Russia’s War in Ukraine; Plus, Corona Calls

Good morning. It's Monday, July 6, 2006. This is up front. I'm Brian Edwards-Tieker. On today's show, Russian missiles hit apartment buildings in Kiev. Ukraine says its drones have struck for the first time the largest oil refinery in Russia. All opening moves ahead of a NATO summit in Turkey. Donald Trump is flying there this morning. I'm scheduled to meet with Ukrainian President Volodymyr Zelensky. We'll talk with John Pfeffer, foreign policy and focus. In the second half of our program, Corona calls with Dr. John Swartzberg. An FDA advisory panel has unanimously recommended an MRNA flu vaccine for approval. Trial suggests it's much more effective than the existing flu vaccine. But the path to making it available runs through another advisory panel that Robert F. Kennedy Jr.. has shut down. We'll talk about it all and take your calls. It's all coming up next. After the news. I'm Max Pringle with these headlines. Mourners flooded the streets of Iran's capital Tehran today to begin the days-long funeral service for the late Supreme Leader Ayatollah Ali Khamenei. He was killed on the first day of the U.S. Israeli war with Iran in February. More from Rika Ann Garcia.

the information about the F-35 Jets capabilities could make its way back to Russia because Turkey has this Russian missile system. And this has been a very contentious factor in the U.S. and Turkey relationship. And that's Sung-Men Kim. The UN Children's Agency reports over 300 children have been killed or injured in Sudan in the first six months of the year, mostly from drone strikes. Sudan has been locked in a civil war between the military and the rapid support forces or RSF since 2023. Fighting has been concentrated in Cordofan, Darfur, and Blue Nile states, with drone warfare causing 60% of the casualties. The UN and others warn of potential atrocities as forces battle for El Obide in North Cortifan. Dron strikes and shelling have targeted civilian infrastructure, putting over 500,000 people at risk. The UN urges protection for civilians and infrastructure. The UN has called the Sudan conflict the world's worst humanitarian crisis. UEFA, Europe's governing body for soccer, has criticized the sports world body, FIFA, for what it called an incomprehensible and unjustifiable decision to let U.S. forward, Fuller and Bolligan, play in a knockout game against Belgium this afternoon, despite a red card ejection in his previous game for a hard foul in the U.S. match last week with Bosnia-Herzegovina. UEFA said in a statement, FIFA, quote, crossed a red line with its decision not to enforce Balagan's mandatory one-game ban after coming under pressure from President Trump. In a statement, UEFA, which includes the Royal Belgian Football Association, said, quote, sometimes rules are open to interpretation, in this case not, unquote. It added, quote, the integrity of the game is at stake and the credibility of a competition is undermined, unquote. FIFA famously awarded Trump its first ever FIFA Peace Prize earlier this year. Many considered it a violation of the body's political neutrality and an attempt to placate Trump ahead of this year's tournament co-hosted by the U.S. so as to ensure the smooth operation and profitability of the tournament. Former House Speaker Nancy Pelosi's husband, Paul Nancy Pelosi, was involved in a hit-and-run accident in Yountville in Napa County over the weekend that left a parked car with major damage. Police say he could face misdemeanor charges. He wasn't arrested because no one was injured. Police referred the 86-year-old to the Department of Motor Vehicles for a process to determine whether he's still fit to drive. Sunday today in the San Francisco Bay Area, highs in the 70s, lows tonight in the 50s. Mostly sunny today in the Central Valley, highs in the 90s, lows tonight in the 60s. Those are the headlines. I'm Max Pringle on KPFA.

