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The Inside Track: Oxygen, a mixed bag and the woods
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Host Garry Aslanyan poses the question at the heart of the latest Inside Track conversation: in 2026, after everything COVID-19 taught us, are we genuinely better prepared for the next pandemic-like event? It's the question that sets the tone for a frank conversation with Catherine Kyobutungi and Ricardo Baptista Leite — covering vaccine manufacturing in Africa, the politics of preparedness, and why the gap between intent and action remains stubbornly wide. The guests also discuss a recent publication on the carcinogenicity of e-cigarettes.
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I'm going to say we had an oxygen and we had mixed bag and we had the woods. How is that? Welcome to the Inside Track, a series from the Global Health Matters Podcast. In this series, we step inside the conversations shaping global health, the debates, the dilemmas, and the decisions that don't always make the headlines. Each episode features two recurring expert pandits, Katherine Chiobotungi and Ricardo Battista Leite, offering informed independent analysis grounded in lived experience. Consider this your invitation to the inside. Hi there and welcome back to the Inside Track. Well, here we are again. How are you, Ricardo? How are you, Catherine?
SPEAKER_03Very well, thank you, Gary.
SPEAKER_02Um I'm very well, thank you.
SPEAKER_04Okay. No, no, you're not convinced, but you have some big news, Catherine. You have some big news. You are now on the Acra Reset panel or something like that. Tell me more.
SPEAKER_02Um yes, I was invited to join the high-level panel for the Acra Reset. Um, just like that.
SPEAKER_04Which is great. It's great, yeah. I mean, I wasn't sure where that whole thing was going. Do you know why they call themselves economic and health sovereignty together? Any reason why they added economic there?
SPEAKER_02Um I guess because I think it has been it's a politically driven process. And I think if you're the if you're the president of Ghana and you want to talk about sovereignty, I think it's hard to isolate health outside the other sovereignty issues that maybe Africans want. So yeah, I think that's how it ended up being both.
SPEAKER_04Okay, well, that's great. Um, so we know who to call next time. We want to know everything about the Accra reset, Catherine.
SPEAKER_02Yeah, congratulations. We just had our first meeting, so I'm waiting to see what happens.
SPEAKER_03And actually, we we we were talking about the Accra reset, I think, in our last episode. So uh very very timely. And uh I couldn't agree more with Gary. Uh, we're very fortunate to have you there, wishing you the best of luck.
SPEAKER_02Thank you. Maybe somebody listened to our episode and said, Oh, I don't know.
SPEAKER_04Must have been that, right? All the magic happens here, right? And uh that's good, that's good. And maybe we'll bring this back um for future episodes um and see where things are going. So again, again, great uh congratulations, Catherine. Um and Ricardo, you had an eventful weekend here. Uh, any chance to convince your family to listen to Insight Track yet?
SPEAKER_03Yeah, actually, so what Gary is referring to is that um once a year uh I go I would go with my wife. This year we actually took our eldest, uh my eldest stepson who also joined us to a pilgrimage uh to uh Fátima uh in Portugal. And so we it was almost um it was uh almost a hundred kilometers over three days that we walked. Um and uh it I found out during that journey that they had they are actually listening to the podcast, although they had not told me. And so you see, that's a divine revelation there. And so I was happy to hear that they liked it very much.
SPEAKER_04Okay, great. Well, um, I hope you're not too tired for our discussion. And um, both of you, let's get started again on our topic of the day. Let's I picked uh are we ready for the next pandemic? And um that's something been obviously on top of a lot of government's mind. Well, I hope, and in terms of preparedness after COVID, and we said never again, and maybe uh are we there? So I just wanted to start by asking from what you've seen and we've been to um locations you are in, or you've countries you've visited or you worked in, or things you've heard about. Do you think we are better prepared today in 2026 uh for uh a pandemic like event that might happen anytime basically?
SPEAKER_02Ricardo I can go fast.
