Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: I'm Noah Feldman. This past week brought two major developments
Speaker 1: in the fight against COVID. First, Joe Biden was elected president,
Speaker 1: meaning we're going to have a new team in Washington
Speaker 1: and new leadership working on the issue. Second, Fiser announced
Speaker 1: early results of its test of its vaccine in human
Speaker 1: subjects and suggested that some ninety percent of the people
Speaker 1: who took the vaccine were successfully protected against COVID. We'll
Speaker 1: be addressing both of these developments in episodes soon. Before
Speaker 1: we do that, however, today we wanted to reshare with
Speaker 1: you an interview with doctor Vvek Morty. Morty is one
Speaker 1: of the people just named by Joe Biden to be
Speaker 1: one of the co chairs of his Anti Coronavirus Task Force.
Speaker 1: In the interview, which we recorded on September thirtieth, doctor
Speaker 1: Morty also discusses the question of how we will get
Speaker 1: people to trust in a vaccine when and if the
Speaker 1: vaccine actually begins to work. In other words, what we
Speaker 1: have for you in this interview is one of the
Speaker 1: heads of Joe Biden's Coronavirus Task Force, laying out the
Speaker 1: policies that he will use when vaccines begin to work.
Speaker 1: It doesn't get more immediately relevant than that. For those
Speaker 1: of you who are regular listeners to the show and
Speaker 1: remember this interview, clearly, don't worry. We have another new
Speaker 1: episode coming your way in the next couple of days.
Speaker 1: For those of you who haven't heard this interview before,
Speaker 1: we really hope that you find it as valuable as
Speaker 1: we did. Doctor Morty was Surgeon General of the United
Speaker 1: States under Barack Obama and he is now coach share
Speaker 1: of the Biden Coronavirus Taskers the ECT. Thank you very
Speaker 1: much for joining me. I want to start with a
Speaker 1: question that you've spent a huge amount of time focused on,
Speaker 1: and that's a question of trust, public trust in science,
Speaker 1: public trust in medicine. And what's particularly driving me to
Speaker 1: ask you this question is that as we move through
Speaker 1: phase three trials for potential vaccines with respect to COVID nineteen,
Speaker 1: there's a lot of uncertainty about how the public will
Speaker 1: react if and when there's an emergency use authorization for
Speaker 1: these vaccines, or if there's publicity around these vaccines. It
Speaker 1: seems to be politically motivated, and that, of course, is
Speaker 1: a question that implicates science, It implicates medicine, it implicates approvals,
Speaker 1: and it implicates politics. So there's a lot to be
Speaker 1: said about this, but intervene in it wherever you would
Speaker 1: like to start. So this is a timely question, and
Speaker 1: I think the issue of trust is one that has
Speaker 1: been growing, frankly during this pandemic response. Let me just
Speaker 1: say a word about why this is so important. It's
Speaker 1: not just about a vaccine during pandemic responses, and I
Speaker 1: saw this when I served a surgeon general during the
Speaker 1: Zeka outbreak and during Ebola as well. Public trust is
Speaker 1: one of the most important resources you have and you
Speaker 1: have to cultivate it at all costs. That means being
Speaker 1: honest with people, even when you've done something wrong. It
Speaker 1: means being open to hard questions even when you don't
Speaker 1: know the answers to them. It means communicating openly, transparently,
Speaker 1: and regularly with people, and in this moment, it also
Speaker 1: means allowing them to hear directly from the source of information,
Speaker 1: which are scientists. You know, science has a guide pandemic responses,
Speaker 1: and when scientists aren't allowed to speak directly in an
Speaker 1: unfettered way with the public. It's shows doubt. What's happening
Speaker 1: here with regarding a vaccine is that we have an
Speaker 1: unfortunate confluence of factors. We have Number one trust, which
Speaker 1: has been I think badly injured over the last several months.
Speaker 1: You have a political cycle which is coming to a
Speaker 1: culmination with this presidential election, and you have a pandemic
Speaker 1: that has not gotten better. In fact, we have the
Speaker 1: most number of cases in the world. We have had
Speaker 1: nearly two hundred thousand people at this point when you
Speaker 1: and I are talking today who have died from COVID
Speaker 1: nineteen to the United States, and we do not see
Speaker 1: a sign of this ending because our response has been poor.
Speaker 1: And so all of these are coming together to make
Speaker 1: people nervous about a decision around a vaccine. And I
Speaker 1: think there's great danger to rushing a vaccine approval or
Speaker 1: an emergency authorization in this environment. The damage is not
Speaker 1: just that people may not take the vaccine. In fact,
Speaker 1: right now from September Kaiser Family Foundation poll, we know
Speaker 1: that fifty four percent of people are saying that they
Speaker 1: would not take the vaccine if it was offered today.
Speaker 1: That's a staggering number, just given the toll that COVID
Speaker 1: has taken, how much it's turned our lives upside down,
Speaker 1: how much people so desperately want this pandemic to be over.
Speaker 1: Yet fifty four percent of people are saying they wouldn't
Speaker 1: take a vaccine if it was approved before the election.
