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Category: Public Health and Medicine
Tags: Biomedical AdvancesHIV PreventionHIV ResearchImplementation SciencePublic Health
Entities: Centers for Disease Control and PreventionDr. Jay BadachariDr. Jerry DonnenbergLenneapirNational Institutes of HealthPEPPrEPRyan White
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Hello and welcome to the director's
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desk, the podcast where we spotlight the groundbreaking work of the National Institutes of Health and the remarkable individuals driving innovation in biomedical research and public health. I'm Dr.
Dr. Jay Badachari, the director of the NIH.
And today I am honored to be joined by Dr. Jerry Donnenberg, NIH
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Associate Director for AIDS Research. Uh Jerry, thank you for joining me today.
I've been looking forward to this conversation for a while now. >> That's great.
Me too. Excited to be here.
>> Okay. So, uh we're doing some exciting things at the NIH with HIV and I wanted to uh introduce you to the audience and
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just so we can tell that story, but first I'd love for folks to hear about your background because I when you told me about it, I found it so interesting. >> Oh, good.
Um well I'm a clinical psychologist by training but um when I left graduate school I ended up in um
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the Chicago area at Northwestern and became very clear to me that there was um some challenges before that I actually had um when I finished college I went and lived in San Francisco for a year and it was >> what roughly what time period? Yeah, it
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was 1987. >> 1987.
This is like the HIV epidemic is sort of taking off. Uh it's very very clear now that it is a virus that's transmitting specifically among particular populations, the the gay men in San Francisco or particular there were other
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populations as well. Right.
>> Right. And I was waitressing at the time and I a lot of people around me were talking about because I wasn't as much a part of the gay community, but I was around all these folks who were experiencing a lot of friend deaths and things like that.
And in the meantime,
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my brother's best friend um had AIDS and was slowly uh uh dying. And so it became really clear to me, I guess, at that time that I wanted to do something about that.
And I wasn't quite sure. So I got
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my degree in clinical psychology thinking that I can do something with mental health and I there was so much suffering and so forth and so that that period was really I mean I I was a medical student in the in the early 90s and um I remember one of the sort of
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formative things that happened to me was I was I was a it was a I was doing a month on the wards >> in Stanford Hospital in in in the ICU and it was filled with dying HIV patients. There was no treatment then that was effective and a and so many young especially young men um were
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coming down with this disease that looked like a death sentence >> and it was really it was really devastating. We lost an entire generation of folks who and mostly gay men at that time but lots of women and injection drug use was a big uh
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transmitter also of the virus. And >> that's still that's still the case, right?
still the case, but it's it's less often the case that it varies across the world where what's the primary transmission mode of transmission >> different in the US than in the US
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though they the um um uh it's it's still that same kind of epidemiology we had in 1980s is still kind of the same epidemiology but in the rest of the world there's some differences. >> Yeah, I don't know that it's the same with injection drug use now.
Here in the
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US, it's a lot of um sex between two people um and primarily men who have sex with men, although we're seeing an increase in heterosexual activity. Just recent CDC data said 20 like one out of
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four transmissions were among heterosexuals. So, and 23% were women.
So, we're we are seeing a different difference in the the shift of who's getting most and about 18% were adolesccents, 55% were less than 35
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years old. So we are really it's, you know, as you would expect with an epidemic, it's it's entering the the broader population, which makes it >> so essential to continue to focus on it, right?
>> Yeah. Um although we're going to talk about opportunities to actually maybe
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maybe completely change it for the better um in just but we're going to get to that. Uh why still let's go back to your story.
um late 80s >> late 80s it was very hard to be in San Francisco at that time and I remember
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just being very sad and you know um and a little bit scared because even though we were studying it we didn't really exactly know how it was transmitted when I was there and um we sort of had ideas and and we were being told that it can't
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be transmitted through saliva and all these things But I think there was just a trepidation across the board. And >> of course there was like the u the blood supply there was a big controversy over even just testing the blood supply, >> right?
>> Um
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>> and that led to Ryan White and the whole Ryan White program which has been unbelievable. And so >> and now now the blood supply is is tested routinely which is which is great but back but back then not so much.
>> No. And it and it it sort of took Ryan White and some other folks to u acquire
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the infection to realize oh the blood supply could be you know damaged and >> but tell Ryan White story just so folks know you may not know. >> Well he was he re I think he was a hemophiliac and he received a blood transfusion and he acquired HIV.
>> He was a a child.
