WEBVTT - A Former Surgeon General on the Coronavirus Pandemic (Rebroadcast) 0:00:15.396 --> 0:00:23.956 Pushkin from Pushkin Industries. This is Deep Background, the show 0:00:23.956 --> 0:00:27.396 where we explore the stories behind the stories in the news. 0:00:27.836 --> 0:00:33.156 I'm Noah Feldman. This past week brought two major developments 0:00:33.356 --> 0:00:37.276 in the fight against COVID. First, Joe Biden was elected president, 0:00:37.476 --> 0:00:39.636 meaning we're going to have a new team in Washington 0:00:39.836 --> 0:00:44.116 and new leadership working on the issue. Second, Fiser announced 0:00:44.236 --> 0:00:48.036 early results of its test of its vaccine in human 0:00:48.116 --> 0:00:51.556 subjects and suggested that some ninety percent of the people 0:00:51.596 --> 0:00:56.956 who took the vaccine were successfully protected against COVID. We'll 0:00:56.956 --> 0:01:01.636 be addressing both of these developments in episodes soon. Before 0:01:01.636 --> 0:01:04.996 we do that, however, today we wanted to reshare with 0:01:05.036 --> 0:01:09.876 you an interview with doctor Vvek Morty. Morty is one 0:01:09.876 --> 0:01:12.836 of the people just named by Joe Biden to be 0:01:12.876 --> 0:01:16.996 one of the co chairs of his Anti Coronavirus Task Force. 0:01:17.716 --> 0:01:20.996 In the interview, which we recorded on September thirtieth, doctor 0:01:20.996 --> 0:01:24.236 Morty also discusses the question of how we will get 0:01:24.276 --> 0:01:27.276 people to trust in a vaccine when and if the 0:01:27.356 --> 0:01:30.956 vaccine actually begins to work. In other words, what we 0:01:31.036 --> 0:01:33.356 have for you in this interview is one of the 0:01:33.436 --> 0:01:37.516 heads of Joe Biden's Coronavirus Task Force, laying out the 0:01:37.556 --> 0:01:41.476 policies that he will use when vaccines begin to work. 0:01:41.996 --> 0:01:45.996 It doesn't get more immediately relevant than that. For those 0:01:46.036 --> 0:01:48.436 of you who are regular listeners to the show and 0:01:48.516 --> 0:01:51.956 remember this interview, clearly, don't worry. We have another new 0:01:51.996 --> 0:01:54.636 episode coming your way in the next couple of days. 0:01:55.076 --> 0:01:57.196 For those of you who haven't heard this interview before, 0:01:57.516 --> 0:01:59.956 we really hope that you find it as valuable as 0:01:59.996 --> 0:02:04.356 we did. Doctor Morty was Surgeon General of the United 0:02:04.356 --> 0:02:09.356 States under Barack Obama and he is now coach share 0:02:09.796 --> 0:02:20.036 of the Biden Coronavirus Taskers the ECT. Thank you very 0:02:20.076 --> 0:02:22.596 much for joining me. I want to start with a 0:02:22.676 --> 0:02:24.836 question that you've spent a huge amount of time focused on, 0:02:24.916 --> 0:02:28.396 and that's a question of trust, public trust in science, 0:02:28.476 --> 0:02:31.796 public trust in medicine. And what's particularly driving me to 0:02:31.836 --> 0:02:35.196 ask you this question is that as we move through 0:02:35.276 --> 0:02:40.636 phase three trials for potential vaccines with respect to COVID nineteen, 0:02:41.716 --> 0:02:45.116 there's a lot of uncertainty about how the public will 0:02:45.156 --> 0:02:48.636 react if and when there's an emergency use authorization for 0:02:48.716 --> 0:02:52.316 these vaccines, or if there's publicity around these vaccines. It 0:02:52.356 --> 0:02:55.916 seems to be politically motivated, and that, of course, is 0:02:55.956 --> 0:03:00.996 a question that implicates science, It implicates medicine, it implicates approvals, 0:03:01.036 --> 0:03:03.716 and it implicates politics. So there's a lot to be 0:03:03.716 --> 0:03:06.436 said about this, but intervene in it wherever you would 0:03:06.436 --> 0:03:09.396 like to start. So this is a timely question, and 0:03:09.476 --> 0:03:13.236 I think the issue of trust is one that has 0:03:13.236 --> 0:03:17.156 been growing, frankly during this pandemic response. Let me just 0:03:17.356 --> 0:03:19.596 say a word about why this is so important. It's 0:03:19.596 --> 0:03:23.516 not just about a vaccine during pandemic responses, and I 0:03:23.556 --> 0:03:25.916 saw this when I served a surgeon general during the 0:03:25.996 --> 0:03:29.276 