 Talk to us first about how climate change brings these zoonotic diseases closer to humanity. We know that climate change matters to everything that keeps us healthy. And many people think about what climate change means to infections, including emerging infections like coronavirus. And there's reason to be concerned because we have watched already the effects of a warming planet on living creatures around the world. As it warms up, we see creatures big and small running to the poles to get out of the heat. And as these organisms move, they may run into other organisms that they've never rubbed shoulders with, they may run into people. And that creates the potential that the pathogens that they might have in them could spill over into another animal, including us. Now, in the case of coronavirus, we have really no understanding of exactly how the disease got most likely from a bad end to a person. And there are other instances in which diseases have emerged in which we know things like deforestation have contributed to the emergence of a disease. And of course deforestation is a major driver of climate change. But in the context of emerging infections, the places that we see climate change mattering to disease emergence most are in diseases transmitted by insects, particularly mosquitoes, and in diseases that are transmitted through water because climate change is driving more intense downfall of rain. And when that happens, we see outbreaks of waterborne diseases. So we can't pin COVID on climate change by any means, but climate change definitely has a role in where infectious diseases can occur. And importantly, some of the same things that are driving climate change, namely deforestation, are also driving the emergence of infections. So tell me a little bit more about how these diseases get from the wild and what some of the major vectors are. You mentioned mosquitoes. There are about 1,400 pathogens that infect people, roughly. And if you look at where those pathogens come from, whether they are infections that just infect people or infections that can affect people and other animals, the majority of them actually affect other animals. When we look at emerging infections, things that are either totally new, like COVID, diseases that are old but making a comeback, measles might be a good example of that, or diseases that have become resistant to treatments, drug-resistant tuberculosis, drug-resistant malaria, these kinds of things. A lion's share, probably 60 or 70% of them, infect other species. And so that tells us something. That tells us that when we look at these emerging infections, they're more likely to come from infections that can actually infect multiple species. So we then look at what's going on in the living world and we see tummels. We see species loss at rates that are unprecedented since the dinosaurs went extinct 65 million years ago. We see climate change, driving species to live in ways and in places they've never had to do before. And then of course, we also realized that people are growing in number, going into places and living in places that were more or less not inhabited by people for more or less ever, at least in an urbanized way. And it's not terribly shocking to see these statistics. So we know that it takes contact between people and animals for diseases to emerge. And we're harvesting more animals. We're destroying homes for animals. We're living in the places where those homes used to be. And so we create these opportunities for the pathogens, the germs that are causing these emerging infections to make the jump from an animal to a person. And I think it's important to realize that number one, we swim in a common germ pool with all animals that have backbones, right? So a good example that are pox viruses. So in humans, we used to have small pox. Well, there's monkey pox and camel pox and pox of lots of other animals that have a shared common ancestor, but it's really the same pathogen that has sort of evolved so that doesn't get so easily transmitted from one species to another. And that's true of essentially all of the diseases of humans. And the second key thing to remember is that the solution to our problem is not to wipe out the rest of nature. So people say, oh, bats, we don't like bats because they're the reservoirs for SARS and MERS and Ebola. It turns out that if we wiped out bats, we would wipe out ourselves. Bats are enormously important to the survival of the human species because they have huge effects on insect populations that matter a lot to people. They have huge effects on pollination services that are very important to people. And so the solution is we need to protect the bats and protect their habitats to protect ourselves as just one example. And I think once we realize how critical it is to protect other species for any number of reasons, including the risk of the emergence of infections, we might see a lot more traction in actions that will do what I like to call primary pandemic prevention, which is not vaccines and not better testing platforms, but actually stopping where these diseases, where they start protecting the animals of nature that allow nature to thrive and us to thrive at the same time. Well, you mentioned bats, what's with bats? Why bats? Yeah, many people have wondered why bats are such an important species when it comes to disease emergence. I mean, bats can carry a number of viruses in particular that don't seem to bother them much, but cause immense problems for people. I mean, rabies is a good example. Ebola is another good example. So-called Nipah viruses, which first emerged in Malaysia, very dangerous disease in bats. And then of course, the coronavirus is SARS and MERS and now COVID-19 all have bats species