1 00:00:15,396 --> 00:00:23,956 Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show 2 00:00:23,956 --> 00:00:27,396 Speaker 1: where we explore the stories behind the stories in the news. 3 00:00:27,836 --> 00:00:33,156 Speaker 1: I'm Noah Feldman. This past week brought two major developments 4 00:00:33,356 --> 00:00:37,276 Speaker 1: in the fight against COVID. First, Joe Biden was elected president, 5 00:00:37,476 --> 00:00:39,636 Speaker 1: meaning we're going to have a new team in Washington 6 00:00:39,836 --> 00:00:44,116 Speaker 1: and new leadership working on the issue. Second, Fiser announced 7 00:00:44,236 --> 00:00:48,036 Speaker 1: early results of its test of its vaccine in human 8 00:00:48,116 --> 00:00:51,556 Speaker 1: subjects and suggested that some ninety percent of the people 9 00:00:51,596 --> 00:00:56,956 Speaker 1: who took the vaccine were successfully protected against COVID. We'll 10 00:00:56,956 --> 00:01:01,636 Speaker 1: be addressing both of these developments in episodes soon. Before 11 00:01:01,636 --> 00:01:04,996 Speaker 1: we do that, however, today we wanted to reshare with 12 00:01:05,036 --> 00:01:09,876 Speaker 1: you an interview with doctor Vvek Morty. Morty is one 13 00:01:09,876 --> 00:01:12,836 Speaker 1: of the people just named by Joe Biden to be 14 00:01:12,876 --> 00:01:16,996 Speaker 1: one of the co chairs of his Anti Coronavirus Task Force. 15 00:01:17,716 --> 00:01:20,996 Speaker 1: In the interview, which we recorded on September thirtieth, doctor 16 00:01:20,996 --> 00:01:24,236 Speaker 1: Morty also discusses the question of how we will get 17 00:01:24,276 --> 00:01:27,276 Speaker 1: people to trust in a vaccine when and if the 18 00:01:27,356 --> 00:01:30,956 Speaker 1: vaccine actually begins to work. In other words, what we 19 00:01:31,036 --> 00:01:33,356 Speaker 1: have for you in this interview is one of the 20 00:01:33,436 --> 00:01:37,516 Speaker 1: heads of Joe Biden's Coronavirus Task Force, laying out the 21 00:01:37,556 --> 00:01:41,476 Speaker 1: policies that he will use when vaccines begin to work. 22 00:01:41,996 --> 00:01:45,996 Speaker 1: It doesn't get more immediately relevant than that. For those 23 00:01:46,036 --> 00:01:48,436 Speaker 1: of you who are regular listeners to the show and 24 00:01:48,516 --> 00:01:51,956 Speaker 1: remember this interview, clearly, don't worry. We have another new 25 00:01:51,996 --> 00:01:54,636 Speaker 1: episode coming your way in the next couple of days. 26 00:01:55,076 --> 00:01:57,196 Speaker 1: For those of you who haven't heard this interview before, 27 00:01:57,516 --> 00:01:59,956 Speaker 1: we really hope that you find it as valuable as 28 00:01:59,996 --> 00:02:04,356 Speaker 1: we did. Doctor Morty was Surgeon General of the United 29 00:02:04,356 --> 00:02:09,356 Speaker 1: States under Barack Obama and he is now coach share 30 00:02:09,796 --> 00:02:20,036 Speaker 1: of the Biden Coronavirus Taskers the ECT. Thank you very 31 00:02:20,076 --> 00:02:22,596 Speaker 1: much for joining me. I want to start with a 32 00:02:22,676 --> 00:02:24,836 Speaker 1: question that you've spent a huge amount of time focused on, 33 00:02:24,916 --> 00:02:28,396 Speaker 1: and that's a question of trust, public trust in science, 34 00:02:28,476 --> 00:02:31,796 Speaker 1: public trust in medicine. And what's particularly driving me to 35 00:02:31,836 --> 00:02:35,196 Speaker 1: ask you this question is that as we move through 36 00:02:35,276 --> 00:02:40,636 Speaker 1: phase three trials for potential vaccines with respect to COVID nineteen, 37 00:02:41,716 --> 00:02:45,116 Speaker 1: there's a lot of uncertainty about how the public will 38 00:02:45,156 --> 00:02:48,636 Speaker 1: react if and when there's an emergency use authorization for 39 00:02:48,716 --> 00:02:52,316 Speaker 1: these vaccines, or if there's publicity around these vaccines. It 40 00:02:52,356 --> 00:02:55,916 Speaker 1: seems to be politically motivated, and that, of course, is 41 00:02:55,956 --> 00:03:00,996 Speaker 1: a question that implicates science, It implicates medicine, it implicates approvals, 42 00:03:01,036 --> 00:03:03,716 Speaker 1: and it implicates politics. So there's a lot to be 43 00:03:03,716 --> 00:03:06,436 Speaker 1: said about this, but intervene in it wherever you would 44 00:03:06,436 --> 00:03:09,396 Speaker 1: like to start. So this is a timely question, and 45 00:03:09,476 --> 00:03:13,236 Speaker 1: I think the issue of trust is one that has 46 00:03:13,236 --> 00:03:17,156 Speaker 1: been growing, frankly during this pandemic response. Let me just 47 00:03:17,356 --> 00:03:19,596 Speaker 1: say a word about why this is so important. It's 48 00:03:19,596 --> 00:03:23,516 Speaker 1: not just about a vaccine during pandemic responses, and I 49 00:03:23,556 --> 00:03:25,916 Speaker 1: saw this when I served a surgeon general during the 50 00:03:25,996 --> 00:03:29,276 Speaker 1: Zeka outbreak and during Ebola as well. Public trust is 51 00:03:29,316 --> 00:03:32,236 Speaker 1: one of the most important resources you have and you 52 00:03:32,316 --> 00:03:35,596 Speaker 1: have to cultivate it at all costs. That means being 53 00:03:35,636 --> 00:03:39,196 Speaker 1: honest with people, even when you've done something wrong. It 54 00:03:39,196 --> 00:03:42,116 Speaker 1: means being open to hard questions even when you don't 55 00:03:42,116 --> 00:03:46,116 Speaker 1: know the answers to them. It means communicating openly, transparently, 56 00:03:46,156 --> 00:03:49,316 Speaker 1: and regularly with people, and in this moment, it also 57 00:03:49,356 --> 00:03:53,236 Speaker 1: means allowing them to hear directly from the source of information, 58 00:03:53,356 --> 00:03:56,476 Speaker 1: which are scientists. You know, science has a guide pandemic responses, 59 00:03:56,516 --> 00:03:59,996 Speaker 1: and when scientists aren't allowed to speak directly in an 60 00:04:00,076 --> 00:04:03,996 Speaker 1: unfettered way with the public. It's shows doubt. What's happening 61 00:04:04,036 --> 00:04:06,956 Speaker 1: here with regarding a vaccine is that we have an 62 00:04:06,996 --> 00:04:11,236 Speaker 1: unfortunate confluence of factors. We have Number one trust, which 63 00:04:11,236 --> 00:04:15,436 Speaker 1: has been I think badly injured over the last several months. 64 00:04:15,996 --> 00:04:18,956 Speaker 1: You have a political cycle which is coming to a 65 00:04:18,996 --> 00:04:23,036 Speaker 1: culmination with this presidential election, and you have a pandemic 66 00:04:23,156 --> 00:04:27,276 Speaker 1: that has not gotten better. In fact, we have the 67 00:04:27,316 --> 00:04:29,836 Speaker 1: most number of cases in the world. We have had 68 00:04:29,956 --> 00:04:32,156 Speaker 1: nearly two hundred thousand people at this point when you 69 00:04:32,196 --> 00:04:34,796 Speaker 1: and I are talking today who have died from COVID 70 00:04:34,876 --> 00:04:37,676 Speaker 1: nineteen to the United States, and we do not see 71 00:04:37,676 --> 00:04:40,436 Speaker 1: a sign of this ending because our response has been poor. 72 00:04:41,116 --> 00:04:43,276 Speaker 1: And so all of these are coming together to make 73 00:04:43,276 --> 00:04:47,836 Speaker 1: people nervous about a decision around a vaccine. And I 74 00:04:47,876 --> 00:04:52,076 Speaker 1: think there's great danger to rushing a vaccine approval or 75 00:04:52,116 --> 00:04:55,516 Speaker 1: an emergency authorization in this environment. The damage is not 76 00:04:55,676 --> 00:04:59,476 Speaker 1: just that people may not take the vaccine. In fact, 77 00:04:59,556 --> 00:05:03,716 Speaker 1: right now from September Kaiser Family Foundation poll, we know 78 00:05:03,796 --> 00:05:06,436 Speaker 1: that fifty four percent of people are saying that they 79 00:05:06,436 --> 00:05:09,196 Speaker 1: would not take the vaccine if it was offered today. 80 00:05:09,636 --> 00:05:12,516 Speaker 1: That's a staggering number, just given the toll that COVID 81 00:05:12,556 --> 00:05:15,236 Speaker 1: has taken, how much it's turned our lives upside down, 82 00:05:15,276 --> 00:05:17,996 Speaker 1: how much people so desperately want this pandemic to be over. 83 00:05:18,276 --> 00:05:20,276 Speaker 1: Yet fifty four percent of people are saying they wouldn't 84 00:05:20,276 --> 00:05:22,956 Speaker 1: take a vaccine if it was approved before the election. 