Zeka outbreak and during Ebola as well. Public trust is 0:03:29.316 --> 0:03:32.236 one of the most important resources you have and you 0:03:32.316 --> 0:03:35.596 have to cultivate it at all costs. That means being 0:03:35.636 --> 0:03:39.196 honest with people, even when you've done something wrong. It 0:03:39.196 --> 0:03:42.116 means being open to hard questions even when you don't 0:03:42.116 --> 0:03:46.116 know the answers to them. It means communicating openly, transparently, 0:03:46.156 --> 0:03:49.316 and regularly with people, and in this moment, it also 0:03:49.356 --> 0:03:53.236 means allowing them to hear directly from the source of information, 0:03:53.356 --> 0:03:56.476 which are scientists. You know, science has a guide pandemic responses, 0:03:56.516 --> 0:03:59.996 and when scientists aren't allowed to speak directly in an 0:04:00.076 --> 0:04:03.996 unfettered way with the public. It's shows doubt. What's happening 0:04:04.036 --> 0:04:06.956 here with regarding a vaccine is that we have an 0:04:06.996 --> 0:04:11.236 unfortunate confluence of factors. We have Number one trust, which 0:04:11.236 --> 0:04:15.436 has been I think badly injured over the last several months. 0:04:15.996 --> 0:04:18.956 You have a political cycle which is coming to a 0:04:18.996 --> 0:04:23.036 culmination with this presidential election, and you have a pandemic 0:04:23.156 --> 0:04:27.276 that has not gotten better. In fact, we have the 0:04:27.316 --> 0:04:29.836 most number of cases in the world. We have had 0:04:29.956 --> 0:04:32.156 nearly two hundred thousand people at this point when you 0:04:32.196 --> 0:04:34.796 and I are talking today who have died from COVID 0:04:34.876 --> 0:04:37.676 nineteen to the United States, and we do not see 0:04:37.676 --> 0:04:40.436 a sign of this ending because our response has been poor. 0:04:41.116 --> 0:04:43.276 And so all of these are coming together to make 0:04:43.276 --> 0:04:47.836 people nervous about a decision around a vaccine. And I 0:04:47.876 --> 0:04:52.076 think there's great danger to rushing a vaccine approval or 0:04:52.116 --> 0:04:55.516 an emergency authorization in this environment. The damage is not 0:04:55.676 --> 0:04:59.476 just that people may not take the vaccine. In fact, 0:04:59.556 --> 0:05:03.716 right now from September Kaiser Family Foundation poll, we know 0:05:03.796 --> 0:05:06.436 that fifty four percent of people are saying that they 0:05:06.436 --> 0:05:09.196 would not take the vaccine if it was offered today. 0:05:09.636 --> 0:05:12.516 That's a staggering number, just given the toll that COVID 0:05:12.556 --> 0:05:15.236 has taken, how much it's turned our lives upside down, 0:05:15.276 --> 0:05:17.996 how much people so desperately want this pandemic to be over. 0:05:18.276 --> 0:05:20.276 Yet fifty four percent of people are saying they wouldn't 0:05:20.276 --> 0:05:22.956 take a vaccine if it was approved before the election. 0:05:23.796 --> 0:05:25.276 So what does that tell us. That tells us that 0:05:25.316 --> 0:05:28.036 people are worried about the process, and they have good 0:05:28.076 --> 0:05:30.756 reason to be, because we've seen a couple of processes 0:05:30.796 --> 0:05:33.796 in the FDA which have been driven by politics, the 0:05:33.916 --> 0:05:37.356 issue of an emergency use authorization for hydroxy chloroquine being one. 0:05:37.796 --> 0:05:41.876 The way in which the convalescent plasma emergency authorization was 0:05:41.916 --> 0:05:45.436 issued with false numbers and hype that was political and 0:05:45.516 --> 0:05:48.996 not scientific. So if the administration really wants to ensure 0:05:49.396 --> 0:05:52.996 that people have faith in an emergency authorization, here's what 0:05:53.036 --> 0:05:55.276 they need to do. They need to, number one, make 0:05:55.316 --> 0:05:59.596 sure that they establish and communicate clearly an explicit standard 0:05:59.996 --> 0:06:03.316 for safety and efficacy that will be met before an 0:06:03.316 --> 0:06:06.476 emergency use authorization is approved. The second thing they have 0:06:06.516 --> 0:06:08.076 to do is they have to make sure that the 0:06:08.156 --> 0:06:12.156 FDA is scientific and very importantly, it's external Advisory Board, 0:06:12.236 --> 0:06:15.036 which is known by the some a clunky acronym VERPAC, 0:06:15.196 --> 0:06:19.476 which stands for a Vaccine and Related Biological Products Advisory Committee. 