SPEAKER_03Well um I I I would I would argue that um in a way uh we we are better informed today after what we lived, particularly through COVID. We are better informed, but uh not uniformly better prepared. Uh that's how I would state it. What I mean by this is of course we have um we have the pandemic agreement negotiations that are happening. We had an initial draft approved last year, but we all know that there's um a bottleneck on one hand with uh the pathogens access and benefit sharing uh system annex, uh the so-called PABS Annex, which um is a problem to be solved. Um, and it doesn't seem like the member states are willing to do so as of yet. And so in reality, the pandemic agreement isn't more than good intentions at this point. There's another very serious bottleneck called the United States of America, uh, which um, as we know, is not truly part of the process, having excluded themselves from the World Health Organization. And so this, of course, raises tremendous, tremendous concern. Um for all of us who who went through the um the process of COVID to see where we were back in 2020, uh, end of 2019 until now, I think um inevitably there were many gains. You know, when we think about detection or sequencing or scientific speed, um, even political awareness towards the topic, certainly I would say, as I was saying at the beginning, we're all better informed. Um, I would even argue that many global health uh organizations have changed processes and become um more sensitized on how to react in these conditions. But uh there, you know, most of these organizations depend on funding. And the funding, I would say, is not where it should be. Uh actually, we're seeing a decrease in in funding from across the board, it's not just the US. And so, you know, you don't want to, after what we went through, and now that there's a greater uh knowledge and consciousness towards the risks and potential impact of um a pandemic threat, um knowledge is not enough. Uh, you need to have the resources and the agreements to move forward. Uh, I would add to all of this that the pandemic uh during COVID, a tremendous sense of inequity uh grew globally in terms of access to the benefits of many of the scientific advancements that were achieved, um, from the most simple ones to the most advanced ones. And that equity issue, especially without solving the PABs issue in the pandemic agreement negotiation, becomes a true problem. Um and and therefore, I'm hoping that uh moving forward, the member states that are still part of the process do find some form of agreement. I, on a very personal note, I'm a strong believer that it would be better to work with coalition of the willing, even if it's 40, 50, 60 countries that are willing to seriously address these challenges, even if we cannot get a full global consensus. Um, because then I believe that the benefits that will come out of that are better than not having anything. And others, as future threats which are inevitable, appear, they will see the benefits of being part of such a coalition. And so I would say there's a mix of uh some deep concern, but also some hope that we may find a path forward, not the path ideal path. One just last one last thing just to say, because it's something that resonated a lot with me during the COVID pandemic, was a lot of uh, because then I deep dive a bit more at the time into the history of pandemics and more particularly the so-called Spanish flu in the beginning of the 20th century. And it's interesting to see that many of the lessons learned were lost because then we didn't have a pandemic over a couple generations that was of that dimension until we hit COVID. My fear is that if um another generation passes, some of the advantages that came out of understanding and being better informed from this pandemic, if they're not institutionalized within governments, within processes, within international organizations, within civil society, that we may take a step back as humanity and lose some of the advantages of being better informed. And so we do need to be proactive, um, to be better prepared. It's not something that will happen naturally, it will depend on leadership. And so I believe we have upcoming elections for the new, the new head of the new director general of the World Health Organization. I believe that whoever stands for that role has a huge responsibility to say what they're coming for in terms of how they stand on this issue and how they're going to ensure that the world will be better prepared in terms of future global health threats.
SPEAKER_04Okay. Well, you Ricardo covered the whole world in his first intervention. So we've left nothing to talk about. No, I'm just joking. Uh, but Catherine, I want to hear from you.
SPEAKER_02Oh, there's there's still a lot to talk about, actually. Um, I think Ricardo has covered what would what I would call the global. So those things which happen in uh you know those uh big capitals of the world. And I think and um I I'll totally agree that it's a mixed bug. Um I think science gave us a head start, and that head start has kept on increasing. I think there's much more advances in terms of the technology. Maybe to take it would even be faster to come up with a vaccine than it was last time. So that's a good thing. And the several things have happened. Uh the institutions which were involved, maybe to a great degree, have learned a lot. They made mistakes, maybe they want to make the same mistakes again. So there's they are good things. But the question is when we say are we better prepared? Um, if we are at 20, are we at 80? No, we're probably at maybe 35, which is better than 20, but not maybe what is required to get us to uh, you know, to prevent all the impacts of something like a pandemic. But I want to focus more on what's on the ground in in some, for instance, most more specifically on the African continent, because one of the issues that came out clearly was the inequity that Ricardo talked about in terms of access to technologies. And of course, the most important technology was vaccines. And as a result, since the pandemic um ended, there was several initiatives to improve vaccine manufacturing capacity on the continent. And of course, led by the African Union with input from the Africa CDC, there was a political process where African government sat down and said, okay, this is completely unacceptable, and we're going to see how we can engineer the ecosystem so that by 2030 we have greater sufficiency when it comes to vaccine manufacturing capacity. So they started several things. And there's a whole strategy that was launched. And one of the things in practical terms, which has happened, was to try to build infrastructure that would make it faster to transfer messenger RNA technology to the African continent. So things have been happening on that front. There was a hub set up in South Africa, um, you know, through WHO. And then there are several other parts of that whole ecosystem on the continent. There's a hub in, sorry, and a facility in Rwanda, and then this is supposed to be like a hub with Spox in Senegal, in Kenya, in Egypt, and all that. So those are happening. There's funding, infrastructure