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Speaker 1: Pushkin from Pushkin Industries. This is Deep Background the show

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Speaker 1: where we explore the stories behind the stories in the news.

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Speaker 1: I'm no affeldment. The possibility of a COVID vaccine grows

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Speaker 1: greater with each passing day, and yet simultaneously, the danger

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Speaker 1: continues to grow that some significant percentage of the population

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Speaker 1: will not trust the vaccine. The breakdown of that trust

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Speaker 1: has to do with the erosion of our trust in

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Speaker 1: all kinds of authority, in government authority generally, and in

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Speaker 1: scientific and medical authorities in particular. It also has very

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Speaker 1: much to do with a deep partisanship that we're encountering

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Speaker 1: in the middle of this pandemic. To discuss trust, how

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Speaker 1: it can be rebuilt, and what indeed needs to be

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Speaker 1: done to get an efficacious vaccine to the American public.

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Speaker 1: I'm joined by doctor Vaveck Murty. Doctor Murty was the

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Speaker 1: Surgeon General of the United States from twenty fourteen to

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Speaker 1: twenty seventeen during Barack Obama's presidency. Is now advising Democratic

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Speaker 1: presidential candidate Joe Biden on his coronavirus response. Vic, thank

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Speaker 1: you very much for joining me. I want to start

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Speaker 1: with a question that you've spent a huge amount of

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Speaker 1: time focused on, and that's a question of trust, public

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Speaker 1: trust in science, public trust in medicine. And what's particularly

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Speaker 1: driving me to ask you this question is that as

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Speaker 1: we move through phase three trials for potential vaccines with

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Speaker 1: respect to COVID nineteen, there's a lot of uncertainty about

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Speaker 1: how the public will react if and when there's an

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Speaker 1: emergency use authorization for these vaccines, or if there's publicity

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Speaker 1: around these vaccines. It seems to be politically motivated, and that,

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Speaker 1: of course is a question that science. It implicates medicine,

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Speaker 1: it implicates approvals, and it implicates politics. So there's a

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Speaker 1: lot to be said about this, but intervening it whatever

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Speaker 1: you would like to start. So this is a timely question,

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Speaker 1: and I think the issue of trust is one that

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Speaker 1: has been growing frankly during this pandemic response. Let me

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Speaker 1: just say a word about why this is so important.

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Speaker 1: It's not just about a vaccine during pandemic responses, and

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Speaker 1: I saw this when I served a surgeon general during

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Speaker 1: the Zeka outbreak and during Ebola as well. Public trust

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Speaker 1: is one of the most important resources you have and

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Speaker 1: you have to cultivate it at all costs. That means

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Speaker 1: being honest with people even when you've done something wrong.

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Speaker 1: It means being open to hard questions, even when you

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Speaker 1: don't know the answers to them. It means communicating openly, transparently,

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Speaker 1: and regularly with people. And in this moment, it also

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Speaker 1: means allowing them to hear directly from the source of information,

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Speaker 1: which are scientists. You know, science hastic guide pandemic responses,

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Speaker 1: and scientists aren't allowed to speak directly in an unfettered

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Speaker 1: way with the public. It's so stubt. What's happening here

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Speaker 1: with regarding a vaccine is that we have an unfortunately

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Speaker 1: confluence of factors. We have Number one trust, which has

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Speaker 1: been I think badly injured over the last several months.

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Speaker 1: You have a political cycle which is coming to a

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Speaker 1: culmination with this presidential election, and you have a pandemic

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Speaker 1: that has not gotten better. In fact, we have the

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Speaker 1: most number of cases in the world. We have had

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Speaker 1: nearly two hundred thousand people at this point when you

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Speaker 1: and I are talking today who have died from COVID

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Speaker 1: nineteen to the United States, and we do not see

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Speaker 1: a sign of this ending because our response has been poor.

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Speaker 1: And so all of these are coming together to make

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Speaker 1: people nervous about a decision around a vaccine, and I

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Speaker 1: think there's great danger to rushing a vaccine approval or

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Speaker 1: an emergency authorization in this environment. The damage is not

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Speaker 1: just that people may not take the vaccine. In fact,

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Speaker 1: right now from September Kaiser Family Foundation poll, we know

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Speaker 1: that fifty four percent of people are saying that they

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Speaker 1: would not take the vaccine if it was offered today.

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Speaker 1: That's a staggering number, just given the toll that COVID

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Speaker 1: has taken, how much it's turned our lives upside down,

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Speaker 1: how much people so desperately want this pandemic to be over.

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Speaker 1: Yet fifty four percent of people are saying they wouldn't

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Speaker 1: take a vaccine if it was approved before the election.

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Speaker 1: So what does that tell us? That tells us that

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Speaker 1: people are worried about the process, and they have good

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Speaker 1: reason to be, because we've seen a couple of processes

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Speaker 1: in the FDA which have been driven by politics, the

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Speaker 1: issue of an emergency use authorization for hydroxy chloroquine being one.

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Speaker 1: The way in which the convalescent plasma emergency authorization was

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Speaker 1: issued with false numbers and hype that was political and

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Speaker 1: not scientific. So if the administration really wants to ensure

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Speaker 1: that people have faith in an emergency authorization. Here's what

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Speaker 1: they need to do. They need to, number one, make

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Speaker 1: sure that they estab and communicate clearly an explicit standard

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Speaker 1: for safety and efficacy that will be met before an

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Speaker 1: emergency use authorization is approved. The second thing they have

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Speaker 1: to do is they have to make sure that the

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Speaker 1: FDA scientists and very importantly it's external Advisory Board which

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Speaker 1: is known by the some a clunky acronym VERTPAC which

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Speaker 1: stands for a Vaccine and Related Biological Products Advisory Committee.