0:06:19.556 --> 0:06:22.916 Both of these groups of scientists must be able allowed 0:06:23.076 --> 0:06:27.236 to communicate directly with the public and share their assessment 0:06:27.556 --> 0:06:31.036 without a political filter. And finally, the data itself from 0:06:31.076 --> 0:06:33.436 the trial needs to be made available to the public 0:06:33.476 --> 0:06:36.916 so that the external scientific community can assess it, can 0:06:36.916 --> 0:06:39.716 come to their conclusions, and can share their opinions with 0:06:39.796 --> 0:06:43.316 the public. Only when these are done should have a 0:06:43.396 --> 0:06:46.956 vaccine be considered for emergency authorization, Because again, the consequences 0:06:46.956 --> 0:06:49.756 is not just people won't take the COVID vaccine, but 0:06:49.876 --> 0:06:53.276 if we allow hesitancy and doubt to be sown about 0:06:53.316 --> 0:06:57.076 the process itself, then people will doubt vaccines even after 0:06:57.156 --> 0:07:00.196 COVID is over. They'll worry that politics are not science, 0:07:00.276 --> 0:07:02.516 is driving the process, and that will ultimately hurt all 0:07:02.516 --> 0:07:05.236 of us. I have to say, when I heard those 0:07:05.276 --> 0:07:07.556 poll numbers about the number of people who wouldn't take 0:07:07.556 --> 0:07:10.636 a vaccine, at first felt shocked, but then I realized 0:07:10.676 --> 0:07:12.796 that I myself had a conversation in fact with my 0:07:12.836 --> 0:07:15.836 own parents, who are you? My father's eighty and my 0:07:15.876 --> 0:07:20.516 mothers in her late seventies, and they had similar skepticism. 0:07:20.716 --> 0:07:23.236 And I was actually horrified in the conversation, and I 0:07:23.316 --> 0:07:25.276 took it upon myself to try to convince them that, 0:07:25.916 --> 0:07:30.836 given their age and the bad outcomes that happen to 0:07:30.916 --> 0:07:33.916 people in that age group, if they do actually develop 0:07:33.956 --> 0:07:36.876 a case of COVID, that they were getting it rationally wrong. 0:07:36.916 --> 0:07:39.716 They ought precisely to be prepared to take a vaccine 0:07:39.716 --> 0:07:42.956 again and provided some emergency used to authorization. And I 0:07:42.996 --> 0:07:46.996 think of my parents is superrational and cautious and sensible 0:07:47.036 --> 0:07:50.316 around medical issues. And that leads me to ask, even 0:07:50.316 --> 0:07:53.916 if the administration, the current administration, the Trump administration, did 0:07:53.996 --> 0:07:56.796 all three of the things that you just said, you know, 0:07:56.876 --> 0:08:01.596 if they actually specified clear protocols for what counted his safety, 0:08:01.956 --> 0:08:04.916 and then they let the scientists at the FDA and 0:08:05.076 --> 0:08:08.436 on the Advisory Committee, the Vaccine Advisory Committee, speak directly 0:08:08.476 --> 0:08:13.076 to the public, and they publicized what data existed from 0:08:13.236 --> 0:08:16.636 Phase three trials. And let's just imagine in the scenario 0:08:16.716 --> 0:08:20.116 that sometime between now and the time of the inauguration 0:08:20.116 --> 0:08:23.436 of the next president, that all of those things pointed 0:08:23.476 --> 0:08:26.636 in the direction of an emergency use authorization, is there 0:08:26.716 --> 0:08:29.636 any credible way that we could get a lot of 0:08:29.636 --> 0:08:32.916 the public, even under those circumstances, to trust the vaccine. 0:08:33.276 --> 0:08:36.116 Or is the damage that's been done already so deep 0:08:36.676 --> 0:08:40.556 that we couldn't credibly imagine that certainly in any Trump 0:08:40.596 --> 0:08:44.956 authorized emergency use. Well, Noah, the damage that has been 0:08:44.996 --> 0:08:47.316 done is deep and it will take years to repair. 