Speaker 1: So what does that tell us. That tells us that
Speaker 1: people are worried about the process, and they have good
Speaker 1: reason to be, because we've seen a couple of processes
Speaker 1: in the FDA which have been driven by politics, the
Speaker 1: issue of an emergency use authorization for hydroxy chloroquine being one.
Speaker 1: The way in which the convalescent plasma emergency authorization was
Speaker 1: issued with false numbers and hype that was political and
Speaker 1: not scientific. So if the administration really wants to ensure
Speaker 1: that people have faith in an emergency authorization, here's what
Speaker 1: they need to do. They need to, number one, make
Speaker 1: sure that they establish and communicate clearly an explicit standard
Speaker 1: for safety and efficacy that will be met before an
Speaker 1: emergency use authorization is approved. The second thing they have
Speaker 1: to do is they have to make sure that the
Speaker 1: FDA is scientific and very importantly, it's external Advisory Board,
Speaker 1: which is known by the some a clunky acronym VERPAC,
Speaker 1: which stands for a Vaccine and Related Biological Products Advisory Committee.
Speaker 1: Both of these groups of scientists must be able allowed
Speaker 1: to communicate directly with the public and share their assessment
Speaker 1: without a political filter. And finally, the data itself from
Speaker 1: the trial needs to be made available to the public
Speaker 1: so that the external scientific community can assess it, can
Speaker 1: come to their conclusions, and can share their opinions with
Speaker 1: the public. Only when these are done should have a
Speaker 1: vaccine be considered for emergency authorization, Because again, the consequences
Speaker 1: is not just people won't take the COVID vaccine, but
Speaker 1: if we allow hesitancy and doubt to be sown about
Speaker 1: the process itself, then people will doubt vaccines even after
Speaker 1: COVID is over. They'll worry that politics are not science,
Speaker 1: is driving the process, and that will ultimately hurt all
Speaker 1: of us. I have to say, when I heard those
Speaker 1: poll numbers about the number of people who wouldn't take
Speaker 1: a vaccine, at first felt shocked, but then I realized
Speaker 1: that I myself had a conversation in fact with my
Speaker 1: own parents, who are you? My father's eighty and my
Speaker 1: mothers in her late seventies, and they had similar skepticism.
Speaker 1: And I was actually horrified in the conversation, and I
Speaker 1: took it upon myself to try to convince them that,
Speaker 1: given their age and the bad outcomes that happen to
Speaker 1: people in that age group, if they do actually develop
Speaker 1: a case of COVID, that they were getting it rationally wrong.
Speaker 1: They ought precisely to be prepared to take a vaccine
Speaker 1: again and provided some emergency used to authorization. And I
Speaker 1: think of my parents is superrational and cautious and sensible
Speaker 1: around medical issues. And that leads me to ask, even
Speaker 1: if the administration, the current administration, the Trump administration, did
Speaker 1: all three of the things that you just said, you know,
Speaker 1: if they actually specified clear protocols for what counted his safety,
Speaker 1: and then they let the scientists at the FDA and
Speaker 1: on the Advisory Committee, the Vaccine Advisory Committee, speak directly
Speaker 1: to the public, and they publicized what data existed from
Speaker 1: Phase three trials. And let's just imagine in the scenario
Speaker 1: that sometime between now and the time of the inauguration
Speaker 1: of the next president, that all of those things pointed
Speaker 1: in the direction of an emergency use authorization, is there
Speaker 1: any credible way that we could get a lot of
Speaker 1: the public, even under those circumstances, to trust the vaccine.
Speaker 1: Or is the damage that's been done already so deep
Speaker 1: that we couldn't credibly imagine that certainly in any Trump
Speaker 1: authorized emergency use. Well, Noah, the damage that has been
Speaker 1: done is deep and it will take years to repair.
Speaker 1: Because people had a very high degree of confidence across
Speaker 1: the population in the CDC before COVID nineteen, and we've
Speaker 1: seen their credibility damaged. The FDA's credibility has taken a hit.
Speaker 1: Even people like doctor Tony Fauci, you know, who are
Speaker 1: very highly regarded by the scientific community and by the
Speaker 1: majority of the public. You know, even doctors credibility has
Speaker 1: taken a hit because of smear jobs and other criticism
Speaker 1: that he's received that has been politically directed. And so
Speaker 1: there's been a lot of hits to trusted sources and
Speaker 1: it will take years for that to recover. Let's just
Speaker 1: say in your scenario that there is in fact, good
Speaker 1: worthy data that tells us that vaccine candidate meets the
Speaker 1: standards for a safety and efficacy and an emergency use
Speaker 1: authorization is issued, what would happen to happen if he
Speaker 1: wanted people to actually be open to taking that vaccine
Speaker 1: as you would need number one, members of the scientific
Speaker 1: community across the country, and not just you know, nationally
Speaker 1: known scientists, but deans of medical schools, doctors and local
Speaker 1: communities who are trusted and respected, nurses who are known
Speaker 1: and respected. He would need them speaking out in local
Speaker 1: communities to help people recognize that people I know, people
Speaker 1: I recognize, institutions that are local to me, trust is vaccine.
