Peter Hotez: The Connection Between Poverty & Tropical Disease | Joe Rogan

in them. What? I mean, it's some sort of chemical now. No, they're antigens, right? They're, they're, they're fluid, macromolecules. What's the liquid stuff? Typically, it would be saline or, you know, saltwater. Now, what is missing from today's vaccine protocol, if anything? In terms of diseases we should be vaccinating for, but we're not. Is there anything? Yeah, there certainly are. You know, one of them is a big, big problem on young infants, especially premature infants, called RSB respiratory syncytial virus infection. What does that come from? It's, you know, it's a respiratory virus that peaks around the same time that flu does. So it's a very severe respiratory illness. So this is, again, one of those vaccines that's not a big moneymaker. So the Bill Melinda Gates Foundation is trying to provide grants for supporting that one. That's a good one. And then there are all the diseases that affect poor people, both in developing countries, even among the poor in the United States. That's the next one called Blue Marble Health. The next one. So this is not released yet? No, this is out. This actually, this actually preceded the Okay, now this book is all about poor people and infectious diseases and that the rise of these infectious diseases even in the United States. That's right. So you know, when we think about, so I, I, you know, led this big campaign to raise awareness of something called neglected tropical diseases, or NTDs. These are the most common afflictions of people living in poverty. I call them the most important disease you've never heard of. They're diseases like schistosomiasis, and Shagas disease and leishmaniasis, and have been devoting my life to seeing if we could develop vaccines for those diseases in the nonprofit sector, you know, because the big pharmaceutical companies just don't see just aren't going to take these on. So we're trying to do it in the nonprofit sector. But this book, the Blue Marble Health book came out of some number crunching that I did using data from the World Health Organization, or something called the Institute for Health Metrics and Evaluation, which is based in Seattle, Washington, that found something very surprising. And that is, most of the world's poverty related diseases are not necessarily in the poorest, most devastated countries of Africa, meaning like Democratic Republic of Congo, or Central African Republic, they're there. But on a numbers basis, most of these poverty related diseases are actually in the G20 economies, the 20 wealthiest economies, together with Nigeria, which is not a G20 country, but as an economy, bigger than the bottom three or four. So that was pretty amazing, amazing for me to find that out because, you know, at first, I didn't believe the numbers because I said, Well, how can it be if they're poverty related diseases, why are they in the 20 wealthiest economies? And then I realized that it's among the poor, living in wealthy countries. So the poorest of the rich today, now account for most of the world's poverty related diseases. And what, what's the cause of this? So why the link with poverty? So that's a great question. One of the things I do in the book is I asked that, well, what is it about poverty that's making you susceptible? I don't think we really know. I mean, clearly, in some cases, if you live in poor dilapidated housing without window screens, things like mosquitoes and kissing bugs and sandflies can get inside the house. Or if you look in poor neighborhoods, like in and around Houston, you see a lot of environmental degradation around the neighborhood. You see discarded tires that breed at these gyptum mosquito were standing water. But I don't think what what, what did the tires do? So yeah, so one of the best habitats for the mosquito that transmits dengue and Zika, and chicken guinea and yellow fever are discarded tires. That's what they love. So this, you know, if you go into poor neighborhoods, you'll see a lot of tire dumping, for instance. And that's those are habitats for that that 80s, a gyptum mosquito, including here in Southern California. So is it when the water gets in the tire? That's right. A little bit of water. That's exactly it. Yeah. You know, I moved into a house once in Encino down the street from here, in fact, and no one had lived in the house for about a year and a half, two years. And the pool had not been taken care of. And I went out into the pool and it was green. And there were schools of mosquito. Mosquito heaven. Mosquito heaven. Yeah. So strange. So you got so yeah, absolutely. You go into poor neighborhoods, abandoned swimming pools, things like that. That's, that's where we're getting a number of these diseases. We don't have very many mosquitoes in Southern California. I mean, it's really kind of amazing in that regard. Like, well, it depends. So you know, in some counties where they do aggressive spraying and things like that, you won't. But many counties, you probably probably some of the poorer counties, poorer districts, you still do. Well, I mean, in terms of the way it is on the East Coast, like I grew up in Boston, and in the summertime, you just have fucking mosquitoes everywhere. They just can't get away from them. And then I've been to Alaska, which is the craziest place I've ever been to in my life in terms of mosquitoes. Right. Have you been? I haven't been to Alaska. It's hilarious. Yeah. You get out of your car and they attack you like a horde of birds. That's because you only get one month of the sea year to do it. Yeah. So they're super aggressive. And they're also very large. The big problem is along the Gulf Coast of the US, we have that 80s gypti mosquito. And that's why I got so worried about Zika virus hitting the Gulf Coast of the US. Yeah. Mosquitoes in other countries obviously contain malaria. I mean, we've been very fortunate that that's never made it over to here. Well, no, we we used to have malaria used to be widespread in the United States. Both the one that was was a real killer disease called falciparum malaria on the Gulf Coast, and even up into Illinois in the Ohio River Valley, we had a lot of malaria. When was that? Because by Vyvax in the 1800s. In fact, there's a