Bit past 708 in the morning. The show is up front. My name is Brian Edwards Teakert. We're going to start as we do most weeks with new developments concerning Russia's war with Ukraine. Our guest, John Pfeffer, the director of foreign policy and focus. Good morning. Good morning. How are you doing today? John, my dog is terrified of fireworks. We took him backpacking in a place that is literally called Desolation Wilderness, hiked seven miles over a mountain to camp next to a remote lake. And we could hear the explosions in South Lake Tahoe on the Nevada side of the border on the 4th of July. Now, is this a function of it being the 250th or is this a more regular occurrence? I think this is a predictable outcome of taking explosives, launching them high into the air and then detonating them. And I can't think for the life of me of why we do it to ourselves. Anyway, how was your weekend? Yeah, I heard some explosions far off in the distance, but otherwise it was an uninterrupted and peaceful time. What we had is like the cosplay version of what people are enduring in the other part of the world. Massive Russian missile salvo on the Ukrainian capital of Kiev overnight appears to have only struck residential areas. Current reports say at least 18 or dead people are still being dragged from rubble. Meanwhile, Ukraine said its long-range drone strikes for the first time last night reached the largest refinery in Russia, which threatens to escalate. Already pretty dire fuel shortages there. And this is all ahead of a NATO summit in Turkey. Donald Trump's already on his way there, and he is scheduled to meet with Volodymyr Zelensky, the head of state of Ukraine. I thought we could kind of talk about the stakes for that meeting to start with. What does Ukraine need out of Donald Trump in the United States at this point? Well, from Donald Trump, personally, it's hard to imagine they're going to get much of anything other than some Anodyne phrases, maybe. From the United States, maybe some accelerated deliveries of Patriot missiles to European allies. Don't know if... Trump administration is going to resume direct shipments to Ukraine of anything, frankly, although Trump did say that that might happen after some kind of a ceasefire or peace deal. And Ukraine desperately needs these Patriot missiles, these defensive systems that can take out ballistic missiles, which Russia is launching at an accelerated pace.

Previously, it was focusing more on cruise missiles, on drones, and Ukraine has the capacity to take out drones. That's perhaps what it's developed, its greatest skill at doing. And it can take out cruise missiles, which come in at a lower altitude, but the ballistic missiles, which go high up into the atmosphere and then come down. are very difficult to defend against. And I don't think they were able to intercept any of the incoming ballistic missiles. They refused to report how many Patriot systems they still have or Patriot missiles in the systems they still have. But they will be going to NATO and asking for the Europeans. to accelerate their deliveries of these missiles. And, you know, the Europeans can wait for the next deliveries, which will come in, say, in 2027, and Ukraine can use what's, you know, currently in European reserves. I think that's the big ask that the Ukrainians are going to make it at the NATO summit. Don't know really what Trump will say or if he has anything to say about that matter. I'm having a hard time understanding the targeting decisions. I mean, the ballistic muscles that Russia launches at Ukraine, they're not cheap. They are not manufactured in enormous numbers, not like the drones that are used for swarm attacks. But it seems like everything hit in this elbow last night was an apartment building in Kiev, not critical infrastructure, not military infrastructure or troop concentrations. Like, do we think Russia's just... bad at targeting or is this part of some strategy that's not obvious? Well, ever since the beginning of the war, the Russians have frankly targeted civilian infrastructure. I mean, if you go back to the days of the attacks on Mariupo, there was a theater there very famously where, you know, a lot of people were taking shelter. It was one of the kind of the strongest structures in the town. And they very clearly put out in front and in back of the theater the Russian words for children. They made it clear that this was where civilians were. There were no soldiers. There were no missile. batteries and the Russians went ahead and bombed it anyway. So, and we've seen, you know, attacks on civilian infrastructure throughout the country. In part, I would say it's because the, one of the Russian strategies is to simply, you know, ensure that the civilian support for the war has deteriorated and the civilians put pressure on the government to end the war. And to a certain extent that has happened. I mean, if you look at public opinion in Ukraine over the course of the last four years, there has been a larger number of people who

will support peace regardless of whether it means they will lose territory, whether Ukraine as a country will lose territory. However, it has also strengthened the anger and the determination of another segment of the Ukrainian population, which of course perceives that the Russians will stop at nothing to take over the country. and absorb it into the larger Russian entity. With these ballistic missile attacks, I think they of course are targeted, but I don't think they have the same kind of ability to say target mid-air as a cruise missile or a drone. I mean, once you launch a ballistic missile that goes up, it comes down. It's been targeted in advance. You can't adjust it mid-air. There might be any number of factors that pull the ballistic missile off target. And so I would argue that those ballistic missile attacks are frankly designed to... to cause as much damage and havoc in civic, civil population. They're not really intended to take out either military targets or energy infrastructure. Russia has other means to do that. So again, this is partly revenge. Vladimir Putin has been very angry at Ukraine's ability to target Russia's energy infrastructure, and he wants to, you know, exact the largest penalty possible in retribution. And in his mind, at least, that is attacking large residential buildings in the large cities, including Kiev, and to, you know, just cause as much pain as possible.

