The Health Curve

How to Save a Life: The Power of Harm Reduction for Drug Misuse - with Michael Gilbert, MPH at Harvard T.H. Chan School of Public Health

• Dr. Jason Arora • Season 1 • Episode 5

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For decades, drug misuse has been met with punishment, stigma, and criminalization—but these approaches haven’t stopped the crisis. Instead, they’ve led to more overdose deaths, more harm, and fewer people getting help. In the U.S., over 100,000 people die from drug overdoses each year, with opioids accounting for nearly 75% of those deaths. Synthetic opioids like fentanyl have fueled a dramatic rise in overdoses, yet many people struggling with drug misuse never receive medical or social support.

In this episode, we explore harm reduction, a science-backed approach that meets people where they are, reduces overdose deaths, and creates safer communities. From safe consumption sites to drug-checking programs, these strategies are becoming more visible in neighborhoods everywhere. But many people still don’t understand what harm reduction is—or why it works.

Joining us is Michael Gilbert, a Harvard-trained public health technologist specializing in behavioral epidemiology, pharmacovigilance, and harm reduction. Together, we break down the facts, the myths, and the real-world impact of harm reduction strategies. Whether you've seen overdose prevention tools in public spaces, heard about new community programs, or just want to know more, this conversation will give you the insights and evidence you need to understand and support this life-saving approach.

UNKNOWN:

Thank you.

SPEAKER_00:

Hello and welcome to The Health Curve. I'm your host Jason Aurora. Today we're going to be diving into a topic that's often misunderstood but increasingly relevant in communities around the world. Harm reduction for drug use. We're talking about opioids like heroin and fentanyl, stimulants like meth and cocaine, and synthetic drugs such as designer opioids and injectable substances. If you're familiar with naloxone distribution, needle exchanges, or supervised consumption sites, then you've encountered harm reduction strategies. But despite their presence in communities across the country and around the world, there's still a lot of confusion and stigma. Many people wonder, do these programs actually work? Are they helping society or are they simply enabling drug use? The reason this matters is stark. Every year, over 100,000 people in the US die from drug overdoses. And globally, an estimated 40 million people suffer from drug use disorders, though that number is likely much higher due to underreporting. It's clear that communities need a better understanding of harm reduction, what it is, how it works, and how we can all contribute to its success. In today's episode, we'll explore how harm reduction can prevent overdose deaths, how it can reduce disease transmission, and how it can improve public safety. To help guide us through this, I'm joined by Michael Gilbert, a public health technologist who specializes in behavioral epidemiology, pharmacovigilance, and harm reduction. Mike has worked on the front lines of harm reduction programs and has seen firsthand how they transform lives. So Mike, thank you for joining us. Tell us a bit about your background and how you got into harm reduction.

SPEAKER_01:

Sure. So I'm an epidemiologist by training, a public health technologist in practice. I started doing harm reduction back about 20 years ago, initially picking up discarded syringes along Alton Baker Park while I was an avid hobby fisherman while at University of Oregon. I brought sharps containers from a local clinic to pick up rigs and started to see a couple of the people who were using that same space as a place to use drugs out of sight of the rest of society. And through talking with them about their needs and understanding what I already knew about syringe access services, syringe disposal, communicable disease, transmission prevention, that kick-started now 20 years of direct service and research in the harm reduction world. I remember

SPEAKER_00:

when we met at the School of Public Health, you telling me about this and how this has become a real passion of yours. You've encountered this in your own community as well through friends, etc., if I have that right.

SPEAKER_01:

Yeah. Opioid overdose was the leading cause of death amongst my friends and community for many years, especially through the aughts as first pharmaceutical opioid use escalated, and then that translated or transitioned into illicitly manufactured fentanyl and other novel synthetic opioids. So I've lost friends, mentors, and other community members to the unnecessary elevated risks of drug use that could have been mitigated or that ultimately claimed their lives over time. It's a tragedy that persists.

SPEAKER_00:

And that's why we're talking about it because, you know, in some ways it's a very hot button topic. It's in politics, it's in everything else. But at the end of the day, we have scientifically backed strategies that do work. And I think the more people who know about them, the better it's going to be. So let's get into it. What is harm reduction and which drugs are we talking about? What types of drugs?