whole there's a book written by Dickens when he visited the United States called Martin Chuzlewit. And when he describes all these sickly people in Illinois and Cairo, Illinois, and the confluence of the Mississippi and the Ohio River, he's clearly describing malaria. Wow, I did not know. So what stopped it? So that's a great question. We so there's actually a very nice book written by a medical historian at Duke University named Margaret Humphries, called malaria, race and poverty. And she has a hypothesis, but I think she's onto something that it the decrease the malaria dropped in associate with aggressive economic development. So that the FDR's New Deal included something called the agricultural Adjustment Act that got people off of off with agrarian pursuits and put them into factories, quality of housing went up. And that's probably what caused a lot of the reduction in these tropical diseases. Remember, they're really diseases of poverty. In fact, I spent a lot of time working in China. And I'm seeing that play out right now in China, you know, China is had this very, very aggressive program of economic development, mostly in the eastern part of the country. But in the southwest part of the country, go into Yunnan Sichuan provinces, you go back in time 75 years, and you still see those diseases. So it's red. Do you think that the best cure or the best way to stop malaria would be just to increase the economy of these areas in Africa where they're experiencing it? Clearly, economic development is a very potent driver. Now what it is about economic development, we still don't have our arms around that yet. But economic development is very important, just like for the neglected tropical diseases we studied. But you know, unfortunately, for many countries, economic development is still decades away. So that's why that's the rationale for developing these vaccines. Is it because economic development moves people into more urban environments where there's less tropical diseases? I think that's part of it, although now we're seeing some tropical diseases thrive in urbanized environments like you know, yellow fever and Zika and dengue as well. So it's not only urbanization, you have has to be urbanization with good planning. That's not done unchecked that outstrips the infrastructure in terms of water and sanitation. So this brings me to the thing that I wanted to talk to you about in the first place, because this is what you brought up to me when we were doing this sci fi show. And you said something to me that has been haunting me ever since, that the vast majority of people that live in tropical climates have parasites. Vast majority. Yeah, that's right. That's right. There's things like toxoplasma, Tondi. So let's look at the let's look at the hit parade, right? The top one is one called Ascoriasis intestinal roundworm. The estimates are on 800 million people have Ascoris roundworms in their bellies. Whoa, 800 million. So more than one in 10 people on the planet, mostly people who live in extreme poverty. 400 million have hookworm infection, 400 million have whipworms. A lot of these are wormy diseases. 200 million people with scabies, which is an ecto parasite on the skin that causes terrible itching and secondary bacterial infections. Schistosomiasis is another one. The point is, every almost every single person who is in extreme poverty, has one of these what I call neglected tropical diseases. And one of the interesting features about them is they're very debilitating. They not so that not only occur in the setting of poverty, but I think they reinforce poverty because they make people too sick to go to work. They make they actually shape we can show they shave IQ points off of kids when they have them. Well, this is the hookworm connection to the idea of the slack jawed, dumb southerner, right? Right. United States of America. Right. And now one of the things that we have found so we're really on the here on my faculty, working with an environmental activist named Catherine Coleman flowers in Alabama found that hookworm is still present in Alabama. So among the people so they understand what we're talking about because for the longest time, there was this stereotype about people that lived in the south that they were a dull minded, right and that this could be directly connected to hookworm infection which had run rampant, right? There was even the term given called they called the germ of laziness that hookworm infection because it causes severe anemia. So if you're walking around with terrible anemia, of course, you're near to you're not feeling up to working a full day and all that sort of stuff. Right. hookworm was widely president, president in the southeastern United States turn to the 20th century. And then as malaria went down with economic development, so so did hookworm infection as well. But we still have pockets in this country. And this wasn't understood at the time, right? They didn't know that these people were infected with hookworm? And for forever, no, up until very recently. So the cause of hookworm wasn't discovered till 1900. What is that cause? It's called Nicator Americanus, the American killer is and that's the name of the worm. And this is from walking barefoot? Or that goes in through the hands or enters all parts of the body. So it's very common to get it from walking barefoot. That's right, which was more common in the south. Right, right. And so that's one of the diseases we've made a vaccine for this now in clinical trials. Hmm. Yeah, when I found that one out, I was like, Oh, my God, well, that's it. That totally makes sense. Because for the longest time, is there was that stereotype. And then when you find out that it's directly connected to a massive infection of this disease, this worm. So these are the diseases that are holding back people who live in poverty. And originally, I thought only in places like the poorest countries in sub-Saharan Africa or Southeast Asia. But now I realize it's these pockets of poverty across the entire planet that people are affected by these diseases. And these diseases can be vaccinated. That's where we're trying to prove that we can make a vaccine against and there is a hookworm vaccine right now in clinical trials. Just in clinical trials.