is being put up. So that's the good side. That if there was a a messenger RNA vaccine, with all these other processes happening, it might be faster to manufacture it for the African continent, even though how fast these facilities would be activated to start manufacturing, that's a different thing. But at least they are there. There's some kind of infrastructure which is being set up for doing that. I think the bigger issue is the health system, the healthcare system. And I'll talk about two parts. One, during the COVID-19 pandemic, lots and lots of countries set up ICU units like overnight. That was one of the biggest areas where investments were made. So they they they set up IC units, bought beds, and all these things which are required. But then recent um evidence has shown that most of those ICU facilities are not functional for different reasons. It was a crisis, so you could set up beds, set up oxygen and all these things. But now, what is required to keep them running so that they are available for the general public right now, those investments did happen. So several IC units are not functional, even though the beds are there, but because there are other things which are missing, the for the staff and uh, you know, everything else that is required. So that's one big thing. We made progress and we've gone back. The second big issue is medical oxygen, which was a huge factor in the care of COVID-19 patients. And again, huge investments in oxygen production plants. But recent studies again show that most of these plants are not functional. Some of them functioned for as short as two weeks, some functioned for three months, and many of them were never actually functional. So there's some small bright spots across the continent. I think Ethiopia tripled its its uh ICU capacity. Uganda went back and forth, so they are they are slightly better than where they were pre-COVID, but they don't have the capacity to like um um ICU capacity that is required if something was less similar, like COVID. Kenya and Uganda still suffering with the oxygen thing. They invested a lot, but most of those plants are not functional. I think Malawi uh is the one that had an oxygen plant that is still functional and perhaps even beyond capacity of what was required during COVID. So still a mixed bag, uh prepared in some ways, but not in all ways.
SPEAKER_04Okay. But Catherine, uh and Ricardo mentioned the agreement, but Catherine, there is this international health regulations, which is basically the um it's not a treaty, but it's um I mean it's for those who are members of WHO. You can opt out, but by being a member of WHO, you are um following the regulations and they updated them in 2024, basically after the COVID experience. Um there are other things like surveillance, labs, um risk communication, you name it. How about those parts? I mean, you've covered some of the system parts, which is extremely important. I've looked at some of the numbers and I I feel from what I heard that it's not like that that part is even either. But what's what's been your observation when it comes to those parts of the system?
SPEAKER_02I think those parts of the system, if I could, I don't know what to call maybe the software of the system, those parts that have to do with um how mem how governments or how countries work with each other. At that level, frameworks, uh, agreements, those things, I think there's been a lot of progress. But the question is, those some of those things existed before. And those were not the problem. They were problematic, but like uh fixing those without fixing the other things, the ecosystem and the infrastructure, without fixing the politics, because the reason why there was these huge vaccine inequities wasn't purely a supply issue, it was a political issue. So those things may be well have progressed. That's why I said we've moved perhaps from 20 to 35 percent. We're not where we were. But the other pieces need to be in place for us to feel like, yeah, if we if maybe something similar came in six months, we'd have a handle um over it. So it might still take us instead of two years, it might take us a year and a half, which is great, but it's not it should take us six months, perhaps. Um a year and a half is better than two, but it's still not great because of those other things.
SPEAKER_04Ricardo, do you want to add anything?
SPEAKER_03Well, yeah, I I mean I agree with Catherine. And um looking at the revised international health regulations, um at least the countries that are are willing uh to be part of that process, that were willing to be part of that process, it does bring it, I would say it does bring some more coordination. Um and you know, it created the concept of a pandemic emergency, uh, it strengthens some of the legal frameworks um that are necessary in the context of preparedness uh and uh implementation. But it there are some very significant issues that are basically uh reflection of what Catherine was mentioning that are not solved. Particularly um the new revised regulations don't fix the core distributive uh injustice that we saw during COVID. So we are going back to the equity issue, it's far from being solved. Namely, the the fact that you know the idea of uh countries sharing pathogens or data um will many times be the ones last in line for diagnostics, therapeutics, and vaccines. So um the incentives, I would say, uh continue not to be not to be not to be aligned. And so um I guess we can say that the the the regulate the the revised international health regulations improve uh the the signal and coordination side of preparedness, but um the PABs issue that we were discussing is really about whether the share and benefits side will be credible. And so basically, are we willing to, as a you know, as a globe uh among all the different member states, are we truly willing to go from good intentions to something that actually can be truly effective in a time of crisis, in a time of um uh a pandemic threat that puts us all at risk. But I also want to reinforce what uh Catherine mentioned around health systems and health system resilience. This is something I feel as I as I personally travel and meet with several leaders of health systems around the world, I feel that there was a positive evolution. There was a greater understanding that the more frail you are in terms of your baseline health system, um, the more vulnerable you are when a crisis hits. Understanding that concept of resilience is absolutely critical. And I think that will actually spill over into discussions into many global health organizations, many of which have been built on a vision focused on vertical approaches on certain disease areas, for example. To address those vertical challenges, we may need to have a wider vision of health system resilience, even if we want to address a specific problem in a health system. So I would say that today one cannot take on even a very specific area of health without integrating uh that specific challenge um into uh a greater vision of system and ensuring that the system can stand the stress test, which ultimately is what uh a pandemic is um for health systems. If you fail that test, people lose their lives.