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Speaker 1: Both of these groups of scientists must be able allowed

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Speaker 1: to communicate directly with the public and share their assessment

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Speaker 1: without a political filter. And finally, the data itself from

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Speaker 1: the trial needs to be made available to the public

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Speaker 1: so that the external scientific community can assess it, can

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Speaker 1: come to their conclusions, and can share their opinions with

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Speaker 1: the public. Only when these are done you should have

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Speaker 1: a vaccine be considered for emergency authorization, because again the

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Speaker 1: consequences is not just people won't take the COVID vaccine,

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Speaker 1: but if we allow hesitancy and doubt to be sown

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Speaker 1: about the process itself, then people will doubt vaccines, and

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Speaker 1: after COVID is over, they'll worry that politics and arts

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Speaker 1: science is driving the process, and that will ultimately hurt

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Speaker 1: all of us. I have to say, when I heard

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Speaker 1: those poll numbers about the number of people who wouldn't

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Speaker 1: take a vaccine, at first I felt shocked, but then

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Speaker 1: I realized that I myself had a conversation in fact

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Speaker 1: with my own parents, who are you. My father's eighty

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Speaker 1: and my mothers in her late seventies, and they had

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Speaker 1: similar skepticism. And I was actually horrified in the conversation,

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Speaker 1: and I took it upon myself to try to convince

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Speaker 1: them that, given their age and the bad outcomes that

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Speaker 1: happen to people in that age group, if they do

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Speaker 1: actually develop a case of COVID, that they were getting

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Speaker 1: it rationally wrong. They ought precisely to be prepared to

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Speaker 1: take a vaccine again and provided some emergency used to authorization.

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Speaker 1: And I think of my parents is superrational and cautious

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Speaker 1: and sensible around medical issues. And that leads me to ask,

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Speaker 1: even if the administration, the current administration, the Trump administration,

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Speaker 1: did all three of the things that you just said,

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Speaker 1: if they actually specify clear protocols for what counted his safety.

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Speaker 1: And then they left the scientists at the FDA and

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Speaker 1: on the advisory committee, the Vaccine Advisory Committee speak directly

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Speaker 1: to the public, and they publicized what data existed from

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Speaker 1: Phase three trials. And let's just imagine in the scenario

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Speaker 1: that sometime between now and the time of the inauguration

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Speaker 1: of the next president, that all of those things pointed

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Speaker 1: in the direction of an emergency use authorization. Is there

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Speaker 1: any credible way that we could get a lot of

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Speaker 1: the public, even under those circumstances, to trust the vaccine

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Speaker 1: or is the damage that's been done already so deep

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Speaker 1: that we couldn't credibly imagine that certainly in any Trump

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Speaker 1: authorized emergency use. Well, Noah, the damage that has been

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Speaker 1: done is deep and it will take years to repair.

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Speaker 1: Because people had a very high degree of confidence across

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Speaker 1: the population in the CDC before COVID nineteen, and we've

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Speaker 1: seen their credibility damaged. The FDA's credibility has taken a hit.

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Speaker 1: Even people like doctor Tony Faucci, you know, who are

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Speaker 1: very highly regarded by the scientific community and by the

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Speaker 1: majority of the public. You know, even doctor Faucci's credibility

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Speaker 1: has taken a hit because of smear jobs and other

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Speaker 1: criticism that he's received that has been politically directed, and

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Speaker 1: so there's been a lot of hits to trusted sources

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Speaker 1: and it will take years for that to recover. Let's

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Speaker 1: just say in your scenario that there is in fact

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Speaker 1: a good worthy data that tells us that vaccine candidate

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Speaker 1: meets the standards for safety and efficacy, and an emergency

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Speaker 1: use authorization is issued. What would happen to happen if

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Speaker 1: you wanted people to actually be open to taking that

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Speaker 1: vaccine as you would need number one, members of the

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Speaker 1: scientific community across the country, and not just you know,

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Speaker 1: nationally known scientists, but deans of medical schools, doctors and

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Speaker 1: local communities who are trusted and respected, nurses who are

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Speaker 1: known and respected. He would need them speaking out in

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Speaker 1: local communities to help people recognize that people I know,

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Speaker 1: people I recognize, institutions that are local to me trust

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Speaker 1: is vaccine. The second thing that you would need to

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Speaker 1: see is you would need to see community organizations get

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Speaker 1: behind it. People would need to hear from non medical

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Speaker 1: voices that they trust as well, whether that's the faith

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Speaker 1: leader you know, their community, they're church leader, their synagogue leader.

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Speaker 1: They would have to hear from friends and family who

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Speaker 1: are getting the vaccine. They would have to hear people

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Speaker 1: are getting this and they're not having significant side effects.

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Speaker 1: All of this mobilization, if you will, all of this

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Speaker 1: messaging will take time, and it will take regardless of

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Speaker 1: who wins the presidency. One of the most complicated and

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Speaker 1: challenging vaccine rollout efforts that this country has ever seen.

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Speaker 1: So that is why I often say that while developing

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Speaker 1: a vaccine for COVID nineteen is extremely challenging, actually rolling

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Speaker 1: it out and administering it to people, getting that shot

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Speaker 1: in the arm of a sufficient number of people that

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Speaker 1: we can achieve herd immunity, that will be just as

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Speaker 1: if not more challenging. You've been advising Joe Biden on

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Speaker 1: COVID related issues, and that means that if Joe Biden

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Speaker 1: would be elected president and to take office in January,

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Speaker 1: you're one of the very small number of people who

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Speaker 1: will be in line for the single hardest, most thankless

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Speaker 1: job imaginable in the Biden administration, and that would be

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Speaker 1: spearheading the actual operation of doing exactly what you're just

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Speaker 1: set of, actually getting the vaccine to people So let

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Speaker 1: me start by asking you about what plans you have

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Speaker 1: been developing. You and the Biden campaign have been developing

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Speaker 1: for how to begin that process. Should keep be elected

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Speaker 1: and should a vaccine become a safe and available Well, no,

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Speaker 1: the Vice President has been really focused on developing and

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Speaker 1: thinking about plans. He never takes for granted that he

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Speaker 1: is going to win the election, but he wants to

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Speaker 1: be prepared to act on day one if he does.

