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Vertex, Inc., dot com. Tonight

0:29

on PBS News Weekend, what

0:31

Atlanta's recent water-made break says

0:34

about America's aging infrastructure. Then

0:36

a new vaccine with the potential

0:39

to eradicate one of the world's

0:41

deadliest diseases, malaria. And

0:43

a new book seeks to explain

0:46

gender identity and the best practices

0:48

retreating transgender youth. I

0:50

have patients who become severely depressed and

0:52

anxious when their bodies start developing in

0:54

a way that doesn't align with their

0:56

gender identity. And we have more and

0:58

more research studies showing that when we

1:00

offer these kids relief with these interventions that their

1:03

mental health is a lot better. Good

1:18

evening. I'm John Yang. The

1:20

day after Israel rescued four hostages

1:23

from Gaza, Palestinians assessed the high

1:25

cost of that operation, one of

1:27

the deadliest days of the eight-month

1:29

war. The Gaza health ministry says

1:32

274 Palestinians were killed and 700 others wounded

1:36

during the Israeli assault inside the

1:39

Nusarat refugee camp. Today, there were

1:41

more Israeli airstrikes in Central Gaza.

1:43

The military says it's targeting Hamas

1:45

infrastructure. Palestinians say enough

1:48

is enough. For

1:50

the millionth time, we deliver a message to the international

1:54

community. We do not want to stop the

1:56

war. We do not know what to

2:00

go. They move us from right to left and

2:02

from left to right. They tell us to go

2:04

to the south, come to the center. Centrist

2:08

Benny Gantz made good on his threat

2:10

to quit Israel's war cabinet over Prime

2:12

Minister Benjamin Netanyahu's handling of the war.

2:14

While underscoring the fractures and frustrations of

2:16

the nation's leadership, it's not likely to

2:19

force Netanyahu from office. Exit

2:21

polls in today's European Union parliamentary elections

2:23

are pointing to a shift to the

2:26

hard right. It was voting

2:28

in 27 EU nations. The big

2:30

issues included the war in Ukraine,

2:32

migration, climate policy and the economy.

2:37

I voted with high prices in mind. Prices

2:39

are going up every day and people cannot

2:42

deal with it. I

2:45

hope my vote and the votes of other young

2:47

people can prevail and show that the far right

2:50

can be stopped more than it has been so

2:52

far. Indications that this

2:54

party is headed for a big loss

2:56

has prompted French President Emmanuel Macron to

2:58

dissolve Parliament and call for new elections.

3:02

In France, President Biden ended his five-day

3:04

visit with a trip to a U.S.

3:06

World War I cemetery outside Paris. Mr.

3:09

Biden and First Lady Jill Biden paid respects to

3:11

the more than 2,200 U.S.

3:13

troops buried there. The president also

3:15

said there's a deal with France to

3:18

use profits from frozen Russian assets

3:20

to help Ukraine. Still

3:22

to come on PBS News Weekend,

3:24

a new vaccine fuels hopes of

3:26

eradicating malaria. And a

3:29

new book delves into the science

3:31

and personal stories behind young people

3:33

struggling with gender identity. This

3:39

is PBS News Weekend from WETA

3:41

Studios in Washington, home of the

3:43

PBS News Hour, weeknights on PBS.