SPEAKER_04Hmm. But do you guys think that each country can or is able to actually invest in the same way into all of these systems? I mean, there were these other mechanisms like pandemic fund and other things that were um sort of requesting countries who are needing sort of help to apply and get funding to build those parts. Is that also even, or what you've seen is helping, or that is still not sufficient in terms of funding or capacity? What's your observation, um, Catherine and and Ricardo, both of you, if you want to pitch in on this?
SPEAKER_02I mean, I think I think that's the whole thing about this being a mixed bug. The account is which have taken advantage of some of these. Funding and try to do things that actually strengthen the underlying health system. But I think the question is uh where do you start? You know, because the things which are obvious, things like oxygen and ICU capacity, those have fallen back to where they were. And I think it goes back to the earlier question of what exists inside countries. And if you have a system that is uh uh where already the whole concept of health system strengthening is not something that healthcare, I mean um health systems do, then everything becomes pro projectized. You have a project to improve oxygen, improve oxygen, but then what happens after that? Things fall up, things fall apart. You have an an a project to improve ICU capacity, then things fall apart. So when you have these other sort of conceptual things that are not clear, when you think about pandemic preparedness, how do you unpack it? What does it mean? And for people to integrate that into their sort of strategic health system strengthening, it becomes problematic. So a lot of the pandemic preparedness work is also project-based, it's program-based, it's um initiatives and interventions that are time-bound. They are not things which have been sort of fully integrated in health system strengthening. But I think one of the things I'll say that Ricardo mentioned is how now what I would call the global health architecture players, you know, the realization that yes, you can be Gavi and you can invest a lot in vaccination programs, and in six months, you know, all your gains can be wiped out because the underlying system was not good. And therefore, how GAVI needs to operate differently to sort of shore up that foundational health systems. I think that was a positive, and I think that's happening in the way um the global health initiatives like GAVI or Global Fund, how they are funding. Now it is okay for countries to say we want to build system things, not treat, you know, not give out medicines or badness or things like that. So that's that's a positive. But again, I think we're still uh we are better off than we were. But I don't think we're in the place where you can say we are prepared for any eventuality. That is many years away.
SPEAKER_03Yeah, I think uh I think Catherine's right. And you know, thinking about the future even of other organizations like the Global Fund, uh so these are all organizations that I think are are already investing in parts of that resilience health system strengthening component. But how this is going to evolve over time will take very strong and uh strategic uh leadership and vision. Um, and quite honestly, it's not an easy task. Um, and also you need the the countries, the member states, the the potential beneficiaries who are part of the process, first of all, to be part of the process, um, but also to want to be part of that process and to want to invest in this in this pathway. You were mentioning, Gary, the pandemic fund and other similar instruments. Even development banks today are providing a lot of funding uh in this space. But as you know, most of them act upon the request of the governments of the member states. And so nobody's going to force some another entity or another government or another country to invest in health system resilience. So there is a tremendous piece of information work that needs to be done, which then raises the political challenge at hands. And I must say, you know, as you know, as both of you know, uh I work a lot with parliamentarians. Uh and the sensitization existed, of course, during COVID. Politically, it has become almost toxic to talk about pandemics in a political arena right now. This is a problem. Um, because politicians, you know, after so many years where health dominated 99.9% of the political discourse during the pandemic, any talk around pandemics or vaccination or all of these topics that are incredibly important, now, after the pandemic, even more important than during the emergency, I would say, because now is the time to prepare for the next pandemic. Now there's a certain hesitancy to even address this topic because people feel that it will take away votes. It will take away support. And this is a huge challenge because one would think, right, politically, if we have a politician who's advocating for our country to be better prepared in the time of crisis, that they would get the support from the population. But it's the other way around because they say, Oh, you're talking about something I don't want to remember as a citizen. I don't want to think about having lost family members and friends and the hardships, the economic impact of what COVID represented for my country, for myself, for my family. And so if it's a topic that politicians are not willing to discuss and debate, it's hard to get them then to prioritize and to move and to put the resources where they're needed. And so, yeah, I mean, actually, the Unite Parliamentarians Network, we're doing our global summit in August in Manila, we're putting pandemic preparedness as a key topic. And several of the organizations that we were mentioning here, including the pandemic fund, will be there precisely because we need, we need the those that actually are the budget holders in each country, the parliamentarians, to take the lead. And so when governments may be hesitant, uh, we hope that parliamentarians can be the voice of the people and keep this as an important topic and agenda. And also, even if we do get a pandemic agreement uh finalized, in many countries, we will have to have some form of ratification process at the national level. And that once again goes through parliaments. If parliamentarians are either unwilling to discuss this topic or uninformed or or or misinformed, then we will be facing serious problems down the road. And so it's it's a global effort, and uh all of us have to be an active part of it, and it's not something that we're going to solve from one day to the next. So I would say it's a systemic change that impacts everyone in in there in this so-called global health space.