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Speaker 1: And what that has meant is not just going about

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Speaker 1: the usual process that you have on transition teams, where

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Speaker 1: you think about the structure of a department and you

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Speaker 1: think about personnel, but it's involved thinking about some very

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Speaker 1: specific areas that are going to require a whole lot

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Speaker 1: more planning. So, for example, how do you actually expand

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Speaker 1: testing sufficiently so that we have enough testing so that

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Speaker 1: everyone who needs a test and get one. How do

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Speaker 1: we ensure that we actually have enough contact tracing capacity

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Speaker 1: in our country. We don't right now, but we really

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Speaker 1: need that we have any hopes of getting this under control.

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Speaker 1: And of course it involves how to think about the

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Speaker 1: deployment of a vaccine. So these have been the topic

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Speaker 1: of countless discussions that I and others have had with

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Speaker 1: Vice President Biden where he asked very specific questions. He's

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Speaker 1: thinking about very specific plans. But a key parts of

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Speaker 1: these plans, certainly for the Vaccine Distribution Fund, include thinking

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Speaker 1: about who the trusted partners are that we will need

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Speaker 1: in communities, like for example, if you think about the partners,

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Speaker 1: it's not just a medical establishment, but it's also schools

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Speaker 1: and employers. We know that schools and workplaces or sites

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Speaker 1: where a vaccine could be administered, and having partners in

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Speaker 1: those spheres is going to be absolutely essential. We know

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Speaker 1: that local government and states are going to be extremely

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Speaker 1: important partners. But here's the way I think the Vice

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Speaker 1: President would approach that partnership differently. In the early part

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Speaker 1: of this COVID response, what we saw is a transfer

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Speaker 1: of responsibility from the federal government to the states, saying,

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Speaker 1: you take care of this, and we will lead behind

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Speaker 1: lead from a different place. We will step back. I

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Speaker 1: think the Vice President realizes that you need to give

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Speaker 1: states the ability to craft their own response, but you

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Speaker 1: also have to lead as a federal government, and one

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Speaker 1: of the places in which you have to lead is

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Speaker 1: in the allocation of resources. So just think about the

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Speaker 1: following question, how do you decide how much vaccine goes

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Speaker 1: to Georgia or Florida, or Massachusetts or California. You can't

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Speaker 1: have that driven by politics. That has to be driven

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Speaker 1: by science and by need. So which raises a second

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Speaker 1: issue that he's been working on, not just partnerships, but

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Speaker 1: thinking about data systems right for understanding where the need

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Speaker 1: is and making sure that we can meet that need

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Speaker 1: right now. I'm worried that we don't have strong, robust

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Speaker 1: data systems that are integrated in our country such that

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Speaker 1: if we administered and rolled out of vaccine today, we

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Speaker 1: would automatically know where it was being delivered, who was

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Speaker 1: getting them, so that we could target our follow up

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Speaker 1: activities appropriately. We have to fix those data systems. So

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Speaker 1: he's been thinking about a number of areas like this

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Speaker 1: and bringing experts together, well beyond myself, you know, experts

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Speaker 1: from really around the country who have done this before.

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Speaker 1: He wants to assemble the best team possible because he

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Speaker 1: knows this is going to be a once in a

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Speaker 1: generation challenge. Let me press you on this. I think

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Speaker 1: you're right from what I know that the data systems

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Speaker 1: that we presently have aren't sufficiently robust to even have

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Speaker 1: a clear sense of what prevalence looks like. And that's

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Speaker 1: before you get to the substantive question, which is, if

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Speaker 1: you're new prevalence, where should you focus resources. Because it's

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Speaker 1: not immediately obvious that you want to focus a vaccine

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Speaker 1: immediately on the heartest areas. There are actually arguments for

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Speaker 1: beginning in more moderately hit areas, and so forth and

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Speaker 1: so on. So, I mean, this is a complex topic

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Speaker 1: in its own right, But given that the data systems

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Speaker 1: almost certainly are not in place, how is it realistic

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Speaker 1: to think that a Biden administration could take the time

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Speaker 1: to build up these data systems in order to then

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Speaker 1: make an informed decision. I mean, if you are doing this,

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Speaker 1: you and a team and people are doing this, you

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Speaker 1: are going to be doing it in media's race. You

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Speaker 1: are going to be inheriting the mess that you have inherited,

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Speaker 1: and you will be under enormous pressure to act quickly. Again,

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Speaker 1: assuming that there is a safe and available vaccine. So

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Speaker 1: I guess I want to say that sounds nice in

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Speaker 1: the abstract, like let's solve the data systems, but there's

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Speaker 1: no way that there's going to be the time that

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Speaker 1: it would take to do that. So how do you

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Speaker 1: make decisions under radical uncertainty without the data systems? So

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Speaker 1: it's a great question, and you're right, we can't wait

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Speaker 1: until the perfect systems are built. You can't wait until

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Speaker 1: all the partners are assembled around the table either, because

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Speaker 1: if thereccine truly is safe and effective, that means that

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Speaker 1: every day you lose our lives that are potentially lost.

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Speaker 1: So what we would have to do is we'd have

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Speaker 1: to do the best we can in the beginning to

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Speaker 1: use the data we have and go to areas that

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Speaker 1: we have great need and start to point the vaccine

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Speaker 1: through existing partners. We also have, thankfully, through the National

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Speaker 1: Academies of Medicine, recommendations on what the priority population should

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Speaker 1: be that we should target. So we know that healthcare

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Speaker 1: workers and other workers in the front line are critical.

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Speaker 1: We know the people at higher risk because of their

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Speaker 1: age or other medical conditions they have, are at higher risk.

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Speaker 1: So we can go to nursing homes, we can go

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Speaker 1: to other locations where high risk populations are and preferentially

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Speaker 1: vaccinate there. There is a lot of low hanging fruit,

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Speaker 1: if you will, in terms of actions that can be

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Speaker 1: taken in the very beginning, even while you're trying to

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Speaker 1: build up systems and build up partners. But all of

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Speaker 1: this is going to be infinitely harder if people are skeptical,

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Speaker 1: if they're doubtful, if they don't trust what you're doing.

