John: Tonight on pbs news weekend. What Atlanta's recent water main break says about America's aging infrastructure. Then, a new vaccine with the potential to eradicate one of the world's deadliest diseases: Malaria. And a new book seeks to explain gender identity and best practices for treating transgender youth. >> I have patients who become severely depressed and anxious when their bodies start developing in a way that doesn't align with their gender identity. And we have more and more research studies showing that when we offer these kids relief with these interventions, that their mental health is a lot better. >> Major funding for the "Pbs news weekend" has been provided by -- >> Consumer cellular, how may I help you? This is a pocket dial. Pocket, I thought I would let you know that with consumer cellular, you get nationwide coverage with no contracts. That is kind of our thing. Have a nice day. ♪♪ >> And with the ongoing support of these individuals and institutions. And friends of the newshour. >> This program was made possible by the corporation for public broadcasting, and by contributions to your pbs station from viewers like you. Thank you. ♪♪ John: Good evening, I'm John yang. The day after Israel rescued four hostages from gaza, Palestinians assessed the high cost of that operation -- one of the deadliest days of the eighth -- eight month war. The gaza health ministry says 274 Palestinians were killed and 700 others wounded during the Israeli assault inside the nuseirat refugee camp. Today, there were more Israeli airstrikes in central gaza. The military says it's targeting hamas infrastructure. Palestinians say enough is enough. >> For the millionth time, we deliver a message to the international community. We do not want aid, we want you to stop the war. We do not know where to go. They move us from right to left, and from left to right, they tell us to go to the south, come to the center. What is going on? We have been suffering for months. John: In France, president Biden ended its five day visit -- I deal with France to use profits. Still to pbs news weekend, eradadating malaria and a new book delves into the signs on personal stories envoy -- for young people struggling with gender identity. >> This is pbs news weekend from W eta studios in Washington, home of the pbs newshour weeknights on pbs. John: For nearly a week earlier this month, the sixth largest city and one of the world's wealthiest nation told residents to boil the tapwater because it might be contaminated. That city was Atlanta. United States drinking water is among the world's safest and most reliable, but an aging infrastructure is posing challenges. The American society of civil engineers estimates that there's a water main break every two minutes. Earlier, I spoke with Shannon Marquez, professor of environmental health sciences at Columbia university's school of public health, and asked why these problems are so common in the United States. >> There are a combination of things happening. Aging infrastructure from years of neglect, underfinanced systems, and having to make decisions that are more like band-aid approaches to addressing challenges as opposed to comprehensive rehabilitation. That, coupled with what we are seeing with extreme weather events and climate change, are really putting our water systems in jeopardy. Many of these systems were constructed for a capacity that is really outgrown now at this point. John: Why the neglect, why the band-aid approach? Is it out of sight, out of mind? >> If you think about what it's going to take to overhaul these systems, the amount of finance, the reality is that water utilities are faced with just being able to do what they can. Patch the holes as they come, patch the main breaks as they come, and there's not enough resources. It really is going to require federal level efforts. And although we have the infrastructure bill, it's not nearly enough to really overcome these challenges. One of the other challenges is the diversity of water systems. The reality is that the governance and regulations around publicly owned treatment works versus community water systems. There is just a huge array of regulations and the structure of that makes it very inefficient. So the reality is, depending on the size and the age of it, there are going to be different problems. There is not a one-size-fits-all solution to this problem. John: How much would it take to really fix the system? Is it more that the federal government has to do it, or is it the problem that we have this sort of confederation of local independent water systems? >> There's going to be a tremendous need with this funding gap. The $55 billion set asidis not enough. Partially because we also need to think about new approaches . Connecting these nodes. There are something like 50 or 60,000 independent water systems in this country and the reality is if you look at the growth and being more efficient, we need to come up with ways to connect them so that we can actually also address these challenges. It's going to take far more as well because we don't even have the data. We don't actually have the information to know what all the challenges are. What we are doing now is just reacting. John: Are there ways to get around the problem of, as you say, in poor communities, underserved communities is there , a way to get around that so that the funding or the support is a little more even among communities? >> Well, I definitely have to think we have to have some creative investments. We really need to think about partnering in ways that create solutions that make the funds more accessible. Oftentimes, even when these programs, the loan programs are available, sometimes communities are missing out because they simply can't put together the package, the proposal to apply for the funding. And then I also think that particularly in an election year , like now, we need to think about how water is a pressing political issue, I to health care or education. -- Akin to health care or education. We need to hold our government officials accountable at all levels to ensure that they're also thinking about this and prioritizing it, because we know it's disenfranchising the poor disproportionally. And so it needs to be on the agenda in ways where we've never seen it before. John: On this broadcast we have covered water problems in Flint, Michigan, in Benton harbor, Michigan, in Jackson, Mississippi. Is it a coincidence that these are all the majority black cities? >> No, it's not a coincidence. I mean, if you look at sort of the tenets of environmental racism, and if you look at the troubled history we've had in this country, it is not a coincidence that once again, the disenfranchised tend to be those that have had really disproportional impacts on their livelihood across the board. So