SPEAKER_04Okay. So Pat, help me. Do I now have hmm? I walked into this a bit more positive. I'm I'm thinking we're ended up with a little bit of a pessimistic note. Maybe, I don't know. But will the treaty uh well, whenever it comes, if it happens, if you want to bet on it, you can mention here if you think it will happen or not. It will um we'll know after this episode airs actually quite quickly where it goes. But will the treaty help with all of those other system issues right away, or is that sufficient? Um and and you can just maybe react to it and we can close down on this one.
SPEAKER_02I mean, I think for me from YCT it's one of those things about um the disconnect with what happens in the global space and what happens in reality in countries. There is such a huge disconnect. The treaty will happen, how it's operationalized will vary from country to country, and the front runners will still stay the front runners. So these things help a little bit, but they're not sufficient. And that's because the focus is up there around where all these things are negotiated, you know, create all these mechanisms and frameworks that um in the ideal world would cascade to the national level where the actual action happens. But what happens is many times those treaties stay up there. They stay up there. And countries we sign up to them, countries we sign up to all sorts of commitments, and they go back home and they do the things that they do. So it it the treaty is a is great, it it helps us move forward in one way. But again, it's I don't think it's sufficient. And it's we shouldn't look at having the treaty is a good thing, but you shouldn't say, oh, now we're out of the woods. Right, because you have the treaty, because the operationalization on the ground.
SPEAKER_04Exactly.
SPEAKER_02You know, yeah, is is something else.
SPEAKER_04Right.
SPEAKER_03So I think Catherine came up with the title for the episode. We're not out of the woods, it's clearly a good message here, because it's such a uh a powerful idea that is so true. And whatever the result, either having a treaty or having a half treaty or having nothing, it doesn't matter. At the end, what matters is what we get done on the ground. Of course, a treaty will facilitate that process, it will help everyone who wants to move in the direction of making sure that the world is better prepared to keep people safe, which is what we're talking about at the end of the day, keeping populations safe from potential health threats and making sure that our economies can stay resilient and robust and don't be negatively impacted because of global health threats like we saw during COVID. That's the bottom line. And so all of us, you know, be it academics, be it uh industry, be it civil society, you know, parliamentarians, politicians, everyone has a responsibility at the national level and at the regional level to continue pushing forward. If we agree on a global framework, that's amazing because that gives us a common language and to strive on and to build on top of, then adapting to our local realities. But what can, and you know, the vast majority of people and organizations and countries actually are supportive of this idea. And we need to build on top of that. So I want to go back to what I said at the beginning, where I believe that ultimately, in the current political context, there will be some players who do not want to be part of this global process. That's okay. Let's work with those who do. We need to focus on the coalition of the willing to make sure that we can continue to progress, to move forward. It's not because of some actors who have stepped away or have decided to not be part of the process that the rest of us should just consider ourselves defeated, uh, knowing that if we act today, we will be ensuring a healthier and safer future for everyone in the future. Okay. I hope that made it a bit more positive as we ended this show.
SPEAKER_04I'm going to say we had an oxygen and we had mixtap and we had the woods. How is that?
SPEAKER_03I think that reflects it well.
SPEAKER_04All right. So next part of our today's episode is the clipping. So our listeners will remember that we pick an article uh that we'll then discuss quickly to see what's happening with science or other um policy and other news. So today's clipping is the article published in carcinogenesis, carcinogenesis, I guess. Um, and it's uh the carcinogenicity of e-cigarettes, a qualitative risk assessment by Bernard Stewart et al. from the University of North South Wales in Australia. Um so we'll keep the link to the article for our listeners. Sadly, it's not open access. Uh, maybe uh that's a whole other episode we'll have in the future on open access. Uh, but I quote uh from the article that nicotine-based e-cigarettes are likely to be carcinogenic to humans who use them, causing an indeterminate burden of oral cancer and lung cancer. Okay, so discuss.