Speaker 1: The second thing that you would need to see is
Speaker 1: you would need to see community organizations get behind it.
Speaker 1: People would need to hear from a non medical voices
Speaker 1: that they trust as well, whether that's the faith leader,
Speaker 1: you know, their community, they're church leader, they're synagogue leader.
Speaker 1: They would have to hear from friends and family who
Speaker 1: are getting the vaccine. They would have to hear people
Speaker 1: are getting this and they're not having significant side effects.
Speaker 1: All of this mobilization, if you will, All of this
Speaker 1: messaging will take time, and it will take regardless of
Speaker 1: who wins the presidency. One of the most complicated and
Speaker 1: challenging vaccine rollout efforts that this country has ever seen.
Speaker 1: So that is why I often say that While developing
Speaker 1: a vaccine for COVID nineteen is extremely challenging, actually rolling
Speaker 1: it out and administering it to people, getting that shot
Speaker 1: in the arm of a sufficient number of people that
Speaker 1: we can achieve herd immunity that will be just as
Speaker 1: if not more challenging. You've been advising Joe Biden on
Speaker 1: COVID related issues, and that means that if Joe Biden
Speaker 1: would be elected president and to take office in January,
Speaker 1: you're one of the very small number of people who
Speaker 1: will be in line for the single hardest, most thankless
Speaker 1: job imaginable in the Biden administration, and that would be
Speaker 1: spearheading the actual operation of doing exactly what you're just
Speaker 1: set of, actually getting the vaccine to people. So let
Speaker 1: me start by asking you about what plans you have
Speaker 1: been developing you and the Biden campaign have been developing
Speaker 1: for how to begin that process. Should keep be elected
Speaker 1: and should a vaccine become a safe and available Well, no,
Speaker 1: the Vice President has been really focused on developing and
Speaker 1: thinking about plans. He never takes for granted that he
Speaker 1: is going to win the election, but he wants to
Speaker 1: be prepared to act on day one if he does.
Speaker 1: And what that has meant is not just going about
Speaker 1: the usual process that you have on transition teams where
Speaker 1: you think about the structure of a department and you
Speaker 1: think about personnel, but it's involved thinking about some very
Speaker 1: specific areas that are going to require a whole lot
Speaker 1: more planning. So, for example, how do you actually expand
Speaker 1: testing sufficiently so that we have enough testing so that
Speaker 1: everyone who needs a test and get one. How do
Speaker 1: we ensure that we actually have enough contact tracing capacity
Speaker 1: in our country. We don't right now, but we really
Speaker 1: need that we have any hopes of getting this under control.
Speaker 1: And of course it involves how to think about the
Speaker 1: deployment of a vaccine. So these have been the topic
Speaker 1: of countless discussions that I and others have had with
Speaker 1: Vice President Biden, where he asked very specific questions. He's
Speaker 1: thinking about very specific plans. But a key parts of
Speaker 1: these plans, certainly for the Vaccine Distribution Fund, include thinking
Speaker 1: about who the trusted partners are that we will need
Speaker 1: in communities, like for example, if you think about the partners,
Speaker 1: it's not just a medical establishment, but it's also schools
Speaker 1: and employers. We know that schools and workplaces are sites
Speaker 1: where a vaccine could be administered, and having partners in
Speaker 1: those spheres is going to be absolutely essential. We know
Speaker 1: that local government and states are going to be extremely
Speaker 1: important partners. But here's the way I think the Vice
Speaker 1: President would approach that partnership differently. In the early part
Speaker 1: of this COVID response, what we saw is a transfer
Speaker 1: of responsibility from the federal government to the states, saying,
Speaker 1: you take care of this, and we will lead behind
Speaker 1: lead from a different place, we will step back. I
Speaker 1: think the Vice President realize is that you need to
Speaker 1: give states the ability to craft their own response, but
Speaker 1: you also have to lead as a federal government, and
Speaker 1: one of the places in which you have to lead
Speaker 1: is in the allocation of resources. So just think about
Speaker 1: the following question, how do you decide how much vaccine
Speaker 1: goes to Georgia or Florida, or Massachusetts or California. You
Speaker 1: can't have that driven by politics. That has to be
Speaker 1: driven by science and by need. So which raises a
Speaker 1: second issue that he's been working on, not just partnerships,
Speaker 1: but thinking about data systems right for understanding where the
Speaker 1: need is and making sure that we can meet that need.
Speaker 1: Right now, I'm worried that we don't have strong, robust
Speaker 1: data systems that are integrated in our country such that
Speaker 1: if we administered and rolled out vaccine today, we would
Speaker 1: automatically know where it was being delivered, who was getting them,
Speaker 1: so that we could target our follow up activities appropriately.