3:50

For nearly a week earlier this month,

3:52

the sixth largest city in one of

3:54

the world's wealthiest nations told its residents

3:56

to boil the tap water because it

3:58

may have been contaminated. That

4:01

city was Atlanta. U.S. drinking

4:03

water is among the world's safest and

4:05

most reliable, but an aging infrastructure is

4:07

posing challenges. The American Society

4:10

of Civil Engineers estimates that there's a

4:12

water main break every two minutes. Earlier,

4:15

I spoke with Shannon Marquez, professor of

4:17

environmental health sciences at Columbia University's School

4:19

of Public Health. I asked her why

4:22

these problems are so common in the

4:24

United States. Well, you

4:26

know, there are a combination of things that are

4:28

happening now, John. Aging infrastructure

4:31

from years of neglect, under-financed

4:34

systems, and

4:36

having to make decisions that

4:38

are more like band-aid approaches

4:40

to addressing these challenges

4:43

as opposed to

4:45

comprehensive rehabilitation. That

4:48

coupled with what we are seeing

4:50

with extreme weather events and climate

4:52

change are also really

4:55

putting our water systems in

4:57

jeopardy. Many of these

4:59

systems were constructed for a capacity

5:01

that is really outgrown now at

5:03

this point. Why the neglect? Why

5:05

the band-aid approach? Is this just out of

5:07

sight, out of mind? Well, in

5:09

fact, if you think about what it's

5:11

going to take to overhaul these systems,

5:14

the amount of finance, the

5:16

reality is that water utilities are faced

5:18

with just being able to do what

5:20

they can, patch the holes as they

5:22

come, patch the main breaks as they

5:25

come. And there's not enough

5:27

resources. It really is going to require federal-level

5:30

efforts. And although we have the

5:32

infrastructure bill, it's not nearly enough

5:35

to really overcome these challenges.

5:37

One of the other challenges

5:39

is the diversity of water

5:41

systems. The reality is that

5:43

the governance and regulations around

5:45

publicly-owned treatment works versus community

5:47

water systems. There is

5:50

just a huge array of

5:52

regs, and the structure of

5:54

that makes it very inefficient. So the

5:56

reality is, depending on the size and

5:58

the age of... There are going to

6:01

be different problems. There's not a one

6:03

size fits all solution to this problem.

6:06

How much would it take to really fix

6:08

the system? Is it more that

6:10

the federal government has to do it or is it

6:12

the problem that we have this sort of confederation

6:15

of local independent water systems?

6:18

So there's going to be a tremendous

6:20

need with this funding gap. I mean,

6:22

the $55 billion that set aside is

6:24

not nearly enough partially

6:26

because we also

6:28

need to think about new

6:30

approaches connecting these nodes. There

6:33

are something like 50 or 60,000 independent

6:35

water systems in this country. And

6:38

the reality is if you look at

6:40

the growth and being more efficient, we

6:42

need to come up with ways to

6:44

connect them so that we can actually

6:46

also address these challenges. It's

6:49

going to take far more as well because

6:51

we don't even have the data. We don't

6:53

actually have the information to know what

6:55

all the challenges are. What

6:58

we are doing now is just reacting. Are

7:01

there ways to get around the problem of, as

7:03

you say, in poor communities, underserved communities, is

7:05

there a way to get around that so

7:08

that the funding and the support is a

7:10

little more even among communities?

7:12

Well, definitely I think we have to

7:14

have some creative investments, right?

7:17

We really need to think about

7:20

partnering in ways that create solutions

7:22

that make the funds more accessible.

7:25

So oftentimes, even when these programs, the

7:27

loan programs are available, sometimes communities are

7:30

missing out because they simply can't put

7:32

together the package, the proposal to apply

7:34

for the funding. And then I also

7:37

think that particularly in election years, like

7:39

now, we need to think about how

7:42

water is a pressing

7:44

political issue akin to

7:47

whether it's healthcare or education.

7:49

We need to hold our

7:52

government officials accountable at all

7:54

levels to ensure that they're

7:56

also thinking about this and

7:58

prioritizing it because... we know

8:00

it's disenfranchising the poor disproportionately. And

8:02

so it needs to be on

8:04

the agenda in ways where we've

8:07

never seen it before. We've

8:09

covered on this, on this broadcast, water

8:11

problems in Flint, Michigan, in Benton

8:13

Harbor, Michigan, and Jackson, Mississippi. Is

8:16

it a coincidence that these are

8:18

all, but nor

8:20

majority black cities? No,

8:22

it's not a coincidence. I mean,

8:24

if you look at sort of

8:26

the tenants of environmental racism, and

8:28

if you look at the troubled

8:30

history we've had in this country,

8:32

it is not a coincidence that

8:35

once again, the disenfranchised

8:37

tend to be those

8:39

that have had really

8:41

disproportional impacts on

8:44

their livelihood across the board.