SPEAKER_02Maybe I I can go fast, and um I'll just say that um I um having been a researcher in non-communicable diseases and have been having a huge focus on uh risk factor uh reduction, especially tobacco use, um, there's a whole community that I'm part of in Kenya, and once in a while they have these campaigns around uh tobacco, you know, harm reduction. And recently, um I think about three years ago, they found out that actually some of these e-cigarette products had been approved in Kenya without due process. So they launched a whole campaign sort of decampaigning them. And every time that campaign was put out there, we got pushback from a very well-organized uh community online that was like, yeah, you're you're missing the point because these are supposed to be actually um harm reduction, because they are an alternative to you know tobacco use. And and they had all sorts of research that showed this and that and how these things were a safer alternative, and therefore when you take them off the market, then you expose more people to tobacco use, uh, which is like the the one that is very harmful. So this paper was quite interesting seeing like this analysis. And I think for maybe for for for listeners out there, the this the thing is how do you determine that something is carcinogenic or maybe it's cancer-causing? I think that would be like the um maybe the lay term. There are several things which are done. One is to say, does this product, for instance, affect certain parts of the body in certain ways? Because it is known how cancer progresses from a healthy tissue, whether it's in the lungs or what, and how it becomes cancerous. So those things are looked at. Then of course they look at animal studies. If you expose them to this product, what happens to these animals? If you do so all these things are done, and then people come to judgment. So what this study has done is to review, I think, more than 170 papers that have been published since 2017. And looking at all these different aspects, saying yes, there is, it is likely. And the word likely is used intentionally, it means something. So it's not definite, but it's likely. Now the problem is should you wait, if something is likely, should you wait until it is definitely cancer-causing before you do something about it? And I think the answer is no, because if you wait, you've made you may need to wait for 15 years for now it to be definite that it's cancer-causing. And in that period, you've exposed millions of people to something that has potential to cause cancer. So it's a very interesting paper, and I think it's quite compelling. If you look at, they looked at the how these substances change the genes that uh which whose expression could lead to cancer. They looked at changes in the tissues in the in the throat and the lungs. They looked at animal studies. I think in mice there was almost a 10-time fold of mice that got cancer compared to those that didn't get these things. So it I think it's it's it's quite compelling. Um the question is maybe you wait for the pushback. Uh maybe we'll we'll get, you know, now new evidence which shows that actually they're not as bad as this analysis has shown. But I think it's a it's a very very, very important study.
SPEAKER_03Yeah, I I I I I appreciate Catherine having framed it this way because I I think this is incredibly important we have this discussion, especially as we're seeing the the younger parts of our population adopting these e-cigarettes and vaping alternatives.
SPEAKER_00But when you add mint, mango, bubblegum, or vanilla, they seem less dangerous. Flavors are meant to hook you and then keep you addicted.
SPEAKER_01Don't be fooled. These tactics are by design to addict, not protect.
SPEAKER_03Uh based on this marketing campaign, which much of it is also subliminal, um to trying to pass on the idea that this is safe. Right? Unlike your conventional smoking, this is safe. And that is a false statement that we already knew to be false because of the chemicals, the nicotine, and so forth within these products. But now I think this study reinforces the cancer-causing nature uh related to the use of these products. This is a huge problem, I would say, that we're facing globally uh because industries that develop these kind of vaping technologies and e-cigarettes have been pushing this narrative around harm reduction, as Catherine mentioned. I remember very much at the beginning of uh the emergence of these products into the market, uh, one big industry asked to meet with me at the time I was an elected representative in the national parliament of Portugal. And they wanted me, because I'm I'm a big advocate for harm reduction uh drug policies, and they wanted me to voice out my support for the this tool to be used as a harm reduction tool for people who are smokers to convert. And for those that are not so familiar with the idea of harm reduction, is you come up with to the conclusion that these people will not stop consuming. So you provide them an alternative that is less harmful, ideally mitigating risk towards their health by changing their behavior into an alternative option. And so their theory being that why we're the reason we are so focused on e-cigarettes is because we know that uh as an industry that this is better than your conventional cigarettes. Mind you, that many of those developing the e-cigarettes are the same ones developing normal cigarettes, and so basically they don't care, but as long as it contributes to their bottom line. But what I told them was okay, you want my support to say that this is useful as harm reduction because basically you want smokers of conventional tobacco smoke to smoke to convert to your e-cigarettes. I say, okay, I will support you on one condition. The condition