The Ukrainian side of the equation, overnight Ukraine said its long-range drone strikes for the first time reached the Omsk refinery, that is the largest oil refinery in Russia. It's a little over 1,500 miles from Ukraine's border with Russia. And like several open source intelligence accounts pouring through footage online seem to have confirmed this. Russian officials have confirmed the attack, not that anything was hit, though. How badly are the attacks on oil infrastructure in Russia, like biting in general life? Well, at the beginning, it seemed as if, you know, the oil gas shortages were confined to Crimea in areas around Crimea, simply because of the difficulty of getting fuel into Crimea, with Ukraine stepping up its efforts to intercept shipments either by sea or by truck. attacking bridges and so forth. But now if you look at a map of Russia, virtually every territory in Russia has been hit by fuel shortages. And that actually is quite extraordinary. And the Ukrainians have managed to reduce the capacity of Russia to supply fuel within the country by about 20% by some estimates. And that means that there is rationing. That means that a lot of, even though industry and agriculture have their own reserves and might have priority access, they're going to be feeling the pinch as well, so it's not just people driving their cars. This will have an impact, if not immediately, then eventually, on Russian manufacturing and agriculture, the ability of the Russians to get the harvest in in time. So this is also contributing to inflation, obviously, the increase in prices as a result of lesser fewer supplies. And a measurable decline in approval ratings for the president. Vladimir Putin's approval ratings have dipped below 70% for the first time in a very long time. And although any leader in any other country would probably be delighted to have a 70% or even a 65% approval rating, that is seen as a very dangerous sign in a country where there really aren't any other political options at this point. And so you're either with him or against them. And if there are enough people who are willing publicly or semi-privately even to admit that they're against him, that spells trouble for the Vladimir Putin administration.

Yeah, and just the fact that the lines pointed down instead of up in the approval ratings has got to cause some pause for concern. I read, I think, on the Medusa website, that it is the quickest drop in approval ratings for Vladimir Putin on record, although again, they remain at a very high absolute rate. Absolutely. And, you know, Vladimir Putin has tried to take the battle over a relatively small town, but a crucial town in the Dombas, Konstantinivka, and said, look, we have victory here. We are making inexorable progress in our campaign to take over the Dombas. Ukraine, of course, has disputed this, said that, yeah, there have been some... units that have infiltrated into this town, but that doesn't by any means mean that Russia has taken over this town. And still, if you look at the calculations, if Russia were to continue on its current pace of very, very modest gains in the Dombas region, it will take them something like a dozen to 14 years to take over the entire Dombas. And that's not a timeline that looks good for Vladimir Putin. Probably not something he would live to see the end of. Exactly. The NATO summit, how much of this is about what Donald Trump will do for Volodymyr Zelensky? How much of this is about what the rest of the NATO powers can do for Ukraine? It's mostly what NATO powers can do for Ukraine, although honestly, the focus of the summit will probably be on money issues. In other words, how much Donald Trump will be demanding that European powers. pony up for NATO defenses, how much the United States is going to be reducing in terms of its own contributions. On the table is a demand from Trump for 5% of GDP devoted to to NATO. And, you know, it's 5% of GDP devoted to military spending. And that's- Which is more than the U.S. spends. Exactly. I mean, the U.S. spends anywhere, well, in 2024, it spent about 3.1%. And, of course, Trump has increased U.S. military spending considerably, but it's still going to be going to fall short of 4%. And, you know, if you look around NATO, Poland probably spends the most percentage wise, maybe the Baltics, but somewhere hovering around 4%. And so there's going to probably be some pushback to that. On the other hand, a lot of countries in NATO, a lot of members of NATO are concerned about the ambivalence that Donald Trump has toward the alliance and towards