85 00:05:23,796 --> 00:05:25,276 Speaker 1: So what does that tell us. That tells us that 86 00:05:25,316 --> 00:05:28,036 Speaker 1: people are worried about the process, and they have good 87 00:05:28,076 --> 00:05:30,756 Speaker 1: reason to be, because we've seen a couple of processes 88 00:05:30,796 --> 00:05:33,796 Speaker 1: in the FDA which have been driven by politics, the 89 00:05:33,916 --> 00:05:37,356 Speaker 1: issue of an emergency use authorization for hydroxy chloroquine being one. 90 00:05:37,796 --> 00:05:41,876 Speaker 1: The way in which the convalescent plasma emergency authorization was 91 00:05:41,916 --> 00:05:45,436 Speaker 1: issued with false numbers and hype that was political and 92 00:05:45,516 --> 00:05:48,996 Speaker 1: not scientific. So if the administration really wants to ensure 93 00:05:49,396 --> 00:05:52,996 Speaker 1: that people have faith in an emergency authorization, here's what 94 00:05:53,036 --> 00:05:55,276 Speaker 1: they need to do. They need to, number one, make 95 00:05:55,316 --> 00:05:59,596 Speaker 1: sure that they establish and communicate clearly an explicit standard 96 00:05:59,996 --> 00:06:03,316 Speaker 1: for safety and efficacy that will be met before an 97 00:06:03,316 --> 00:06:06,476 Speaker 1: emergency use authorization is approved. The second thing they have 98 00:06:06,516 --> 00:06:08,076 Speaker 1: to do is they have to make sure that the 99 00:06:08,156 --> 00:06:12,156 Speaker 1: FDA is scientific and very importantly, it's external Advisory Board, 100 00:06:12,236 --> 00:06:15,036 Speaker 1: which is known by the some a clunky acronym VERPAC, 101 00:06:15,196 --> 00:06:19,476 Speaker 1: which stands for a Vaccine and Related Biological Products Advisory Committee. 102 00:06:19,556 --> 00:06:22,916 Speaker 1: Both of these groups of scientists must be able allowed 103 00:06:23,076 --> 00:06:27,236 Speaker 1: to communicate directly with the public and share their assessment 104 00:06:27,556 --> 00:06:31,036 Speaker 1: without a political filter. And finally, the data itself from 105 00:06:31,076 --> 00:06:33,436 Speaker 1: the trial needs to be made available to the public 106 00:06:33,476 --> 00:06:36,916 Speaker 1: so that the external scientific community can assess it, can 107 00:06:36,916 --> 00:06:39,716 Speaker 1: come to their conclusions, and can share their opinions with 108 00:06:39,796 --> 00:06:43,316 Speaker 1: the public. Only when these are done should have a 109 00:06:43,396 --> 00:06:46,956 Speaker 1: vaccine be considered for emergency authorization, Because again, the consequences 110 00:06:46,956 --> 00:06:49,756 Speaker 1: is not just people won't take the COVID vaccine, but 111 00:06:49,876 --> 00:06:53,276 Speaker 1: if we allow hesitancy and doubt to be sown about 112 00:06:53,316 --> 00:06:57,076 Speaker 1: the process itself, then people will doubt vaccines even after 113 00:06:57,156 --> 00:07:00,196 Speaker 1: COVID is over. They'll worry that politics are not science, 114 00:07:00,276 --> 00:07:02,516 Speaker 1: is driving the process, and that will ultimately hurt all 115 00:07:02,516 --> 00:07:05,236 Speaker 1: of us. I have to say, when I heard those 116 00:07:05,276 --> 00:07:07,556 Speaker 1: poll numbers about the number of people who wouldn't take 117 00:07:07,556 --> 00:07:10,636 Speaker 1: a vaccine, at first felt shocked, but then I realized 118 00:07:10,676 --> 00:07:12,796 Speaker 1: that I myself had a conversation in fact with my 119 00:07:12,836 --> 00:07:15,836 Speaker 1: own parents, who are you? My father's eighty and my 120 00:07:15,876 --> 00:07:20,516 Speaker 1: mothers in her late seventies, and they had similar skepticism. 121 00:07:20,716 --> 00:07:23,236 Speaker 1: And I was actually horrified in the conversation, and I 122 00:07:23,316 --> 00:07:25,276 Speaker 1: took it upon myself to try to convince them that, 123 00:07:25,916 --> 00:07:30,836 Speaker 1: given their age and the bad outcomes that happen to 124 00:07:30,916 --> 00:07:33,916 Speaker 1: people in that age group, if they do actually develop 125 00:07:33,956 --> 00:07:36,876 Speaker 1: a case of COVID, that they were getting it rationally wrong. 126 00:07:36,916 --> 00:07:39,716 Speaker 1: They ought precisely to be prepared to take a vaccine 127 00:07:39,716 --> 00:07:42,956 Speaker 1: again and provided some emergency used to authorization. And I 128 00:07:42,996 --> 00:07:46,996 Speaker 1: think of my parents is superrational and cautious and sensible 129 00:07:47,036 --> 00:07:50,316 Speaker 1: around medical issues. And that leads me to ask, even 130 00:07:50,316 --> 00:07:53,916 Speaker 1: if the administration, the current administration, the Trump administration, did 131 00:07:53,996 --> 00:07:56,796 Speaker 1: all three of the things that you just said, you know, 132 00:07:56,876 --> 00:08:01,596 Speaker 1: if they actually specified clear protocols for what counted his safety, 133 00:08:01,956 --> 00:08:04,916 Speaker 1: and then they let the scientists at the FDA and 134 00:08:05,076 --> 00:08:08,436 Speaker 1: on the Advisory Committee, the Vaccine Advisory Committee, speak directly 135 00:08:08,476 --> 00:08:13,076 Speaker 1: to the public, and they publicized what data existed from 136 00:08:13,236 --> 00:08:16,636 Speaker 1: Phase three trials. And let's just imagine in the scenario 137 00:08:16,716 --> 00:08:20,116 Speaker 1: that sometime between now and the time of the inauguration 138 00:08:20,116 --> 00:08:23,436 Speaker 1: of the next president, that all of those things pointed 139 00:08:23,476 --> 00:08:26,636 Speaker 1: in the direction of an emergency use authorization, is there 140 00:08:26,716 --> 00:08:29,636 Speaker 1: any credible way that we could get a lot of 141 00:08:29,636 --> 00:08:32,916 Speaker 1: the public, even under those circumstances, to trust the vaccine. 142 00:08:33,276 --> 00:08:36,116 Speaker 1: Or is the damage that's been done already so deep 143 00:08:36,676 --> 00:08:40,556 Speaker 1: that we couldn't credibly imagine that certainly in any Trump 144 00:08:40,596 --> 00:08:44,956 Speaker 1: authorized emergency use. Well, Noah, the damage that has been 145 00:08:44,996 --> 00:08:47,316 Speaker 1: done is deep and it will take years to repair. 146 00:08:47,756 --> 00:08:51,436 Speaker 1: Because people had a very high degree of confidence across 147 00:08:51,436 --> 00:08:55,156 Speaker 1: the population in the CDC before COVID nineteen, and we've 148 00:08:55,196 --> 00:08:59,116 Speaker 1: seen their credibility damaged. The FDA's credibility has taken a hit. 149 00:09:00,596 --> 00:09:03,756 Speaker 1: Even people like doctor Tony Fauci, you know, who are 150 00:09:03,876 --> 00:09:06,916 Speaker 1: very highly regarded by the scientific community and by the 151 00:09:06,956 --> 00:09:10,396 Speaker 1: majority of the public. You know, even doctors credibility has 152 00:09:10,436 --> 00:09:14,316 Speaker 1: taken a hit because of smear jobs and other criticism 153 00:09:14,316 --> 00:09:17,236 Speaker 1: that he's received that has been politically directed. And so 154 00:09:17,716 --> 00:09:19,836 Speaker 1: there's been a lot of hits to trusted sources and 155 00:09:19,876 --> 00:09:22,556 Speaker 1: it will take years for that to recover. Let's just 156 00:09:22,596 --> 00:09:25,276 Speaker 1: say in your scenario that there is in fact, good 157 00:09:25,396 --> 00:09:29,156 Speaker 1: worthy data that tells us that vaccine candidate meets the 158 00:09:29,236 --> 00:09:31,596 Speaker 1: standards for a safety and efficacy and an emergency use 159 00:09:31,636 --> 00:09:34,556 Speaker 1: authorization is issued, what would happen to happen if he 160 00:09:34,676 --> 00:09:37,556 Speaker 1: wanted people to actually be open to taking that vaccine 161 00:09:38,196 --> 00:09:41,316 Speaker 1: as you would need number one, members of the scientific 162 00:09:41,316 --> 00:09:44,316 Speaker 1: community across the country, and not just you know, nationally 163 00:09:44,356 --> 00:09:48,036 Speaker 1: known scientists, but deans of medical schools, doctors and local 164 00:09:48,036 --> 00:09:50,756 Speaker 1: communities who are trusted and respected, nurses who are known 165 00:09:50,796 --> 00:09:53,436 Speaker 1: and respected. He would need them speaking out in local 166 00:09:53,436 --> 00:09:57,116 Speaker 1: communities to help people recognize that people I know, people 167 00:09:57,116 --> 00:10:00,836 Speaker 1: I recognize, institutions that are local to me, trust is vaccine. 