0:08:47.756 --> 0:08:51.436 Because people had a very high degree of confidence across 0:08:51.436 --> 0:08:55.156 the population in the CDC before COVID nineteen, and we've 0:08:55.196 --> 0:08:59.116 seen their credibility damaged. The FDA's credibility has taken a hit. 0:09:00.596 --> 0:09:03.756 Even people like doctor Tony Fauci, you know, who are 0:09:03.876 --> 0:09:06.916 very highly regarded by the scientific community and by the 0:09:06.956 --> 0:09:10.396 majority of the public. You know, even doctors credibility has 0:09:10.436 --> 0:09:14.316 taken a hit because of smear jobs and other criticism 0:09:14.316 --> 0:09:17.236 that he's received that has been politically directed. And so 0:09:17.716 --> 0:09:19.836 there's been a lot of hits to trusted sources and 0:09:19.876 --> 0:09:22.556 it will take years for that to recover. Let's just 0:09:22.596 --> 0:09:25.276 say in your scenario that there is in fact, good 0:09:25.396 --> 0:09:29.156 worthy data that tells us that vaccine candidate meets the 0:09:29.236 --> 0:09:31.596 standards for a safety and efficacy and an emergency use 0:09:31.636 --> 0:09:34.556 authorization is issued, what would happen to happen if he 0:09:34.676 --> 0:09:37.556 wanted people to actually be open to taking that vaccine 0:09:38.196 --> 0:09:41.316 as you would need number one, members of the scientific 0:09:41.316 --> 0:09:44.316 community across the country, and not just you know, nationally 0:09:44.356 --> 0:09:48.036 known scientists, but deans of medical schools, doctors and local 0:09:48.036 --> 0:09:50.756 communities who are trusted and respected, nurses who are known 0:09:50.796 --> 0:09:53.436 and respected. He would need them speaking out in local 0:09:53.436 --> 0:09:57.116 communities to help people recognize that people I know, people 0:09:57.116 --> 0:10:00.836 I recognize, institutions that are local to me, trust is vaccine. 0:10:01.076 --> 0:10:03.276 The second thing that you would need to see is 0:10:03.316 --> 0:10:05.996 you would need to see community organizations get behind it. 0:10:06.316 --> 0:10:09.836 People would need to hear from a non medical voices 0:10:09.876 --> 0:10:12.196 that they trust as well, whether that's the faith leader, 0:10:12.276 --> 0:10:15.436 you know, their community, they're church leader, they're synagogue leader. 0:10:15.956 --> 0:10:18.236 They would have to hear from friends and family who 0:10:18.276 --> 0:10:21.196 are getting the vaccine. They would have to hear people 0:10:21.236 --> 0:10:24.596 are getting this and they're not having significant side effects. 0:10:24.636 --> 0:10:27.556 All of this mobilization, if you will, All of this 0:10:27.716 --> 0:10:31.716 messaging will take time, and it will take regardless of 0:10:31.716 --> 0:10:36.556 who wins the presidency. One of the most complicated and 0:10:36.796 --> 0:10:40.156 challenging vaccine rollout efforts that this country has ever seen. 0:10:40.636 --> 0:10:44.796 So that is why I often say that While developing 0:10:44.836 --> 0:10:48.716 a vaccine for COVID nineteen is extremely challenging, actually rolling 0:10:48.756 --> 0:10:51.356 it out and administering it to people, getting that shot 0:10:51.396 --> 0:10:53.556 in the arm of a sufficient number of people that 0:10:53.636 --> 0:10:55.876 we can achieve herd immunity that will be just as 0:10:56.196 --> 0:11:00.196 if not more challenging. You've been advising Joe Biden on 0:11:00.476 --> 0:11:03.636 COVID related issues, and that means that if Joe Biden 0:11:03.676 --> 0:11:06.796 would be elected president and to take office in January, 0:11:07.196 --> 0:11:09.796 you're one of the very small number of people who 0:11:09.836 --> 0:11:12.756 will be in line for the single hardest, most thankless 0:11:12.876 --> 0:11:15.796 job imaginable in the Biden administration, and that would be 0:11:16.236 --> 0:11:20.196 spearheading the actual operation of doing exactly what you're just 0:11:20.236 --> 0:11:23.836 set of, actually getting the vaccine to people. So let 0:11:23.836 --> 0:11:27.076 me start by asking you about what plans you have 0:11:27.196 --> 0:11:29.836 been developing you and the Biden campaign have been developing 0:11:30.436 --> 0:11:34.436 for how to begin that process. Should keep be elected 0:11:34.516 --> 0:11:38.076 and should a vaccine become a safe and available Well, no, 0:11:38.236 --> 0:11:42.476 the Vice President has been really focused on developing and 0:11:42.556 --> 0:11:45.916 thinking about plans. He never takes for granted that he 0:11:45.996 --> 0:11:47.996 is