that you yes. yes. well, yeah. thank you for for breaking that down you have this example in the book too of an hiv drug that was going to be given for free. can you just share kind of sum up that? that moment and how that actually proved to be a watershed moment for for hiv drug pricing. so when the hiv drugs at some

point the hiv drugs were not available in asia and africa because they were priced at of 10 to 15,000 dollars per patient per year. now most people even in the us cannot afford it and i go into how this hiv drug was funded by american taxpayers. but what happens is the entire portion that is the research and development of a drug is subsidized either by universities most of the drugs in the last few decades have come out of universities that are taxpayer funded but the minute they get the potential to get to the market the the molecule is acquired by a farmer company and the the social role of you know, that this fruit of medicine is withheld and the singular purpose of this becomes turning profits for pharma companies with the hiv drug. what happened?

this is easy. is that an indian generate drug make a ziploc? offered to make that drug for a dollar a day and it was the new york times called it a watershed moment the prices came crashing down and big pharma had to re-adjusted. its prices so they were literally charged in $15,000 for a drug that costs 350 dollars per patient per year. and that's after this is early 90s and around the same time. the trip's laws. the trips agreement went into force in 1995 to make sure that something like this never happens. the the company was headed by a brilliant doctor called a yusufamy and american pharmaceutical ceos, and that point called him a pirate and a thief for making the drugs

available at people rates whereas in africa and indonesia, he's known as the robin hood of drugs and you know this whole conversation and as someone who lives in the global south and my career has been writing about infectious diseases and watching people die. like flies i felt like there is urgency to decenter this conversation to the point of view of the developing world. and that's kind of what i try to do when i extensively talk about the hiv movement and people who died from hiv. we don't need to keep making that mistakes or millions of people have to die for for to convince someone sitting in the developed world to part with technology, which doesn't even cost money. right that's a great point. we're gonna go into some of our questions in the chat and

there's one question. here. we have been so aware of the covid vaccine disparity between rich and poor nations. are there a lot of other vaccines that this? that this is the same problem for and we just haven't acknowledged it. yeah, absolutely. so cancer drugs is a big problem tb drugs i go into the book about a drug called but aquiline and that drug is a genuine example of public health communities coming together passing the heart around to fund r&d of a drug. that was just desperately needed and the minute the drug became available. it got logged into patent monopolies hepatitis c has a drug called so firstly egypt is one of the countries very badly affected by a hep c and this drunk ground for gram is more expensive than gold and one of the things again with covid we

see the same things. these are taxpayer funder drugs. we have 12 vaccines one is funded by german taxpayers. some is funded by indian taxpayers american taxpayers, and we just 3d and don't want to share and it keeps coming back one of the things. that i was with great frustration, especially in the us where someone like bernie sanders talks about trying to help and he's called radical and leftists for seeing the most common sensical thing and the the conversation about access to medicine and right to health is a global one because what we have is a global oligopoly of a very few pharmaceutical companies all of which are based either in the us or in uk or japan. and unless the patients also start having this conversation as a global one. we cannot hold this system to account and for me all of it begins with the patent law.

we cannot have drugs regulated legally the same way we regulate iphones or refrigerators. it's just not same. yeah, yeah our next question going back to the discussion on gates. are you suggesting the who and global health would be better off without bill gates financial contributions? what does anyone else doing in the us that is making a tangible difference? you know that this is a complicated question. but if i have to say, yes, the global health will be better without philanthropy being the fundamental source of funding health. so who can have a global kitty? again with medicines and patented medicines. there's something called the medicine patent pool, which is an idea of mr. jamie love who's

based in dc. it's a global north idea, but i give this out as an example that there are a hundred ways to fund global health. oh this one the medicine patent pool says that countries can pull together the money to buy the patent from the innovative pharmaceutical company and then give it to countries so they can then manufacture drugs for whatever like 40 or malaria or whatever and contain infectious. jesus but the thing is pharmaceutical companies are not ready to sell the patterns even at a reasonable price because they don't want to open their books to say exactly how much they spend researching a particular molecule what they say is this one molecule has to pay for all the failures that came before us now. i also only for the drugs but with who again who is not an american organization, but what

it now does there was a the new republic had a brilliant essay where it said that and i quote it in my book that what we see is a hostile takeover of w h o by the gates foundation the organization like who becomes becomes monogamously faithful to certain philanthropic organizations. it comes at the cost of black and brown national health and these the reasons why? these are the reasons why global health has never been this vulnerable. we are at a point where we have many challenges from climate change and multiple infectious disease pandemics, and they are all on the move because of global trade and the sooner we get to the point that we have to stop making heroes out of singular people as against the gates foundation for years has been thrown money at indian