168 00:10:01,076 --> 00:10:03,276 Speaker 1: The second thing that you would need to see is 169 00:10:03,316 --> 00:10:05,996 Speaker 1: you would need to see community organizations get behind it. 170 00:10:06,316 --> 00:10:09,836 Speaker 1: People would need to hear from a non medical voices 171 00:10:09,876 --> 00:10:12,196 Speaker 1: that they trust as well, whether that's the faith leader, 172 00:10:12,276 --> 00:10:15,436 Speaker 1: you know, their community, they're church leader, they're synagogue leader. 173 00:10:15,956 --> 00:10:18,236 Speaker 1: They would have to hear from friends and family who 174 00:10:18,276 --> 00:10:21,196 Speaker 1: are getting the vaccine. They would have to hear people 175 00:10:21,236 --> 00:10:24,596 Speaker 1: are getting this and they're not having significant side effects. 176 00:10:24,636 --> 00:10:27,556 Speaker 1: All of this mobilization, if you will, All of this 177 00:10:27,716 --> 00:10:31,716 Speaker 1: messaging will take time, and it will take regardless of 178 00:10:31,716 --> 00:10:36,556 Speaker 1: who wins the presidency. One of the most complicated and 179 00:10:36,796 --> 00:10:40,156 Speaker 1: challenging vaccine rollout efforts that this country has ever seen. 180 00:10:40,636 --> 00:10:44,796 Speaker 1: So that is why I often say that While developing 181 00:10:44,836 --> 00:10:48,716 Speaker 1: a vaccine for COVID nineteen is extremely challenging, actually rolling 182 00:10:48,756 --> 00:10:51,356 Speaker 1: it out and administering it to people, getting that shot 183 00:10:51,396 --> 00:10:53,556 Speaker 1: in the arm of a sufficient number of people that 184 00:10:53,636 --> 00:10:55,876 Speaker 1: we can achieve herd immunity that will be just as 185 00:10:56,196 --> 00:11:00,196 Speaker 1: if not more challenging. You've been advising Joe Biden on 186 00:11:00,476 --> 00:11:03,636 Speaker 1: COVID related issues, and that means that if Joe Biden 187 00:11:03,676 --> 00:11:06,796 Speaker 1: would be elected president and to take office in January, 188 00:11:07,196 --> 00:11:09,796 Speaker 1: you're one of the very small number of people who 189 00:11:09,836 --> 00:11:12,756 Speaker 1: will be in line for the single hardest, most thankless 190 00:11:12,876 --> 00:11:15,796 Speaker 1: job imaginable in the Biden administration, and that would be 191 00:11:16,236 --> 00:11:20,196 Speaker 1: spearheading the actual operation of doing exactly what you're just 192 00:11:20,236 --> 00:11:23,836 Speaker 1: set of, actually getting the vaccine to people. So let 193 00:11:23,836 --> 00:11:27,076 Speaker 1: me start by asking you about what plans you have 194 00:11:27,196 --> 00:11:29,836 Speaker 1: been developing you and the Biden campaign have been developing 195 00:11:30,436 --> 00:11:34,436 Speaker 1: for how to begin that process. Should keep be elected 196 00:11:34,516 --> 00:11:38,076 Speaker 1: and should a vaccine become a safe and available Well, no, 197 00:11:38,236 --> 00:11:42,476 Speaker 1: the Vice President has been really focused on developing and 198 00:11:42,556 --> 00:11:45,916 Speaker 1: thinking about plans. He never takes for granted that he 199 00:11:45,996 --> 00:11:47,996 Speaker 1: is going to win the election, but he wants to 200 00:11:48,036 --> 00:11:50,756 Speaker 1: be prepared to act on day one if he does. 201 00:11:51,556 --> 00:11:54,476 Speaker 1: And what that has meant is not just going about 202 00:11:54,476 --> 00:11:57,956 Speaker 1: the usual process that you have on transition teams where 203 00:11:57,996 --> 00:12:00,076 Speaker 1: you think about the structure of a department and you 204 00:12:00,116 --> 00:12:03,756 Speaker 1: think about personnel, but it's involved thinking about some very 205 00:12:03,756 --> 00:12:06,076 Speaker 1: specific areas that are going to require a whole lot 206 00:12:06,116 --> 00:12:09,756 Speaker 1: more planning. So, for example, how do you actually expand 207 00:12:09,796 --> 00:12:13,116 Speaker 1: testing sufficiently so that we have enough testing so that 208 00:12:13,156 --> 00:12:15,236 Speaker 1: everyone who needs a test and get one. How do 209 00:12:15,276 --> 00:12:19,476 Speaker 1: we ensure that we actually have enough contact tracing capacity 210 00:12:19,476 --> 00:12:21,716 Speaker 1: in our country. We don't right now, but we really 211 00:12:21,756 --> 00:12:24,996 Speaker 1: need that we have any hopes of getting this under control. 212 00:12:25,316 --> 00:12:27,756 Speaker 1: And of course it involves how to think about the 213 00:12:27,916 --> 00:12:31,196 Speaker 1: deployment of a vaccine. So these have been the topic 214 00:12:31,236 --> 00:12:34,276 Speaker 1: of countless discussions that I and others have had with 215 00:12:34,476 --> 00:12:38,276 Speaker 1: Vice President Biden, where he asked very specific questions. He's 216 00:12:38,476 --> 00:12:41,276 Speaker 1: thinking about very specific plans. But a key parts of 217 00:12:41,316 --> 00:12:45,716 Speaker 1: these plans, certainly for the Vaccine Distribution Fund, include thinking 218 00:12:45,756 --> 00:12:48,996 Speaker 1: about who the trusted partners are that we will need 219 00:12:49,156 --> 00:12:52,276 Speaker 1: in communities, like for example, if you think about the partners, 220 00:12:52,276 --> 00:12:55,116 Speaker 1: it's not just a medical establishment, but it's also schools 221 00:12:55,116 --> 00:12:58,636 Speaker 1: and employers. We know that schools and workplaces are sites 222 00:12:58,676 --> 00:13:02,596 Speaker 1: where a vaccine could be administered, and having partners in 223 00:13:02,636 --> 00:13:05,876 Speaker 1: those spheres is going to be absolutely essential. We know 224 00:13:05,956 --> 00:13:08,876 Speaker 1: that local government and states are going to be extremely 225 00:13:09,116 --> 00:13:11,636 Speaker 1: important partners. But here's the way I think the Vice 226 00:13:11,676 --> 00:13:15,596 Speaker 1: President would approach that partnership differently. In the early part 227 00:13:15,596 --> 00:13:19,116 Speaker 1: of this COVID response, what we saw is a transfer 228 00:13:19,156 --> 00:13:22,956 Speaker 1: of responsibility from the federal government to the states, saying, 229 00:13:22,956 --> 00:13:26,676 Speaker 1: you take care of this, and we will lead behind 230 00:13:26,796 --> 00:13:29,036 Speaker 1: lead from a different place, we will step back. I 231 00:13:29,036 --> 00:13:31,036 Speaker 1: think the Vice President realize is that you need to 232 00:13:31,036 --> 00:13:33,556 Speaker 1: give states the ability to craft their own response, but 233 00:13:33,596 --> 00:13:35,996 Speaker 1: you also have to lead as a federal government, and 234 00:13:36,156 --> 00:13:38,236 Speaker 1: one of the places in which you have to lead 235 00:13:38,276 --> 00:13:40,636 Speaker 1: is in the allocation of resources. So just think about 236 00:13:40,636 --> 00:13:43,116 Speaker 1: the following question, how do you decide how much vaccine 237 00:13:43,156 --> 00:13:48,316 Speaker 1: goes to Georgia or Florida, or Massachusetts or California. You 238 00:13:48,356 --> 00:13:50,836 Speaker 1: can't have that driven by politics. That has to be 239 00:13:50,916 --> 00:13:53,596 Speaker 1: driven by science and by need. So which raises a 240 00:13:53,676 --> 00:13:56,036 Speaker 1: second issue that he's been working on, not just partnerships, 241 00:13:56,076 --> 00:14:00,036 Speaker 1: but thinking about data systems right for understanding where the 242 00:14:00,116 --> 00:14:02,076 Speaker 1: need is and making sure that we can meet that need. 243 00:14:02,156 --> 00:14:06,196 Speaker 1: Right now, I'm worried that we don't have strong, robust 244 00:14:06,276 --> 00:14:08,796 Speaker 1: data systems that are integrated in our country such that 245 00:14:08,836 --> 00:14:11,876 Speaker 1: if we administered and rolled out vaccine today, we would 246 00:14:11,876 --> 00:14:14,916 Speaker 1: automatically know where it was being delivered, who was getting them, 247 00:14:14,916 --> 00:14:18,236 Speaker 1: so that we could target our follow up activities appropriately. 