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Speaker 1: And that's why the other plank of this so essential

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Speaker 1: that we've been talking about is the importance of communicating

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Speaker 1: openly honesty about what our plans are and what progress

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Speaker 1: we're making from day one. This is a kind of

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Speaker 1: crisis communication that has been deployed by Republican and democratic

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Speaker 1: administrations alike in prior pandemics. It's not the purview of

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Speaker 1: one party, but it hasn't been done well in this response,

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Speaker 1: and that's why we have a lot of ground to

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Speaker 1: make up. We'll be back in a moment. I'm deeply

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Speaker 1: worried that, regardless of the outcome of the election, if

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Speaker 1: a vaccine becomes available and safe under a Republican administration,

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Speaker 1: a lot of Democrats won't trust it, and that if

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Speaker 1: a vaccine becomes available and safe under a democratic administration,

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Speaker 1: a lot of Republicans won't trust it. In other words,

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Speaker 1: my worry is that the profound political partisan differences that

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Speaker 1: we have are fully bleeding into people's trust in scientific

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Speaker 1: institutions and medical institutions. What's our long run societal solution

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Speaker 1: to that problem. I mean, I'm not asking you to

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Speaker 1: solve the problem of partisan division. Nobody can do that,

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Speaker 1: and it's been with us in certain respects, although waning

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Speaker 1: and waxing throughout our history. I'm talking about the very

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Speaker 1: concrete problem, much closer to your area of expertise, which

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Speaker 1: is that people's trust in science and medicine is coming

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Speaker 1: to be deeply inflected by their partisan views. How do

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Speaker 1: we break that linkage no matter who's president. Yeah. And

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Speaker 1: the reason to be concerned because we've seen that on

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Speaker 1: a number of measures, whether it's people's views of the

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Speaker 1: masks and whether they're appropriate or not and useful, or

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Speaker 1: people's view of other precautions related to COVID. There has

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Speaker 1: been a partisan divide here. But what's interesting, as a

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Speaker 1: side note, is if you look at this data on

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Speaker 1: vaccines and specially the COVID nineteen vaccine. I mentioned that

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Speaker 1: fifty four percent of people are saying they would not

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Speaker 1: take the vaccine if it was available for election day.

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Speaker 1: That actually includes forty eight percent of Democrats, but sixty

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Speaker 1: percent of Republicans. So in a very interesting way, we're

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Speaker 1: finding that both Democrats and Republicans have deep worries about

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Speaker 1: the vaccine. But the larger point around polarization and affecting

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Speaker 1: how we take in information and what we trust is

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Speaker 1: absolutely true and it will be deadly as it has

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Speaker 1: been to date regards to coronavirus. I think one critical strategy,

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Speaker 1: and there are many here, but the one I'll mention

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Speaker 1: is that we have to go local in terms of

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Speaker 1: mobilizing information sources. Typically, people think, well, if you get

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Speaker 1: somebody on a major network in terms of news, or

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Speaker 1: a national radio station, that's how you get the message out.

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Speaker 1: But I think increasingly in this polarized world where people

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Speaker 1: are listening to their own sources, you actually have to

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Speaker 1: go much more local. You have to think, how do

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Speaker 1: I ensure that an individual's doctor actually knows that the

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Speaker 1: truth about this vaccine so they can recommend them. How

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Speaker 1: do I ensure that other people who are trusted members

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Speaker 1: of a community, like faith leaders, know the truth about

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Speaker 1: this vaccine so they can advise people. Because when you

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Speaker 1: have doubts about whether people are telling you to truth,

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Speaker 1: all of us as human beings go to the people

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Speaker 1: we know and that we have trusted for a long time,

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Speaker 1: that our friends, our family, our nurses and doctors, are

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Speaker 1: faith leaders and other trusted populations like this. So I

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Speaker 1: think if ultimately we want to convince people that the

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Speaker 1: vaccines is safe and effective, if indeed the evidence backs

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Speaker 1: that up, we've got to think about how to mobilize

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Speaker 1: those voices, and I think those will end up being

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Speaker 1: much much more important than getting people on cable news

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Speaker 1: and on national radio. That raises the really hard question

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Speaker 1: of how do you reach the local leaders that you're

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Speaker 1: talking about. We live in an era where local newspapers,

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Speaker 1: which at one time would have been a standard way

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Speaker 1: to reach people locally, because you can have a local

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Speaker 1: newspaper article about the local physician or faith leader who says,

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Speaker 1: you know, the vaccine is great, but they're in retreat,

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Speaker 1: or in many parts of the country they're already gone.

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Speaker 1: And one of the ways that people now increasingly communicate

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Speaker 1: with their trusted sources, whether it's family or friends or

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Speaker 1: local leaders, is actually through social media. And in that environment,

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Speaker 1: authority isn't quite as powerful as it once was in

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Speaker 1: historical terms, and things can go the other way relatively

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Speaker 1: quickly there can be a decentralized distribution of distrustful information.

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Speaker 1: I agree with you that we want to get people

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Speaker 1: to hear an important and true message from people who

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Speaker 1: may trust. But how do you at a national level

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Speaker 1: think about reaching those people if it's not through going

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Speaker 1: on CNN and MSNBC, which you do so frequently and

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Speaker 1: so skillfully. Well, no, I think this is not easy work.

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Speaker 1: It's a hard grind, if you will, because it requires

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Speaker 1: a lot of conversations. This is I think why people

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Speaker 1: have gravitated so much toward national news and national media.

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Speaker 1: It has the illusion that seeming to be more efficient, right,

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Speaker 1: you reach more people, Hey, why wouldn't that be better?