Speaker 1: We have to fix those data systems. So he's been
Speaker 1: thinking about a number of areas like this and bringing
Speaker 1: experts together, well beyond myself, you know, experts from really
Speaker 1: around the country who have done this before. He wants
Speaker 1: to assemble the best team possible because he knows this
Speaker 1: is going to be a once in a generation challenge.
Speaker 1: Let me press you on this. I think you're right
Speaker 1: from what I know that the data systems that we
Speaker 1: presently have aren't sufficiently robust to even have a clear
Speaker 1: sense of what prevalence looks like. And that's before you
Speaker 1: get to the substantive question, which is, if you're new prevalence,
Speaker 1: where should you focus resources. Because it's not immediately obvious
Speaker 1: that you want to focus a vaccine immediately on the
Speaker 1: heart of sted areas. There are actually arguments for beginning
Speaker 1: in more moderately hit areas and so forth and so on.
Speaker 1: So I mean, this is a complex topic in its
Speaker 1: own right. But given that the data systems almost only
Speaker 1: are not in place, how is it real to think
Speaker 1: that a Biden administration could take the time to build
Speaker 1: up these data systems in order to then make an
Speaker 1: informed decision. I mean, if you are doing this, you
Speaker 1: and a team of people are doing this, you are
Speaker 1: going to be doing it in media's race. You are
Speaker 1: going to be inheriting the mess that you have inherited,
Speaker 1: and you will be under enormous pressure to act quickly. Again,
Speaker 1: assuming that there is a safe and available vaccine. So
Speaker 1: I guess I want to say that sounds nice in
Speaker 1: the abstract, like let's solve the data systems, but there's
Speaker 1: no way that there's going to be the time that
Speaker 1: it would take to do that. So how do you
Speaker 1: make decisions under radical uncertainty without the data systems? So
Speaker 1: it's a great question, and you're right, we can't wait
Speaker 1: until the perfect systems are built. You can't wait until
Speaker 1: all the partners are assembled around the table either, because
Speaker 1: if this vaccine truly is safe and effective, that means
Speaker 1: that every day you lose our lives that are potentially lost.
Speaker 1: So what we would have to do is we'd we'd
Speaker 1: have to do the best we can in the beginning,
Speaker 1: use the data we have and go to areas that
Speaker 1: we know have great need, and start to deploying the
Speaker 1: vaccine through existing partners. We also have, thankfully, through the
Speaker 1: National Academies of Medicine, recommendations on what the priority population
Speaker 1: should be that we should target, So we know that
Speaker 1: healthcare workers and other workers in the front line are critical.
Speaker 1: We know the people at higher risk because of their
Speaker 1: age or other medical conditions they have, are at higher risk,
Speaker 1: so we can go to nursing homes, we can go
Speaker 1: to other locations where high risk populations are and preferentially
Speaker 1: vaccinate there. There is a lot of low hanging fruit,
Speaker 1: if you will, in terms of actions that can be
Speaker 1: taken in the very beginning, even while you're trying to
Speaker 1: build up systems and build up partners. But all of
Speaker 1: this is going to be infinitely harder if people are skeptical,
Speaker 1: if they're doubtful, if they don't trust what you're doing.
Speaker 1: And that's why the other plank of this that's so
Speaker 1: essential that we've been talking about is the importance of
Speaker 1: communicating openly, honestly about what our plans are and what
Speaker 1: progress we're making from day one. This is a kind
Speaker 1: of crisis communication that has been deployed by Republican and
Speaker 1: democratic administrations alike in prior pandemics. It's not the purview
Speaker 1: of one party, but it hasn't been done well in
Speaker 1: this response, and that's why we have a lot of
Speaker 1: ground to make up. We'll be back in a moment.
Speaker 1: I'm deeply worried that, regardless of the outcome of the election,
Speaker 1: if a vaccine becomes available and safe under a Republican administration,
Speaker 1: a lot of Democrats won't trust it, and that if
Speaker 1: a vaccine becomes available and safe under a democratic administration,
Speaker 1: a lot of Republicans won't trust it. In other words,
Speaker 1: my worry is that the profound political partisan differences that
Speaker 1: we have are fully bleeding into people's trust in scientific
Speaker 1: institutions and medical institutions. What's our long run societal solution
Speaker 1: to that problem. I mean, I'm not asking you to
Speaker 1: solve the problem of partisan division. Nobody can do that,
Speaker 1: and it's been with us in certain respects, although waning
Speaker 1: and waxing throughout our history. I'm talking about the very
Speaker 1: concrete problem, much closer to your area of expertise, which
Speaker 1: is that people's trust in science and medicine is coming
Speaker 1: to be deeply inflected by their partisan views. How do
Speaker 1: we break that linkage no matter who's president. Yeah, And
Speaker 1: the reason to be concerned because we've seen that on
Speaker 1: a number of measures, whether it's people's views of the
Speaker 1: masks and whether they're appropriate or not and useful, or
Speaker 1: people's view of other precautions related to COVID. There has
Speaker 1: been a partisan divide here. But what's interesting, as a
Speaker 1: side note is if you look at this data on
Speaker 1: vaccines and specially the COVID nineteen vaccine. I mentioned that
Speaker 1: fifty four percent of people are saying they would not
Speaker 1: take the vaccine if it was available before election day.