248 00:14:18,596 --> 00:14:20,716 Speaker 1: We have to fix those data systems. So he's been 249 00:14:20,756 --> 00:14:23,796 Speaker 1: thinking about a number of areas like this and bringing 250 00:14:23,836 --> 00:14:27,116 Speaker 1: experts together, well beyond myself, you know, experts from really 251 00:14:27,156 --> 00:14:29,796 Speaker 1: around the country who have done this before. He wants 252 00:14:29,836 --> 00:14:32,436 Speaker 1: to assemble the best team possible because he knows this 253 00:14:32,516 --> 00:14:34,956 Speaker 1: is going to be a once in a generation challenge. 254 00:14:35,636 --> 00:14:37,916 Speaker 1: Let me press you on this. I think you're right 255 00:14:38,276 --> 00:14:40,316 Speaker 1: from what I know that the data systems that we 256 00:14:40,356 --> 00:14:44,476 Speaker 1: presently have aren't sufficiently robust to even have a clear 257 00:14:44,556 --> 00:14:48,556 Speaker 1: sense of what prevalence looks like. And that's before you 258 00:14:48,596 --> 00:14:51,236 Speaker 1: get to the substantive question, which is, if you're new prevalence, 259 00:14:51,556 --> 00:14:54,236 Speaker 1: where should you focus resources. Because it's not immediately obvious 260 00:14:54,236 --> 00:14:56,316 Speaker 1: that you want to focus a vaccine immediately on the 261 00:14:56,356 --> 00:14:58,996 Speaker 1: heart of sted areas. There are actually arguments for beginning 262 00:14:58,996 --> 00:15:01,116 Speaker 1: in more moderately hit areas and so forth and so on. 263 00:15:01,316 --> 00:15:02,916 Speaker 1: So I mean, this is a complex topic in its 264 00:15:02,956 --> 00:15:06,716 Speaker 1: own right. But given that the data systems almost only 265 00:15:06,716 --> 00:15:09,956 Speaker 1: are not in place, how is it real to think 266 00:15:09,996 --> 00:15:13,636 Speaker 1: that a Biden administration could take the time to build 267 00:15:13,676 --> 00:15:17,316 Speaker 1: up these data systems in order to then make an 268 00:15:17,316 --> 00:15:19,676 Speaker 1: informed decision. I mean, if you are doing this, you 269 00:15:19,716 --> 00:15:21,796 Speaker 1: and a team of people are doing this, you are 270 00:15:21,796 --> 00:15:23,676 Speaker 1: going to be doing it in media's race. You are 271 00:15:23,756 --> 00:15:26,956 Speaker 1: going to be inheriting the mess that you have inherited, 272 00:15:27,196 --> 00:15:31,316 Speaker 1: and you will be under enormous pressure to act quickly. Again, 273 00:15:31,436 --> 00:15:35,076 Speaker 1: assuming that there is a safe and available vaccine. So 274 00:15:35,516 --> 00:15:37,076 Speaker 1: I guess I want to say that sounds nice in 275 00:15:37,156 --> 00:15:39,756 Speaker 1: the abstract, like let's solve the data systems, but there's 276 00:15:39,796 --> 00:15:41,796 Speaker 1: no way that there's going to be the time that 277 00:15:41,836 --> 00:15:43,436 Speaker 1: it would take to do that. So how do you 278 00:15:43,436 --> 00:15:47,916 Speaker 1: make decisions under radical uncertainty without the data systems? So 279 00:15:48,076 --> 00:15:50,716 Speaker 1: it's a great question, and you're right, we can't wait 280 00:15:50,796 --> 00:15:53,156 Speaker 1: until the perfect systems are built. You can't wait until 281 00:15:53,156 --> 00:15:56,276 Speaker 1: all the partners are assembled around the table either, because 282 00:15:56,276 --> 00:15:58,756 Speaker 1: if this vaccine truly is safe and effective, that means 283 00:15:58,796 --> 00:16:02,676 Speaker 1: that every day you lose our lives that are potentially lost. 284 00:16:02,916 --> 00:16:05,716 Speaker 1: So what we would have to do is we'd we'd 285 00:16:05,716 --> 00:16:07,236 Speaker 1: have to do the best we can in the beginning, 286 00:16:07,316 --> 00:16:09,636 Speaker 1: use the data we have and go to areas that 287 00:16:09,756 --> 00:16:11,996 Speaker 1: we know have great need, and start to deploying the 288 00:16:12,076 --> 00:16:15,716 Speaker 1: vaccine through existing partners. We also have, thankfully, through the 289 00:16:15,836 --> 00:16:20,076 Speaker 1: National Academies of Medicine, recommendations on what the priority population 290 00:16:20,156 --> 00:16:22,716 Speaker 1: should be that we should target, So we know that 291 00:16:22,956 --> 00:16:26,236 Speaker 1: healthcare workers and other workers in the front line are critical. 292 00:16:26,276 --> 00:16:28,236 Speaker 1: We know the people at higher risk because of their 293 00:16:28,316 --> 00:16:31,396 Speaker 1: age or other medical conditions they have, are at higher risk, 294 00:16:31,476 --> 00:16:33,636 Speaker 1: so we can go to nursing homes, we can go 295 00:16:33,716 --> 00:16:36,996 Speaker 1: to other locations where high risk populations are and preferentially 296 00:16:37,436 --> 00:16:40,316 Speaker 1: vaccinate there. There is a lot of low hanging fruit, 297 00:16:40,316 --> 00:16:42,156 Speaker 1: if you will, in terms of actions that can be 298 00:16:42,236 --> 00:16:45,276 Speaker 1: taken in the very beginning, even while you're trying to 299 00:16:45,476 --> 00:16:48,356 Speaker 1: build up systems and build up partners. But all of 300 00:16:48,396 --> 00:16:52,036 Speaker 1: this is going to be infinitely harder if people are skeptical, 301 00:16:52,076 --> 00:16:54,836 Speaker 1: if they're doubtful, if they don't trust what you're doing. 302 00:16:54,876 --> 00:16:56,836 Speaker 1: And that's why the other plank of this that's so 303 00:16:56,996 --> 00:16:59,876 Speaker 1: essential that we've been talking about is the importance of 304 00:16:59,916 --> 00:17:03,476 Speaker 1: communicating openly, honestly about what our plans are and what 305 00:17:03,596 --> 00:17:06,636 Speaker 1: progress we're making from day one. This is a kind 306 00:17:06,676 --> 00:17:10,076 Speaker 1: of crisis communication that has been deployed by Republican and 307 00:17:10,116 --> 00:17:14,676 Speaker 1: democratic administrations alike in prior pandemics. It's not the purview 308 00:17:14,716 --> 00:17:17,116 Speaker 1: of one party, but it hasn't been done well in 309 00:17:17,116 --> 00:17:18,876 Speaker 1: this response, and that's why we have a lot of 310 00:17:18,876 --> 00:17:22,196 Speaker 1: ground to make up. We'll be back in a moment. 311 00:17:31,436 --> 00:17:34,756 Speaker 1: I'm deeply worried that, regardless of the outcome of the election, 312 00:17:35,076 --> 00:17:39,396 Speaker 1: if a vaccine becomes available and safe under a Republican administration, 313 00:17:39,476 --> 00:17:42,196 Speaker 1: a lot of Democrats won't trust it, and that if 314 00:17:42,196 --> 00:17:45,196 Speaker 1: a vaccine becomes available and safe under a democratic administration, 315 00:17:45,556 --> 00:17:47,836 Speaker 1: a lot of Republicans won't trust it. In other words, 316 00:17:48,076 --> 00:17:51,836 Speaker 1: my worry is that the profound political partisan differences that 317 00:17:51,916 --> 00:17:57,956 Speaker 1: we have are fully bleeding into people's trust in scientific 318 00:17:57,996 --> 00:18:03,156 Speaker 1: institutions and medical institutions. What's our long run societal solution 319 00:18:03,716 --> 00:18:05,876 Speaker 1: to that problem. I mean, I'm not asking you to 320 00:18:05,876 --> 00:18:08,436 Speaker 1: solve the problem of partisan division. Nobody can do that, 321 00:18:08,516 --> 00:18:12,356 Speaker 1: and it's been with us in certain respects, although waning 322 00:18:12,356 --> 00:18:14,876 Speaker 1: and waxing throughout our history. I'm talking about the very 323 00:18:14,916 --> 00:18:18,676 Speaker 1: concrete problem, much closer to your area of expertise, which 324 00:18:18,716 --> 00:18:22,796 Speaker 1: is that people's trust in science and medicine is coming 325 00:18:22,836 --> 00:18:26,356 Speaker 1: to be deeply inflected by their partisan views. How do 326 00:18:26,436 --> 00:18:30,956 Speaker 1: we break that linkage no matter who's president. Yeah, And 327 00:18:31,396 --> 00:18:33,796 Speaker 1: the reason to be concerned because we've seen that on 328 00:18:33,836 --> 00:18:37,636 Speaker 1: a number of measures, whether it's people's views of the 329 00:18:37,756 --> 00:18:40,996 Speaker 1: masks and whether they're appropriate or not and useful, or 330 00:18:41,196 --> 00:18:43,516 Speaker 1: people's