8:46

So whether it's health or

8:48

education, these communities are facing

8:50

the same challenges. And so

8:52

this water issue is just overlaid

8:54

in the same way. And

8:57

so that should not be surprising to us.

9:00

What is surprising is how

9:02

we continue to neglect these

9:04

very same communities. And so

9:06

whether we're talking about, again,

9:08

the education system in those

9:10

communities or health care and

9:12

access to health care. And

9:14

now thinking about water, just

9:17

the mere fact that you're living in the

9:19

U.S. and are planning

9:21

your day relative to how you're

9:23

going to access safe drinking

9:25

water. It's quite shocking. Shannon

9:28

Marquez of Columbia University, thank you very

9:30

much. Thanks so much, John. Area

9:42

is one of the world's deadliest

9:44

diseases throughout Africa every year. It

9:46

kills nearly a half million children

9:48

younger than five. But a

9:50

new vaccine, only the second of

9:52

its kind, holds the promise of

9:54

saving thousands of lives and moving

9:56

closer to eradicating malaria. Ali Rogan

9:58

has more. At

10:00

the end of May, the Central

10:02

African Republic became the first country

10:04

to receive doses of the new

10:06

R21 Matrix M malaria vaccine. It's

10:08

intended for children between five months

10:10

and three years old who were

10:12

among the most vulnerable to the

10:14

disease. UNICEF, the U.N.'s

10:17

main organization for children, says eight countries

10:19

in Africa are set to receive these

10:21

R21 shipments. And

10:23

experts say two vaccines are exponentially

10:25

better than one, helping not just

10:27

to immunize more people, but to

10:29

reduce the illness's spread. Andrew

10:32

Jones is the deputy director of immunization

10:34

supplies for UNICEF. Andrew, thank you so

10:37

much for joining me. The first vaccine

10:39

was rolled out, approved more than two

10:41

and a half years ago. So

10:44

what are the differences between this vaccine

10:46

and the vaccine that was already available?

10:48

They're very similar vaccines. In fact, the

10:51

first vaccine, which is called

10:53

RTSS manufactured by GlaxoSmithKline, is

10:56

largely a copy of

10:58

this vaccine. So they're expected to have

11:01

similar impact in kids. The big difference

11:03

when RTSS was released, it was being

11:05

manufactured in Belgium and it was being

11:08

manufactured at relatively old plants.

11:11

There were quite limited in capacity, which was

11:13

a challenge because, as you

11:15

can imagine, the demand for this vaccine

11:17

has been massive. And so this second

11:19

vaccine has a much greater supply. The

11:22

other point to note is that the first

11:24

vaccine has to be combined. It comes in

11:27

a powder and a diluent, so you mix

11:29

the two together, whereas this R21 vaccine is

11:32

fully liquid. So it's a little bit easier to use

11:34

in the field. Do you have any sense

11:37

of how many additional people are going to

11:39

be able to be vaccinated now that there's

11:41

two versions on the market? Well,

11:43

the initial rollout starts a bit slow. I mean,

11:45

it's kind of one of these exponential things where

11:47

the demand has been pending for a while and

11:49

then the message to countries was, well, you know,

11:51

you're going to have to be a little patient.

11:54

This is going to take some time. And so

11:56

one of the differences with this

11:58

vaccine compared to normal childhood other

14:00

vaccines against other parasitic diseases?

14:02

Yeah, it's a good question. So the malaria

14:04

parasite is a very tricky parasite.

14:07

It's always shifting and changing. Even this

14:09

vaccine is 40 or

14:12

so percent effective. Again, much

14:15

like as you know, on COVID is the time

14:17

after the vaccination goes, your sort of

14:19

protection drops. So it's not as if it's like

14:21

a single point, right? It's changing. But

14:24

40% of a big number is still a big number. Certainly

14:28

people who want to eradicate malaria want to see a

14:30

vaccine that's 80, 90% effective, where

14:32

you can really look at disease

14:34

elimination. There are other products

14:36

in development still a few years out that are aiming to

14:38

do more in terms

14:41

of eradicating the disease. And I

14:43

think with everything we do, we learn more. There

14:46

is new TB vaccines that are underway.