going to win the election, but he wants to 0:11:48.036 --> 0:11:50.756 be prepared to act on day one if he does. 0:11:51.556 --> 0:11:54.476 And what that has meant is not just going about 0:11:54.476 --> 0:11:57.956 the usual process that you have on transition teams where 0:11:57.996 --> 0:12:00.076 you think about the structure of a department and you 0:12:00.116 --> 0:12:03.756 think about personnel, but it's involved thinking about some very 0:12:03.756 --> 0:12:06.076 specific areas that are going to require a whole lot 0:12:06.116 --> 0:12:09.756 more planning. So, for example, how do you actually expand 0:12:09.796 --> 0:12:13.116 testing sufficiently so that we have enough testing so that 0:12:13.156 --> 0:12:15.236 everyone who needs a test and get one. How do 0:12:15.276 --> 0:12:19.476 we ensure that we actually have enough contact tracing capacity 0:12:19.476 --> 0:12:21.716 in our country. We don't right now, but we really 0:12:21.756 --> 0:12:24.996 need that we have any hopes of getting this under control. 0:12:25.316 --> 0:12:27.756 And of course it involves how to think about the 0:12:27.916 --> 0:12:31.196 deployment of a vaccine. So these have been the topic 0:12:31.236 --> 0:12:34.276 of countless discussions that I and others have had with 0:12:34.476 --> 0:12:38.276 Vice President Biden, where he asked very specific questions. He's 0:12:38.476 --> 0:12:41.276 thinking about very specific plans. But a key parts of 0:12:41.316 --> 0:12:45.716 these plans, certainly for the Vaccine Distribution Fund, include thinking 0:12:45.756 --> 0:12:48.996 about who the trusted partners are that we will need 0:12:49.156 --> 0:12:52.276 in communities, like for example, if you think about the partners, 0:12:52.276 --> 0:12:55.116 it's not just a medical establishment, but it's also schools 0:12:55.116 --> 0:12:58.636 and employers. We know that schools and workplaces are sites 0:12:58.676 --> 0:13:02.596 where a vaccine could be administered, and having partners in 0:13:02.636 --> 0:13:05.876 those spheres is going to be absolutely essential. We know 0:13:05.956 --> 0:13:08.876 that local government and states are going to be extremely 0:13:09.116 --> 0:13:11.636 important partners. But here's the way I think the Vice 0:13:11.676 --> 0:13:15.596 President would approach that partnership differently. In the early part 0:13:15.596 --> 0:13:19.116 of this COVID response, what we saw is a transfer 0:13:19.156 --> 0:13:22.956 of responsibility from the federal government to the states, saying, 0:13:22.956 --> 0:13:26.676 you take care of this, and we will lead behind 0:13:26.796 --> 0:13:29.036 lead from a different place, we will step back. I 0:13:29.036 --> 0:13:31.036 think the Vice President realize is that you need to 0:13:31.036 --> 0:13:33.556 give states the ability to craft their own response, but 0:13:33.596 --> 0:13:35.996 you also have to lead as a federal government, and 0:13:36.156 --> 0:13:38.236 one of the places in which you have to lead 0:13:38.276 --> 0:13:40.636 is in the allocation of resources. So just think about 0:13:40.636 --> 0:13:43.116 the following question, how do you decide how much vaccine 0:13:43.156 --> 0:13:48.316 goes to Georgia or Florida, or Massachusetts or California. You 0:13:48.356 --> 0:13:50.836 can't have that driven by politics. That has to be 0:13:50.916 --> 0:13:53.596 driven by science and by need. So which raises a 0:13:53.676 --> 0:13:56.036 second issue that he's been working on, not just partnerships, 0:13:56.076 --> 0:14:00.036 but thinking about data systems right for understanding where the 0:14:00.116 --> 0:14:02.076 need is and making sure that we can meet that need. 0:14:02.156 --> 0:14:06.196 Right now, I'm worried that we don't have strong, robust 0:14:06.276 --> 0:14:08.796 data systems that are integrated in our country such that 0:14:08.836 --> 0:14:11.876 if we administered and rolled out vaccine today, we would 0:14:11.876 --> 0:14:14.916 automatically know where it was being delivered, who was getting them, 0:14:14.916 --> 0:14:18.236 so that we could target our follow up activities appropriately. 