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Speaker 1: The problem is it comes with a heavy filter that

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Speaker 1: people don't necessarily trust. And so the way that I

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Speaker 1: would think about this is that we would need to

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Speaker 1: reach out, for example, to local organizations that bring together

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Speaker 1: faith leaders. We need to reach out to the YMCAs,

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Speaker 1: to the rotary clubs. We'll need to reach out to

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Speaker 1: associations of librarians. We'll need to reach out to groups

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Speaker 1: where we can get in front of people, talk to

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Speaker 1: them and then start engaging their local chapters. And if

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Speaker 1: that sounds like really tough, tedious, tenuous work. It is.

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Speaker 1: It's not easy to do because what we're really talking about, Noah,

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Speaker 1: even though we haven't used this word before, is we're

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Speaker 1: talking about relationship building, right, and relationship building can take time.

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Speaker 1: But I think that it doesn't mean that we'll never

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Speaker 1: be able to get a vaccine out for months and months.

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Speaker 1: I think that there are enough people who believe that

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Speaker 1: this is an urgent crisis and will understand the science

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Speaker 1: behind it, that we will have some uptake of the vaccine.

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Speaker 1: The question is how to sustain that and get to

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Speaker 1: a sufficient level where we have her in immunity. There's

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Speaker 1: one other point I want to raise here, though, if

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Speaker 1: this is indeed about relationships, and if what we need

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Speaker 1: our organizations that have a lot of relationships in the

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Speaker 1: local level. It's been particularly worrisome to me over the

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Speaker 1: last many years that we've had a breakdown in those

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Speaker 1: kind of community organizations over the last many decades, like

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Speaker 1: in this country. You know, something that's been well documented

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Speaker 1: by about Putnam, you know, I've been Harvard and by others,

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Speaker 1: But this decline in participation in community organizations and affiliation

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Speaker 1: with community groups leaves people with fewer sources that they

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Speaker 1: actually trust that are easy to access in a crisis

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Speaker 1: like this, and I see that as deeply worrisome. It's

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Speaker 1: one of the reasons why when I left my time

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Speaker 1: in government, when I was thinking about what do I

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Speaker 1: work on, what do I want to contribute to in

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Speaker 1: the world. That's why I kept coming back to this

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Speaker 1: idea of social connection as being such an important topic,

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Speaker 1: because if you don't have strong connections in your life,

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Speaker 1: then you don't have people you trust. If you don't

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Speaker 1: have people you trust, then you're reliant on social media,

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Speaker 1: on cable news, on other sources for your information, and

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Speaker 1: you don't have people to talk through doubts and worries with.

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Speaker 1: And I think we are bearing the consequences of a

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Speaker 1: deterioration in social connect in social organizations. But that said,

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Speaker 1: we still have many organizations in our communities that we

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Speaker 1: can lean on, and that's going to have to be

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Speaker 1: our priority in a new administration. Let me ask you

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Speaker 1: about how deeply penetrated a vaccine would actually have to

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Speaker 1: be to achieve her immunity. I mean, I realized there's

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Speaker 1: not an exact number that one can define with respect

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Speaker 1: to a particular pandemic, although there is some general guidance

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Speaker 1: that we have from epidemiologists. And the reason I want

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Speaker 1: to ask you about that is what sort of emerging

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Speaker 1: in my mind as I listen to you is that

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Speaker 1: a lot of us have been thinking, well, how do

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Speaker 1: we get out of this? Well, maybe the right way

434
00:23:45,036 --> 00:23:47,156
Speaker 1: to get out of it is with a vaccine, But

435
00:23:47,356 --> 00:23:49,556
Speaker 1: what I'm hearing from you is that actually getting a

436
00:23:49,596 --> 00:23:52,436
Speaker 1: vaccine is not necessarily the way out. The way out

437
00:23:52,516 --> 00:23:55,316
Speaker 1: is to have a vaccine and then have that vaccine

438
00:23:55,396 --> 00:23:58,196
Speaker 1: be sufficiently trusted by a broad enough swath of population

439
00:23:58,596 --> 00:24:02,156
Speaker 1: that when it is distributed and taken, it gets sufficient

440
00:24:02,156 --> 00:24:05,116
Speaker 1: penetration to actually reach her immunity. And that may be

441
00:24:05,156 --> 00:24:08,636
Speaker 1: a very very different thing. I'm letting that sort of

442
00:24:08,676 --> 00:24:11,036
Speaker 1: see through my thinking right now. So let's just walk

443
00:24:11,076 --> 00:24:14,436
Speaker 1: through it. Start with what percentage do you think roughly

444
00:24:14,516 --> 00:24:18,716
Speaker 1: we would need to reach for the vaccine to be efficacious? So, Noah,

445
00:24:18,756 --> 00:24:22,236
Speaker 1: that number depends on how effective the vaccine is. So

446
00:24:22,276 --> 00:24:25,156
Speaker 1: if we had a vaccine that was one hundred percent effective,

447
00:24:25,676 --> 00:24:29,556
Speaker 1: which would be exceedingly unusual, then we would have to

448
00:24:29,636 --> 00:24:32,916
Speaker 1: vaccinate somewhere in their neighborhood of a seventy percent of

449
00:24:32,956 --> 00:24:35,676
Speaker 1: the population, maybe a little bit less because you know,

450
00:24:35,756 --> 00:24:38,596
Speaker 1: number of people have had the virus already, they may

451
00:24:38,636 --> 00:24:40,956
Speaker 1: have some short term immunity, but it would have to

452
00:24:40,956 --> 00:24:43,436
Speaker 1: be around seventy percent. But if you start dropping that,

453
00:24:43,796 --> 00:24:46,956
Speaker 1: if you get to a vaccine that's around fifty percent effective,

454
00:24:46,956 --> 00:24:49,876
Speaker 1: which is a threshold in fact that the FDA set

455
00:24:49,996 --> 00:24:53,756
Speaker 1: and it's June thirtieth guidance, then even if you vaccinated

456
00:24:53,796 --> 00:24:56,156
Speaker 1: everybody in the country, you're not necessarily going to get

457
00:24:56,156 --> 00:24:58,476
Speaker 1: to her immunity levels. Now, that doesn't mean that it's