14:48

There's talk about an HIV vaccine trials.

14:50

And we would expect for something like

14:52

an HIV vaccine, for example, we'd also

14:55

see something that wasn't 90% effective. So

14:58

even this idea from a

15:00

program perspective, we're working with a vaccine

15:02

that's partially effective. And what does that

15:04

mean for your strategies is an important

15:06

learning experience. Andrew Jones, Deputy Director

15:09

for Immunization Supplies with UNICEF. Thank you

15:11

so much. Thank you. According

15:22

to the advocacy group, the Human

15:24

Rights Campaign, half of the states

15:26

in America have passed laws or

15:28

policies restricting treatment for young people

15:30

diagnosed with gender dysphoria. That's the

15:33

discomfort or distress that might occur

15:35

when someone's gender identity differs from

15:37

their sex assigned at birth. Some

15:39

of those laws are on hold

15:41

while court challenges work their way

15:43

through the system. The

15:45

legislative debate on these measures has often

15:47

been long on emotion, but short on

15:49

science and medicine. A new book

15:51

seeks to use science and research to

15:53

explain gender identity and treatments for

15:56

transgender youth. It's called Free to

15:58

Be, understanding kids... gender identity.

16:00

The author is Dr. Jack Turban.

16:02

He's the founding director of the

16:04

Gender Psychiatry Program at the University

16:07

of California, San Francisco. Dr. Turban,

16:09

thanks for joining us. Let's begin

16:11

with sort of the basics, gender

16:13

identity, sex assigned at birth. What do

16:15

they mean? And how can they be different? So,

16:17

gender identity is your psychological sense of

16:20

yourself in terms of masculinity and femininity.

16:23

It's extraordinarily complicated, right? We know from research

16:25

that there is a biological basis of

16:27

how we think about ourselves in terms

16:29

of gender, but then we interact

16:31

with society and culture to create this really complex

16:34

understanding of who we are and how we think

16:36

about ourselves. Sex assigned

16:38

at birth, also unfortunately complicated. It could

16:41

be based on your chromosomes, based

16:43

on different sex organs. But,

16:46

generally, there are these biological characteristics that

16:49

end up being on your birth certificate. And so,

16:52

when I say sex assigned at birth, I'm usually

16:54

referring to what's on someone's birth certificate. And when

16:56

they conflict, what happens? So,

16:58

for most people, their gender identity aligns

17:00

more or less with their sex assigned

17:02

at birth. But a lot of my

17:04

patients, there's a misalignment. And

17:07

so, they may identify as transgender

17:09

or gender nonbinary, which

17:11

just means that they have a sense of

17:13

themselves that doesn't align with their sex assigned

17:15

at birth. For some of those kids, they

17:17

have really intense gender dysphoria, where there's distress

17:19

related to their body not aligning with their

17:21

gender identities. For other kids, they don't have

17:24

so much distress about their body. And so,

17:26

the big thing I try and explain in

17:28

the book is just this nuance of what

17:30

gender-related experiences are like and what those experiences

17:32

are like for all different kids. Early on

17:34

in the book, you quote an endocrinologist named

17:36

Dr. Norman Speck, who's sort of a

17:38

leader in this field, as saying, being

17:40

transgender isn't a condition of the brain,

17:43

but of the body. Explain that. Yeah, so

17:45

he's an endocrinologist. I'm a psychiatrist. We think

17:48

about it a little bit differently. The way

17:50

he thinks about it is that their body

17:52

has betrayed them, essentially, that their gender identity

17:54

is who they are. And that's what's important

17:56

in the endocrine interventions that he offers for

17:58

some young people. are meant to

18:01

align the body with the gender identity that

18:03

he thinks is really the core of who

18:05

those people are. And having said that, what

18:07

are the implications of that for

18:09

treatment of young people who

18:11

are transgender? The way in reality

18:13

we approach these kids is they have

18:16

a comprehensive mental health evaluation to really

18:18

understand their gender history, what

18:20

other mental health conditions they may have, and

18:22

also understand their relationship with their physical bodies.