Speaker 1: That actually includes forty eight percent of Democrats but sixty
Speaker 1: percent of Republicans. So in a very interesting way, we're
Speaker 1: finding that both Democrats and Republicans have deep worries about
Speaker 1: the back scene. But the larger point around polarization and
Speaker 1: affecting how we take in information and what we trust
Speaker 1: is absolutely true and it will be deadly as it
Speaker 1: has been to date regards to coronavirus. I think one
Speaker 1: critical strategy and there are many here, but the one
Speaker 1: I'll mention is that we have to go local in
Speaker 1: terms of mobilizing information sources. Typically people think, well, if
Speaker 1: you get somebody on a major network in terms of news,
Speaker 1: or a national radio station, that's how you get the
Speaker 1: message out. But I think increasingly in this polarized world
Speaker 1: where people are listening to their own sources, you actually
Speaker 1: have to go much more local. You have to think,
Speaker 1: how do I ensure that an individual's doctor actually knows
Speaker 1: that the truth about this vaccine so they can recommend them.
Speaker 1: How do I ensure that other people who are trusted
Speaker 1: members of a community, like faith leaders, know the truth
Speaker 1: about this vaccine so they can advise people. Because when
Speaker 1: you have doubts about whether people are telling you the truth,
Speaker 1: all of us as human beings go to the people
Speaker 1: we know and that we have trusted for a long time,
Speaker 1: that our friends, our family, our nurses and doctor are
Speaker 1: faith leaders and other trusted populations like this. So I
Speaker 1: think if ultimately we want to convince people that the
Speaker 1: vaccines is safe and effective, if it indeed the evidence
Speaker 1: backs that up, we've got to think about how to
Speaker 1: mobilize those voices, And I think those will end up
Speaker 1: being much much more important than getting people on cable
Speaker 1: news and on national radio. That raises the really hard
Speaker 1: question of how do you reach the local leaders that
Speaker 1: you're talking about. We live in an era where local newspapers,
Speaker 1: which at one time would have been a standard way
Speaker 1: to reach people locally, because you can have a local
Speaker 1: newspaper article about the local physician or faith leader who says,
Speaker 1: you know, the vaccine is great, but they're in retreat,
Speaker 1: or in many parts of the country, they're already gone.
Speaker 1: And one of the ways that people now increasingly communicate
Speaker 1: with their trusted sources, whether it's family or friends or
Speaker 1: local leaders, is actually through social media. And in that environment,
Speaker 1: authority isn't quite as powerful as it once was in
Speaker 1: historical terms, and things can go the other way relatively quickly.
Speaker 1: There can be a decentralized distribution of distrustful information. I
Speaker 1: agree with you that we want to get people to
Speaker 1: hear an important and true message from people who may trust.
Speaker 1: But how do you at a national level think about
Speaker 1: reaching those people if it's not through going on CNN
Speaker 1: and MSNBC, which you do so frequently and so skillfully. Well, No,
Speaker 1: I think this is not easy work. It's a hard grind.
Speaker 1: If you will, because it requires a lot of conversations.
Speaker 1: This is I think why people have gravitated so much
Speaker 1: toward national news and national media. It has the illusion
Speaker 1: that seeming to be more efficient, right, you reach more people, Hey,
Speaker 1: why wouldn't that be better? The problem is it comes
Speaker 1: with a heavy filter that people don't necessarily trust. And
Speaker 1: so the way that I would think about this is
Speaker 1: that we would need to reach out, for example, to
Speaker 1: local organizations that bring together faith leaders. We need to
Speaker 1: reach out to the YMCAs, to the rotary clubs, will
Speaker 1: need to reach out to associations of librarians. We'll need
Speaker 1: to reach out to groups where we can get in
Speaker 1: front of people, talk to them, and then start engaging
Speaker 1: their local chapters. And if that sounds like really tough, tedious,
Speaker 1: tenuous work, it is. It's not easy to do because
Speaker 1: what we're really talking about, Noah, even though we haven't
Speaker 1: used this word before, is we're talking about relationship building, right,
Speaker 1: and relationship building can take time. But I think that
Speaker 1: it doesn't mean that we'll never be able to get
Speaker 1: a vaccine out for months and months. I think that
Speaker 1: there are enough people who believe that this is an
Speaker 1: urgent crisis and who will understand the science behind it,
Speaker 1: that we will have some uptake of the vaccine. The
Speaker 1: question is how to sustain that and get to a
Speaker 1: sufficient level where we have her in immunity. There's one
Speaker 1: other point I want to raise here, though, if this
Speaker 1: is indeed about relationships, and if what we need our
Speaker 1: organizations that have a lot of relationships in the local level.
Speaker 1: It's been particularly worrisome to me over the last many
Speaker 1: years that we've had a breakdown in those kind of
Speaker 1: community organizations over the last many decades, like in this country.