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>> He was a ch I think maybe he was eight at the time or nine. I can't remember now.
But then no one like he wasn't wanted back at school. Everyone was afraid to be near him.
They didn't want to play with him. And his mom became an enormous advocate.
And he ultimately
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passed away obviously. But he launched, we now have this Ryan White program that provides, you know, special med guaranteed medical care services for people with HIV because he they fought the good fight, you know, for many of
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many of us. >> So, um, let's fast forward in time.
It's it's the mid 1990s and there's a huge breakthrough of drugs that actually prevent someone who is HIV infected from developing AIDS. AIDS is the full-blown
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manifestation the all the all the terrible dise illnesses that lead to people dying. HIV is is the virus and sometimes there's years between >> getting infected.
Um, now you have a set of drugs available in the mid1 1990s
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that actually stops patients who have HIV from getting AIDS. >> Correct.
And actually in some cases turns it back around. I saw people who we thought were never going to make it actually make an incredible recovery.
And there are many stories of people who
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put their their lives in order assuming they were going to die and quit their jobs and decided they were going to do other things for the you know the last remaining months and then there was this huge turnaround and they survived. And now of course we see that people can
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live almost a completely normal lifespan with as long as they have access to care and to treatment and to these medications that you're talking about. >> Right.
And I remember uh again just going back to my experience back then uh was I was in med school for a long time because I did this crazy path. Um but uh
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the same wards that have been filled with dying HIV HIV patients in the early 90s the mid 90s like 1996 97 they're empty. It was amazing >> that that's I mean I'm not a physician but that was what I knew to be true like
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they and some of them got converted to be other you know wards for other kinds of illnesses cuz and it was crazy because during the height of the epidemic people we didn't have enough space for all the people who were um dying and who were in the hospital and
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so you had these crazy setups with people in hallways and and then all of a sudden these these you know places are empty. It was really a miracle.
That's what it felt like at the time. >> I bet.
>> And um so you're you're you do clinical psychology. You decide you're going to
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devote your life to uh helping people through this epidemic >> and I you know I was working with children and adolescence most really adolesccents and families and it just became clear that a lot of adolescence
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were engaging in risky sexual activity. So for me I was like that's a you're you're you know put you're putting yourself at risk by doing that.
And there was so what I could see was there were so many reasons why that was happening right um poverty
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uh structural factors crime you know you're in these areas where you know there are so many issues on the table that in some cases sexual activity was a was a way to earn money you know u if
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you're a sex worker those that sort of stuff and so um from my perspective, I really wanted to prevent sexually transmitted infections of which HIV is one. But with young people, even if they get infected, you're not going to see it for 10 years, right?
So, at the stage
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that I was working at, I had to sort of try to intervene and get folks to reduce their high-risisk test whether it was through condom use or through learning how to negotiate relationships, be assertive in their communication with
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with their partners. um express themselves.
Uh so we we talked a lot about sort of how to communicate and how you know what's a healthy relationship, what's not a healthy relationship. And so I was doing all of that and I got you
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know I was really fortunate I got a lot of funding from NIH to to do that you know do that work and um did a lot of it in Chicago. >> You became a professor.
>> I did. So I started out at Northwestern for five years and then because I was
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doing a lot of prevention, there was a there was a whole group of folks doing prevention at the University of Illinois Chicago and it was such a good fit for what I you know the populations I wanted to to work with. And so I moved over to the University of Illinois and I w I
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went gung-ho in my research program. And so just for the the uh folks at home, like the the research program, it's it's not like you're trying to sit in the lab and try to find uh new drugs or something like you're you're trying to figure out how can you take what's
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there, the tools we have and then help people who are at risk from these conditions to to to use those resources uh >> and to change behavior. Right?
Early on, we thought that if you just gave people
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the knowledge of what they had to do, they would do it. But I think we all know we, you know, a lot of things influence our behavior, right?
Our motivation in the minute, in the moment. And so we worked a lot on behavior change.
And so, but interestingly to
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what you say, I have done things like develop interventions, adapt interventions that already exist because there's really good things out there and but we know that, you know, in order to be most effective, they have to fit the population that you're working
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with. They have to be sort of tailored and the context.
And so, I did a lot of that. Did a lot of testing randomized trials.
>> You're not forcing people to do this. what you're saying is like how do how do you work with people so that you know it fits their goals?
They so so that the
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the kind of knowledge that you're trying to tell them about how to how to avoid having this these deadly infections happen um can fit within the goals that the people themselves have. It's not a >> right.