whether it's health or education, these communities are facing the same challenges. And so this water issue is just overlaid in the same way. So that should not be surprising to us. What is surprising is how we continue to neglect these very same communities. Whether we are talking about the education system in those communities or health care and access to health care, and now thinking about water, just the mere fact that you're living in the U.S. And are planning your day relative to how you're going to access safe drinking water, is quite shocking. John: Shannon Marquez of Columbia university, thank you very much. >> Thanks so much, John. ♪♪ John: Malaria is one of the world's deadliest diseases. Throughout Africa every year year it kills nearly a half million children younger than five. But a new vaccine, only the second of its kind, holds the promise of saving thousands of lives, and moving closer to eradicating malaria. Ali rogin has more. Ali: Unicef, the U.N. Main organization for children says eight countries and Africa are set to receive shipments of vaccines and experts say that two vaccines are much better than one, helping to reduce the spread. Andrew Jones is the deputy director for immunizations for unicef. Thank you for joining me. The first vaccine was approved more than two and a half years ago. One of the differences between this vaccine and the one that was already available? >> They are very similar. The first vaccine is largely a copy of this vaccine so they are expected to have a similar impact. When this was released it was manufactured in Belgium at relatively old plants that were limited in capacity. Which was a challenge because you can imagine the demand for the vaccine has been massive so this second vaccine has a much greater supply. The other point to note is the first vaccine has to be combined. It comes in a powder and you mix them together. This vaccine is fully liquid so it is a little easier to use. Ali: Do you have any sense of how many additional people will be able to be vaccinated now that there are two versions on the market? >> The initial rollout starts a bit slow. It's kind of one of these exponential things where the demand has been pending for a while. Then the did -- then the message to countries was you were going to have to be a little patient this will take time. And so one of the the differences with this vaccine compared to normal childhood vaccines are given at a different time. So childhood vaccines are given sort of in this age where they're two three months, this vaccine is delivered to kids over six months, with the last dose being when they're almost two years old, they have four doses here. Our main challenge right now is getting, getting countries ready to accept it. The additional doses in the next few years, we would have been capped at 20 million. Right now we are not cap so we're expecting that while this year and next year it's a gradual increase by 2026 and beyond we'll see a lot more countries, using this vaccine. Half a million kids right now die from malaria every year, which is an enormous number. And so being able to impact that, I mean, there are tools out there like bed nets, like spraying, but this is going to be an important new tool. >> Ali: What needs to occur for the countries that are receiving the vaccine to be ready to receive them? >> There are a few interesting points. One of these is the fact that it is a nontraditional dosing. So these four doses, last one being delivered very late. Big difference there is kids aren't necessarily coming to the clinics then. And so it's a new what we sort of say a new touchpoint, right? A new place where parents have to bring their kids. So I think one of the things is just getting the advocacy and communication out there that, you bring your kids back for is that. Secondly is there's a lot of , other interventions out there from malaria. I mentioned this many of the other vaccines against, -- against rotavirus, diarrhea. There is no preventative measure. There is treatment. The difference is there's other and malaria. The difference is there's other preventive measures like bed nets. Ali: Why in the past has it been so difficult to create these vaccines for parasitic borne diseases? Does the rollout of these malaria vaccines bode well for the development of other vaccines against other parasitic diseases? >> That's a good question. The malaria parasite is a very tricky parasite. It is always changing. Even this vaccine, it is 40% effective or so. But it is changing. 40% is a big number -- of a big number is still a big number. Certainly people who want to eradicate malaria want to see a vaccine that is 90% effective. There are other products in development still a few years out. We would expect something like an HIV vaccine, for example, we also see something that was not 90% effective so even this vaccine, being partially effective, what does it mean for your strategies. This is an important learning experience. Ali: Andrew Jones, deputy director for immunization supplies with unicef, thank you so much. >> Thank you. John: According to the human rights campaign, half the states in America have passed laws and policies restricting treatment young people diagnosed with gender dysphoria. That's the discomfort or distress that might occur when someone's gender identity differs from their sex assigned at birth. Some of those laws are on hold while court challenges work their way through the system. The legislative debate on these measures has often been long on emotion, but short on science and medicine. A new book seeks to use science and research to explain gender identity and treatments for transgender youth. It's called "Free to be: Understanding kids and gender identity." The author is Dr. Jack turban. He's the founding director of the gender psychiatry program at the university of California, San Francisco. Dr. Tobin, thank you for joining us. Let's begin with the basics. Gender identity. Sex assigned at birth. What do they mean, and how are they different? Dr. Jack turban: So gender identity is your psychological sense of yourself in terms of masculinity and femininity. It's extraordinarily complicated, and we know from research that there is a biological basis of how we think about ourselves in terms of gender, but then we interact with society and culture to create this really complex understanding of who we are and how we think about ourselves. Sex assigned at birth also it could be based on your unfortunately complicated. Chromosomes based on different sex organs. But generally there are these biological characteristics, that end up being on your birth certificate. When I say sex assigned at birth I'm usually referring to what's , on someone's birth certificate. John: When there is conflict, what happens? Dr. Jack turban: So for most