SPEAKER_01:

Sure. So writ large, I'd say harm reduction are strategies that have emerged and been developed by and for people who use drugs to optimize outcomes and reduce risks under hazardous and volatile conditions, especially around drugs. Generally, when we talk about harm reduction, people focus on stimulants, opioids, benzodiazepines. Alcohol has a strange sort of carve-out in this domain. There is alcohol harm reduction. We've all seen that. Anytime you're urged to drink responsibly during a Super Bowl ad, that is harm reduction messaging. It's not telling you not to drink. It's telling you how to do so in order to avoid the worst of the outcomes that might occur. But for my purposes, it's generally focused on stimulants, opioids, benzodiazepines, dissociatives, and other controlled substances.

SPEAKER_00:

And what are some of the versions of it? I mean, how does it work? It is what it says on the tin, right? It's harm reduction, but just paint a picture for us as to what that entails and how it works.

SPEAKER_01:

Sure. So, you know, in terms of what those strategies services are, that would include syringe services, syringe access and disposal. That would include the distribution of safer use supplies, especially around alternatives to injection as means to reduce the risks associated with specific routes of administration. That would include naloxone distribution, overdose education and response trainings, strategies for navigating medical legal systems and, you drug checking as well, just simple direct to consumer forensic technologies that help us to understand what's in people's baggies before it goes into their bodies or to determine whether or how or when, in what manner it might be used by the people who

SPEAKER_00:

have it. A lot of people seem to think that this is a crazy solution to be giving people drugs or enabling them to continue taking these drugs. Which doesn't fit the logic, right, when you look at it on the surface, but there is a scientific basis to harm reduction. There's been a lot of research in this space. So how does it work exactly and why does it work?

SPEAKER_01:

To be clear, there are components of harm reduction that would involve giving people drugs. That's generally referred to as safe supply. That's not something that we generally do here in the States. Safe supply would refer to insulating people from the volatility of the illicit market. This is most notably practiced in Switzerland and other parts of Western Europe and in Canada through extra legal means. But in general, in the States and in my own practice, we don't distribute drugs per se. distribute material resources to reduce the risks associated with the use of drugs and also informational supports to help people navigate those risks, to understand the sort of choice architecture that they have, and to avoid transmission or acquisition of infections or to experience an overdose. So what does harm reduction seek to do? It seeks to reduce the risks associated with drug use. It is focused on solutions for people who do use drugs. And we know that certain public policies make drugs more or less dangerous. Criminalization leads to interpersonal violence, incarceration, socioeconomic marginalization, alienation from medical care, and an inherent volatility in the supply of drugs. So not knowing the provenance and composition of the substances that one use can lead to any number of the sort of adverse outcomes that I had mentioned earlier. Our aim is to ensure that in this environment where there are sort of unforced errors leading to escalated risks that go sort of beyond the, you know, perhaps inherent risks associated with drugs, that we can help to mitigate those and help people to survive, thrive, and thrive. not, again, experience those injuries that they might otherwise encounter in the course of having non-medical drug use be part of their lives. Now, we know that people... use drugs in our society. This is a sort of a historical reality and a persistent fact. We understand that in the absence of a social order or other conditions that might reduce drug use, there will continue to be people who use drugs. And so long as there are people who use drugs, we want to make sure that they are not unnecessarily injured or don't cause unnecessary harm to others.

SPEAKER_00:

Yeah, and it's a bit of chicken and egg in that there are certain things that predispose people to drug misuse, and then drug misuse itself causes the secondary health impacts as well. So if we think about some examples that maybe not in the US, but in other countries, the distribution of specific drugs to replace kind of the street versions, which might not be as clean, maybe chopped up with other stuff and can lead to overdoses or death or sickness would be one example, right? And then things like needle exchanges, where as a result of using a needle exchange surface, you're going to reduce rates of HIV transmission, hepatitis, that sort of thing. So can you tell us a bit more about that? Like what kinds of secondary health impacts can some of these harm reduction techniques help with?

