Program: The repurcussions of RFK Jr's mRNA funding cut

Preeya Alexander: What's your preferred beverage, Liv? Do you like a little fruit juice or a soft drink?

Olivia Willis: I really try not to drink a lot of fruit juice and soft drink because of the sugar content. I don't mind a fruit juice from now and then, like a fresh orange juice or something. Soft drink, not a whole lot. What about you?

Preeya Alexander: I am the same. I am very aware of the sugar that gets put into drinks, and I have to admit, I'll occasionally have an artificially sweetened beverage and I like it, and I like a little soft drink, and I think I'm doing…

Olivia Willis: Like a diet one or a reduced sugar…?

Preeya Alexander: Yes, no sugar added, and I feel like I'm doing the right thing because I'm not having the sugar. But there's a recent study suggesting that that may not be the case, that people like me, who go, oh, I'll take the artificial sweetener instead of the sugar, are in fact still at risk of type 2 diabetes, and there have been headlines everywhere this week on it, and I think a lot of people are wondering; am I doing the right thing, and do I have to change my behaviours?

Olivia Willis: So it's no sugar and now no artificial sugar either. What do we have?

Preeya Alexander: I know. Well, that's coming up on the Health Report. I'm Preeya Alexander on Wurundjeri land.

Olivia Willis: And I'm Olivia Willis, also on Wurundjeri land.

Preeya Alexander: Also on the show, a new report suggests that a lot of young Australians are struggling with loneliness, and it does have impacts on health.

Olivia Willis: Women with gynaecological cancers are bringing their stories into university classrooms to help future doctors and nurses better understand the signs and symptoms. 

But first, in news this week, the US Department of Health and Human Services, which we know is led by RFK Jr, announced on Tuesday that it has cancelled nearly $500 million worth of grants and contracts for developing mRNA vaccines. So these vaccine development projects, there's 22 of them, they're being led by pharmaceutical companies like Pfizer and Moderna, and the projects are basically developing mRNA vaccines to prevent things like flu, COVID-19, H5N1 bird flu, which, at least in the case of bird flu, we know has caused widespread infections this year in animals, in poultry and cows mainly, but also now in humans. 

The US Health Department, they say the decision follows what they describe as a comprehensive review of mRNA related investments that kind of kicked off during the COVID-19 pandemic, and they have said that a few federally funded mRNA projects will keep going, basically because they're at the very end stage. But it's a pretty controversial decision and is something that has really dismayed a lot of scientists and global health experts in the US and around the world, because mRNA technology is of course considered to hold huge potential for treating and preventing all kinds of diseases, and were a really essential part of the response to Covid.

Preeya Alexander: I mean, this is RFK, who has previously said that mRNA vaccines, the Covid vaccine, is the deadliest vaccine ever made, that's a quote, and he has recently popped a video on Instagram saying, 'As the pandemic showed us, mRNA vaccines don't perform well against viruses that infect the upper respiratory tract,' completely ignoring the evidence for Covid vaccines. And these vaccines have saved millions and millions of lives globally. We know that they're a seatbelt for people if you get infected with Covid, particularly if you're high risk, so over 65, if you're pregnant, these vaccines do reduce your risk of severe disease, of going to hospital, of dying from Covid. There's a lot of research now that cements that. So this is a really problematic stance that puts science backwards, because it means that we're missing out on potential developments in the mRNA technology space, as you just said, you were talking about autoimmune diseases and cancer and, gosh, this is a real door-stopper, I guess, on science.

Olivia Willis: Absolutely. And I think thinking about its potential, there's been a lot of discussion about the role of mRNA vaccines for pandemic prevention efforts in the future. And a lot of experts responding to this announcement have said that reducing funding or cancelling these projects will undermine our ability, at least in the US, the ability to rapidly counter fast-moving pathogens and threats, and that's because mRNA vaccines, they can be developed at a much quicker speed than traditional vaccines can. So, unlike traditional vaccines, these take years often to develop and test, and mRNA shots can be made often within months and pretty quickly altered as the virus that they target changes. And instead of using a kind of weakened or inactivated form of the virus that it's targeting, an mRNA shot contains genetic instructions, delivers those to the body. They're basically instructions that tell the body to produce…

Preeya Alexander: A blueprint.

Olivia Willis: Exactly, a little fragment of the virus, which then sets the body's immune response off. So it kind of does the same thing, it trains the immune system to fight the virus, but it does so in a slightly different way.