Speaker 1: You know, something that's been well documented by about Putnam,
Speaker 1: you know, I've been Harvard and by others. But this
Speaker 1: decline in participation in community organizations and affiliation with community
Speaker 1: groups leaves people with fewer sources that they actually trust,
Speaker 1: that are easy to access in a crisis like this,
Speaker 1: and I see that as deeply worrisome. It's one of
Speaker 1: the reasons why when I left my time in government,
Speaker 1: when I was thinking about what do I work on,
Speaker 1: what do I want to contribute to in the world.
Speaker 1: That's why I kept coming back to this idea of
Speaker 1: social connection as being such an important topic, because if
Speaker 1: you don't have strong connections in your life, then you
Speaker 1: don't have people you trust. If you don't have people
Speaker 1: you trust, then you're reliant on social media, on cable news,
Speaker 1: on other sources for your information, and you don't have
Speaker 1: people to talk through doubts and worries with. And I
Speaker 1: think we are bearing the consequences of a deterioration in
Speaker 1: social connection in social organizations. But that said, we still
Speaker 1: have many organizations in our communities that we can lean on,
Speaker 1: and that's going to have to be our priority in
Speaker 1: a new administration. Let me ask you about how deeply
Speaker 1: penetrated a vaccine would actually have to be to achieve
Speaker 1: her immunity. I mean, I realized there's not an exact
Speaker 1: number that one can define with respect to a particular pandemic,
Speaker 1: although there is some general guidance that we have from epidemiologists.
Speaker 1: And the reason I want to ask you about that
Speaker 1: is what sort of emerging in my mind as I
Speaker 1: listen to you, is that a lot of us have
Speaker 1: been thinking, well, how do we get out of this? Well,
Speaker 1: maybe the right way to get out of it is
Speaker 1: with a vaccine. But what I'm hearing from you is
Speaker 1: that actually getting a vaccine is not necessarily the way out.
Speaker 1: The way out is to have a vaccine and then
Speaker 1: have that vaccine be sufficiently trusted by a broad enough
Speaker 1: swath of population that when it is distributed and taken,
Speaker 1: it gets sufficient penetration to actually reach her immunity. And
Speaker 1: that may be a very very different thing. I'm letting
Speaker 1: that sort of seep through my thinking right now. So
Speaker 1: let's just walk through it. Start with, what percentage do
Speaker 1: you think roughly we would need to reach for the
Speaker 1: vaccine to be efficacious? So, Noah, that number depends on
Speaker 1: how effective the vaccine is. So if we had a
Speaker 1: vaccine that was one hundred percent effective, which would be
Speaker 1: exceedingly unusual, then we would have to vaccinate somewhere in
Speaker 1: their neighborhood of a seventy percent of the population, maybe
Speaker 1: a little bit less, because you know a number of
Speaker 1: people have had the virus already, they may have some
Speaker 1: short term immunity, but it would have to be around
Speaker 1: seventy percent. But if you start dropping that, if you
Speaker 1: get to a vaccine that's around fifty percent effective, which
Speaker 1: is a threshold in fact that the FDA set and
Speaker 1: it's June thirtieth guidance, then even if you vaccinated everybody
Speaker 1: in the country. You're not necessarily going to get to
Speaker 1: hurt immunity levels. Now, that doesn't mean that it's still
Speaker 1: not worthwhile. See herd immunity is not a switch that
Speaker 1: we flip on or off. There are benefits to be gained,
Speaker 1: you know, if we get halfway there. Their benefits to
Speaker 1: be gained if we get three quarters of the way there.
Speaker 1: But what this means, given the fact that getting to
Speaker 1: hurt immunity levels will take time and will be difficult,
Speaker 1: is it means that many of the precautions that we're
Speaker 1: taking right now in terms of distancing and wearing masks,
Speaker 1: and upping our game in terms of personal hygiene and
Speaker 1: washing our hands, that those behavior changes will be with
Speaker 1: us for a while, certainly through twenty twenty one and
Speaker 1: very likely beyond that. It doesn't mean that we're going
Speaker 1: to have to stay in our homes for years and years.
Speaker 1: We will learn, as we have already in the last
Speaker 1: six months, safer ways to come together in smaller groups,
Speaker 1: you know, outside, or to even improve our current ventilation
Speaker 1: systems and other measures indoors to make the risk of
Speaker 1: getting coronavirus lower. So we will find safer ways to
Speaker 1: re engage in our life. But our life is not
Speaker 1: going to go back to pre pandemic sort of ways
Speaker 1: until probably at least several years from now. I just
Speaker 1: want to make sure that everybody who's listening gets the
Speaker 1: full weight of what you're saying. First, even a perfectly
Speaker 1: effective vaccine, perfeclyifficacious vaccine, which basically doesn't exist in the
Speaker 1: real world for almost anything that we think of being
Speaker 1: vaccinated for, would have to reach seventy percent of the
Speaker 1: population before we can say at her immunity, and we
Speaker 1: can remove various forms of social distancing and masks and separation.