SPEAKER_01:

Sure. So let's talk about something that's very visible to many people, which is public drug use and public drug markets. We have opioid agonists that are used as treatments for substance use disorders, opioid use disorders specifically. We also have safer supply of pharmaceutical stimulants for people who need those to perform their activities of daily life and live the best and most thriving lives that they can. To the extent that substances are available to people through controlled supply chains, through, you know, of known quality and potency, that those are accessed not through illicit means, and that those can be consumed without sort of fear of incarceration or without prohibition. Just as we have safe places to consume alcohol, they're called bars, we have no equivalents for other drugs. And so there are sort of, I think, Conditions that are perceived as social disorder that derive from the criminalization of those drugs. And there are also knock-on effects around alienation from care. Can you tell your physician, another clinician, a social worker about drug use? And if so or if not, how does that impact the solutions or choices available to you to manage one's own well-being? In terms of the communicable disease side of things, distributing syringes specifically, say, It reduces the reuse of syringes. This means that even on an individual basis, this can help to reduce things like skin and soft tissue infections. I think one thing that people don't often realize is the risk and the cost of treating things like... vascular disease and myocardial infections that can be associated. So skin and soft tissue infections associated with injection drug use are quite complex, quite costly, and have a significant impact on people's wellness long-term. When it then comes to things like communication or transmission of HIV, hepatitis C, we know that reducing sharing of syringes can eliminate a vector of transmission there. We also know that Reduction of the prevalence of those communicable diseases amongst people who use drugs reduces the risks to all of society. One of the things that we often hear about are people concerned about seeing syringes in the streets. And there's ample literature to suggest that the distribution of syringes through syringe services programs doesn't actually increase the prevalence of improperly discarded syringes. In fact, it can often improve those conditions by creating access to safe disposal mechanisms. Same for one-for-one versus need-based distribution. There's no evidence in favor of advantages in terms of improperly discarded syringes, the reduction of those being associated with more restrictive syringe access policies. But in any case, the distribution of syringes helps to ensure that given syringe is only used once, that the people using that syringe are less likely to have a communicable infection, and that any given syringe that does occur that is improperly discarded and present in the streets is less likely to pose a risk of reinfection to somebody.

SPEAKER_00:

So it sounds like the positive impacts are both to the health of the people who are using these drugs, but also to the rest of society as well. So that's, I think that's really important to frame up. And even things like supervised consumption, where people are taking these drugs under the supervision of, I believe, trained medical staff, right? That reduces overdose deaths, doesn't it? By up to a third. But let's come back to the impact on community and society, because I think that's really important, because a lot of our listeners may not necessarily have this issue themselves. They may not know people who have this issue, but they will be seeing it on the street. So let's talk a little bit about the positive impacts to the community at large.

SPEAKER_01:

Sure. I can start this on a personal basis. So I have a toddler. And I'm the one who picks up syringes from the dugout at the park where he does his soccer camps. I also distribute syringes, encampment area across a river from that same place, because I know that I'm also the only person who's bringing sharps containers to that area and making sure that they are disposed of properly. And so long as we live in a world where there are syringes in that dugout, I'm going to do whatever I can to reduce the risk to my family and also show my son how to show up and build the kind of world that we want to live in. Based on my reading of the evidence, based on my experience and practice, the best way to ensure that a potential needle stick doesn't lead to a communicable disease infection is to reduce the prevalence of that communicable disease amongst people who use needles and to reduce the likelihood that the needle has been used by more than one person, both of which are well-demonstrated in the literature on syringe access services. So we've been studying the impacts of distribution, efforts to improve disposal for years now. I think it's also helpful to ground this in the case histories and to acknowledge that HIV and Hep C infections that are caused by community-based needle sticks are nonexistent to my knowledge. There have been many cases in clinical settings, and that's something that we strive to improve in those settings, where we have all of the resources to address those with respect to sharps and protocols and everything else. But just at a baseline, I think there is an inherent fear. When people see a syringe in the street, it can be scary. It's sort of bears a lot of the baggage of the messaging and fear that we have around communicable diseases. Knowing what the sort of practical reality is on a person level and population statistical level, I think is important just as a background so that we don't see the risks as infinite and the benefits as marginal. We'll get

SPEAKER_00:

back to this conversation in just a moment. But if you're finding this episode helpful, Here's a quick ask. Take a second to follow or subscribe to the HealthCurve podcast wherever you're listening. And if someone in your life would benefit from this episode or any of the others you've heard, please send it their way. All right, let's get back to it. Right. And so the evidence supports the fact that harm reduction strategies work both for the individuals who are taking drugs themselves and for the community. What were we doing before this? So before harm reduction, there was a lot of criminalization, the war on drugs, all that sort of thing. You obviously talked about public policies earlier. What kinds of things have been tried that may be most people's initial reaction of how to respond to this? Or it may be just the way we've indoctrinated this as a way to deal with it. But what has been tried and not worked?