as reservoirs. And scientists have gotten very interested in this because it seems kind of weird that one group of species, but it's not really that weird. Remember bats are mammals, they're not birds. So they're closer to us than many other species. And again, we have co-evolved. I mean, we don't have a recent common ancestor, but we do have a common ancestor much more so than a person would with a rodent. And so the pathogens that have evolved in us and bats are the same group of pathogens. I mean, they're coronaviruses and bats and they're coronaviruses and people. Bats seem to have peculiar aspects to their immune system that enable them to tolerate these viruses in ways that our immune systems don't. So the viruses are in these bats. The bats don't seem to be horribly affected by them, but the same virus gets into our body and it goes crazy and our immune systems also go crazy. And so there's some early research that suggests that bats really create tolerance to the virus in the sense that they sort of tell the immune system tells itself, don't go crazy over this. And we see parallels to this in childhood immunity. So a good example of this is chicken pox. If you get chicken pox when you're three, four and five, the odds that you get a very bad case are very slim. If you get chicken pox when you're 20 or 25, it's a disaster. And that's because of the immune system of three, four and five year old response to viruses very differently than immune response in a 20 year old. And it seems that bats have sort of a similar thing going on when it comes to viruses. And I think the research question of most interests now is what can we learn about what's going on in a bats immune system that can help us actually tone our own immune systems when we get infected with these viruses because of course they are related, they're evolutionarily related. The systems are not completely different. In fact, they're mostly the same. And are there things that we can learn so that we can intervene in these viruses and be helpful. And of note in that regard, you remember very early on in the coronavirus, this current pandemic, one of the first drugs that was tried was steroids. And steroids are essentially immunosuppressants. And one of the big problems with coronavirus infection is it makes the immune system go crazy. So this is as much damage from the virus as it is from the immune system trying to kill the virus. And the steroids were intended to tamp it down. And the early results showed that if you got the steroids early in the course it could make you worse because you might suppress your immune system that could contain it. But when you're really sick, the steroids seem to help. Which is to say the immune response was as much of a problem as the virus itself. So we can learn a lot hopefully from understanding bats and potentially help us find ways to weather a future storm. Are we? Yeah. The example you gave reminded me that I had been talking to Dr. Rita Colwell that who had done a lot of studying on cholera. And she was talking about how climate change and warming oceans had brought a lot of this cholera virus closer to areas both in Bangladesh and also in Northern Europe. And the example you're giving about deforestation and the emergence of the displacement of bats and the emergence of some of these viruses. And almost it seems like the factors that are driving climate change are also driving these disease-borne illnesses. There's no question that climate change is connected to the COVID epidemic or pandemic. There's no question that climate change is connected to COVID. Not necessarily in the sense that climate change led directly to the emergence of the disease but in the sense that emerging infections that we've seen in the past have occurred as a result of land use changes, particularly deforestation. And those land use changes are major contributors to climate change travel. And so it's important to recognize that climate solutions, namely in this case preventing deforestation are also pandemic prevention solutions. And what's critical at this juncture is that we get those values on the table. We have such a tendency to look at forests as potentially just a carbon sink or as a critical home for indigenous populations for their water purification and capture services. And we look at these things in isolation and we don't even consider that the forest, protecting the forest may be a huge part of protecting against the next pandemic. And we have to consider the sum total value of nature. And only when we do so will it become painfully obvious as it is to many of us who have looked at these issues for a while that we really have no choice but to protect nature if we want to protect ourselves. And that the only reason that we do in fact continue to destroy nature is because we believe we can do so without any repercussion to our own species. And that myth is perpetuated by overly narrow views of what happens when we extract things from nature at a scale which fundamentally transforms the relationship of our species with all the other species on the planet upon which our health depend. Yeah, the pandemic certainly has, you know I know I've been talking to some oceanographers who are studying coral reefs in Hawaii. They say, well, there's a little bit of good news here that there's lower CO2 levels, lower pollution, fewer tourists, is that true? Do you think and will that last? It's absolutely true that during COVID there were periods of time when greenhouse gas emissions were lower during any given point in the year than they have been years past. The air pollution fell dramatically in many parts of the world that people obviously were traveling less. These are all true, but in the context of