Preeya Alexander: And I think if we had an influenza pandemic like Covid tomorrow, the way the traditional flu vaccine is made, Liv, is with chicken eggs, growing the virus inside chicken eggs, and if we needed mass production, relying on that system is just not feasible, it takes too long, and we're not going to be able to generate the numbers that we need, which is where you need the mRNA technology. So not investing in something really does impact preparedness for what is to come.

Olivia Willis: And this announcement, it comes in the context of earlier this year, the US Department of Health also revoked about $600 million in funding to Moderna, or a contract it had with Moderna which was around developing a vaccine against bird flu. And, as you say, RFK has been a long-time sceptic of vaccines, he's made a lot of changes since coming into office in January around reshaping policy related to vaccines, foods, medicines. Part of that overhaul of US policy has been recently firing a panel of vaccine experts which advised the government and replacing them with his own appointees. And in the first meeting of that new panel, they voted to ban a long-standing vaccine preservative, which is being targeted and discussed a lot by the anti-vaccine movement, despite having a really strong safety record, and RFK has also ordered a new study on the long-debunked link between vaccines and autism, and has changed recommendations around COVID-19 shots as well. So I guess this latest development comes in the context of some other pretty big changes to vaccines in the US. 

We should say that the health department there says it will favour other types of vaccines over mRNA ones, for example, whole-cell vaccines. So whole-cell vaccine technology, I think is more than 100 years old. In countries like Australia, whole-cell vaccines for whooping cough, for example, aren't used anymore because they tend to trigger stronger side effects and adverse reactions than newer technologies. But it seems like that's the direction they're going to be going with.

Preeya Alexander: Interesting time for science, and certainly in the US. 

In Australia, though, there have been some developments when it comes to PTSD treatment. And in 2023 Australia actually became the first country to reschedule MDMA, a psychoactive synthetic substance, from a prohibited substance to a controlled one for the treatment of PTSD. And there have just been clinical practice guidelines released for the appropriate use of MDMA to treat PTSD. It's been released for public consultation, and it's been developed by Monash University's Centre for Medicine Use and Safety and Neuromedicines Discovery Centre. This was fascinating, I found this a fascinating read. 

Olivia Willis: What's in there?

Preeya Alexander: There's a lot in there. But I think we need to start by acknowledging that PTSD is a very complex condition that can significantly impact people's quality of life, sleep, mood. It can cause hyper-vigilance, apathy. There are first-line approved therapies. So a lot of patients can benefit from therapies like trauma-focused CBT, cognitive processing therapy, EMDR, with specialised psychologists. There are pharmacotherapies like SSRIs and SNRIs, which can have some benefit in PTSD. The use of MDMA is really sub-specialised, and this guideline discusses the group that it might be for. So people aged 18 and over who've had PTSD, they've got moderate to severe symptoms, they've tried first-line therapies and failed.

Olivia Willis: A fairly substantial number though of people who try therapies, it doesn't work.

Preeya Alexander: So this guideline I think is to guide psychologists, psychiatrists, GPs, about who are the candidates that might benefit from this. What are the risks? Because there are side effects like nausea, headaches. But what we're talking about here is using MDMA. So it's not recreational, it's different, it's regulated, it's made in a lab…

Olivia Willis: And in a controlled setting.

Preeya Alexander: Yes, and that's the thing, it's in a controlled setting, and it's MDMA assisted psychotherapy. So the guideline is very clear that this is not about MDMA as a standalone therapy. It's alongside psychotherapy. But what's fascinating is it's using the MDMA to stimulate all the neurotransmitters, the noradrenaline, serotonin, dopamine, oxytocin, the kind of cuddle hormone as people know it, and so you get that increased empathy and connectedness, and then you have this psychotherapy alongside it. So someone works through their trauma and their feelings. 

There has been studies and research done in this space about, you know, is it an effective therapy? What are the potential harms? And certainly the Royal Australian and New Zealand College of Psychiatrists say there is limited and emerging evidence that this needs to be done in a controlled setting, and I think this will be a small subset of people and it's highly regulated, where authorised psychiatrists need to apply for all the paperwork to actually attain this therapy for their patients. 

Olivia Willis: So the guidelines are open for public consultation now, and presumably once they receive feedback they will then kind of formalise them.