I mean, everyone wants to survive. Everyone wants to live, right?
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And no one wants to be unhealthy, >> right? >> And everyone wants to live a healthy lifestyle or at least feel healthy.
And so we could help them see that what are the strategies that you can use that will keep you healthy and what are the triggers that get in your way, right?
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And so we would have things like let's think about the people, places, and situations that trigger you to go do drugs to go, you know, if or maybe you're really sad and you're you so you go and you drink because it'll make you feel better. Getting them to see that
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connection and then also helping them to see that how they think about things affects how they feel and then how they behave. And if you and that if you can >> cognitive behavior >> behavioral theory, right?
Okay. And if you can change >> you haven't been paying attention, Jerry.
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>> Thank you. If they if you change the way someone thinks about something, you can change how they feel and then how they behave.
So we did a lot of that. That was my mental health kind of coming into the HIV.
>> But then there's there's also folks who already have HIV that now these drugs
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are available. You got to remember to take them.
You if if there's side effects, you have to figure out you can go to your doctor. I mean a lot of that is also part of the uh the sort of like the uh the scope of what you have to do to actually make the make address the the pandemic right
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>> and we we think about the continuum of prevention and care right so first if you get you got to get tested so you know your status then if you're negative there's a whole bunch of things you could do to stay negative but if you're positive then you move in like we got to get them linked to care then we got to
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get them to stay in care and get the medication and we got to retain maintain them in care and then we want to make sure that they're taking their medication as prescribed. So they their viral load is suppressed.
And if you think of the virus as sort of we don't
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have a cure obviously, but if you take your medication the way it's prescribed, the virus goes to sleep in your body. And then if you stop taking your medication, it wakes up and it does all its things.
And you were mentioning other illnesses like opportunistic infections. Many people at that time it
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wasn't so much that the virus killed them but when you have no immune system you're so vulnerable to anything that comes your way and that's we we would see a lot of people die of these un you know opportunistic infections. >> Those new drugs come out in mid '90s um now you with those new drugs and further
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developments of those drugs over time it became possible to have basically almost zero virus. whole statement that the the the tagline was U equals U.
What what does what's U equals U mean? >> I'm so glad you asked me that.
It means um undetectable means untransmissible.
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That means if your viral load is so asleep you can't even detect it, then you cannot transmit the virus to another person. And of course for years we worried about zero discord in couples, meaning one person has HIV, the other person doesn't.
and how do they
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negotiate th that relationship especially if they want to have children right and so with you equals you we discovered okay if we can keep someone completely virally suppressed they won't transmit it to their partner >> so so we have we have a technology if
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it's used right that uh that someone with HIV can live a full life and also if they're taking the drugs appropriately um not have any risk of transmitting it to other Correct. >> And and now uh but there's also but
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people could still get HIV. I mean like I think the latest stats I saw something like 39,000 people in 2023 got HIV >> in the United States.
>> In the United States alone, right? And of course many many many more outside the United States, >> right?
>> Um this whole Okay. So just if I'm going
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to characterize your your field, it's some it's you're you're applying psychology to give people tools to interact with their environment, their their the way they think about things. Um and also the technologies are available to to give them the tools to stay healthy in the face of this this of
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these deadly threats. Um, >> yes, I'd say all of that is true, but I think what's hard and we I think we have to recognize that that's for sort of someone where everything in their environment is perfect, right?
And that is really hard. If you're poor and you
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know, you have to work two jobs, it might be hard to take your medication. It's it's stigmatizing to take the medication.
people, you know, you don't want other people to see you doing that. Or, you know, your family may not be so supportive, so you don't want them to see you doing it.
Um, and perhaps you
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live uh in a place that's really crowded and you don't have space for yourself. Or you you you know, you have to decide, are you going to put food on the table or not?
So, you may engage in certain behaviors that are really hard or there's tons of trauma, right, from
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different things. So trauma can get in the way of all this stuff.
So I think, you know, maybe at first we we it's a little like, well, if we just tell them to take it and if they knew that they just could take it and be virally suppressed, it everything would be okay. But I think we didn't necessarily
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recognize all the context factors that could interfere with that. Which is why it's been so important to have new formulations, new ways of delivery because people have to fit what they need to take to choice.
>> For some people, it's easy to remember
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to take a pill every day. Some people it's not.
>> Correct. >> Right.