people, their gender identity aligns more or less with their sex assigned at birth. But a lot of my patients, there is misalignment. They may identify as transgender or gender or non-binary, which just means that they have a sense of themselves that doesn't align with their sex assigned to birth. For some of those kids, they have really intense gender dysphoria where there's distress elated to their body not aligning with their gender identities. For other kids, they don't have so much distress about their body. And so the big thing I try and explain in the book is just this nuance of what gender related experiences are like and what those experiences are like for all different kids. John: Early on in the book, you quote an endocrinologist named doctor Norman pack, who was sort of a leading leader in this field, saying being transgender isn't a condition of the brain, but of the body. Explain that. Dr. Jack turban: Yeah. So he's an endocrinologist, I am a psychiatrist, so we think about it a little bit differently. The way he thinks about it is that their body has betrayed them, essentially, that their their gender identity is who they are and that is what is important. And the endocrine interventions that he offers for some young people are meant to align the body with the gender identity that he thinks is really the core of who those people are. John: And having said that, what are the implications of that for treatment of young people, who are transgender? Dr. Jack turban: The way in reality we approach these kids is they have a comprehensive mental health evaluation to really understand their gender history, what are their mental health conditions they may have and also understand their relationship with their physical bodies. So for some of these young people, but not all, they might be candidates for certain medical interventions. So things like puberty blockers or gender affirming hormones like estrogen or testosterone. John: Now, a lot of these laws that have been passed in the states limit treatments on, transgender minors, young people. They say they are trying to protect them. You say they are actually harming them. Explain that. Dr. Jack turban: So for a lot of these kids, these are really important interventions that improve their mental health. So I have patients who become severely depressed and anxious when their bodies start developing in a way that doesn't align with their gender identity. And we have more and more research studies showing that when we offer these kids relief with these interventions, that their mental health is a lot better. So unfortunately, these bills just ban the treatment altogether so that none of the kids can access these treatments that, you know, we see help them. John: A lot of the supporters of these bills also point to Europe, where some countries are banning puberty blockers, other treatments. There's a pediatrician in Britain named Hilary Cass who was commissioned to review the scientific data on this, and she said it was remarkably weak. What do you say to that? Dr. Jack turban: I think a lot of people don't realize the nuances that were in that document. In a lot of ways, it actually agrees with how we practice care in the United States. It recommended that you should do a comprehensive mental health evaluation before starting these interventions. That you should have a holistic view of the young person to understand if there are both medical and non-medical interventions that might be appropriate. The big area of divergence between her report and how doctors think in the united States is that she recommended that treatment only be provided in the context of a clinical trial where they're collecting more data. I think that United States doctors don't quite agree with that because they worry about coercing people into clinical trials. And also that it just may not be feasible that there are so many of these young people who need care that we wouldn't be able to set that clinical trial up. John: You use the word coercion. Some of the supporters of these bills also talk about young people somehow being persuaded, somehow being coerced into being transgender. What would you say to that? Dr. Jack turban: Yeah, I think that is unfortunately more of a political talking point than the reality of care. When patients come to see me, if anything, they're frustrated that I'm really slowing them down. We're doing these comprehensive mental health evaluations, making sure they really understand what these treatments do, what they don't do. There are difficult conversations to be had, including around things like fertility preservation. For these kids, that's often very difficult because it can exacerbate their gender dysphoria to go through that process. And most kids don't even access the care because there is such a strain on the system. They need to find a therapist who can do that mental health evaluation. They need to get into the clinic, then they really need to get all the education from the doctors to their family. So it's really a slow, involved process. And I would say the opposite of anyone being rushed into it or certainly not pushed into it. John: Your book illustrates a lot of your points using, case histories, using some of the patients you've been treating over the years. How long have you been doing this, and what drew you to this field? Dr. Jack turban: Yeah, I first came to this about a decade ago as a medical student at the time, actually, and my mentor was a journalist. Before I even finished medical school, I was interviewing doctors who were taking care of these kids. And I met doctors who did essentially conversion efforts or trying to force these kids to be cisgender. They were not having very good success. I met doctors who were practicing this affirming model of care, which just means supporting the kids, sometimes with medical interventions, sometimes with simple things like a new name or pronouns, helping them talk to their family about it. I was struck by the experiments -- experiences of these kids that they were going through such a difficult time and it seems that these affirming models of care were helping them so much, so eventually that inspired me to become a child psychiatrist. And I've been doing this, I'd say, for about a decade. John: Dr. Jack turban, thank you very much. Dr. Jack turban: Thank you. ♪♪ John: That is pbs news weekend for this Sunday. I'm John yang. For all of my colleagues, thanks for joining us. Have a good week. >> Major funding for the "Pbs news weekend" has been provided by -- ♪♪ and with the ongoing support of these individuals and institutions. This program was made possible by the corporation for public broadcasting, and by contributions to your pbs station from viewers like you. Thank you. ♪♪ [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy.] ♪♪ ♪♪