view of other precautions related to COVID. There has 331 00:18:43,596 --> 00:18:46,476 Speaker 1: been a partisan divide here. But what's interesting, as a 332 00:18:46,556 --> 00:18:48,436 Speaker 1: side note is if you look at this data on 333 00:18:48,596 --> 00:18:52,436 Speaker 1: vaccines and specially the COVID nineteen vaccine. I mentioned that 334 00:18:52,476 --> 00:18:54,516 Speaker 1: fifty four percent of people are saying they would not 335 00:18:55,036 --> 00:18:57,556 Speaker 1: take the vaccine if it was available before election day. 336 00:18:57,876 --> 00:19:01,796 Speaker 1: That actually includes forty eight percent of Democrats but sixty 337 00:19:01,836 --> 00:19:05,196 Speaker 1: percent of Republicans. So in a very interesting way, we're 338 00:19:05,196 --> 00:19:08,756 Speaker 1: finding that both Democrats and Republicans have deep worries about 339 00:19:08,756 --> 00:19:11,836 Speaker 1: the back scene. But the larger point around polarization and 340 00:19:12,276 --> 00:19:14,836 Speaker 1: affecting how we take in information and what we trust 341 00:19:14,956 --> 00:19:17,316 Speaker 1: is absolutely true and it will be deadly as it 342 00:19:17,356 --> 00:19:20,596 Speaker 1: has been to date regards to coronavirus. I think one 343 00:19:20,636 --> 00:19:22,636 Speaker 1: critical strategy and there are many here, but the one 344 00:19:22,676 --> 00:19:25,196 Speaker 1: I'll mention is that we have to go local in 345 00:19:25,276 --> 00:19:28,996 Speaker 1: terms of mobilizing information sources. Typically people think, well, if 346 00:19:28,996 --> 00:19:31,676 Speaker 1: you get somebody on a major network in terms of news, 347 00:19:31,716 --> 00:19:33,596 Speaker 1: or a national radio station, that's how you get the 348 00:19:33,636 --> 00:19:36,636 Speaker 1: message out. But I think increasingly in this polarized world 349 00:19:36,636 --> 00:19:39,676 Speaker 1: where people are listening to their own sources, you actually 350 00:19:39,676 --> 00:19:41,556 Speaker 1: have to go much more local. You have to think, 351 00:19:41,556 --> 00:19:46,796 Speaker 1: how do I ensure that an individual's doctor actually knows 352 00:19:46,996 --> 00:19:49,356 Speaker 1: that the truth about this vaccine so they can recommend them. 353 00:19:49,716 --> 00:19:52,556 Speaker 1: How do I ensure that other people who are trusted 354 00:19:52,596 --> 00:19:54,636 Speaker 1: members of a community, like faith leaders, know the truth 355 00:19:54,636 --> 00:19:57,916 Speaker 1: about this vaccine so they can advise people. Because when 356 00:19:57,996 --> 00:20:00,836 Speaker 1: you have doubts about whether people are telling you the truth, 357 00:20:01,156 --> 00:20:03,196 Speaker 1: all of us as human beings go to the people 358 00:20:03,236 --> 00:20:05,996 Speaker 1: we know and that we have trusted for a long time, 359 00:20:06,196 --> 00:20:10,036 Speaker 1: that our friends, our family, our nurses and doctor are 360 00:20:10,396 --> 00:20:13,436 Speaker 1: faith leaders and other trusted populations like this. So I 361 00:20:13,476 --> 00:20:16,356 Speaker 1: think if ultimately we want to convince people that the 362 00:20:16,436 --> 00:20:19,276 Speaker 1: vaccines is safe and effective, if it indeed the evidence 363 00:20:19,276 --> 00:20:21,236 Speaker 1: backs that up, we've got to think about how to 364 00:20:21,276 --> 00:20:23,676 Speaker 1: mobilize those voices, And I think those will end up 365 00:20:23,716 --> 00:20:27,356 Speaker 1: being much much more important than getting people on cable 366 00:20:27,396 --> 00:20:31,036 Speaker 1: news and on national radio. That raises the really hard 367 00:20:31,076 --> 00:20:33,196 Speaker 1: question of how do you reach the local leaders that 368 00:20:33,236 --> 00:20:37,356 Speaker 1: you're talking about. We live in an era where local newspapers, 369 00:20:37,436 --> 00:20:39,196 Speaker 1: which at one time would have been a standard way 370 00:20:39,236 --> 00:20:41,076 Speaker 1: to reach people locally, because you can have a local 371 00:20:41,116 --> 00:20:45,436 Speaker 1: newspaper article about the local physician or faith leader who says, 372 00:20:45,556 --> 00:20:48,516 Speaker 1: you know, the vaccine is great, but they're in retreat, 373 00:20:48,876 --> 00:20:51,236 Speaker 1: or in many parts of the country, they're already gone. 374 00:20:51,756 --> 00:20:54,356 Speaker 1: And one of the ways that people now increasingly communicate 375 00:20:54,436 --> 00:20:57,356 Speaker 1: with their trusted sources, whether it's family or friends or 376 00:20:57,356 --> 00:21:01,476 Speaker 1: local leaders, is actually through social media. And in that environment, 377 00:21:01,916 --> 00:21:04,756 Speaker 1: authority isn't quite as powerful as it once was in 378 00:21:04,836 --> 00:21:08,996 Speaker 1: historical terms, and things can go the other way relatively quickly. 379 00:21:09,116 --> 00:21:13,996 Speaker 1: There can be a decentralized distribution of distrustful information. I 380 00:21:14,316 --> 00:21:15,876 Speaker 1: agree with you that we want to get people to 381 00:21:15,876 --> 00:21:18,196 Speaker 1: hear an important and true message from people who may trust. 382 00:21:18,676 --> 00:21:21,036 Speaker 1: But how do you at a national level think about 383 00:21:21,076 --> 00:21:25,476 Speaker 1: reaching those people if it's not through going on CNN 384 00:21:25,476 --> 00:21:29,676 Speaker 1: and MSNBC, which you do so frequently and so skillfully. Well, No, 385 00:21:29,836 --> 00:21:33,556 Speaker 1: I think this is not easy work. It's a hard grind. 386 00:21:33,556 --> 00:21:36,236 Speaker 1: If you will, because it requires a lot of conversations. 387 00:21:36,796 --> 00:21:39,716 Speaker 1: This is I think why people have gravitated so much 388 00:21:39,756 --> 00:21:42,756 Speaker 1: toward national news and national media. It has the illusion 389 00:21:42,796 --> 00:21:46,156 Speaker 1: that seeming to be more efficient, right, you reach more people, Hey, 390 00:21:45,956 --> 00:21:49,396 Speaker 1: why wouldn't that be better? The problem is it comes 391 00:21:49,436 --> 00:21:52,836 Speaker 1: with a heavy filter that people don't necessarily trust. And 392 00:21:52,876 --> 00:21:55,276 Speaker 1: so the way that I would think about this is 393 00:21:55,316 --> 00:21:57,716 Speaker 1: that we would need to reach out, for example, to 394 00:21:58,116 --> 00:22:01,036 Speaker 1: local organizations that bring together faith leaders. We need to 395 00:22:01,036 --> 00:22:03,676 Speaker 1: reach out to the YMCAs, to the rotary clubs, will 396 00:22:03,756 --> 00:22:06,356 Speaker 1: need to reach out to associations of librarians. We'll need 397 00:22:06,356 --> 00:22:08,636 Speaker 1: to reach out to groups where we can get in 398 00:22:08,676 --> 00:22:11,596 Speaker 1: front of people, talk to them, and then start engaging 399 00:22:11,596 --> 00:22:16,076 Speaker 1: their local chapters. And if that sounds like really tough, tedious, 400 00:22:16,076 --> 00:22:20,036 Speaker 1: tenuous work, it is. It's not easy to do because 401 00:22:20,076 --> 00:22:22,796 Speaker 1: what we're really talking about, Noah, even though we haven't 402 00:22:22,836 --> 00:22:25,716 Speaker 1: used this word before, is we're talking about relationship building, right, 403 00:22:25,756 --> 00:22:28,956 Speaker 1: and relationship building can take time. But I think that 404 00:22:29,116 --> 00:22:30,956 Speaker 1: it doesn't mean that we'll never be able to get 405 00:22:30,996 --> 00:22:32,756 Speaker 1: a vaccine out for months and months. I think that 406 00:22:32,796 --> 00:22:35,076 Speaker 1: there are enough people who believe that this is an 407 00:22:35,156 --> 00:22:37,756 Speaker 1: urgent crisis and who will understand the science behind it, 408 00:22:37,796 --> 00:22:39,996 Speaker 1: that we will have some uptake of the vaccine. The 409 00:22:40,076 --> 00:22:42,196 Speaker 1: question is how to sustain that and get to a 410 00:22:42,236 --> 00:22:44,996 Speaker 1: sufficient level where we have her in immunity. There's one 411 00:22:45,036 --> 00:22:46,996 Speaker 1: other point I want to raise here, though, if this 412 00:22:47,076 --> 00:22:49,916 Speaker 1: is indeed about relationships, and if what we need our 413 00:22:49,996 --> 00:22:52,836 Speaker 1: organizations that have a lot of relationships in the local level. 