So like an injection might be better than the pill. For some people it depends on you.
depends on who who you are the the the the your life circumstance all of that that's like u I think it has go you said you taught me taught me this goes by the name of implementation science right there's a
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science of understanding the context of people's lives >> uh and how it inter interacts with decisions that they make and and uh uh on the resources that are available so it's not just that we have this amazing technology that that can help you live a
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long time even if you have HIV it's how do you make it so that's available really available and for people in in the way they live in the way they feel in the circumstances the way they are to have to have it happen right >> yes that's I think that's a great summary and we know there are health disparities right we know that there are
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people who aren't getting access to these great medications and I do want to say NIH has invested in incredible ways to bring us to this point we are only here because of the the many investments
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that NIH has done And now and and and with NIH being mostly biomed now we get an opportunity to shift a little bit because we have these tools. Okay, let's understand what we need to do to get these to the people who need
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it the most. >> Okay.
So I want to leap forward. So okay we we went mid 90s we have this amazing development.
They start being essentially like HIV becomes a a chronic disease chronic condition. Right.
Right. Um, lots of folks living with HIV, U equals U means that they actually if
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they're taking their meds correctly, many of them they pose no risk to anybody. >> That's true.
But I will say 65% of people with HIV in the US are not virally suppressed and not necessarily because it's their fault for whatever reason, right? Could be structural.
>> It's still a problem. It's not hasn't
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gone away. >> Um, a few years later there there became there was a new technology with the name of PREP, right?
And so prep prep is for people who have not had HIV, >> right? >> Uh they they take a drug, they take a pill with usually it's once when first
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prep came out, it was like you had to take a whole bunch of pills or a few pills >> every day. You had to take a pill >> every day.
And if if you are exposed to HIV, you injection happens. It could even be like you're a doctor and you get stuck with a with an HIV infected needle, you have no risk of getting HIV.
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Correct. PREP stops you from getting HIV if you're uninfected with HIV.
You take PrEP and you have no risk of getting HIV. >> That is true.
Um but it and and there are different formulations of prep, right? So be
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recognizing that not everyone wants to take a pill every single day. >> It's easy to forget.
>> I mean I mean >> even my antibiotics if I'm to 10day course if I if I forget my last day I'm like oh you know >> I won't tell your doctor. Don't worry, Jerry.
Fantastic. >> Thank you.
>> Um, no, I I I mean, honestly, look, it
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just it it's u it's often difficult to remember, especially after you've gotten better, especially if it's for something where you're you might get it. It's not actually addressing something that you have, right?
If if I'm really really sick, I'll remember to take the pill, but if I'm not that sick, if I, in fact,
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I'm not sick at all. I just taking this to prevent my getting something.
And it's also hard like that, you know, one of the things the re the research has struggled with is why would you take it if you're not engaged in >> risky behavior? >> Yeah.
So, does that mean you do it on
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demand? Do you do it and there's been a lot of controversy?
Um, fortunately there are some new formulations that say if you take it, you've got like it it'll protect you within two hours, which is a really powerful change from, you know,
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it it's also prep is much more forgiving of men than of women. Women have to really adhere for it to protect, whereas men it it can be a little bit less um stringent.
Okay. So, let's let's focus
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on this and I want to now jump again forward in time to last year. All right.
Um, last year, uh, I saw in Science magazine, um, their their breakthrough of the year, science breakthrough of the year was a was a was a essentially a
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version of prep that that's injectable. And if you inject it, you get one injection and for six months, the, you know, the FDA just approved it for this purpose.
Mhm. >> Um, you have zero risk of developing HIV
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even even if you're exposed to it. >> 6 months.
It might even be a year, Jerry, from understanding. >> Well, in Yes.
Well, they're moving to that for sure. And right now, >> one injection.
>> I know. For six months, >> it's a game changer.
>> It can't. >> So, why Okay, explain why that's such an
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important thing because like you I think you've already set this groundwork for it, but just just so I understand. So, because you already had the pill, >> right?
Why Why do you need any? Yeah.
because there are so many barriers to taking a pill every day and like we've talked about and I think for many people
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who would you know benefit from an injection you do it once and you don't have to think about it again you don't have to worry about the stigma of other people seeing you and that came out a lot the the recent international aid society conference that there's that people really prefer it because you know
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it's not as easy to uh you don't forget yet, you know, you go once. It is a there is a startup period, but you you can avoid the stigma of people around you looking at you taking it taking pills and wondering what you're doing.
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Um, there are some populations who are very used to taking injections for birth control. So, for them, you know, it's kind of not that hard to just have this as an injectable.