being that you will not allow your products to be sold to anyone who is not clearly a smoker today, and so going, just like we do with harm reduction drug policy, you were not giving methadone to people who are not opioid users. And so if you want to use that term of harm reduction, I will support that. I will support it if you use it from a medical scientific perspective, if you're using the term harm reduction seriously. And what they said was, well, think about it, and I never saw them again, because they disappeared. And what the that company in particular started selling their products in basically every gas station in Portugal. And that goes to the issue where it's actually much easier to sell these products than it is your conventional tobacco. And so this goes to show that the industry has no concern at all uh in terms of people's health. The these products are built to get into a younger population that was not willing to smoke your old style tobacco that used to be promoted in the 1940s and 1950s because the consciousness over decades was built that they are harmful for health. And they are now adopting these e-cigarettes and alternatives under the false premise that they are safe, and we know today that they are not safe, beyond the fact that the long-term effects we still do not know, but most probably will even be equally detrimental. And so I think it's extremely important that policies be updated to have the same level of I would say of uh rigorous approach towards these kinds of products uh that we have in terms of conventional tobacco, because it shocks me also when I go to certain airports, for example. And you know how you have these smoking areas in certain tobacco and certain airports, and sometimes the like the smoking area for for e-cigarettes, uh there's one, there's a specific area for e-cigarettes and another one for conventional tobacco. And you look into the conventional tobacco lounge, it's full of smoke, and everybody looks, you know, kind of grayish or yellowish, and it looks horrible. And then you look into this e-cigarette lounge that looks like an Apple store, right? It's all beautiful, and they're serving matcha tea or whatever, and they're creating this sense of well-being and this idea, this false notion that it is a lifestyle choice. And that is incredibly attractive to Gen Z and Gen Zers and to the youth. And it's something that concerns me deeply because it's all based on false messaging. And and building on top of this, you know, as the CDC says, that apparently it e-cigarettes could be potentially a little bit less harmful than your conventional cigarette. And what industry said from there is no, it's not it's not harmful at all. And so they extrapolate it to this false messaging that is grabbing a whole new generation of consumers that will be addicted for life. And that's something that I think uh as health experts, as scientists, we have the obligation to highlight the potential risk and to highlight the strategies that these industries are using.
SPEAKER_04Hmm. Okay.
SPEAKER_02So uh maybe if I could sorry, if I could if I could add in some numbers here, um um, you know, from just to give some perspective. Um 80%. Of people who start using e-cigarettes don't quit. Eighty percent don't quit. They now they instead of getting addicted to to tobacco cigarettes, they get addicted to e-cigarettes. So just think about that with this whole young population that's where these things are being marketed. That's one thing. And then apparently, again, science shows that people who use e-cigarettes are four times more likely to start smoking now regular cigarettes than those who don't use e-cigarettes. So 80% don't quit, and then they are four times more likely to start smoking tobacco, uh, I mean cigarettes. And then the other statistic is that um in terms of quitting um smoking, now if you give it to people who are smoking, uh nicotine patches, I think about 15 percent quit in six months, and e-cigarettes it's about twenty-five percent in six months. If you take it to one year, nicotine patch is about nine percent, and e-cigarettes is about I think twelve. So you're exposing your whole generation of young people to something which is supposed to be safe. And I I would totally agree. If if they are harm-reducing products, then market them and give them only to people already smoking. But again, 12% I mean, stop smoking in a year, that's not that's as much as you'd think. And compared to nicotine patches, that's like uh, I don't know. It's uh so it the public health benefit, I think, is doubtful.
SPEAKER_03It's doubtful. And I think this this research shows dual use.
SPEAKER_02Exactly. So this shows that um yeah, I think uh something drastic needs to be done about them.
SPEAKER_04Okay, so this is what happens at uh clipping. Uh our audience would appreciate an article became such a hot topic for us to discuss. So um that was really good. I hope that those listening put all of these things into perspective and now question uh these various opinions and all of that and put things into perspective. Basically, um I mean weeping was sold off uh as um off-ramp from smoking or to quit smoking, but uh it's becoming a new sort of um um on-ramp to long-term potential cancer risk, and we probably need some new regulations for for this particular product, if not in the same level, but um some kind of way to control and and bust uh the myth um around uh them that are floating around. Okay, both uh thank you for that. So let's go to our last part, and our last section is the kudos section. So I hope you came prepared to give kudos to uh someone, something that has happened in global health in recent weeks. Um Catherine, you go first today.
SPEAKER_02Can I do two kudos?
SPEAKER_04That's fine. Quick though.