climate change they're essentially irrelevant. The greenhouse gas is going to the atmosphere particularly carbon dioxide is up there for centuries if not millennia. And even a dip for many, many months is not really gonna change the long-term growth of greenhouse gases in the atmosphere. The air pollution effects are real. You know, having less air pollution is critical. We learned just recently that fossil fuels, burning fossil fuels, which contributes 80% of the greenhouse gases to the atmosphere also contributes to about eight million premature deaths in the world every year. That's one in five deaths globally. It's 300,000 in the United States every year. And so air pollution is a big deal and having less of it is good. And so we saw that, but I think the critical thing to realize when it comes to these changes that COVID makes for climate change is that climate change to many people is a far and away not relevant to me problem. And that's because it has been discussed as a long-term change to the climate and more relevant to people who haven't been born yet than the people today. So of course, when a pandemic comes along, people rightly say, let's fix this pandemic, we'll worry about climate change later. And so the important lesson for me here is that there hopefully will never be in my lifetime or my children or my grandchildren's lifetime, anything like what we've been through in the past year, but the odds are not for that frankly, but there's gonna be something, a stock market collapse, a sadly a terrorist attack, a hack of our networks, there will be more crises of various forms and they will always push climate change off. And so we must find the ways to work on climate change that matter to people right now so that the urgency of the problem isn't a tension between the urgency of knowing that climate change is gonna be bad in 100 years or much worse 100 years if you don't do something right now and any other problem that walks along. We need to talk about the reality that 8 million people are dying from fossil fuel based air pollution in the world and wouldn't we be better off if 8 million people weren't dying because of the energy needed to fuel their lives? Now, let's be clear, there are many people in the world who still don't have access to electricity at all, and we have a very difficult challenge right now in weighing the very clear benefits of getting people electricity for their health. You think these efforts have been set back by, I don't know whether you'd call it the politicization of science or the polarization of science, but there's been so much, the same sort of climate change denial, it seems like it now morphed over into coronavirus denial. Where did this spring from? And what do you as a scientist think about this? Sure. So there are lots of folks who are really concerned with an increasingly loose relationship between scientifically grounded knowledge and what people's understanding of how the world works looks like. And one rightly would ask, is this new? Are we in fact losing our grip on the enlightenment, the whole idea that science is a pathway to understanding the world in ways that benefit us? And I'm not so sure that's true. I don't think there's been any change in our gene pool. We've always been a suggestible species. We've always fallen victim to false ideologies that have been espoused by very charismatic people for political or personal gain. The challenge of the moment is that, one, there are many, many, many people in the United States and around the world who feel dispossessed. We don't understand the communities we live in. We don't understand the decisions that people are making on our behalf without our say. We feel as though our freedom and our livelihoods are being stripped from us, and we have no say. Now, many of these people have been historically privileged in these societies. And so this is news to them because historically these things were not happening. To people who are not privileged, this is the status quo and this is what they have fought against. But of course, life is what you expect from it. So the sense of dispossession and the sense that things aren't going the way that they have or should or are good for me and my welfare feed into discrediting science and knowledge because if you confront reality, it's too painful. If you confront the reality of, for example, wealth in the United States where the average white family in the United States has seven times more wealth than the average black family. It's very hard to say that blacks and whites in the United States are getting a fair shake, an equal shake, right? And you look at knowledge. And so knowledge becomes very threatening. When science provides facts that are threatening to your worldview, you don't necessarily want to embrace it more. You want to run away. Now, at the same time, we have technology that has enabled our gullibility and our species difficulty with essentially staring at the sun, right? Staring at ourselves is like staring at the sun. You can only do it for so long before it hurts. And that enables us to spread myths like never of war. I mean, in the 19th century, Mark Twain said things, you know, it takes a lie to, I'm gonna botch the Twain code, but it takes a lie a heartbeat to get around the world where the truth will take years and years. And so there's a very easy means for people to have validation of false beliefs with large numbers of people through social media. And there ain't no way that anyone outside of that group is gonna penetrate easily in there with the reality that no one wants to accept. There's nothing interesting from a psychological science standpoint about this, research, understanding how our brains and our cultures work when