0:14:18.596 --> 0:14:20.716 We have to fix those data systems. So he's been 0:14:20.756 --> 0:14:23.796 thinking about a number of areas like this and bringing 0:14:23.836 --> 0:14:27.116 experts together, well beyond myself, you know, experts from really 0:14:27.156 --> 0:14:29.796 around the country who have done this before. He wants 0:14:29.836 --> 0:14:32.436 to assemble the best team possible because he knows this 0:14:32.516 --> 0:14:34.956 is going to be a once in a generation challenge. 0:14:35.636 --> 0:14:37.916 Let me press you on this. I think you're right 0:14:38.276 --> 0:14:40.316 from what I know that the data systems that we 0:14:40.356 --> 0:14:44.476 presently have aren't sufficiently robust to even have a clear 0:14:44.556 --> 0:14:48.556 sense of what prevalence looks like. And that's before you 0:14:48.596 --> 0:14:51.236 get to the substantive question, which is, if you're new prevalence, 0:14:51.556 --> 0:14:54.236 where should you focus resources. Because it's not immediately obvious 0:14:54.236 --> 0:14:56.316 that you want to focus a vaccine immediately on the 0:14:56.356 --> 0:14:58.996 heart of sted areas. There are actually arguments for beginning 0:14:58.996 --> 0:15:01.116 in more moderately hit areas and so forth and so on. 0:15:01.316 --> 0:15:02.916 So I mean, this is a complex topic in its 0:15:02.956 --> 0:15:06.716 own right. But given that the data systems almost only 0:15:06.716 --> 0:15:09.956 are not in place, how is it real to think 0:15:09.996 --> 0:15:13.636 that a Biden administration could take the time to build 0:15:13.676 --> 0:15:17.316 up these data systems in order to then make an 0:15:17.316 --> 0:15:19.676 informed decision. I mean, if you are doing this, you 0:15:19.716 --> 0:15:21.796 and a team of people are doing this, you are 0:15:21.796 --> 0:15:23.676 going to be doing it in media's race. You are 0:15:23.756 --> 0:15:26.956 going to be inheriting the mess that you have inherited, 0:15:27.196 --> 0:15:31.316 and you will be under enormous pressure to act quickly. Again, 0:15:31.436 --> 0:15:35.076 assuming that there is a safe and available vaccine. So 0:15:35.516 --> 0:15:37.076 I guess I want to say that sounds nice in 0:15:37.156 --> 0:15:39.756 the abstract, like let's solve the data systems, but there's 0:15:39.796 --> 0:15:41.796 no way that there's going to be the time that 0:15:41.836 --> 0:15:43.436 it would take to do that. So how do you 0:15:43.436 --> 0:15:47.916 make decisions under radical uncertainty without the data systems? So 0:15:48.076 --> 0:15:50.716 it's a great question, and you're right, we can't wait 0:15:50.796 --> 0:15:53.156 until the perfect systems are built. You can't wait until 0:15:53.156 --> 0:15:56.276 all the partners are assembled around the table either, because 0:15:56.276 --> 0:15:58.756 if this vaccine truly is safe and effective, that means 0:15:58.796 --> 0:16:02.676 that every day you lose our lives that are potentially lost. 0:16:02.916 --> 0:16:05.716 So what we would have to do is we'd we'd 0:16:05.716 --> 0:16:07.236 have to do the best we can in the beginning, 0:16:07.316 --> 0:16:09.636 use the data we have and go to areas that 0:16:09.756 --> 0:16:11.996 we know have great need, and start to deploying the 0:16:12.076 --> 0:16:15.716 vaccine through existing partners. We also have, thankfully, through the 0:16:15.836 --> 0:16:20.076 National Academies of Medicine, recommendations on what the priority population 0:16:20.156 --> 0:16:22.716 should be that we should target, So we know that 0:16:22.956 --> 0:16:26.236 healthcare workers and other workers in the front line are critical. 0:16:26.276 --> 0:16:28.236 We know the people at higher risk because of their 0:16:28.316 --> 0:16:31.396 age or other medical conditions they have, are at higher risk, 0:16:31.476 --> 0:16:33.636 so we can go to nursing homes, we can go 0:16:33.716 --> 0:16:36.996 to other locations where high risk populations are and preferentially 0:16:37.436 --> 0:16:40.316 vaccinate there. There is a lot of low hanging fruit, 0:16:40.316 --> 0:16:42.156 if you will, in terms of actions that can be 0:16:42.236 --> 0:16:45.276 taken in the very beginning, even while you're trying to 0:16:45.476 --> 0:16:48.356 build up systems and build up partners. But all of 0:16:48.396 --> 0:16:52.036 this is going to be infinitely harder if people are skeptical, 0:16:52.076 --> 0:16:54.836 if they're doubtful, if they don't trust what you're doing. 