458
00:24:58,476 --> 00:25:01,436
Speaker 1: still not worthwhile. See, herd immunity is not a switch

459
00:25:01,476 --> 00:25:03,756
Speaker 1: that we flip on or off. There are benefits to

460
00:25:03,796 --> 00:25:05,676
Speaker 1: be gained, you know, if we get halfway there, there

461
00:25:05,756 --> 00:25:07,316
Speaker 1: benefits to be gained if we get three quarters of

462
00:25:07,316 --> 00:25:10,636
Speaker 1: the way there. But what this means, given the fact

463
00:25:10,716 --> 00:25:13,316
Speaker 1: that getting to hurt immunity levels will take time and

464
00:25:13,356 --> 00:25:16,156
Speaker 1: will be difficult, is it means that many of the

465
00:25:16,196 --> 00:25:19,196
Speaker 1: precautions that we're taking right now in terms of distancing

466
00:25:19,516 --> 00:25:22,876
Speaker 1: and wearing masks and really upping our game in terms

467
00:25:22,876 --> 00:25:26,276
Speaker 1: of personal hygiene and washing our hands, that those behavior

468
00:25:26,396 --> 00:25:29,276
Speaker 1: changes will be with us for a while. Certainly through

469
00:25:29,396 --> 00:25:33,316
Speaker 1: twenty twenty one and very likely beyond that. It doesn't

470
00:25:33,316 --> 00:25:34,796
Speaker 1: mean that we're going to have to stay in our

471
00:25:34,796 --> 00:25:37,836
Speaker 1: homes for years and years. We will learn, as we

472
00:25:37,916 --> 00:25:40,996
Speaker 1: have already in the last six months, safer ways to

473
00:25:41,036 --> 00:25:44,156
Speaker 1: come together in smaller groups, you know, outside, or to

474
00:25:44,196 --> 00:25:49,036
Speaker 1: even improve our current ventilation systems and other measures indoors

475
00:25:49,076 --> 00:25:52,796
Speaker 1: to make the risk of getting coronavirus lower. So we

476
00:25:52,836 --> 00:25:56,196
Speaker 1: will find safer ways to re engage in our life,

477
00:25:56,196 --> 00:25:58,236
Speaker 1: But our life is not going to go back to

478
00:25:58,396 --> 00:26:02,436
Speaker 1: pre pandemic sort of ways until probably at least several

479
00:26:02,516 --> 00:26:04,636
Speaker 1: years from now. I just want to make sure that

480
00:26:04,836 --> 00:26:07,956
Speaker 1: everybody who's listening gets the full weight of what you're saying.

481
00:26:09,476 --> 00:26:13,996
Speaker 1: Even a perfectly effective vaccine, perfectly efficacious vaccine, which basically

482
00:26:14,076 --> 00:26:16,356
Speaker 1: doesn't exist in the real world for almost anything that

483
00:26:16,436 --> 00:26:19,196
Speaker 1: we think of being vaccinated for, would have to reach

484
00:26:19,236 --> 00:26:21,556
Speaker 1: seventy percent of the population before we can say we're

485
00:26:21,556 --> 00:26:25,436
Speaker 1: at her immunity and we can remove various forms of

486
00:26:25,476 --> 00:26:29,676
Speaker 1: social distancing and masks and separation. As you go down

487
00:26:30,156 --> 00:26:34,876
Speaker 1: the efficacy numbers, you get greater and greater probability that

488
00:26:34,996 --> 00:26:37,796
Speaker 1: a good number of people will still be getting the virus,

489
00:26:38,596 --> 00:26:41,596
Speaker 1: and as you go down, you need more and more

490
00:26:41,596 --> 00:26:43,516
Speaker 1: people to be vaccinated, And of course that's going to

491
00:26:43,596 --> 00:26:47,796
Speaker 1: be actually inversely correlated in the real world. Right if

492
00:26:47,836 --> 00:26:49,996
Speaker 1: we heard that the vaccine was one hundred percent efficacious,

493
00:26:50,036 --> 00:26:52,956
Speaker 1: more people would be inclined to take it, and ironically,

494
00:26:53,036 --> 00:26:54,436
Speaker 1: what we need is the other way around. The less

495
00:26:54,436 --> 00:26:56,436
Speaker 1: efficationous vaccine needs more people to take it. But if

496
00:26:56,436 --> 00:26:58,716
Speaker 1: people say it's only fifty percent effective, a lot of

497
00:26:58,716 --> 00:27:01,876
Speaker 1: people will mistakenly say, and therefore I shouldn't take it.

498
00:27:01,876 --> 00:27:04,796
Speaker 1: I mean mistakenly in the rational sense that rationally you

499
00:27:04,876 --> 00:27:07,596
Speaker 1: really should take it if it has any capacity to

500
00:27:07,636 --> 00:27:09,516
Speaker 1: help you provide it that you don't think, the danger

501
00:27:09,596 --> 00:27:11,796
Speaker 1: is still great. So we could very easily get an

502
00:27:11,836 --> 00:27:16,276
Speaker 1: extremely messy situation with like a ninety percent efficacious vaccine

503
00:27:16,516 --> 00:27:18,876
Speaker 1: but lots of people not taking it. And then the

504
00:27:19,036 --> 00:27:23,436
Speaker 1: upshot of that I'm hearing you saying is that masks

505
00:27:23,516 --> 00:27:26,276
Speaker 1: are going to continue even after the vaccine is out there.