414 00:22:53,316 --> 00:22:56,156 Speaker 1: It's been particularly worrisome to me over the last many 415 00:22:56,236 --> 00:22:59,876 Speaker 1: years that we've had a breakdown in those kind of 416 00:22:59,876 --> 00:23:03,516 Speaker 1: community organizations over the last many decades, like in this country. 417 00:23:03,716 --> 00:23:07,356 Speaker 1: You know, something that's been well documented by about Putnam, 418 00:23:07,476 --> 00:23:09,716 Speaker 1: you know, I've been Harvard and by others. But this 419 00:23:10,076 --> 00:23:13,756 Speaker 1: decline in participation in community organizations and affiliation with community 420 00:23:13,756 --> 00:23:17,276 Speaker 1: groups leaves people with fewer sources that they actually trust, 421 00:23:17,356 --> 00:23:19,836 Speaker 1: that are easy to access in a crisis like this, 422 00:23:20,476 --> 00:23:22,956 Speaker 1: and I see that as deeply worrisome. It's one of 423 00:23:22,956 --> 00:23:26,516 Speaker 1: the reasons why when I left my time in government, 424 00:23:26,596 --> 00:23:28,516 Speaker 1: when I was thinking about what do I work on, 425 00:23:28,676 --> 00:23:30,476 Speaker 1: what do I want to contribute to in the world. 426 00:23:31,036 --> 00:23:33,116 Speaker 1: That's why I kept coming back to this idea of 427 00:23:33,316 --> 00:23:36,956 Speaker 1: social connection as being such an important topic, because if 428 00:23:36,956 --> 00:23:39,676 Speaker 1: you don't have strong connections in your life, then you 429 00:23:39,716 --> 00:23:41,916 Speaker 1: don't have people you trust. If you don't have people 430 00:23:41,956 --> 00:23:46,196 Speaker 1: you trust, then you're reliant on social media, on cable news, 431 00:23:46,196 --> 00:23:49,796 Speaker 1: on other sources for your information, and you don't have 432 00:23:49,836 --> 00:23:52,516 Speaker 1: people to talk through doubts and worries with. And I 433 00:23:52,556 --> 00:23:56,036 Speaker 1: think we are bearing the consequences of a deterioration in 434 00:23:56,116 --> 00:24:00,556 Speaker 1: social connection in social organizations. But that said, we still 435 00:24:00,596 --> 00:24:03,156 Speaker 1: have many organizations in our communities that we can lean on, 436 00:24:03,196 --> 00:24:05,356 Speaker 1: and that's going to have to be our priority in 437 00:24:05,516 --> 00:24:09,876 Speaker 1: a new administration. Let me ask you about how deeply 438 00:24:09,956 --> 00:24:13,356 Speaker 1: penetrated a vaccine would actually have to be to achieve 439 00:24:13,356 --> 00:24:15,276 Speaker 1: her immunity. I mean, I realized there's not an exact 440 00:24:15,356 --> 00:24:18,596 Speaker 1: number that one can define with respect to a particular pandemic, 441 00:24:18,636 --> 00:24:22,116 Speaker 1: although there is some general guidance that we have from epidemiologists. 442 00:24:22,156 --> 00:24:23,636 Speaker 1: And the reason I want to ask you about that 443 00:24:23,916 --> 00:24:26,596 Speaker 1: is what sort of emerging in my mind as I 444 00:24:26,636 --> 00:24:29,316 Speaker 1: listen to you, is that a lot of us have 445 00:24:29,356 --> 00:24:31,796 Speaker 1: been thinking, well, how do we get out of this? Well, 446 00:24:31,836 --> 00:24:33,356 Speaker 1: maybe the right way to get out of it is 447 00:24:33,356 --> 00:24:36,036 Speaker 1: with a vaccine. But what I'm hearing from you is 448 00:24:36,076 --> 00:24:39,636 Speaker 1: that actually getting a vaccine is not necessarily the way out. 449 00:24:39,676 --> 00:24:41,796 Speaker 1: The way out is to have a vaccine and then 450 00:24:42,036 --> 00:24:44,836 Speaker 1: have that vaccine be sufficiently trusted by a broad enough 451 00:24:44,836 --> 00:24:48,476 Speaker 1: swath of population that when it is distributed and taken, 452 00:24:48,996 --> 00:24:52,396 Speaker 1: it gets sufficient penetration to actually reach her immunity. And 453 00:24:52,396 --> 00:24:55,796 Speaker 1: that may be a very very different thing. I'm letting 454 00:24:55,836 --> 00:24:57,996 Speaker 1: that sort of seep through my thinking right now. So 455 00:24:58,076 --> 00:25:01,276 Speaker 1: let's just walk through it. Start with, what percentage do 456 00:25:01,316 --> 00:25:03,716 Speaker 1: you think roughly we would need to reach for the 457 00:25:03,796 --> 00:25:07,556 Speaker 1: vaccine to be efficacious? So, Noah, that number depends on 458 00:25:07,596 --> 00:25:10,516 Speaker 1: how effective the vaccine is. So if we had a 459 00:25:10,596 --> 00:25:14,116 Speaker 1: vaccine that was one hundred percent effective, which would be 460 00:25:14,476 --> 00:25:18,316 Speaker 1: exceedingly unusual, then we would have to vaccinate somewhere in 461 00:25:18,356 --> 00:25:21,436 Speaker 1: their neighborhood of a seventy percent of the population, maybe 462 00:25:21,476 --> 00:25:23,676 Speaker 1: a little bit less, because you know a number of 463 00:25:23,716 --> 00:25:26,556 Speaker 1: people have had the virus already, they may have some 464 00:25:26,636 --> 00:25:28,996 Speaker 1: short term immunity, but it would have to be around 465 00:25:28,996 --> 00:25:31,716 Speaker 1: seventy percent. But if you start dropping that, if you 466 00:25:31,756 --> 00:25:34,796 Speaker 1: get to a vaccine that's around fifty percent effective, which 467 00:25:34,796 --> 00:25:37,716 Speaker 1: is a threshold in fact that the FDA set and 468 00:25:37,836 --> 00:25:41,796 Speaker 1: it's June thirtieth guidance, then even if you vaccinated everybody 469 00:25:41,796 --> 00:25:43,836 Speaker 1: in the country. You're not necessarily going to get to 470 00:25:43,916 --> 00:25:46,316 Speaker 1: hurt immunity levels. Now, that doesn't mean that it's still 471 00:25:46,356 --> 00:25:49,196 Speaker 1: not worthwhile. See herd immunity is not a switch that 472 00:25:49,236 --> 00:25:51,876 Speaker 1: we flip on or off. There are benefits to be gained, 473 00:25:52,076 --> 00:25:53,756 Speaker 1: you know, if we get halfway there. Their benefits to 474 00:25:53,876 --> 00:25:55,396 Speaker 1: be gained if we get three quarters of the way there. 475 00:25:55,876 --> 00:25:59,156 Speaker 1: But what this means, given the fact that getting to 476 00:25:59,236 --> 00:26:01,796 Speaker 1: hurt immunity levels will take time and will be difficult, 477 00:26:02,276 --> 00:26:04,836 Speaker 1: is it means that many of the precautions that we're 478 00:26:04,836 --> 00:26:08,196 Speaker 1: taking right now in terms of distancing and wearing masks, 479 00:26:08,356 --> 00:26:11,956 Speaker 1: and upping our game in terms of personal hygiene and 480 00:26:11,996 --> 00:26:14,916 Speaker 1: washing our hands, that those behavior changes will be with 481 00:26:14,996 --> 00:26:18,516 Speaker 1: us for a while, certainly through twenty twenty one and 482 00:26:18,796 --> 00:26:21,596 Speaker 1: very likely beyond that. It doesn't mean that we're going 483 00:26:21,636 --> 00:26:24,076 Speaker 1: to have to stay in our homes for years and years. 484 00:26:24,436 --> 00:26:26,516 Speaker 1: We will learn, as we have already in the last 485 00:26:26,516 --> 00:26:30,356 Speaker 1: six months, safer ways to come together in smaller groups, 486 00:26:30,396 --> 00:26:34,916 Speaker 1: you know, outside, or to even improve our current ventilation 487 00:26:34,996 --> 00:26:38,036 Speaker 1: systems and other measures indoors to make the risk of 488 00:26:38,396 --> 00:26:41,836 Speaker 1: getting coronavirus lower. So we will find safer ways to 489 00:26:42,476 --> 00:26:45,036 Speaker 1: re engage in our life. But our life is not 490 00:26:45,076 --> 00:26:48,036 Speaker 1: going to go back to pre pandemic sort of ways 491 00:26:48,316 --> 00:26:51,316 Speaker 1: until probably at least several years from now. I just 492 00:26:51,316 --> 00:26:54,316 Speaker 1: want to make sure that everybody who's listening gets the 493 00:26:54,356 --> 00:26:58,036 Speaker 1: full weight of what you're saying. First, even a perfectly 494 00:26:58,076 --> 00:27:02,516 Speaker 1: effective vaccine, perfeclyifficacious vaccine, which basically doesn't exist in the 495 00:27:02,556 --> 00:27:04,756 Speaker 1: real world for almost anything that we think of being 496 00:27:04,836 --> 00:27:07,636 Speaker 1: vaccinated for, would have to reach seventy percent of the 497 00:27:07,676 --> 00:27:11,436 Speaker 1: population before we can say at her immunity, and we 498 00:27:11,436 --> 00:27:15,516 Speaker 1: can remove various forms of social distancing and masks and separation. 