SPEAKER_01:

I have to note that one strategy has been outright negligence. We saw HIV just absolutely ravage communities of people who use drugs as, you know, through the 80s and 90s and still into the thousands. We see disproportionate risk amongst people who use drugs, even though we have solutions to substantially mitigate those risks. But incarceration is another approach that has been historical and enthusiastically proposed in future. One of the challenges of that is that we see increased risk of drug-related injury after incarceration. So you can take somebody who is using drugs and put them into prison or jail. And for one, drugs are not absent from prison or jail. Two, people who have marginal sort of drug use behaviors upon entry to those environments can often see them escalated or see their sort of network expand in directions or shrink in directions that are likely to lead to more drug use and more risky drug use in future. And upon release, we see that people are more likely to overdose. So incarceration does not solve for the individual population level risks of drug use. It certainly does not eliminate drug use, as we've seen from the last decades of war on drugs. And there's a sort of a softer version of that, or at least framed as softer, which is mandatory treatment. So this would be like diversion programs or the like, which is essentially compulsory treatment substance use disorder treatment. The challenge there is these are, one, not very effective. You could flip a coin and do better than the outcomes associated with compulsory treatment, and they are very costly. So I'm not generally one to make recommendations on public health effectiveness with a sort of dollar bottom line, but I do know that in terms of the dollars per quali or the dollars per any other objective outcome that we're trying to seek, Incarceration and compulsory treatment are both extremely expensive, and they don't actually achieve the outcomes that might be sought by using them in an effective way.

SPEAKER_00:

So just very quickly, explain what compulsory treatment is, just for our listeners who may not understand.

SPEAKER_01:

Sure. So compulsory treatment would be, we know that there are effective modalities for treatment of substance use disorders. And frankly, there are effective modalities for people who don't fit the clinical description of having a substance use disorder. There may be people who have a relationship to drugs that is dysfunctional in their lives, that doesn't meet the DSM criteria, that other people in their lives might not recognize as being a manifestation of substance. their substance use.

SPEAKER_00:

Yeah, these people are just taking drugs but functioning normally, and people don't even know that they have a problem, right?

SPEAKER_01:

Yeah. I mean, I would suggest that perhaps the majority of people who use drugs have not received a substance use disorder diagnosis. And especially when we get into the sort of class and other socio-demographic divides, some people's drug use is the focus of scrutiny and criminalization policy interventions where other people's drug use is considered benign, recreational, advantageous to their lives, but they nonetheless would do and can benefit from harm reduction interventions that they may or may not even be aware of in the course of their drug use. So that's all to say, there are very good evidence-based clinical psychosocial interventions for substance use. The challenge is that when those are compulsory, when those are sort of backed by threats of incarceration or monetary damages, we see the efficacy of them absolutely plummet. So cognitive behavioral therapy, contingency systems can be very effective for managing chaotic or problematic substance use. But when you force people to do those, they are substantially less effective. And that's where harm reduction also creates an environment, a touchpoint for health and social services for many people, where if they are not inclined, ready to engage in those psychosocial supports today, knowing that they have somebody who they can ask, knowing that there is a place where they can talk about that without being condemned for their present active drug use, creates a resource and an entry point for access to those supports that they might not otherwise have.

SPEAKER_00:

Yeah. And the health of an individual and drug use, there's a lot of overlap between the two, right? And that, again, we go back to that chicken and egg. There are things that predispose people to using drugs, and then there are the impacts of using the drugs themselves. So it's very complicated. And I think Having tried all these different things where you say you have to go to therapy or else or we'll put you in jail, these things have been tried and they don't work. And so this is the reason we have harm reduction, which is used pretty widely and it's been vetted and is widely supported by leading healthcare institutions around the world, right?

SPEAKER_01:

Yeah, that's correct. And I'd say, too, I want to give credit where credit is due. Harm reduction strategies that are now considered mainstream, that are now very well supported by the evidence, began as strategies amongst people who use drugs to avoid the worst outcomes associated with their drug use. Part of that is that the origins of harm reduction are not clinical. The origins of harm reduction are not institutional. It is mutual aid and self-preservation.