respecting the Article 5 commitment to come to the defense of any NATO members that have been attacked. And therefore, they already are motivated to spend more of their budgets on the military, not so much to to substitute for what the United States is withdrawn from NATO, but simply to have stronger militaries in general, anticipating that the United States is not going to be there potentially in the future. And how much of that will be available for Ukraine? Well, I mean, there is a strong commitment to Ukraine. I mean, even from politicians that have, at least in the past, been on Donald Trump's side, like Giorgia Meloni of Italy. But Maloney has seemingly soured on Donald Trump has criticized him for a number of reasons, but one of which is that he is not coming to the defense of countries like Ukraine. So I think there will be a push from a lot of NATO members to kind of double down on the defense of Ukraine. And the defense of Ukraine in this sense means, you know, sending money, sending armaments, sending advisors, but not intervening in the war directly, which of course would be a red line for a lot of reasons. Well, a red line for who? Well, it's a red line for Russia. has threatened, well, I mean it has threatened on any number of occasions escalation to nuclear war, use of tactical nuclear weapons in the Ukrainian conflict if NATO were to enter into this war. But of course taking the war to NATO members as well and indirect threats against the Baltic nations for the most part. But again, you know, for all the threats that Russia has made about previous red lines, namely the permission for Ukraine to have long-range strikes against Russia itself, for instance, despite all of those previous red lines, Russia actually hasn't escalated to the nuclear threshold, though it continues to use a lot of ballistic missiles, which, of course, could be outfitted with nuclear warheads. nor has Russia engaged NATO troops directly. Again, there have been both fears and indirect threats that that might happen from Russia, and that hasn't happened as a result of red lines being passed in the past. But this particular red line of NATO troops actually entering into this conflict, that would be a red line that NATO too seems to abide by. And, you know, it would not be popular, obviously.

among populations in Europe that have been pretty steadfastly against military participation. But it would also signal an escalation in this war that I think the European militaries are not prepared to engage in at the moment. President Trump had apparently lengthy preliminary phone calls over the weekend with Vladimir Putin. That one reported out as 90 minutes and with Volodymyr Zelensky. What do we know about the content of those calls? What do we think the Trump administration is proposing by way of resolving the conflict? Well, you know, I think that Trump would, he has said on any number of occasions that he wants to be the person who ends this war, and he's willing to, you know, mostly twist arms on both sides, although there are, obviously, if you look at the peace plan that the United States borrowed the Russian language for and then put forward in its own multi-point plan. There are some incentives in there as well, mostly incentives for Russia, removal of sanctions, invitation back into the global economy, and a lot of money that would be available for Trump family and friends in terms of investment opportunities either in reconstruction in Ukraine or new economic opportunities in Russia. So ample opportunities for, frankly, corruption. But so far, Vladimir Putin in particular has frustrated those efforts because Vladimir Putin is held to his main objectives, namely the seizure of all of the Donbas. And so Trump has also been kind of pissed off at the inability that he has had to end this war. God knows what he said for 90 minutes with Vladimir Putin. I'm sure there's an exchange of mutual flattery. But whether they talked about anything specific, that's hard to know. All right. John Fevre, we should probably leave it there. Thank you so much for spending another Monday with us. We'll find out next week how the summit went. Sounds good. Thanks for having me on the show. John Pfaffer is the director of Foreign Policy in Focus. He joins us most Mondays at the start of the program to go over new developments concerning Russia's war in Ukraine and other developments around the world that we can plausibly connect to it. That takes us to just about 729 in the morning. The show is up front. My name is Brian Edwards Teakert. I hope everybody had a good holiday weekend. However you celebrated, as you heard on this program, choosing the signing of the Declaration of Independence as the birthday for this country is a somewhat fraught endeavor. I hope our coverage was able to bring a little bit more historical context to it.

and that the booms did not terrify any easily traumatized human or animal in your life too much or for too long. Coming up in the second half of our program, we're going to be joined by Dr. John Swartzberg, clinical professor emeritus of infectious diseases at UC Berkeley School of Public Health for another edition of Corona Calls, where we take your questions about all things infectious disease. We're going to be talking about the recent unanimous recommendation by an FDA panel. of a new mRNA flu vaccine. Clinical trials of the vaccine suggest it's much more effective than existing flu vaccines. The underlying technology suggested something that could be adjusted to address new variants of influenza much more quickly than the existing flu vaccine. But its path to actually becoming available to the public is quite murky. because the panel that that would normally move through at the CDC has been disbanded by Robert F. Kennedy Jr.. So we'll be taking that up in the news and we'll be taking your questions. Next. After the news. I'm Max Pringle with these headlines. Mourners flooded the streets of Iran's capital, Tehran today, to begin the days-long funeral service for the late Supreme Leader Ayatollah Ali Khamenei. He was killed on the first day of the U.S. Israeli war with Iran in February. More from Rika Ann Garcia.