499 00:27:16,276 --> 00:27:21,396 Speaker 1: As you go down the efficacy numbers, you get greater 500 00:27:21,436 --> 00:27:23,716 Speaker 1: and greater probability that a good number of people will 501 00:27:23,716 --> 00:27:27,916 Speaker 1: still be getting the virus. And as you go down, 502 00:27:28,516 --> 00:27:30,276 Speaker 1: you need more and more people to be vaccinated, And 503 00:27:30,356 --> 00:27:33,916 Speaker 1: of course that's going to be actually inversely correlated in 504 00:27:33,916 --> 00:27:36,316 Speaker 1: the real world. Right if we heard that the vaccine 505 00:27:36,356 --> 00:27:38,916 Speaker 1: was one hundred percent efficacious, more people would be inclined 506 00:27:38,956 --> 00:27:41,236 Speaker 1: to take it, And ironically, what we need is the 507 00:27:41,276 --> 00:27:43,636 Speaker 1: other way around. The less efficationous vaccine needs more people 508 00:27:43,636 --> 00:27:44,996 Speaker 1: to take it. But if people say it's only fifty 509 00:27:44,996 --> 00:27:47,716 Speaker 1: percent effective. A lot of people will mistakenly say, and 510 00:27:47,756 --> 00:27:50,396 Speaker 1: therefore I shouldn't take it. I mean mistakenly in the 511 00:27:50,476 --> 00:27:53,596 Speaker 1: rational sense that rationally you really should take it if 512 00:27:53,756 --> 00:27:56,316 Speaker 1: it has any capacity to help you provide it that 513 00:27:56,356 --> 00:27:58,316 Speaker 1: you don't think, the danger is still great. So we 514 00:27:58,356 --> 00:28:01,556 Speaker 1: could very easily get an extremely messy situation with like 515 00:28:01,556 --> 00:28:05,276 Speaker 1: a ninety percent efficacious vaccine but lots of people not 516 00:28:05,316 --> 00:28:08,036 Speaker 1: taking it. And then the upshot of that I'm hearing 517 00:28:08,076 --> 00:28:12,436 Speaker 1: you saying is that masks are going to continue even 518 00:28:12,596 --> 00:28:16,036 Speaker 1: after the vaccine is out there. Social distancing measures, including 519 00:28:16,436 --> 00:28:19,476 Speaker 1: not getting together with medium groups of people or a 520 00:28:19,516 --> 00:28:23,076 Speaker 1: large groups of people indoors, those restrictions are going to 521 00:28:23,116 --> 00:28:25,836 Speaker 1: continue for at least twenty twenty one, and maybe for 522 00:28:26,276 --> 00:28:28,556 Speaker 1: several years longer. And that is, in a certain sense, 523 00:28:29,396 --> 00:28:32,796 Speaker 1: a much more depressing picture than a lot of us 524 00:28:32,796 --> 00:28:36,356 Speaker 1: have been imagining as progress towards the vaccine seems to 525 00:28:36,396 --> 00:28:39,196 Speaker 1: be advancing. I mean, am I getting it right? I 526 00:28:39,196 --> 00:28:42,956 Speaker 1: mean You're saying it very cautiously and very rationally, But 527 00:28:43,036 --> 00:28:46,796 Speaker 1: what I'm hearing is actually a pretty striking rational conclusion 528 00:28:46,876 --> 00:28:50,756 Speaker 1: that we're very, very very far from anything approaching normal life, 529 00:28:51,876 --> 00:28:54,396 Speaker 1: So yes, no, I mean, you know, I try never 530 00:28:54,436 --> 00:28:56,876 Speaker 1: to be alarmist about these things, because there's you got 531 00:28:56,876 --> 00:28:58,636 Speaker 1: to admit, there's a lot we don't know, and I'm 532 00:28:58,636 --> 00:29:01,876 Speaker 1: always outing to stake hoping for major breakthroughs. But I 533 00:29:01,876 --> 00:29:05,076 Speaker 1: think the realistic picture is that we are looking at 534 00:29:05,116 --> 00:29:07,756 Speaker 1: our life continuing to be changed for several years now 535 00:29:07,756 --> 00:29:09,396 Speaker 1: and now I want to be clear by one thing, 536 00:29:09,876 --> 00:29:11,236 Speaker 1: That does not mean that we're going to be in 537 00:29:11,236 --> 00:29:13,276 Speaker 1: the exact state that we're in right now in a year. 538 00:29:13,796 --> 00:29:16,596 Speaker 1: In fact, I think that we will be more able 539 00:29:16,636 --> 00:29:18,796 Speaker 1: to get our children back to school, that we will 540 00:29:18,836 --> 00:29:21,276 Speaker 1: find safer ways to do that. In fact, we know 541 00:29:21,356 --> 00:29:23,796 Speaker 1: safer ways, we're just not really implementing them right now. 542 00:29:24,116 --> 00:29:26,916 Speaker 1: I do think they will see more workplaces actually up 543 00:29:26,956 --> 00:29:29,916 Speaker 1: and running again, because again we will, hopefully if we 544 00:29:29,996 --> 00:29:32,556 Speaker 1: have advances in testing, and if we have people more 545 00:29:32,556 --> 00:29:36,276 Speaker 1: observant precautions and we get local prevalence of the virus down, 546 00:29:36,356 --> 00:29:39,916 Speaker 1: we can have workplaces operating at least in a partial 547 00:29:39,956 --> 00:29:42,476 Speaker 1: way or even close to normal, in ways that we 548 00:29:42,516 --> 00:29:44,796 Speaker 1: haven't near these last several months. So I think we 549 00:29:44,836 --> 00:29:48,396 Speaker 1: will make progress, and even with getting together socially, I 550 00:29:48,396 --> 00:29:51,316 Speaker 1: think we will find ways to get together in small 551 00:29:51,356 --> 00:29:54,756 Speaker 1: groups indoors and socialize and see each other, but we'll 552 00:29:54,796 --> 00:29:57,076 Speaker 1: do in ways that are safer, just like how you 553 00:29:57,116 --> 00:30:01,356 Speaker 1: see some schools actually able to bring children together with masks, 554 00:30:01,396 --> 00:30:05,356 Speaker 1: with distancing in indoor environments to learn. So we are 555 00:30:05,396 --> 00:30:08,556 Speaker 1: an incredibly adaptable species. We've adapted a lot in the 556 00:30:08,596 --> 00:30:11,036 Speaker 1: last six month. We will adapt a lot more. But 557 00:30:11,116 --> 00:30:14,076 Speaker 1: what I do think we should be realistic about is 558 00:30:14,116 --> 00:30:16,916 Speaker 1: that when a vaccine arrives, it's not like tomorrow or 559 00:30:16,916 --> 00:30:19,196 Speaker 1: even in a month or in six months that suddenly 560 00:30:19,196 --> 00:30:22,516 Speaker 1: will go back to having full arenas at basketball games, 561 00:30:22,516 --> 00:30:26,716 Speaker 1: and having crowded concerts and having large groups get together 562 00:30:26,796 --> 00:30:30,396 Speaker 1: for birthday parties and other festive occasions. That will come 563 00:30:30,396 --> 00:30:33,276 Speaker 1: back eventually, but it's going to take some time. The 564 00:30:33,316 --> 00:30:37,676 Speaker 1: public pressure though the moment a vaccine is broadly available, 565 00:30:37,836 --> 00:30:40,676 Speaker 1: a safe vaccine is broadly available, to go back to 566 00:30:40,796 --> 00:30:44,956 Speaker 1: normal at the basketball arena, it's going to be overwhelming. 567 00:30:45,276 --> 00:30:48,636 Speaker 1: I mean, I wonder how any president, even a president 568 00:30:48,716 --> 00:30:52,516 Speaker 1: informed by science and advised by the best advisors, we'll 569 00:30:52,556 --> 00:30:55,796 Speaker 1: be able to resist the kind of pressure that's going 570 00:30:55,836 --> 00:30:57,916 Speaker 1: to be associated with that. You know, I think it 571 00:30:57,996 --> 00:31:00,756 Speaker 1: is going to be increasingly difficult. But here's what I'll 572 00:31:00,916 --> 00:31:04,516 Speaker 1: use this analogy. Like when you sprain your ankle, if 573 00:31:04,556 --> 00:31:07,756 Speaker 1: you choose to arrest for a requisite period of time 574 00:31:07,996 --> 00:31:10,596 Speaker 1: and then actually get your physical therapy, you will recover 575 00:31:10,676 --> 00:31:13,356 Speaker 1: a lot faster than if you just continue to walk 576 00:31:13,356 --> 00:31:15,556 Speaker 1: on it and never do any pt. If you think 577 00:31:15,596 --> 00:31:18,516 Speaker 1: about our COVID response, we've been doing more the latter 578 00:31:18,596 --> 00:31:21,076 Speaker 1: than the former. And I attribute a lot of this 579 00:31:21,156 --> 00:31:24,156 Speaker 1: to leadership. Like what we told people our political leadership 580 00:31:24,676 --> 