SPEAKER_00:

People helping

SPEAKER_01:

themselves and their community who have these problems, right? exists. And that too. So yes, it's well supported, but it's also spotty. You know, there are cities, I don't believe any more states, but at least, you know, there are, especially even within cities that are well covered, there are often gaps. Many places have harm reduction services, nine to five in a brick and mortar environment. And that's lovely. I applaud and I'm appreciative for all of those services. But for instance, when I was doing direct service in Boston, it was all in the evenings and in the places where the people were, where the services weren't. And so we continue to live in a situation, the environment of harm reduction, the landscape of it continues to have smaller groups filling in the gaps where the larger, more well-resourced organizations operate.

SPEAKER_00:

Right. And this is, again, one of the reasons we're doing this podcast is to help raise awareness of these things so that we can get more support. And the more people advocate for themselves and their communities, the more support hopefully we'll see. What would you say to people who have the impression that harm reduction is a temporary fix that doesn't lead to recovery?

SPEAKER_01:

I'd say that harm reduction plays an important role in a cascade of care that can include recovery and treatment services. I have personally given... hundreds of referrals directly to programs that I know to be the best fit for the person who is seeking that referral. I don't tend to print out a pamphlet because it'll be obsolete as soon as the ink is dry, but knowing people in the health and social services world, we can provide referrals that are informed by the history of where people have been, what their experiences have been, what their peers' experiences have been, what their needs are outside of their substance use-related treatment goals. And also, I'd say To the extent that it's framed as temporary, I will advocate for keeping people free of HIV infection, keeping people insulated from a hypoxic brain injury at any time in their lives. But it also means that should there come a time in their life when they are ready to make a change, when they're interested in changing their relationship to drugs, my hope is that they can do so without Right. So we've talked about

SPEAKER_00:

What is harm reduction? How does it work? What does it look like in practice? What is some of the scientific basis for it? What else have we tried and did that work? What are some of the barriers to getting this out there more and how to overcome those barriers? Like what can communities do? What can we all do to help support harm reduction services more widely other than things like this, where we raise awareness and help people understand, you know, the rationale?

SPEAKER_01:

Well, I think understanding the rationale and understanding the evidence is important. I think a great deal of the opposition that we see uses the same tropes that have been well investigated, you know, questions that are asked and answered in scientific investigation. And so, you know, a low effort read on the sort of predicates for why the services are performed, when and where and how they are performed is important. is a useful thing. So if you're listening to this podcast, you are educating yourself in that way, and that is appreciated. Other things are to support funding for harm reduction programs and to understand the role that they play in the larger health and social services ecosystem in your community. They are not orthogonal to or in competition or contradiction to treatment and recovery services. They are important complements and reinforcing that complementarity, including with co-location, can be a really important strategy for integrating a system of care that cares for all people. If you see people on the streets who are distributing supplies, understanding the motivations, aims, modalities, Bringing to that work, I think, is very helpful. And if you see public disorder, if you see discarded syringes, if you see drug use showing up as a disruptive phenomenon, part of your life, thinking about what is the solution to this? What are we trying to optimize for and what are the best evidence-based practices for doing that is something that I think we'd all do well to reflect on and understand that some of the most salient paths and solutions are known to be the least effective. and that we need to be collectively more creative, curious, constructive in our response to the excess risk of drug use that's manifested or influenced by social policies and public interventions.

SPEAKER_00:

Very simply, if we want to help our communities, help the people that are suffering from this and protect people, follow the science. The research has been done. Look at the evidence. You don't have to be an expert on this to understand that whilst it may be counterintuitive to do something like harm reduction, where you are not saying, hey, you have to stop or else, the research shows that it works. And so there's a method to that. What would you say to people, and I've had people say this to me, who say, Harm reduction is enabling ongoing drug use because it's all about enabling the rights of those individuals and not trying to infringe on those rights. I've heard that said a few times, and you and I, I think, agree there's a lot wrong with that statement. So what would you say to that?