problems, but none of them have found structural solutions that make indian hospitals better because then that means that it will shut the shop the fount of injustice means that there has to be continued the wretchedness in poor countries that then big philanthropy can come and help and the biggest examples of this was just devastating second way. india has never seen debts like that and we will carry into generational trauma from that. where did all the money gets foundation is invested in india go. it's a question to ask. so yeah, a short answer is bill gates is not the solution to our problems. okay. thank you for that question. here's another question. you have been brainstorming this book for years. what was the real push that inspired you to start and how

has your research or perspective changed since then? well, i wish i wish i had an answer that was not just so revealing of me. i i was reporting on this book as a new story and i write about this one teenage girl who had to go to court and that kind of shook me and my idea of india because we are a democratic country and i said, we are a pharmacy of the world and i just still cannot reconcile that my government and my health ministry like this teenager die because we kept denying her this one drug, but actually we just locked under patent and they wanted to protect the patent of an american company and this teenager is an example of how all of these families are getting just destroyed and i kept supporting it as a long form essay and news story. eventually i had friends who did

an intervention and at that point i had around 25,000 words written and i was refusing to commit to it as a book and they made me realize i had a book and a friend made me write a book proposal, which i did very grudgingly, but then i did find a publisher and then i had to act on it and how has the book changed me? i kind of feel the one thing that i learned while reporting on the book because i also did end up spending a lot of time in the us. um is that we need more black and brown solidarity. i i realize how calculate the injustice when i was just in india. i had a very smaller view of how the system was just not not set up to serve the poor but when i did spend time in the us and during the pandemic even in the

us black and brown communities have different traits of mortality for the same living in the same cities, and it kind of made me realize how we need one unified voice if we are to talk about right to help and i really hope the book achieves or conveys that message. um, thank you for that. another question we have is what is the biggest myth about tb and what should everybody know? i will see in my reporting people are traumatized i have had friends who report saying that i had nightmares that i had tb and the biggest myth about tv is that that it affects just the lungs. and i write in the book which is why i do not focus on patients with pulmonary gb. i write about one kid who has tb in her ankle bone and tv in the

brain tb intestines, and i kind of don't it's not on the nose, but that was my reason to over and over again profile patients who had to be not in the lungs because outside of the medical community people don't realize that tv is exactly like cancer and the chemotherapy is exactly as toxic as cancer. so, yeah. yeah, another question. i'm a nursing student at the uw u of w which department office person do i contact to actually contribute to global health. i'm frustrated because so many health clinics in my hometown throw of vaccines. yeah yesterday i was reading about how canada is just going to bin millions of covid vaccines and i believe again, i

i do not know the structural solutions in in the us or canada as much but i am must sociologist by training and i do believe that the solution to this is in the politics of it contacting your local representative is one way to start because these wax seeds are desperately needed in asia and africa and it it boils my blood to watch it. just expire or when i have lost so many friends and family members in the last two years who would have lived if you know if we just learned to share and be kinder to each other and i do believe the solutions for this medical problem are political.

hmm connecting to covid i wondered if you could talk about how covid has turned tv into a bigger threat and what can be done about that. so in countries in high board in countries, which is india and south africa are two of the countries with the highest burden what happened with covid in india in particular was terrifying because we had a brutal lockdown which then meant that patients could not reach health systems get their medicines and which then meant that they developed resistance. which also that meant that because they were locked in with their families. they spread it that disease too their loved ones and it has been heartbreaking to i keep getting emails from tv patients saying i'm terrified. i'll in fact my mother i'll you know and all of these things

have actually also resulted in a dip in the because people are not reaching the health systems. the health systems are not able to count better. so i kind of feel that the next couple of years will see a increase i've taken mortality, but i do believe there are opportunities here like something like the nhs was born out of the world war and every crisis is an opportunity and i am optimistic because why tv doesn't have fun covid is overflowing with funds and respiratory diseases have never had this kind of attention and the technologies that we used to diagnose covid can be also used to screen for tb and there is there is there is a way to kind of merge programs the same way as many countries merged hiv and tb programs to scream someone who's coming in with hiv to also screen them for tb because they