0:16:54.876 --> 0:16:56.836 And that's why the other plank of this that's so 0:16:56.996 --> 0:16:59.876 essential that we've been talking about is the importance of 0:16:59.916 --> 0:17:03.476 communicating openly, honestly about what our plans are and what 0:17:03.596 --> 0:17:06.636 progress we're making from day one. This is a kind 0:17:06.676 --> 0:17:10.076 of crisis communication that has been deployed by Republican and 0:17:10.116 --> 0:17:14.676 democratic administrations alike in prior pandemics. It's not the purview 0:17:14.716 --> 0:17:17.116 of one party, but it hasn't been done well in 0:17:17.116 --> 0:17:18.876 this response, and that's why we have a lot of 0:17:18.876 --> 0:17:22.196 ground to make up. We'll be back in a moment. 0:17:31.436 --> 0:17:34.756 I'm deeply worried that, regardless of the outcome of the election, 0:17:35.076 --> 0:17:39.396 if a vaccine becomes available and safe under a Republican administration, 0:17:39.476 --> 0:17:42.196 a lot of Democrats won't trust it, and that if 0:17:42.196 --> 0:17:45.196 a vaccine becomes available and safe under a democratic administration, 0:17:45.556 --> 0:17:47.836 a lot of Republicans won't trust it. In other words, 0:17:48.076 --> 0:17:51.836 my worry is that the profound political partisan differences that 0:17:51.916 --> 0:17:57.956 we have are fully bleeding into people's trust in scientific 0:17:57.996 --> 0:18:03.156 institutions and medical institutions. What's our long run societal solution 0:18:03.716 --> 0:18:05.876 to that problem. I mean, I'm not asking you to 0:18:05.876 --> 0:18:08.436 solve the problem of partisan division. Nobody can do that, 0:18:08.516 --> 0:18:12.356 and it's been with us in certain respects, although waning 0:18:12.356 --> 0:18:14.876 and waxing throughout our history. I'm talking about the very 0:18:14.916 --> 0:18:18.676 concrete problem, much closer to your area of expertise, which 0:18:18.716 --> 0:18:22.796 is that people's trust in science and medicine is coming 0:18:22.836 --> 0:18:26.356 to be deeply inflected by their partisan views. How do 0:18:26.436 --> 0:18:30.956 we break that linkage no matter who's president. Yeah, And 0:18:31.396 --> 0:18:33.796 the reason to be concerned because we've seen that on 0:18:33.836 --> 0:18:37.636 a number of measures, whether it's people's views of the 0:18:37.756 --> 0:18:40.996 masks and whether they're appropriate or not and useful, or 0:18:41.196 --> 0:18:43.516 people's view of other precautions related to COVID. There has 0:18:43.596 --> 0:18:46.476 been a partisan divide here. But what's interesting, as a 0:18:46.556 --> 0:18:48.436 side note is if you look at this data on 0:18:48.596 --> 0:18:52.436 vaccines and specially the COVID nineteen vaccine. I mentioned that 0:18:52.476 --> 0:18:54.516 fifty four percent of people are saying they would not 0:18:55.036 --> 0:18:57.556 take the vaccine if it was available before election day. 0:18:57.876 --> 0:19:01.796 That actually includes forty eight percent of Democrats but sixty 0:19:01.836 --> 0:19:05.196 percent of Republicans. So in a very interesting way, we're 0:19:05.196 --> 0:19:08.756 finding that both Democrats and Republicans have deep worries about 0:19:08.756 --> 0:19:11.836 the back scene. But the larger point around polarization and 0:19:12.276 --> 0:19:14.836 affecting how we take in information and what we trust 0:19:14.956 --> 0:19:17.316 is absolutely true and it will be deadly as it 0:19:17.356 --> 0:19:20.596 has been to date regards to coronavirus. I think one 0:19:20.636 --> 0:19:22.636 critical strategy and there are many here, but the one 0:19:22.676 --> 0:19:25.196 I'll mention is that we have to go local in 0:19:25.276 --> 0:19:28.996 terms of mobilizing information sources. Typically people think, well, if 0:19:28.996 --> 0:19:31.676 you get somebody on a major network in terms of news, 0:19:31.716 --> 0:19:33.596 or a national radio station, that's how you get the 0:19:33.636 --> 0:19:36.636 message out. But I think increasingly in this polarized world 0:19:36.636 --> 0:19:39.676 where people are listening to their own sources, you actually 0:19:39.676 --> 0:19:41.556 have to go much more local. You have