SPEAKER_01:

Sure. Well, I would say that providing safer use supplies, be it syringes, be it safer smoking supplies or materials for other routes of administration, are doesn't enable people to use drugs in a meaningful way in the sense that people will use those drugs in more hazardous ways for want of safer supplies. If the risk of acquiring hepatitis C were enough to prevent people from reusing syringes, we wouldn't see the incredible diffusion of hepatitis C amongst people who use drugs that we did over recent decades. The notion that there's elasticity of demand based on the risks of drug use and that if it only gets a little more hazardous, maybe people will make a choice to stop is simply not borne out by the epidemic the behavioral science, or any other available evidence to us on what will impact drug use behaviors and what we can do to mitigate the risks associated with drug use. I'll say, too, that the same line of reasoning is applied not only to things like syringe distribution, but also, say, to drug checking. Drug checking is where you can bring a sample of a substance, have it tested, and know its composition, potency, other characteristics, contamination perhaps, in advance of or in order to inform its consumption. The idea that this is enabling... It's challenging to substantiate. Well, for one, most of the evidence shows that if anything, it reduces the likelihood that a drug will be used. It reduces the likelihood that a more hazardous route of administration will be used. And to the extent that it does contribute to or is in line with a pattern of information and behavior that leads to that drug being used, it is doing so for the Drugs that are found to be what they were claimed to be, that are as they were purported to be when they were acquired. So what are we enabling? We're enabling people to not acquire HIV and Hep C. We're enabling people to not overdose. And we're enabling people to sustain whatever facets of their well-being can be sustained throughout their lives until such time as they perhaps have a different relationship to drugs, or even if they never do, it is better that somebody not acquire and transmit communicable infections. It is better that people not suffer from skin and soft tissue infections. It is better that people not experience overdose and the consequences of that than

SPEAKER_00:

that

SPEAKER_01:

they

SPEAKER_00:

do. People are conflating two separate issues here, right? It feels like this is not to do with individual rights. This is just what the science tells us.

SPEAKER_01:

Yeah, and so there are aspects of drug use that harm reduction in the form in which it's practiced in the United States doesn't touch. Let's say interpersonal violence is an enormous risk to people who use drugs. especially for communities who are more vulnerable to violence from other communities or subpopulations. And there's nothing but perhaps some social networking and solidarity and community building that harm reduction programs may serve that will insulate people from being physically attacked, being subject to violence. The fact that harm reduction doesn't target and eliminate that risk to people who use drugs is not an incrimination of harm reduction as a practice. So too, the fact that there are people using drugs in a park is, I would argue, not a valid recrimination of harm reduction either. That is the symptom of social marginalization, the fact there is not a place where people can use drugs. I mean, perhaps that is, you know, if you want to go further upstream, a consequence of unmet needs in people's lives that contribute to demand for drugs that is met by an illicit market that the sort of civic infrastructure that we have in our society simply fails to address. So that we can and that we do go into the community to do what we can to mitigate the risks of that can be mitigated to prevent the infections and injuries that can be prevented should not be discarded because it doesn't create the utopian ideal of a society that I think many people, including those who use drugs, might aspire to build. The thing that I would want people to know or bring to mind when thinking about harm reduction, when seeing how it shows up in their community might raise some uncomfortable feelings fears is that harm reduction is there to address the unforced errors and tragic consequences of a broken society. Some people might say it's a band-aid. Some people might say it's not a total solution, to which I would say, if you are cut, do you not apply a bandage? And I would want to also make sure that people bring to mind that an intervention that is intended to reduce individual and population-level risks of communicable disease and individual injuries, for which we all bear the social costs and repercussions, shouldn't be expected to be a panacea for all of those injuries, tragedies, and And again, the manifestations of the excess risk associated with drug use in society, we can do better across many dimensions of society. And en route to doing so, and I am hopeful that we are en route to a less broken relationship to substances in society, we need to make sure that we are addressing those avoidable injuries that we are doing what we can in the world as it exists today to reduce the suffering that we can.

SPEAKER_00:

And I think that's really critical in that we have to do what we can. The reason I started this podcast is I did feel that there is no replacement for health literacy and education and patients advocating for themselves and their communities. We can build all sorts of technologies. Both you and I work in technology and have done for many years We can try and influence policy directly. We can provide services ourselves. But in the end, if people know what works and why we have it, they can start advocating for themselves and start to support what works. Mike, thank you so much for joining us. And thank you for all the great work you're doing in your community and in communities you've been a part of for the last 20 years, you know, trying to help out with this stuff. I mean, you've probably helped a lot of people who needed it. So thank you for all the great public health work that you're doing. And it's been really great having you. I've learned so much from this myself, and I hope our

SPEAKER_01:

listeners have as well. Wonderful. Thank you so much. It's been a pleasure to join

SPEAKER_00:

you. Thanks,

SPEAKER_01:

Mike.