506
00:27:26,556 --> 00:27:31,316
Speaker 1: Social distancing measures, including not getting together with medium groups

507
00:27:31,316 --> 00:27:34,716
Speaker 1: of people or large groups of people indoors, those restrictions

508
00:27:34,756 --> 00:27:37,556
Speaker 1: are going to continue for at least twenty twenty one

509
00:27:37,596 --> 00:27:40,156
Speaker 1: and maybe for several years longer, and that is, in

510
00:27:40,196 --> 00:27:44,636
Speaker 1: a certain sense, a much more depressing picture than a

511
00:27:44,676 --> 00:27:47,716
Speaker 1: lot of us have been imagining as progress towards the

512
00:27:47,756 --> 00:27:51,116
Speaker 1: vaccine seems to be advancing. I mean, am I getting

513
00:27:51,116 --> 00:27:53,676
Speaker 1: it right? I mean, you're saying it very cautiously and

514
00:27:53,916 --> 00:27:57,676
Speaker 1: very rationally, but what I'm hearing is actually a pretty

515
00:27:57,676 --> 00:28:01,636
Speaker 1: striking rational conclusion that we're very, very very far from

516
00:28:01,676 --> 00:28:05,996
Speaker 1: anything approaching normal life. So yes, no, I mean, you know,

517
00:28:06,196 --> 00:28:08,756
Speaker 1: I try never to be alarmist about these things, because

518
00:28:08,796 --> 00:28:10,476
Speaker 1: there's got to admit, there's a lot we don't know,

519
00:28:10,716 --> 00:28:14,236
Speaker 1: and I'm always optimistic, hoping for major breakthroughs. But I

520
00:28:14,236 --> 00:28:17,436
Speaker 1: think the realistic picture is that we are looking at

521
00:28:17,436 --> 00:28:20,316
Speaker 1: our life continuing to be changed for several years now. Now.

522
00:28:20,316 --> 00:28:22,556
Speaker 1: I want to be clear by one thing, That does

523
00:28:22,556 --> 00:28:24,036
Speaker 1: not mean that we're going to be in the exact

524
00:28:24,076 --> 00:28:26,516
Speaker 1: state that we're in right now in a year. In fact,

525
00:28:26,636 --> 00:28:29,276
Speaker 1: I think that we will be more able to get

526
00:28:29,276 --> 00:28:32,516
Speaker 1: our children back to school, that we will find safer

527
00:28:32,556 --> 00:28:34,276
Speaker 1: ways to do that. In fact, we know safer ways,

528
00:28:34,276 --> 00:28:36,716
Speaker 1: we're just not really implementing them right now. I do

529
00:28:36,796 --> 00:28:39,996
Speaker 1: think they will see more workplaces actually up and running again,

530
00:28:40,316 --> 00:28:43,596
Speaker 1: because again we will, hopefully if we have advances in testing,

531
00:28:43,996 --> 00:28:46,396
Speaker 1: and if we have people more observant precautions and we

532
00:28:46,436 --> 00:28:49,236
Speaker 1: get local prevalence of the virus down, we can have

533
00:28:49,476 --> 00:28:52,876
Speaker 1: workplaces operating at least in a partial way or even

534
00:28:52,876 --> 00:28:55,436
Speaker 1: close to normal, in ways that we haven't near these

535
00:28:55,516 --> 00:28:58,196
Speaker 1: last several months. So I think we will make progress.

536
00:28:58,316 --> 00:29:01,236
Speaker 1: And even with getting together socially, I think we will

537
00:29:01,276 --> 00:29:05,116
Speaker 1: find ways to get together in small groups indoors and

538
00:29:05,316 --> 00:29:07,796
Speaker 1: socialize and see each other, but we'll do it in

539
00:29:07,836 --> 00:29:10,316
Speaker 1: ways that are safer, just like you see some schools

540
00:29:10,636 --> 00:29:14,516
Speaker 1: actually able to bring children together with masks, with distancing

541
00:29:14,796 --> 00:29:18,396
Speaker 1: in indoor environments to learn. So we are an incredibly

542
00:29:18,556 --> 00:29:21,556
Speaker 1: adaptable species. We've adapted a lot in the last six months.

543
00:29:21,556 --> 00:29:24,396
Speaker 1: We will adapt a lot more. But what I do

544
00:29:24,436 --> 00:29:27,036
Speaker 1: think we should be realistic about is that when a

545
00:29:27,116 --> 00:29:29,676
Speaker 1: vaccine arrives, it's not like tomorrow or even in a

546
00:29:29,716 --> 00:29:32,156
Speaker 1: month or in six months that suddenly we'll go back

547
00:29:32,196 --> 00:29:36,116
Speaker 1: to having full arenas at basketball games and having crowded

548
00:29:36,156 --> 00:29:39,996
Speaker 1: concerts and having large groups get together for birthday parties

549
00:29:39,996 --> 00:29:43,676
Speaker 1: and other festive occasions. That will come back eventually, but

550
00:29:43,756 --> 00:29:46,836
Speaker 1: it's going to take some time. The public pressure though

551
00:29:47,156 --> 00:29:50,956
Speaker 1: the moment a vaccine is broadly available, a safe vaccine

552
00:29:51,036 --> 00:29:54,236
Speaker 1: is broadly available to go back to normal at the

553
00:29:54,236 --> 00:29:58,036
Speaker 1: basketball arena. It's going to be overwhelming. I mean, I

554
00:29:58,076 --> 00:30:02,036
Speaker 1: wonder how any president, even a president informed by science

555
00:30:02,076 --> 00:30:05,436
Speaker 1: and advised by the best advisors, we'll be able to

556
00:30:05,476 --> 00:30:08,916
Speaker 1: resist the kind of pressure that's going to be associated

557
00:30:08,916 --> 00:30:10,676
Speaker 1: with that. You know, I think it is going to

558
00:30:10,716 --> 00:30:14,156
Speaker 1: be increasingly difficult. But here's what I'll use this analogy.