Speaker 1: As you go down the efficacy numbers, you get greater
Speaker 1: and greater probability that a good number of people will
Speaker 1: still be getting the virus. And as you go down,
Speaker 1: you need more and more people to be vaccinated, And
Speaker 1: of course that's going to be actually inversely correlated in
Speaker 1: the real world. Right if we heard that the vaccine
Speaker 1: was one hundred percent efficacious, more people would be inclined
Speaker 1: to take it, And ironically, what we need is the
Speaker 1: other way around. The less efficationous vaccine needs more people
Speaker 1: to take it. But if people say it's only fifty
Speaker 1: percent effective. A lot of people will mistakenly say, and
Speaker 1: therefore I shouldn't take it. I mean mistakenly in the
Speaker 1: rational sense that rationally you really should take it if
Speaker 1: it has any capacity to help you provide it that
Speaker 1: you don't think, the danger is still great. So we
Speaker 1: could very easily get an extremely messy situation with like
Speaker 1: a ninety percent efficacious vaccine but lots of people not
Speaker 1: taking it. And then the upshot of that I'm hearing
Speaker 1: you saying is that masks are going to continue even
Speaker 1: after the vaccine is out there. Social distancing measures, including
Speaker 1: not getting together with medium groups of people or a
Speaker 1: large groups of people indoors, those restrictions are going to
Speaker 1: continue for at least twenty twenty one, and maybe for
Speaker 1: several years longer. And that is, in a certain sense,
Speaker 1: a much more depressing picture than a lot of us
Speaker 1: have been imagining as progress towards the vaccine seems to
Speaker 1: be advancing. I mean, am I getting it right? I
Speaker 1: mean You're saying it very cautiously and very rationally, But
Speaker 1: what I'm hearing is actually a pretty striking rational conclusion
Speaker 1: that we're very, very very far from anything approaching normal life,
Speaker 1: So yes, no, I mean, you know, I try never
Speaker 1: to be alarmist about these things, because there's you got
Speaker 1: to admit, there's a lot we don't know, and I'm
Speaker 1: always outing to stake hoping for major breakthroughs. But I
Speaker 1: think the realistic picture is that we are looking at
Speaker 1: our life continuing to be changed for several years now
Speaker 1: and now I want to be clear by one thing,
Speaker 1: That does not mean that we're going to be in
Speaker 1: the exact state that we're in right now in a year.
Speaker 1: In fact, I think that we will be more able
Speaker 1: to get our children back to school, that we will
Speaker 1: find safer ways to do that. In fact, we know
Speaker 1: safer ways, we're just not really implementing them right now.
Speaker 1: I do think they will see more workplaces actually up
Speaker 1: and running again, because again we will, hopefully if we
Speaker 1: have advances in testing, and if we have people more
Speaker 1: observant precautions and we get local prevalence of the virus down,
Speaker 1: we can have workplaces operating at least in a partial
Speaker 1: way or even close to normal, in ways that we
Speaker 1: haven't near these last several months. So I think we
Speaker 1: will make progress, and even with getting together socially, I
Speaker 1: think we will find ways to get together in small
Speaker 1: groups indoors and socialize and see each other, but we'll
Speaker 1: do in ways that are safer, just like how you
Speaker 1: see some schools actually able to bring children together with masks,
Speaker 1: with distancing in indoor environments to learn. So we are
Speaker 1: an incredibly adaptable species. We've adapted a lot in the
Speaker 1: last six month. We will adapt a lot more. But
Speaker 1: what I do think we should be realistic about is
Speaker 1: that when a vaccine arrives, it's not like tomorrow or
Speaker 1: even in a month or in six months that suddenly
Speaker 1: will go back to having full arenas at basketball games,
Speaker 1: and having crowded concerts and having large groups get together
Speaker 1: for birthday parties and other festive occasions. That will come
Speaker 1: back eventually, but it's going to take some time. The
Speaker 1: public pressure though the moment a vaccine is broadly available,
Speaker 1: a safe vaccine is broadly available, to go back to
Speaker 1: normal at the basketball arena, it's going to be overwhelming.
Speaker 1: I mean, I wonder how any president, even a president
Speaker 1: informed by science and advised by the best advisors, we'll
Speaker 1: be able to resist the kind of pressure that's going
Speaker 1: to be associated with that. You know, I think it
Speaker 1: is going to be increasingly difficult. But here's what I'll
Speaker 1: use this analogy. Like when you sprain your ankle, if
Speaker 1: you choose to arrest for a requisite period of time
Speaker 1: and then actually get your physical therapy, you will recover
Speaker 1: a lot faster than if you just continue to walk
Speaker 1: on it and never do any pt. If you think
Speaker 1: about our COVID response, we've been doing more the latter
Speaker 1: than the former. And I attribute a lot of this
Speaker 1: to leadership. Like what we told people our political leadership
Speaker 1: was that we got to shut down for some period
Speaker 1: of time and then we opened up quickly right before
Speaker 1: levels of the virus were truly low in communities, and
Speaker 1: we were reluctant to put in place mask mandates in
Speaker 1: many communities around the country. We were reluctant to push
Speaker 1: for bars and other higher risk indoor spaces to actually
Speaker 1: close down. And so what you saw was this stuttering
Speaker 1: response and a level of infection that never truly got low.