to think, 0:19:41.556 --> 0:19:46.796 how do I ensure that an individual's doctor actually knows 0:19:46.996 --> 0:19:49.356 that the truth about this vaccine so they can recommend them. 0:19:49.716 --> 0:19:52.556 How do I ensure that other people who are trusted 0:19:52.596 --> 0:19:54.636 members of a community, like faith leaders, know the truth 0:19:54.636 --> 0:19:57.916 about this vaccine so they can advise people. Because when 0:19:57.996 --> 0:20:00.836 you have doubts about whether people are telling you the truth, 0:20:01.156 --> 0:20:03.196 all of us as human beings go to the people 0:20:03.236 --> 0:20:05.996 we know and that we have trusted for a long time, 0:20:06.196 --> 0:20:10.036 that our friends, our family, our nurses and doctor are 0:20:10.396 --> 0:20:13.436 faith leaders and other trusted populations like this. So I 0:20:13.476 --> 0:20:16.356 think if ultimately we want to convince people that the 0:20:16.436 --> 0:20:19.276 vaccines is safe and effective, if it indeed the evidence 0:20:19.276 --> 0:20:21.236 backs that up, we've got to think about how to 0:20:21.276 --> 0:20:23.676 mobilize those voices, And I think those will end up 0:20:23.716 --> 0:20:27.356 being much much more important than getting people on cable 0:20:27.396 --> 0:20:31.036 news and on national radio. That raises the really hard 0:20:31.076 --> 0:20:33.196 question of how do you reach the local leaders that 0:20:33.236 --> 0:20:37.356 you're talking about. We live in an era where local newspapers, 0:20:37.436 --> 0:20:39.196 which at one time would have been a standard way 0:20:39.236 --> 0:20:41.076 to reach people locally, because you can have a local 0:20:41.116 --> 0:20:45.436 newspaper article about the local physician or faith leader who says, 0:20:45.556 --> 0:20:48.516 you know, the vaccine is great, but they're in retreat, 0:20:48.876 --> 0:20:51.236 or in many parts of the country, they're already gone. 0:20:51.756 --> 0:20:54.356 And one of the ways that people now increasingly communicate 0:20:54.436 --> 0:20:57.356 with their trusted sources, whether it's family or friends or 0:20:57.356 --> 0:21:01.476 local leaders, is actually through social media. And in that environment, 0:21:01.916 --> 0:21:04.756 authority isn't quite as powerful as it once was in 0:21:04.836 --> 0:21:08.996 historical terms, and things can go the other way relatively quickly. 0:21:09.116 --> 0:21:13.996 There can be a decentralized distribution of distrustful information. I 0:21:14.316 --> 0:21:15.876 agree with you that we want to get people to 0:21:15.876 --> 0:21:18.196 hear an important and true message from people who may trust. 0:21:18.676 --> 0:21:21.036 But how do you at a national level think about 0:21:21.076 --> 0:21:25.476 reaching those people if it's not through going on CNN 0:21:25.476 --> 0:21:29.676 and MSNBC, which you do so frequently and so skillfully. Well, No, 0:21:29.836 --> 0:21:33.556 I think this is not easy work. It's a hard grind. 0:21:33.556 --> 0:21:36.236 If you will, because it requires a lot of conversations. 0:21:36.796 --> 0:21:39.716 This is I think why people have gravitated so much 0:21:39.756 --> 0:21:42.756 toward national news and national media. It has the illusion 0:21:42.796 --> 0:21:46.156 that seeming to be more efficient, right, you reach more people, Hey, 0:21:45.956 --> 0:21:49.396 why wouldn't that be better? The problem is it comes 0:21:49.436 --> 0:21:52.836 with a heavy filter that people don't necessarily trust. And 0:21:52.876 --> 0:21:55.276 so the way that I would think about this is 0:21:55.316 --> 0:21:57.716 that we would need to reach out, for example, to 0:21:58.116 --> 0:22:01.036 local organizations that bring together faith leaders. We need to 0:22:01.036 --> 0:22:03.676 reach out to the YMCAs, to the rotary clubs, will 0:22:03.756 --> 0:22:06.356 need to reach out to associations of librarians. We'll need 0:22:06.356 --> 0:22:08.636 to reach out to groups where we can get in 0:22:08.676 --> 0:22:11.596 front of people, talk to them, and then start engaging 0:22:11.596 --> 0:22:16.076 their local chapters. And if that sounds like really tough, tedious, 0:22:16.076 --> 0:22:20.036 tenuous work, it is. It's not easy to do because 0:22:20.076 --> 0:22:22.796