And I think that um it
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it's a gamecher because what we saw with prep and we didn't do very well in oral prep is we didn't understand all the barriers to taking the medicine, getting the medicine, storing the medicine. There were we and we didn't anticipate
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that. So it was kind of a failure in many ways.
There are very you know relative to what we wanted to see there are very few people on prep. So if people don't have to have those specific challenges that's it can be a game changer.
That
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was my reaction too when I saw the the drug called Lenneapir, right? Um and uh the key thing that that's so good about it is because it can helps people potentially depending on your life circumstances.
That's the exact right way to prevent uh the risk of getting
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HIV when you are in a situation where like you are going to be exposed to HIV most likely. Well, that's a good point.
And I think what happens is if people, let's say you're not in, you don't anticipate something and then you go to a bar or you meet someone and you're going to end up having uh sexual
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activity and you weren't taking PrEP. There is also a medication called PEP that you can take afterwards.
And all of these are sort of part of the same class as I understand of medications, but um you know, better to prevent than post.
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But there's postexposure prophylaxis, there's preexposure prophylaxis, but if you take an injection, you don't really have to worry about it dayto day. You just say, "Okay, I'm safe for six months." And now you're safe from HIV.
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That doesn't mean you're safe from ever sexually transmitted. >> One problem at a time, Jerry.
One problem at a time. Okay.
So, um Okay. So, now um now we have this toolkit.
Uh it seems like we can we can stop someone who has HIV from dying prematurely
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t from spreading the disease at all. We have a a suite of tools that prevents people who are at high risk of being exposed to HIV from contracting HIV even if they are exposed.
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to me that that that looks like a toolkit that that that will actually help us get rid of HIV altogether if we just deploy it properly. >> I think you are right on.
I mean, we can't get rid of it because it's still for people with it, but I think we can
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end it as a public health threat, right? We can stop it from being transmitted to others.
If we can if we can get this right, we can end the epidemic. And now of course President Trump in 2019 gave a speech I think it was state of union
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speech where he committed the country to ending the HIV epidemic in 10 years. Now I remember that speech uh I remember because it was struck me because I've been tracking I've actually published on HIV once once time.
So um um and uh it struck me as like a very ambitious goal.
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I mean I of and I was like this is this is great but it felt like at the time in 2019 that we didn't have the whole toolkit we needed to do it. Uh now we have the toolkit don't we?
>> I think we have the toolkit. There are
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people who will say we will never really get it until there's a cure. But I believe we could get pretty darn close and at the very least we could get it so it's not a public health threat.
>> So why is there any reason to wait? Why
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don't we just do this? Why don't we just really commit to ending the HIV epidemic, actually doing it with the toolkit we have now.
>> I think we got to do our best. I think we should and
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>> we owe it to the p the the the the the public at large to the people who would get HIV if we didn't do it if we didn't actually implement the toolkit. But what's missing like what's what's >> now we have to figure out how to do it.
We got to do it better this time. Right >> now you're you're the head of office of
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a or the the was the deputy director of the office. I I was >> the director of the office of a research director.
So now that tell me about that. What what is that?
So we our office coordinates all of the HIV AIDS research across the entire NIH meaning
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we get an our allocation from Congress and we identify within our strategic plan where the funds are most appropriate to go based on the highest priority. So this is not a theoretical question about what what's missing, what should we do next for for you.
This is
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your job is to help help me understand, help the public understand where should we put our resource now because it seems to me let's put it on the the thing that actually ends the epidemic, right? >> Yes.
>> So what do we where how do we do that? How are you thinking about this?
>> I think what we want to do is ramp up
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implementation science. And I didn't mention earlier, but I founded and directed a center for implementation science back at the University of Illinois because I had been developing and testing all these interventions, but when funding runs out, then they sit on a shelf and we aren't figuring out how
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to sustain that, right? So now is our opportunity to look at how are we going to get these tools to the people who most need them?
How are we going to give them the choice that they need? So if we if we can put a a thing an array of
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options in front of them and say which one's going to work for you and why and I and it may differ by population, right? It may be different for black women than it is for gay men and but that's what we have to understand.
It may be different in the south than it is
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in the east um of the United science in the sense right you have to understand the the needs of the local population. You have to work with public health uh who understand their communities much better than you know we might up here >> and we have to work with communities.