mourners wept as authorities revealed the casket containing Khomeini's body at the Grand Masala in Tehran. The funeral is being held months after an airstrike killed him at the start of the war. He was 86 years old. Iran's government expects to see millions flood the streets of the capital in scenes reminiscent of the burial of the late Supreme Leader Ayatollah Ruhola Khomeini in 1989. That could provide a boost for Iran's government, particularly as it tried... to leverage its hold on the Strait of Hormuz in negotiations with the United States over a permanent end to the war. I'm Rika and Garcia. Ukrainian officials said today that Russia has launched a massive missile and drone attack on Ukraine, killing at least 18 people. The assault highlights gaps in Ukraine's air defenses, particularly the need for more Patriot Interceptor missiles. Twelve people died in the capital Keeve. Russia's main target and six more in the wider region. Ukrainian President Volodemir Volodymyr Zelensky is expected to address the issue at a NATO summit in Ankara this week. The attack follows a deadly strike on Kyiv last Thursday. Ukraine's Air Force reports that all 29 ballistic missiles hit their targets, underscoring the urgent need for more defense support. Former House Speaker Nancy Pelosi's husband, Paul Nancy Pelosi, was involved in a hit-and-run accident in Yountville in Napa County over the weekend that left a parked car with major damage. Police say he could face misdemeanor charges. The Napa County Sheriff's Office said Nancy Pelosi's brown convertible hit a legally parked car on the side of the road. He stopped briefly and then drove away. No injuries were reported. A witness saw the collision and called 911. Shortly afterward, sheriff's deputies found Nancy Pelosi with damage to the front of his car on a road roughly a quarter of a mile away. He reportedly told officers he knew that he'd hit something but was not sure when or what caused the damage. He wasn't arrested because no one was injured. Police referred the 86-year-old to the Department of Motor Vehicles for a process to determine whether he's still fit to drive. Sunday today in the San Francisco Bay Area, highs in the 70s, lows tonight in the 50s. Mostly sunny today in the Central Valley, highs in the 90s, lows tonight in the 60s. Those are the headlines. I'm Max Pringle on KPFA. Bit past 7.33 in the morning. The show is up front. My name is Brian Edwards-Tigger. We're going to turn as we do most weeks at this time to new developments in the world of COVID-19 and other infectious diseases and the public health responses to them. Our guest is Dr. Jim Jordan Swartzberg. Clinical professor emeritus of infectious diseases at UC Berkeley School of Public Health. Good morning, Dr. Swartzberg. Good morning. I thought we could start with a news item that we didn't get to last week. Well, you were away on your vacation, advisory panel at the FDA, unanimously recommended approval of a new MRNA-based flu vaccine that clinical trials suggest is 27 percent more effective than the existing flu vaccine.

at preventing disease, somewhat more effective at preventing other outcomes like hospitalization and death. I want to talk about the politics of getting it from that recommendation to public availability in a bit. But first, maybe we could just go through what it would mean to have a more effective and an mRNA-based vaccine available. Sure. It's a pleasure to talk about this because the news is quite good. The first thing is that the advisory committee to the FDA, the acronym is called Virpac, met and unanimously, as you pointed out, approved this vaccine or recommended for approval of this MRNA vaccine for influenza. And the remarkable thing about that meeting was that it was normal. By that, I mean, the committee met. The committee was personed by qualified people to give a recommendation, and they gave a recommendation. It was the first time they had met in a year, although they're supposed to meet several times a year. We haven't seen something like this since this new regime came in in Washington. So that was the first thing that caught my eye. But in specifically talking about vaccine, there are three good things and one less good thing or not good thing. Let's take the not good thing first, and that is that the side effects from the mRNA influenza vaccine were more than the traditional vaccine. None were serious, mostly were mild to moderate in terms of side effects like injection pain, injection site pain, fatigue, headaches, low-grade fever, sort of what I think many of us remember from the... earlier in MRNA vaccines against COVID. Feel punk for a day or two. They were more common in people who got this mRNA vaccine versus the standard vaccine. So that was the less good, not good news, but three pieces of good news. One, as you pointed out, Brian, the phase three trials. suggested that vaccines are much more effective against influenza. The MRNA vaccines are compared to the standard influenza vaccine against preventing infection, as you pointed out, and also preventing more serious consequences of infection like ER visits, hospitalizations. So that was really good news. A more effective influenza vaccine is something we really need. The second was tied to that, and that is that some of the research behind these vaccines that was published suggested that the immunity duration is likely to be longer with the influenza vaccine made by the MRNA technique versus the older techniques. That's important because when you get the flu shot, let's say typically in October.