00:31:26,516 Speaker 1: was that we got to shut down for some period 581 00:31:26,556 --> 00:31:29,276 Speaker 1: of time and then we opened up quickly right before 582 00:31:29,796 --> 00:31:32,676 Speaker 1: levels of the virus were truly low in communities, and 583 00:31:32,716 --> 00:31:35,756 Speaker 1: we were reluctant to put in place mask mandates in 584 00:31:35,796 --> 00:31:39,316 Speaker 1: many communities around the country. We were reluctant to push 585 00:31:39,436 --> 00:31:42,916 Speaker 1: for bars and other higher risk indoor spaces to actually 586 00:31:42,916 --> 00:31:46,076 Speaker 1: close down. And so what you saw was this stuttering 587 00:31:46,156 --> 00:31:49,756 Speaker 1: response and a level of infection that never truly got low. 588 00:31:49,916 --> 00:31:53,116 Speaker 1: Like almost every other country, every other developed country was 589 00:31:53,156 --> 00:31:55,756 Speaker 1: able to go up and come down to a low level, 590 00:31:55,796 --> 00:31:58,196 Speaker 1: and now they're trying to keep that level low. We 591 00:31:58,276 --> 00:32:01,236 Speaker 1: actually never got to a low level. We're still smoldering 592 00:32:01,276 --> 00:32:04,156 Speaker 1: at a very very high rate of daily cases. And 593 00:32:04,276 --> 00:32:06,596 Speaker 1: the thing is that public only has limited patients, and 594 00:32:06,636 --> 00:32:08,436 Speaker 1: that's the risk of taking as long as we have 595 00:32:08,516 --> 00:32:10,956 Speaker 1: to get it right. So the new president will have, 596 00:32:11,116 --> 00:32:13,876 Speaker 1: yes a herculean task. You know. I thought that President 597 00:32:13,916 --> 00:32:16,316 Speaker 1: Obama and Vice President Biden had a massive task in 598 00:32:16,316 --> 00:32:18,196 Speaker 1: front of them in two thousand and nine when they 599 00:32:18,236 --> 00:32:20,836 Speaker 1: began the presidency at the time of the Great Recession. 600 00:32:21,276 --> 00:32:24,876 Speaker 1: But I think the difficulty of this health economic, and 601 00:32:25,236 --> 00:32:28,596 Speaker 1: really a crisis of public confidence, I think will dwarf 602 00:32:28,796 --> 00:32:32,396 Speaker 1: anything we've seen in a few generations. I want to 603 00:32:32,436 --> 00:32:35,636 Speaker 1: thank you back for joining me and I for one 604 00:32:35,676 --> 00:32:38,756 Speaker 1: to hope that your participant in the process of rebuilding 605 00:32:38,796 --> 00:32:42,876 Speaker 1: trust in institutions and in directing us to a rational 606 00:32:42,916 --> 00:32:46,716 Speaker 1: and calm and efficacious way of addressing these problems. I 607 00:32:46,756 --> 00:32:49,036 Speaker 1: appreciate those kind words. I do want to say that, 608 00:32:49,076 --> 00:32:52,756 Speaker 1: as much as what we've talked about today is perhaps 609 00:32:52,796 --> 00:32:55,196 Speaker 1: sobering and not know the message I think all of 610 00:32:55,276 --> 00:32:57,276 Speaker 1: us would want in terms of feeling like this thing 611 00:32:57,316 --> 00:32:59,436 Speaker 1: is going to go way tomorrow, I actually do feel 612 00:32:59,436 --> 00:33:02,916 Speaker 1: optimistic overall about the future. And the reason I feel 613 00:33:02,956 --> 00:33:05,396 Speaker 1: optimistic is, you know, I have been blessed in the 614 00:33:05,396 --> 00:33:07,676 Speaker 1: work that I've been doing over the last six months 615 00:33:07,876 --> 00:33:11,516 Speaker 1: to see the deep of scientific and medical talent that 616 00:33:11,556 --> 00:33:13,916 Speaker 1: we have in our country and frankly with collaborators around 617 00:33:13,916 --> 00:33:17,996 Speaker 1: the world. So many of these extraordinary individuals are standing 618 00:33:17,996 --> 00:33:20,236 Speaker 1: at the ready. They want to help, they want to 619 00:33:20,236 --> 00:33:24,316 Speaker 1: do their part to address COVID nineteen, and we just 620 00:33:24,316 --> 00:33:33,836 Speaker 1: need to bring them off the sidelines. The takeaways from 621 00:33:33,876 --> 00:33:38,596 Speaker 1: listening to doctor vieveck Morty are pretty significant. Since the 622 00:33:38,676 --> 00:33:42,276 Speaker 1: time of our interview, doctor Morty was actually named by 623 00:33:42,356 --> 00:33:45,916 Speaker 1: Joe Biden to be co chair of his Coronavirus Task Force. 624 00:33:46,316 --> 00:33:48,956 Speaker 1: He will therefore be at the center of the new 625 00:33:49,076 --> 00:33:54,556 Speaker 1: leadership that the Biden administration intends to take on regarding coronavirus. And, 626 00:33:54,636 --> 00:33:58,996 Speaker 1: as doctor Morty noted in the interview, as vaccines emerge 627 00:33:59,196 --> 00:34:02,836 Speaker 1: and as they become more effective, a crucial goal will 628 00:34:02,876 --> 00:34:06,316 Speaker 1: be spreading them fairly and broadly and getting people to 629 00:34:06,356 --> 00:34:10,996 Speaker 1: trust the system in order to take that Those distribution 630 00:34:11,076 --> 00:34:15,196 Speaker 1: challenges about which doctor Morti spoke are going to be very, 631 00:34:15,636 --> 00:34:19,716 Speaker 1: very significant. The vaccines about which we have early numbers 632 00:34:19,956 --> 00:34:24,676 Speaker 1: require refrigeration at an extraordinarily cold temperature. They are possible 633 00:34:24,716 --> 00:34:27,716 Speaker 1: to manufacture its scale, but distribution at scale is going 634 00:34:27,756 --> 00:34:30,716 Speaker 1: to be challenging. That means that along the way, we 635 00:34:30,796 --> 00:34:32,996 Speaker 1: will have a significant period of time where we have 636 00:34:33,076 --> 00:34:37,596 Speaker 1: something much less than universal access to the vaccine. On 637 00:34:37,636 --> 00:34:39,756 Speaker 1: top of that, there is the question of whether the 638 00:34:39,796 --> 00:34:43,476 Speaker 1: public will choose to take the vaccine, a further issue 639 00:34:43,716 --> 00:34:47,276 Speaker 1: the doctor Morty addressed, and one which he suggested can 640 00:34:47,396 --> 00:34:53,556 Speaker 1: only be solved by slow patient advocacy, clarity, and transparency. 641 00:34:54,356 --> 00:34:57,076 Speaker 1: I would like nothing better than to be even more 642 00:34:57,116 --> 00:35:00,356 Speaker 1: optimistic than doctor Morti was in his interview about how 643 00:35:00,436 --> 00:35:04,116 Speaker 1: quickly things can get back to normal, especially if lots 644 00:35:04,116 --> 00:35:06,596 Speaker 1: and lots and lots of people get access to the vaccines, 645 00:35:06,796 --> 00:35:10,036 Speaker 1: and the vaccines work and people actually take the vaccines. 646 00:35:10,636 --> 00:35:15,996 Speaker 1: The reality may be substantially more complicated, as this conversation 647 00:35:16,036 --> 00:35:19,836 Speaker 1: with doctor Morty suggests. In any case, we thought it 648 00:35:19,876 --> 00:35:22,516 Speaker 1: would be valuable to share this interview with you again 649 00:35:22,876 --> 00:35:26,596 Speaker 1: in light of its increased salience for our national conversation. 650 00:35:27,316 --> 00:35:29,396 Speaker 1: We'll be back to you soon with a new episode. 651 00:35:30,636 --> 00:35:35,796 Speaker 1: Until then, be careful, be safe, and be well. Deep 652 00:35:35,836 --> 00:35:38,876 Speaker 1: background is brought to you by Pushkin Industries. Our producer 653 00:35:38,916 --> 00:35:42,196 Speaker 1: is Lydia Gencott. Our engineer is Martin Gonzalez, and our 654 00:35:42,236 --> 00:35:45,636 Speaker 1: showrunner is Sophie Crane mckibbon. Theme music by Luis Guerra 655 00:35:46,156 --> 00:35:49,476 Speaker 1: at Pushkin. Thanks to Mia Lobell, Julia Barton, Heather Faine, 656 00:35:49,596 --> 00:35:53,556 Speaker 1: Carlie mcliori, Maggie Taylor, Eric Sandler, and Jacob Weisberg. You 657 00:35:53,596 --> 00:35:56,036 Speaker 1: can find me on Twitter at Noah R. Feldman. I 658 00:35:56,076 --> 00:35:58,436 Speaker 1: also write a column for Bloomberg Opinion, which you can 659 00:35:58,436 --> 00:36:02,236 Speaker 1: find at bloomberg dot com slash feld To discover Bloomberg's 660 00:36:02,236 --> 00:36:06,356 Speaker 1: original slate of podcasts, go to Bloomberg dot com slash Podcasts, 661 00:36:06,636 --> 00:36:08,716 Speaker 1: and if you liked what you've heard today, please write 662 00:36:08,716 --> 00:36:12,036 Speaker 1: a review or tell Afrad this is deep background