are likely to have an opportunistic infection. so these are all structural solutions, but i do believe in the next couple of years if if health systems and again help ministries and politics politicians are more responsive and open the change. we we could look at curtailing this because again mask wearing has been destigmatized in ways. it has never been before we are also having a very very in a very loud and very valuable conversation about anti-vaxis, but it is an opportunity to address science denialism. so there is opportunity within all of this. i i remain hopeful that's why i didn't expect you to say that but not it's day off brand for me, but i do remember soft bread, but no, that's but that's

real. that's realistic. we have a question and we just have time april for one more. so if anyone has anything, please get it in there. what if the reviews of your book been like in india versus the us do you find both parties are picking up on certain things? i am the book has not been released in india. asia could releases on the first of april and i am very nervous about it because we also have an authority and government and everything that you read that became. the book is a compilation of stories that i was not allowed to report for the newspapers. i was working for so i remain on edge about the reaction in india the reaction in the us i will say makes me again as someone who i know my american friends and my american journalists get very frustrated with the growing

intolerance in the us, but someone like me a rank outside would not be allowed to make such a strong commentary about the us but also about india and the new york times had a the flattering review and i am thankful for it. i do hope this is why we expect more from the us we expect more. we believe in democratic structures in the us because something like that, for example amber cannot come to my country and have such a critical commentary on something uniquely indian. and i am glad that that is allowed in certain bubbles. and i'm glad i have the privilege to have one foot here and one foot there and kind of have juggle between the space. so yeah, yes, but countdown to

april. april 1st you know, i wanted to ask i didn't get to to talk about this the cast equality movement, you know, we talked about cast a little bit. and in your book you describe how it was inspired by the civil rights movement in the united states. can you share about that? yeah, thank you for that question. i am a geek i start i'm not out on civil society movement. so it's such a unique parallel between india and the us because dr. king was inspired by gandhi. he came to india and said that he's in he's he visits most countries as a tourist but to india he comes as a pilgrim and he went back and he launched the montgomery bus boycott which then inspired the hiv movement which then inspired many global health movements, but also in india in 1972 something called

the dalit panthers was set up which was inspired by the black panthers and there is such that which is why i believe in this intersectionality and you know, the the need for black and brown solidarity across nations and you know these parallels between india and us is such a beautiful but fragile relationship between east and the west and it was a complete privilege. i was surprised that it's not known enough and i was very happy to then include it because the cast apartheid in india is entirely in keeping with the racial etiquette of the jim crow era or the apartheider in south africa, but very few people know about it. and we kind of need to you know, the medical apartheid we talk about race and how it impacts in many other ways education for

example, but we never foregrounded in conversation about access to health movements and i take this tangent and i meander into this to kind of foreground this conversation. yeah, i think your russian doll example is is a good one. just the the journey that we go through the book and it's all interlocking. it's all interconnected. i think you really weaved the story together well, and it works in these these different parts. last question for you, just you know, you did touch on leaving with some hope but really what do you hope the takeaway is from from your book? you know, i really the book ends with a very strong full-throated call for entirely disbanding the current intellectual property regime or having a tree

negotiated such that it gives equal it gives equal value to black and brown lives and not just foreground controlling diseases in black and brown countries as against caring for the patients who live there. so i do hope if there is one takeaway from it. or two takeaways from it. i want i would like for these toxic medicines for tb that are making patients go deaf, but they are being used because newer medicines are not available. i really hope if who or you know governments are listening. they face out injectables that are toxic and we also should have a association that is more realistic about the intellectual property laws without you know, accusing people of being too emotional or you know when they bring it up we need to it's not

a easy conversation to have but we need to have it now. well, thank you so much video. it was a pleasure and honor to to talk to you about your book, especially since you and i and our other fellow nieman sam made a trip to mercy brown's grave. when i explain who that is real quick, so mercy brown is the inspiration for the character of lucy weston drive in dracula's mobile and she remains buried in chestnut hills cemetery in exeter, rhode island, and i'm lucky to have friends and my name and family who at the peak of the second wave and i was in boston took me to the graveyard to cheer me up and it job, um, and i hope you pick up the book because there's lots of pop culture and it is about like but

it is it has lot of gallows humor. it does it does. phantom play get your copy. thank you so much video back to town hall. yes, thank you so much amber for leading this conversation. it was so nice to have you here nvidia. thank you for calling in from your beautiful location. thank you for skype human in with the gloomy seattle tonight and educating us on your beautiful book and i am so excited for your launch in india. i know it's gonna be great. it's gonna be perfect and i'm so excited for you. thank you so much. this is such a