you lose anywhere from five to twelve percent of its efficacy roughly every month so that's why we don't recommend getting the flu shot too early because influenza typically comes to our latitude in december maybe january And that's when it really starts to hit. And you want to have good immunity at that time. So having something, a vaccine that gives longer and perhaps broader duration of therapy of a immunity is really important. And the research suggested that the mRNA vaccine does that. Another was that. the manufacturing. And when you hear manufacturing, you say, okay, that's good. But let's dive into that a little bit. The traditional flu vaccines are either grown in chicken eggs or in what's called tissue culture. And the process from making the decision as to what the composition of the flu vaccine will be, typically that's done around February of each year, the process of getting that vaccine produced is roughly about a six-month process. Long time, so it means that the People who pick the composition of the vaccine, the scientists who do that, have to do that many months in advance, which means that we could be picking a vaccine against something that is either no longer circulating or less likely to be circulating. We saw that this last year. The vaccine was still good, but it could have been better had we been able to wait until the spring to make that decision. And the good news is with MRNA vaccine production, any kind of MRI vaccine production, it can be done really quickly. It doesn't take the six months. Frankly, you can do it in a couple of months. That is, once you decide what the composition is, within a couple months, it can be in people's arms. So that's a big plus giving us the opportunity to pick a... composition of the vaccine for next fall, for example, much sooner. So we could, here we are in July, it's still possible that we could have an influenza vaccine that is much more contemporaneous with the types of influenza that are likely to be circulating next winter. So really, almost all good news with this. What's happened in terms of the cold chain required to keep our MRNA vaccines intact? A lot of our listeners will remember this was the biggest logistical impediment when the COVID vaccines first came out. They had to be chilled to a temperature below what most freezers can manage and kept that temperature.

until less than 12 hours before administration. A major logistical hurdle here, a virtual impossibility in a lot of poorer parts of the world. Is that something that's been resolved with the MRNA vaccine technology? It's been resolved, but not completely. That is, the real cold temperatures aren't necessary any longer. So that's good news about MRNA vaccines in general. It would still be nice to not require cold temperatures to administer this, but at this time, we don't have that. I suspect we will in the future, but a lot of those problems that we saw early on with the COVID-MRNA vaccines. or have been resolved to a large extent. Okay, so normally what would happen with a new vaccine like this MRNA influenza vaccine is the FDA would get a recommendation, then it would make a formal decision on approval that's scheduled for August 5th. And then the question of who should get the vaccine and what schedule it should be taken on would be left up to an advisory panel at the CDC called the Advisory Committee on Immunization Practices. That's advisory, but a de facto policy setting body for the government and health authorities across the country. That panel currently doesn't exist. So what happens next, assuming the influenza MRNA vaccine gets approved August 5th? Nobody knows. This is just one of so many examples of the chaos and confusion that's been created by the regime in Washington. There's without the ACIP, the panel that you mentioned, meeting, and as you point out, it doesn't even exist at this point, we don't know what's going to happen. But here's one scenario that... A lot of people think is likely and I think is likely. The ACIP will not meet, and therefore the CDC will not give recommendations, but the FDA panel, I think, on August 5th, is going to approve the vaccine. So that means that the manufacturers can manufacture the vaccine and distribute the vaccine, and doctors can decide how to administer it. To whom to administer it will be a decision by the physician. And the physicians are going to take their cue, not from the CDC, but from their... Here in California, the consortium of the four states, California, Oregon, Washington, Hawaii will opine on this, give its recommendations. And other states have similar situations, either in consortia or by themselves, to make do the same thing. So we'll see both states, if not all of the states.

