In this episode of A Moment in Health, Dr. Ashish Jha highlights a troubling new data point: premature mortality among Americans ages 18 to 64 rose by 27.2% between 2012 and 2022, driven largely by opioid overdoses, early cardiovascular disease, violence, and the early COVID-19 years. He reviews a new Nature study showing that COVID-19 mRNA vaccines may boost the effectiveness of cancer immunotherapy, finding that patients who received an mRNA vaccine within 100 days of starting treatment were twice as likely to be alive three years later, likely due to broad immune activation. Dr. Demetre Daskalakis, former director of the CDC's National Center for Immunization and Respiratory, joins to discuss where Americans can turn for reliable, evidence-based public health information at a time when federal guidance has become less consistent.

Dr. Jha discusses:

• Racial Disparities in Premature Mortality and Unrealized Medicare Benefits Across US States — JAMA Health Forum
• SARS-CoV-2 mRNA vaccines sensitize tumours to immune checkpoint blockade — Nature

About the Guest

Dr. Demetre Daskalakis served as the director of the CDC's National Center for Immunization and Respiratory Diseases (NCIRD) from 2023 to 2025. He also previously served as the director of the CDC's Division of HIV Prevention and Deputy Coordinator for the National Mpox Response at the White House.

About the Host

Dr. Ashish K. Jha is the dean of the Brown University School of Public Health.

Music by Katherine Beggs, additional music by Lulu West and Maya Polsky

Hey everybody. Ashish Jha here from a rainy and cold Providence, Rhode Island. Coming back at you for another episode of a moment in health, the podcast where we talk about a data point, discuss a study, answer a question. Let's get to the data point. The data point is 27.2% 27% that's the increase in premature mortality in the US between 2012 and 2022 that number comes to us from colleague Irene Papa Nicholas. We've heard from her before. She looked at Americans dying prematurely between the ages of 18 and 64 and found that there was a 27% increase, 27.2% to be specific, increase in premature mortality rates between 18 and 64 year old folks in America during that decade. Papers out in JAMA Health Forum and a couple of key things to understand, Mississippi and West Virginia had the highest mortality rates. Last point I'll make about this is when you look at our life expectancy differences between us and let's say, European countries, especially western and northern European countries, large part of the reason we have lower life expectancy is because of all of the premature mortality that we have from a variety of factors. Opioids obviously a major factor, premature cardiovascular disease, car accidents, gun violence, there's a whole range of things. And what Irene and colleagues find is that that number has gotten worse over that decade, driven a large part by opioids, but also because it picks up the first couple years of the covid pandemic, that's obviously contributing as well. So not great news, but that's your data point of the week.

All right, study of the week. The study of the week, comes from the October 22 2025 issue of the journal Nature, and it's entitled SARS covid to mRNA vaccines sensitize tumors to immune checkpoint blockade. All right, the science in this study is a little bit nerdy, and I might actually take a minute to get into it, but let me give you the headline, finding cancer patients who received mRNA covid vaccines within 100 days of starting immunotherapy, were twice as likely to be alive three years later compared to those who did not receive a vaccine. And it's not that these people were being protected against covid, is that they were less likely to die of cancer. Now, these are not vaccines that are targeting cancer, right? These are general covid vaccines. So what's going on. Why would a general covid vaccine possibly be helpful for immunotherapy? Here is the nerdy part of this that I think it's worth just taking a minute to talk about. So your immune system is constantly on the hunt for cancer cells in your body, and when it finds cancer cells, it destroys them. So how do cancers arise? Well, they arise because tumors basically create a micro environment around them that shuts the immune system off. They're what we call immunologically cold. Now, immune checkpoint inhibitors, these are this new class of immunologic drugs activate your immune system and get your immune system all revved up to go after cancer, but they're only effective in about 20 to 40% of people because the cancer cells have gotten really smart about shutting off the immune system locally. Give somebody a covid vaccine, and their entire immune system revs up everywhere. Obviously, the primary effect is building antibodies and T cells against covid, but there's a general immunologic activation. And what that means is that then these immune modulators, these new drugs are just end up working far more effectively. It's a very interesting scientific analysis that essentially shows

that vaccines, mRNA vaccines, probably almost any mRNA vaccine, likely has enough benefit in terms of turning on your immune system that it will allow other anti cancer drugs to work much more effectively. So this study is not definitive. It doesn't kind of nail it. It's not a randomized trial, but it is a combination of both really careful basic science work and a bunch of really carefully done observational data that is highly suggested that this is where we're going to go, and we will need randomized trials to see if this really bears out.

All right. And now for the question of the week, and for the question of the week, I have a very special guest, Dr Demetre Daskalakis, who recently stepped down from the CDC as the director of the Center for Immunization and Respiratory respiratory diseases. I met him when he was running the mpox response at the White House. And so I've known Demetre now for several years. And Demetre, thanks so much for being on. Thank you so much. Ashish, good to see you. Good to see you. All right. So here's my question for you, my friend. My question for you is, you know, information which is the lifeblood of public health. We've typically gone to the CDC for critical public health information, that source of reliable information feels a lot less reliable right now. So the question for you is, what are you telling your friends and family about? Where can they go for high quality, reliable information about a range of public health issues?