confronted with knowledge that contradicts deeply held moral beliefs goes back 70 years or more. And if you wanna ask about that, we can talk about that because I've done a lot of work in that area. But I don't think anything's changed about our species when it comes to misinformation. I think we're living in a moment in time where we have a nasty confluence of a large number of people who are feeling more dispossessed and easy access to validation of false beliefs through social media. And that's what you were saying earlier. Something is always stepping to the front of the line when it comes to climate change. So recognizing what we've seen in the past year which is a huge shock to everyone's lives and how that can affect people's engagement on something like climate change, we need to ask what can we do to make climate change the issue that stays in people's focus, that stays as something that we want to act upon because it's gonna matter to us today. And what's very clear and really doable is addressing the root causes of climate change which is burning fossil fuels because so much harm is happening from burning fossil fuels. In the United States, hundreds of thousands of people every year are dying because we're burning so much fossil fuel. And those burdens are not equally shared. They disproportionately affect black Americans, Latinx Americans, they have disproportionate effects on women who are pregnant, people who are older, they have disproportionate effects on people with existing chronic medical problems. The very people in society we need to protect. And so we could in fact prevent huge disease burdens and address historical inequities while at the same time providing for a planet that's livable for our children. And I think in that light, we in fact do have a message that matters to people because when you stop burning gas on the freeway and that pollution goes away, lives are saved that day in the community around that traffic. When a coal-fired power plant shuts down, the community living downwind of that power plant has better health that day. When the pollution stops. And if you talk to any mother, and it's usually the mother, who brings a child in, let me say that again, it's not fair to the LGBTQ community. Parent? If you talk to any parent or guardian of a child who brings them into a hospital suffering from an asthma attack and the child is struggling to breathe and ask them if you could get rid of the air pollution that triggered your child's asthma attack, would you do that? And the answer would be absolutely because there are a few things I've seen that scare a grown up more than watching a child almost suffocating in front of their face. But if you give that same parent a different question, even if that parent is enormously concerned with climate change, and really committed to dedicated action on it, and said, would you want to stop burning fossil fuels in your community to reduce greenhouse gases so that the planet will be better for your child's future? And say, well, of course I do, but right now I don't want my child to suffocate in front of me. You realize very quickly, we need to think differently about how we talk about climate change so that it becomes personal, it becomes actionable, it becomes real in the context of a human experience. And when we do that, I think we'll see a lot more individuals see how important it is and how health promoting it can be to do what we need to do to address climate change. Has your work on this issue affected you personally? I mean, has it changed your life? So when I started working on climate and health and I'm a pediatrician, I routinely got asked by colleagues, what are you doing as a pediatrician working on climate change? We give vaccines and tell children to wear, children wear bike helmets and give guidance to say, eat more fruits and vegetables. And we do all those things. And a lot more. But it really was clear to me then and I think is clear to more of us now that if a pediatrician's primary job is to not just treat ear infections and treat diseases that arise in childhood but really to promote health, really to work with children and families so that we're positioning them for a life that is filled with their best possible health and their best possible attainment of opportunity is really what pediatricians are supposed to do. And then you look at climate change and when I looked at climate change, I said, boy, it's kind of hard to do our mission as pediatricians and not address climate change. And it's not surprising in that light that you see the American Academy of Pediatrics, for instance, being one of the first, if not the first professional medical organizations to take this issue head on. And pediatricians to be among the most vocal folks about this because our job is to ensure the healthiest possible path for children. So there's a direct relation to what my job is here. But then of course I'm a parent. And so it's very personal to me that it's hard to know what I know and walk on as if nothing in the climate sphere was gonna be relevant to my job as a parent. I mean, being a parent is hard work. Parents get way too little credit and a lot of criticism for being good parents. And why do we work so hard as parents? It's because we want our children to do well. We want them to grow up and at least have some of the things and hopefully all if not more of the things that we've been able to enjoy about the world as adults. And the thing about climate change is it forecloses on those possibilities for them. So one part of being a parent is in fact being concerned for me about what we're doing about climate change. So in that sense it gets very, it's both a professional responsibility and a personal one.