Speaker 1: Like almost every other country, every other developed country was
Speaker 1: able to go up and come down to a low level,
Speaker 1: and now they're trying to keep that level low. We
Speaker 1: actually never got to a low level. We're still smoldering
Speaker 1: at a very very high rate of daily cases. And
Speaker 1: the thing is that public only has limited patients, and
Speaker 1: that's the risk of taking as long as we have
Speaker 1: to get it right. So the new president will have,
Speaker 1: yes a herculean task. You know. I thought that President
Speaker 1: Obama and Vice President Biden had a massive task in
Speaker 1: front of them in two thousand and nine when they
Speaker 1: began the presidency at the time of the Great Recession.
Speaker 1: But I think the difficulty of this health economic, and
Speaker 1: really a crisis of public confidence, I think will dwarf
Speaker 1: anything we've seen in a few generations. I want to
Speaker 1: thank you back for joining me and I for one
Speaker 1: to hope that your participant in the process of rebuilding
Speaker 1: trust in institutions and in directing us to a rational
Speaker 1: and calm and efficacious way of addressing these problems. I
Speaker 1: appreciate those kind words. I do want to say that,
Speaker 1: as much as what we've talked about today is perhaps
Speaker 1: sobering and not know the message I think all of
Speaker 1: us would want in terms of feeling like this thing
Speaker 1: is going to go way tomorrow, I actually do feel
Speaker 1: optimistic overall about the future. And the reason I feel
Speaker 1: optimistic is, you know, I have been blessed in the
Speaker 1: work that I've been doing over the last six months
Speaker 1: to see the deep of scientific and medical talent that
Speaker 1: we have in our country and frankly with collaborators around
Speaker 1: the world. So many of these extraordinary individuals are standing
Speaker 1: at the ready. They want to help, they want to
Speaker 1: do their part to address COVID nineteen, and we just
Speaker 1: need to bring them off the sidelines. The takeaways from
Speaker 1: listening to doctor vieveck Morty are pretty significant. Since the
Speaker 1: time of our interview, doctor Morty was actually named by
Speaker 1: Joe Biden to be co chair of his Coronavirus Task Force.
Speaker 1: He will therefore be at the center of the new
Speaker 1: leadership that the Biden administration intends to take on regarding coronavirus. And,
Speaker 1: as doctor Morty noted in the interview, as vaccines emerge
Speaker 1: and as they become more effective, a crucial goal will
Speaker 1: be spreading them fairly and broadly and getting people to
Speaker 1: trust the system in order to take that Those distribution
Speaker 1: challenges about which doctor Morti spoke are going to be very,
Speaker 1: very significant. The vaccines about which we have early numbers
Speaker 1: require refrigeration at an extraordinarily cold temperature. They are possible
Speaker 1: to manufacture its scale, but distribution at scale is going
Speaker 1: to be challenging. That means that along the way, we
Speaker 1: will have a significant period of time where we have
Speaker 1: something much less than universal access to the vaccine. On
Speaker 1: top of that, there is the question of whether the
Speaker 1: public will choose to take the vaccine, a further issue
Speaker 1: the doctor Morty addressed, and one which he suggested can
Speaker 1: only be solved by slow patient advocacy, clarity, and transparency.
Speaker 1: I would like nothing better than to be even more
Speaker 1: optimistic than doctor Morti was in his interview about how
Speaker 1: quickly things can get back to normal, especially if lots
Speaker 1: and lots and lots of people get access to the vaccines,
Speaker 1: and the vaccines work and people actually take the vaccines.
Speaker 1: The reality may be substantially more complicated, as this conversation
Speaker 1: with doctor Morty suggests. In any case, we thought it
Speaker 1: would be valuable to share this interview with you again
Speaker 1: in light of its increased salience for our national conversation.
Speaker 1: We'll be back to you soon with a new episode.
Speaker 1: Until then, be careful, be safe, and be well. Deep
Speaker 1: background is brought to you by Pushkin Industries. Our producer
Speaker 1: is Lydia Gencott. Our engineer is Martin Gonzalez, and our
Speaker 1: showrunner is Sophie Crane mckibbon. Theme music by Luis Guerra
Speaker 1: at Pushkin. Thanks to Mia Lobell, Julia Barton, Heather Faine,
Speaker 1: Carlie mcliori, Maggie Taylor, Eric Sandler, and Jacob Weisberg. You
Speaker 1: can find me on Twitter at Noah R. Feldman. I
Speaker 1: also write a column for Bloomberg Opinion, which you can
Speaker 1: find at bloomberg dot com slash feld To discover Bloomberg's
Speaker 1: original slate of podcasts, go to Bloomberg dot com slash Podcasts,
Speaker 1: and if you liked what you've heard today, please write
Speaker 1: a review or tell Afrad this is deep background