giving recommendations for this. Not only that, but advisory committee, or excuse me, not advisory committees, but medical organizations will also be giving their recommendations, like the American College of Physicians, the Infectious Disease Society of America, the American Academy of Obstetricians and Gynaecologists, American Academy of Family Practitioners, etc. They'll all give an opinion about this. And we know what those opinions are going to be in terms of the medical societies and most of the states, and that is, they're going to recommend the vaccine. If they recommend the vaccine, we'll see what we saw last year, and that is that the insurance companies will likely follow that because it's in the insurance company's interest to administer the vaccine to as many people as possible because it is going to prevent. ER visits, hospitalizations, ICU admissions and deaths. And so the insurance companies have a vested interest in approving this. So I am guessing now, but I think that that's what we're going to see if ACIP does not meet. Is there any risk that in a world with a really fragmented policy regime where Some states are using the old flu vaccine, where some states in hospitals are preferencing the MRNA one, that there's not enough economies of scale in manufacturing any one vaccine to keep a pharmaceutical company doing it? I don't know the answer to that. I imagine that's a scenario that could play out. But I don't know the manufacturing capabilities. I do know that in terms of manufacturing the mRNA vaccines, it's easy to do to produce a lot very quickly. So that suggests that that will not be a problem, but I don't know. I was speaking to Dr. John Swordsberg. He's clinical professor emeritus of infectious diseases at UC Berkeley School of Public Health, and he's here in part to answer your questions about infectious disease in public health. The phone number, 1,800-9508, that's 1-800-908 for your corona calls. Dr. Swartzberg, I thought we could start with one from the inbox. This comes from Janice in Sebastopol, who writes, my partner. is recovering from pneumonia, age 79. This is a wake-up call for me to get a pneumonia vaccination. I understand there are three types of pneumonia vaccine. I am 80, healthy and active, and wonder which one is the most effective. There are newer types of... pneumonia vaccine. Let me just clarify, though. We call it the pneumonia vaccine, but it's a vaccine against a specific bacterium called Streptococcus pneumonia, or sometimes called the pneumococcus. It's the most common bacterial cause of pneumonia in older adults.

It certainly occurs in young adults, and it certainly occurs in very young children, and serious in young children, but it's a particular problem in older adults. And so let's focus on that group right now, but not forgetting if you have very young children, make sure your child gets this vaccine. It gives very good protection against this bacterium in terms of preventing serious disease. and actually even in terms of preventing infection. So it's a very good vaccine. It's been around a long time. And on a fairly steady basis, it's been approved. It turns out that there are around 100 different specific types of streptococcus pneumonia. And our immunity works against each specific type primarily. So the more types we can cover, the more protection you're going to get. So the improvement in the vaccine has been in one area that is broadening or increasing the number of types it protects against. And right now, these newer vaccines protect against many more types that cause human disease. Fortunately, not all 100. typically cause human disease. So we don't have to cover all 100 of those to really give excellent protection. So the newer vaccines, to answer Janice's question, give broader protection. And those are the ones she should aim for. Depending upon where you live, one of the vaccines gives a little better protection to the types that are circulating in those areas, for example, in Alaska, versus some of the areas in the lower 48 states. So that's something you need to talk about with your doctor. The other thing that's been approved about these vaccines has been that they are more potent. That is, they give better. immunity to protect us against these specific types. And these newer vaccines give that. So those are the ones you should aim for, which ones you should specifically get. You can read about them on the CDC site. The last time I checked, which was about a month ago, the CD site was still accurate about that. But you should, of course, check with your physician and get her or his advice about which you should get. Something you kind of waved at, pneumonia is a confusing descriptor because it is any infectious disease that inflames the tiny air sacs in your lungs. And although it's commonly caused by the family of bacteria you described, it can also be caused by viruses like COVID or fungal infections, things that would in no way be impacted by that specific vaccine. That's right. Pneumonia is a generic term for involvement in those little teeny air sacs we have where air exchange takes place with our blood. So any infection that involves those air sacs, they're called alveoli.