18:25

And so for some of these young people,

18:27

but not all, they might be candidates for

18:30

certain medical interventions. So things like puberty blockers

18:32

or gender-affirming hormones like estrogen or testosterone. Now,

18:34

a lot of these laws that have been

18:36

passed in the States limit

18:39

treatments on transgender

18:41

minors, young people. They say

18:43

that they're trying to protect them. You're saying they're

18:45

actually harming them. Explain that. So for

18:47

a lot of these kids, these are

18:49

really important interventions that improve their mental

18:51

health. So I have patients who become

18:53

severely depressed and anxious when their bodies

18:55

start developing in a way that doesn't

18:58

align with their gender identity. And

19:00

we have more and more research studies showing that when

19:02

we offer these kids relief with these interventions that their

19:04

mental health is a lot better. So

19:07

unfortunately, these bills just ban the treatment

19:09

altogether so that none of the kids

19:12

can access these treatments that we

19:14

see help them. A lot of the support

19:16

of these bills also point to Europe, where

19:18

some countries are banning puberty blockers, other treatments.

19:20

There's a pediatrician in Britain named Hilary Cass

19:23

who was commissioned to review the scientific data

19:25

on this. And she said it was remarkably

19:27

weak. What do you say to that? I

19:29

think a lot of people don't realize the

19:32

nuances that were in that document. And in a

19:34

lot of ways, it actually agrees with how we

19:36

practice care in the United States. So

19:38

it recommended that you should do a comprehensive

19:40

mental health evaluation before starting these interventions. They

19:43

should have a holistic view of the young

19:45

person to understand if there are both medical

19:47

and non-medical interventions that might be appropriate. The

19:50

big area of divergence between her report

19:53

and how doctors think in the United States

19:55

is that she recommended that treatment only be

19:57

provided in the context of a clinical trial.

20:00

collecting more data. I think U.S. doctors

20:02

don't quite agree with that, because they

20:04

worry about coercing people into clinical trials,

20:07

and also that it just may not be feasible, that

20:09

there are so many of these young people who need

20:11

care that we wouldn't be able to set that clinical

20:13

trial up. You used the word coercion. Some of the

20:15

supporters of these bills also talk about young people somehow

20:17

being persuaded, somehow being coerced

20:19

into being transgender. What would you say

20:22

to that? Yeah, I think that's

20:24

more, unfortunately, a political talking

20:26

point than the reality of care. When

20:28

patients come to see me, if anything,

20:31

they're frustrated that I'm really slowing them

20:33

down. We're doing these comprehensive mental health

20:35

evaluations, making sure they really understand what

20:37

these treatments do, what they don't do.

20:39

There are difficult conversations to be had,

20:42

including around things like fertility preservation. For

20:45

these kids, that's often very difficult, because

20:47

it can exacerbate their gender dysphoria to

20:49

go through that process. And

20:51

most kids don't even access the care, because there

20:54

is such a strain on the system. They need

20:56

to find a therapist who can do that mental

20:58

health evaluation. Then they need to get

21:00

into the clinic. Then they really need to get all

21:02

the education from the doctors to their family. So

21:05

it's really a slow, involved process. And

21:07

I would say the

21:09

opposite of anyone being rushed into it or certainly

21:11

not pushed into it. Your book

21:13

illustrates a lot of your points using case

21:16

histories, using some of the patients you've been treating over

21:18

the years. How long have you been doing this? And

21:20

what drew you to this field? Yeah,

21:22

I first came to this about a decade

21:24

ago as a medical student

21:27

at the time, actually. And my mentor

21:29

was a journalist. And so

21:31

before I even finished medical school, I

21:33

was interviewing doctors who were taking care

21:35

of these kids. And

21:37

I met doctors who did

21:40

essentially conversion efforts or trying to force these kids

21:42

to be cisgender. They were not having very good

21:44

success. I met doctors who were

21:46

practicing this affirming model of care, which

21:48

just means supporting the kids, sometimes with medical

21:50

interventions, sometimes with simple things like a new

21:53

name or pronouns, helping them talk to their

21:55

family about it. And I

21:57

was just really struck by the

21:59

experiences.