SPEAKER_02This is this is not global health, but I want to give kudos to Pope Leo. I think he's amazing. I I and I think it's global health some in some ways because I think he's bringing back like values like empathy, like kindness, like uh, and I think that's what we miss in global health because everything that's happened in the past is because we lost those values. So that's my first kudos. The second kudos is I was at an event um hosted by the Gates Foundation in Kenya. Um right now it's a little bit controversial to be at an event hosted by the Gates Foundation, but um it was an event with the grantees of the Gates Foundation, of which we are one, and there were about 300 organizations in the room. And then there were this spotlight of some of the grantees that they are funding. And there was one gentleman who took, I think, his sister-in-law to a labor suit to have a baby, and the sister-in-law got PPH, which is postpartum hemorrhage. And during that experience, um, he observed certain things, you know, during that experience. And one of the things he observed was this uh new technology, very low-cost technology, around how PPH has been managed over the last couple of years that is actually saving women's lives. And it's a drip that is put and used, and then this drip sort of traps the blood. And depending on how much blood has been trapped, healthcare workers know exactly what to do. So it's calibrated. If the blood is here, you do X, if it's here, you do X. Very simple low-cost technology that is saving lives. So this this gentleman observed this and then he got curious. And once he learned what this could do, he said, I'm going to manufacture as many draps as possible and to save as many lives as possible. So he started a small, you know, fabric fabrication um uh outfit and started manufacturing dreps from a small little shark. And now the guy is manufacturing millions of dreps and exporting them to within Africa, outside Africa. And I was I was just fascinated. And the company is called, I need to get it right, it's called um Njeembuma. Njebuma, uh, which means something very specific. But I was I was really blown away that somebody took this life-changing experience, personal experience, and turned into something which is just amazing. So kudos to the Njmboom team in based in Kenya, and kudos to Poplio. That's my kudos for the week.
SPEAKER_04Okay. So, Catherine, I'm gonna say uh maybe it's because we mentioned the Pope in the last episode we had. You know, all comes down to inside track, right? Uh, it's all the influence that we have on the global discourse, including at that kind of level. Ricardo, what's your kudos today?
SPEAKER_03So um my kudos actually uh I was at the School World Forum last week in Oxford, which is uh one of my favorite conferences uh annually to go to. People are just extremely kind to each other. Uh in this time and age, I uh uh I must say that that's a rarity, and to to feel that kind of spirit and ecosystem um felt good. Uh and um, so of course, kudos to the school team. But I want to highlight in particular, and that's my my choice for the for this episode, is to actually one of the awardees. Uh so at the school forum every year, there's a school award for social innovation. One of the awardees uh here this year in 2026 was the Child Life Foundation, uh based out of Pakistan. And basically, the the premise was that Pakistan faces one of the highest child mortality rates in the world, with nearly 1,000 children dying every day from treatable conditions like pneumonia. And what the Child Life Foundation did uh was to start to work towards preventing those deaths by strengthening Pakistan's uh struggling pediatric emergency care system, you know, working with governments um to rehabilitate and manage their pediatric emergency rooms, uh, with you know, building up their public hospitals to have really world-class facilities capable of responding to needs. And because of their work, they've they've actually been uh able to achieve a tenfold reduction in child mortality in emergency rooms that child life manages. And that I think alone is extraordinary. Now they're building governmental doctors' um capacity and scaling uh the number of ERs that they are investing in. They're also investing a lot in um telemedicine sites. They already have more than 400 telemedicine sites, and they're the organization is hoping to deliver life-saving care to 20 million children each year. So a good team with a good vision and with a lot of drive can save lives, and I think that deserves the kudos this week.
SPEAKER_04Great. Thanks for that. Kudos. And my mine is actually related to what something Catherine talked about in terms of what we've learned about through COVID and um things like Gavi and others doing things differently. Um, you know, in April it's the World Immunization Week, and there were some numbers about um how the um sort of big catch up uh that was a uh two, three-year program that they put together to actually cover children who were not vaccinated, partly because of the time of COVID, etc., and about 36 countries in Africa and Asia, and they really got some good results in the last three years, getting those children, uh, including those with zero dose of any kind of vaccine, actually. And that was actually quite interesting to see. So kudos to this big uh catch-up uh campaign um done at um these 36 countries, and about 100 million vaccine doses were um uh really delivered for life-saving um diseases, and they didn't look just for under ones, I think they went up to five years old to kind of not miss anyone. So that's my um kudos for today. So if uh we want, we can. So that's yet another um lesson. So I think this brings us to the end of today's inside track. Again, thank you, Catherine and Ricardo, and we'll see you next time. See you then, thank you. Thank you. Bye-bye and bye. Bye-bye. To learn more about the topic discussed in this episode, visit the episode's webpage where you will find additional readings, show notes, and translations. Don't forget to get in touch with us via social media, email, or by sharing a voice message. And be sure to subscribe or follow us wherever you get your podcast. Global Health Matters is produced by PDR, a United Nations co sponsored research program based at the World Health Organization. Thank you for listening.