is called pneumonia. If you have infection in the tubes that lead to those air sacs, but not those air sacs, we call that bronchitis. So that's a distinction that you hear about, but those are just descriptive terms, as you pointed out, Brian, of the anatomy of where the infection takes place. The specific cause of bronchitis are causes of bronchitis, the specific causes of pneumonia, or the specific causes of bronchal pneumonia, meaning having both bronchitis and pneumonia. There are myriad causes. It turns out that the bacteria we were talking about with Janice's question, it turns out the bacteria that is really common to cause pneumonia. and can cause bronchitis, of course, but causes pneumonia is streptococcus pneumonia. So that's, it really gives us a lot of protection against a really common cause of really serious pneumonia. I should add that it also gives really good protection against that bacterium getting in our bloodstream causing sepsis. It gives us really good protection against that bacterium going anywhere in our body. And it has a predilection for going to the brain, the lining of the brain, called the meninges. So it's a very common cause of bacterial meningitis. And then this vaccine protects against all of those things. And earlier I mentioned very young children. It's a very common cause of ear infections. pneumonia, bronchitis, and meningitis. So it offers tremendous protection against very young children. So terribly important for children and infants. I think you have anticipated the part two of Janice's question. She writes, his pneumonia, her partner's pneumonia, appears to have been caused by bacteria released during a dental appointment. Would the pneumonia vaccine have likely prevented his getting ill in this way? Streptococcus pneumonia can live in the mouth. And so with a dental procedure, it's possible that aspiration takes place. Aspiration, meaning that the bacteria in the oral cavity gets down into the airways. So the answer is yes, it's possible, but there are lots and lots of bacteria that live in the oral cavity. And so it could have been another one that the, quote, pneumonia vaccine would not have protected against. So no guarantees with that, but it is possible that from a dental procedure that would occur.

All right. Slow morning on the phone lines, Dr. Sportsberg. I think we're all shaking out the cobwebs from the holiday weekend. I wanted to touch on one more news item before we let you go. Last week, there was a big study on records from the Veterans Administration for 2.5 million adults in total. Looking at the question of whether there's a higher risk of adverse impacts for people getting both the influenza vaccine and the COVID vaccine. on the same day. And for the adverse impacts that they measured, which were not, do you feel bad, but like, do you need to get medical care? The answer was no. No worse risk of adverse impacts from getting both vaccines on the same day. How significant a finding is that does it change anything about how we do vaccination campaigns? Sure. This was an important study. It showed exactly what you described. The reason it's important is because over the decades, we've learned that if you combine vaccines, people are more likely to get them. Let me be more specific with this COVID and the influenza vaccine combined. People are more likely to do one and done kind of shopping. They'll go in, get both of them go on with their lives. If you go in and get one, we find that people often don't go in and get the other. So that's why it's really logistically important to do this because it assures that more people are going to have the protection they need from the vaccines. What has made people reluctant to do that, is that they're concerned that they're going to have more serious side effects. If you have side effects from one and then another shot, and then you get the other shot at the same time, it'll be different arms. You're going to get side effects from that, and so you'll have more side effects. And this study showed, as you pointed out, in terms of more serious side effects, more

side effects that lasted longer and were a little more severe, again, not dangerous. It didn't show a difference. So that means you could go in and do that. It means taking less time off work to go in twice. Or if you're taking care of children at home, it means not having to find somebody twice to take care of your children while you go and get protected. So that's where it's really important. One study is great to see. It'll be nice to see more studies like this, demonstrating that efficacy. But it could mean that the vaccine will be approved to be given with the COVID vaccine together in the fall, which would be really convenient for people. Would we expect that to be generalizable to the the mRNA influenza vaccine we discussed earlier? Sure, absolutely. You know, the vaccines that combine vaccines are not new. They've been around for many, many, many decades, MMNR, mumps, measles, and rebella. Older than that, DTAPE, diphtheria, tetanus, pertussis, whooping cough. So we... We've been giving those vaccines for a long time. We've been giving the MMNR plus chicken pox altogether. So there's lots of experience giving multiple vaccines at the same time in the same shot, much less two different arms. All right. Dr. Schwarzberg, we'll leave it there for this week. Thank you so much for spending another Monday with us. You're welcome. Thank you for asking me. Dr. John Swartzberg is Clinical Professor Emeritus of Infectious Diseases at UC Berkeley School of Public Health. He joins us most Mondays after 730 news headlines to go over new developments in the world of infectious disease. If you want to send in a question for next week, email Corona Calls at KPFA.org. That does it for Upfront this morning. We are weekdays at 7 a.m. We post information about our topics and guests at KPFA.org. Our producer is Kimya Akbri. Our engineer is Kirsten Thomas. My name is Brian Edwards Teakert. Thanks as well to Max Pringle for the news headlines. Remember if you're incarcerated and postal mail is your easiest means of communication. You can send a letter to Upfront, KPFA, 1929 Martin Luther King Jr. Way, Berkeley, California, 94704. Stay up. Stay tuned. Law and disorder is coming your way in two minutes at eight.

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