They know what they need and we have to
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work with health care providers because in many cases health care providers are not necessarily trained to ask questions that might be sensitive around drug use or sexual risk-taking. And these are opportunities for us to focus on the broader systems so that we can improve
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uptake that they can improve their processes for getting their patients or their people on board. We have to work with communities who have their hands on the pulse of what they need and they can tell us this is what we need and this is how you need to do it.
You know, it's
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funny because like you mentioned earlier about the NIH, like the DNA of the NIH is, you know, basic biomedical research, you know, lab lab work, >> but this is a science too. Like there's there's there's there's analytics, there's uh tracking data, there's like uh trying to understand um uh
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essentially populations at risk. You know, there's epidemiology involved.
There's all kinds of of scientific disciplines in order to do what you're suggesting we do. One of the ways I sometimes think about it, which I wonder what you think about this, is there's sort of the tension between internal
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validity and external validity, right? Internal validity is I think the more traditional gold standard where you just control every single thing about a research experiment.
So you are 100% confident that that result is exactly
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from that because you've controlled everything. But in the real world, we can't control everything.
So sometimes you have to sacrifice a little bit of that to say but what's how is it going to matter and how is it going to work here because this is the context that people are living in. They have
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co-orbidities. So like if you're going to do a study on cardiovascular disease and you're going to exclude everyone who has diabetes and obesity.
It's not going to >> Yeah. It works in your study but it doesn't work in the real world.
>> Exactly. >> Implementation science is about how to make things work in the real world.
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>> Exactly. >> And that's what we need here, isn't it?
Right. That's what I believe.
I believe we I I will say I think we continue to need discovery. Like one of the things we've talked about is some men these drugs are all used for the same thing, right?
Prevention and treatment. So if
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it doesn't work for prevention, it's not going to work for treatment. And and we're seeing a little bit of viral resistance right now.
>> We still need to do some basic science. >> So we still need to do basic science.
We still need, you know, therapeutics. We still need to understand that.
But I would agree that we have tools and our
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responsibility is to the people right now who could benefit from those and we aren't reaching everyone. That's a big key piece of implementation science.
Why aren't we reaching everyone? What are we missing?
So we can increase ri uh reach. We can increase adoption of these.
We
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can get you know people to come and or we go to them. That's a big one.
We can sustain. These are all research questions.
It's like you said, it's a science. It's not, you know, um it's not the same.
>> It it doesn't sound if you're just used
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to doing work with labs, it's it doesn't sound but it is scientific. There's rigor in understanding the populations who are uh who are at risk, rigor in uh understanding the constraints that prevent them from taking advantage of these amazing new technological advances
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that we have. Uh but if we do it right, let me just put this in the form of a question.
C can we actually achieve the goal of ending the HIV epidemic by the end of this decade? >> That's I hope so.
I'm going to I'm sure
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>> I think yes I'm actually I think we can too. I think I I'm you know I'm a the other part of me is like I should I promise >> Jerry Jerry Jerry Jerry we it's not it's it's a question of commitment right it's like when when um uh President Kennedy
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said we're going to reach the moon in a decade >> and yeah >> you had to start somewhere somewhere right >> and and because he he knew the technological tools were there just needed the the organ to organize a a research program if you will an
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implementation program, if you will, to actually achieve the goal, which seemed unachievable. That's what it feels like to me right now.
>> We have the technological tools we need. >> What we need is an organization and the implementation of it in a in a way so
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that we can actually move our society to to achieve this thing that which now seems unimaginable, but is actually possible. I think our partnerships with the other federal agencies are critical to this and the CDC hers I mean they're the
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implementers so we do the science and we say oh this really works this is evidence-based this is the best you know implementation strategy you can use and then we ask them to do it because it's not our place to do the the care or the
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treatment and so if as long as we continued to work and we worked beautifully across the federal agencies for the first and the epidemic initiative and I think we can definitely accomplish that. >> Well, thank you Jerry for your spending your time with me.
Um, and let's work
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together. I'm really looking forward to let's let's uh we can look back and say we really did this.
We we actually >> launched the program that ended the epidemic. Um >> I when I took this job last October, I said I want to be in the room when it happens.
>> Yeah. All right.
Well, thank you so
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much. >> Thank you so much.
Um, thank you for joining me on the director's desk. Uh, to our listeners, thank you for tuning in.
Uh, drop your comments in the chat as to what subjects we should cover. Please be sure to hit that like button and subscribe button for your preferred podcast platforms.
Until next time, I'm Dr. Jay Bodachari and this has been the
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director's desk.