Yeah. So thanks for the question. I think that my general answer is you have to go a layer below the CDC. I think that that's a really good place to start. And so that, for me, means a couple of things for individuals who are lucky enough to have clinicians who look after them, I think most of the issues around public health that actually impact personal health are great things to discuss with your physician or your clinician, whoever they are, in the event that you don't have such a person in your life, which unfortunately may become a more common event with some changes that may happen in insurance, I think that the next answer is local public health department, and so I sort of look for truth in layers. So my provider, the person who knows me and who knows my family and friends, they're the first hit in the circumstance where you don't have such a thing, or you'd like a different point of view. I think that other places that you can trust are your local health departments, starting with the state and then going deeper, closer to where you live. If you are looking for Vaccine Information today, I would say that a really good place to look is Sid wrap. So this is the University of Minnesota's work, and they, I think, have more information than you may ever need. But if you really want to do a deep dive, they've done a really good job of approximating what CDC would normally do. The hard part is distinguishing signal and noise. Some of the material that's up on CDC is great, like I've been looking at the measles information, that looks great. I wouldn't necessarily trust what I see about vaccines or vaccine safety. Wow.

So the good news is, there are still good sources of information out there. The bad news is, it's gotten a lot more fragmented. It's not quite as easy, and obviously, even if you have a regular provider, not always easy to get in and get information from them. But that's a great place to start. You're right. I do want to emphasize Sid wrap a little bit for those of you don't know, University of Minnesota. Mike Osterholm, who's been a fantastic source of very, very good information. Well, we're also seeing a little bit. I just wonder if you can reflect on this other people. Caitlin jet Lina has a

next person I was going to talk about. There

are these other sources. I know Caitlin. I know her stuff. I read it. I think it's really high quality. But how do you advise people sorting out newsletters other areas, and how do they sort out what's good and what's less good?

Yeah, I think, I think that this is one of those moments in public health. We always try to sort of discern signal from noise. And now, unfortunately, we've transmitted that to real life people to have to figure out a little bit of what the signal is from the noise. And so I think, I think sources like Caitlin, your local epidemiologist, is great, but I think I go back to sort of focusing on places that you could historically trust. And so thinking about your again, your own doctor, the organizations that represent those doctors, sometimes that's more information than the average human wants to know, but I think that the American Academy of Pediatrics is doing a fantastic job talking about what pediatricians need to know and what parents need to know. I think ACOG is doing a great job for pregnant people to make sure that they know what they need to know, and again, to differentiate what is definitely noise around things like Tylenol from signal. So I think it's the clinician, your local health department, your state health department. And if you want a deeper dive, look at places like Sid drop. Look at places like your local epidemiologist, and then also the organizations that we have trusted for decades, even if they're people who are trying to make you feel like you should trust them less. Awesome. Okay.

Dimitri, that was very helpful. So a range of options. You can do a little triangulation across those you'll find a lot of consistency, but it is while information has gotten a little less streamlined, a little more fragmented, what you've offered is a lot of very concrete advice about information, where people can get reliable information. Thank you so much for joining me. So much for joining me. That was awesome. Really appreciate it. Thanks for having me.

And there you have it, another episode of a moment in health where we talked about one data point 27.2% that's the increase in premature mortality in the US between 2012 and 2022 new study out in JAMA Health Forum, we talked about one study, the SARS covid Two, mRNA vaccines, sensitizing tumors to immune checkpoint blockade therapies. Really exciting study that shows that mRNA vaccines against covid generally ramp up your immune system such that. Right? These new class of drugs are just end up being far more effective. And then, last but not least, we heard from Demetre Daskalakis, who recently stepped down from the CDC as a director for center for Immunization and Respiratory diseases. These are the folks who think about vaccines and flu and covid and RSV and all those things. The question I asked him was, what are you telling your friends and family about where they can get reliable health information right now, given how uneven the information from CDC is, and he did a great job, I think he laid out that first, you wanna talk to people you know and trust, clinicians, if you have one, if you have a doctor, if you have a nurse practitioner, or somebody you have a relationship with, go there first. If you don't or it's not easy. Think about local public health departments. Start with your state health department. Drill down to local and county health departments. Look at physician groups such as the American Academy of Pediatrics or the American Academy of Family practitioners, or ACOG American College of Obstetrics and Gynecology, for if you're a pregnant woman, what kind of advice you would get. And then there are others, of course, for Vaccine Information, there's something called sidrap at the University of Minnesota. There are good sources standing up at a time where the CDC is falling down on the job. And I thought Dimitris discussion of that was very, very useful. All right. Thanks so much for listening, everybody. And I will see you

all back in a week for another episode of a moment of health where we're gonna, you know what we're going to do. We talk about data point, a study, answer a question. Have a great week. Everyone. You.