559
00:30:14,276 --> 00:30:18,116
Speaker 1: Like when you sprain your ankle, if you choose to

560
00:30:18,236 --> 00:30:20,996
Speaker 1: arrest for a requisite period of time and then actually

561
00:30:21,076 --> 00:30:23,796
Speaker 1: get your physical therapy, you will recover a lot faster

562
00:30:24,356 --> 00:30:26,036
Speaker 1: than if you just continue to walk on it and

563
00:30:26,076 --> 00:30:29,316
Speaker 1: never do any pt. If you think about our COVID response,

564
00:30:29,636 --> 00:30:32,156
Speaker 1: we've been doing more the latter than the former. And

565
00:30:32,516 --> 00:30:34,636
Speaker 1: I attribute a lot of this to leadership. Like what

566
00:30:34,676 --> 00:30:37,796
Speaker 1: we told people our political leadership was that we got

567
00:30:37,796 --> 00:30:39,396
Speaker 1: to shut down for some period of time and then

568
00:30:39,436 --> 00:30:42,996
Speaker 1: we opened up quickly, right before levels of the virus

569
00:30:42,996 --> 00:30:45,996
Speaker 1: were truly low in communities, and we were reluctant to

570
00:30:46,036 --> 00:30:49,676
Speaker 1: put in place mask mandates in many communities around the country.

571
00:30:49,996 --> 00:30:53,516
Speaker 1: We were reluctant to push for bars and other higher

572
00:30:53,596 --> 00:30:56,716
Speaker 1: risk indoor spaces to actually close down. And so what

573
00:30:56,756 --> 00:31:00,356
Speaker 1: you saw was this stuttering response and a level of

574
00:31:00,356 --> 00:31:03,836
Speaker 1: infection that never truly got low. Like almost every other country,

575
00:31:04,156 --> 00:31:06,876
Speaker 1: every other developed country was able to go up and

576
00:31:06,916 --> 00:31:08,716
Speaker 1: come down to a low level, and now they're trying

577
00:31:08,716 --> 00:31:11,516
Speaker 1: to keep that level low. We actually never got to

578
00:31:11,556 --> 00:31:14,436
Speaker 1: a low level. We're still smoldering at a very very

579
00:31:14,516 --> 00:31:17,156
Speaker 1: high rate of daily cases. And the thing is that

580
00:31:17,196 --> 00:31:19,756
Speaker 1: public only has limited patients, and that's a risk of

581
00:31:19,796 --> 00:31:21,596
Speaker 1: taking as long as we have to get it right.

582
00:31:21,956 --> 00:31:24,796
Speaker 1: So the new president will have, yes a herculean task.

583
00:31:24,876 --> 00:31:27,316
Speaker 1: You know. I thought that President Obama and Vice President

584
00:31:27,356 --> 00:31:29,116
Speaker 1: Biden had a massive task in front of them in

585
00:31:29,156 --> 00:31:31,716
Speaker 1: two thousand and nine when they began the presidency at

586
00:31:31,716 --> 00:31:34,196
Speaker 1: the time of the Great Recession. But I think the

587
00:31:34,276 --> 00:31:38,836
Speaker 1: difficulty of this health, economic, and really a crisis of

588
00:31:38,916 --> 00:31:42,276
Speaker 1: public confidence, I think will dwarf anything we've seen in

589
00:31:42,316 --> 00:31:45,956
Speaker 1: a few generations. I want to thank you back for

590
00:31:46,076 --> 00:31:48,636
Speaker 1: joining me and I for one to hope that your

591
00:31:48,716 --> 00:31:52,716
Speaker 1: participant in the process of rebuilding trust in institutions and

592
00:31:53,396 --> 00:31:56,996
Speaker 1: in directing us to a rational and calm and efficacious

593
00:31:57,036 --> 00:32:00,356
Speaker 1: way of addressing these problems. I appreciate those kind words.

594
00:32:00,516 --> 00:32:02,676
Speaker 1: I do want to say that, as much as what

595
00:32:02,796 --> 00:32:06,676
Speaker 1: we've talked about today is perhaps sobering and not know

596
00:32:06,716 --> 00:32:08,236
Speaker 1: the message I think all of us would want in

597
00:32:08,356 --> 00:32:10,636
Speaker 1: terms of like this thing is going to go away tomorrow,

598
00:32:10,916 --> 00:32:13,996
Speaker 1: I actually do feel optimistic overall about the future. And

599
00:32:14,356 --> 00:32:16,996
Speaker 1: the reason I feel optimistic is, you know, I have

600
00:32:17,036 --> 00:32:18,836
Speaker 1: been blessed in the work that I've been doing over

601
00:32:18,836 --> 00:32:22,076
Speaker 1: the last six months to see the deep well of

602
00:32:22,196 --> 00:32:24,876
Speaker 1: scientific and medical talent that we have in our country

603
00:32:24,916 --> 00:32:27,636
Speaker 1: and frankly with collaborators around the world. So many of

604
00:32:27,676 --> 00:32:31,356
Speaker 1: these extraordinary individuals are standing at the ready. They want

605
00:32:31,396 --> 00:32:34,356
Speaker 1: to help, they want to do their part to address

606
00:32:34,436 --> 00:32:37,436
Speaker 1: COVID nineteen, and we just need to bring them off

607
00:32:37,476 --> 00:32:47,076
Speaker 1: the sidelines. Listening to doctor Morte talk about the recreation

608
00:32:47,116 --> 00:32:51,796
Speaker 1: of trust was a very sobering experience for me. As

609
00:32:51,796 --> 00:32:55,196
Speaker 1: he spoke, I gradually came to see much more clearly

610
00:32:55,236 --> 00:32:58,676
Speaker 1: than I had done before that just having a vaccine

611
00:32:58,956 --> 00:33:01,836
Speaker 1: will not really be the end of the problems that

612
00:33:01,876 --> 00:33:05,916
Speaker 1: we face. Even if a vaccine were completely efficacious, which

613
00:33:05,996 --> 00:33:09,516
Speaker 1: doctor Morti emphasized is pretty unusual, we would still need

614
00:33:09,556 --> 00:33:12,636
Speaker 1: to see some seventy percent of the population taking the vaccine.

615
00:33:13,396 --> 00:33:16,036
Speaker 1: That will not be a simple thing to accomplish, not

616
00:33:16,076 --> 00:33:19,196
Speaker 1: merely because it's difficult to distribute a vaccine, but because

617
00:33:19,316 --> 00:33:22,916
Speaker 1: some significant number of people may not trust the vaccine

618
00:33:23,236 --> 00:33:26,596
Speaker 1: no matter who is president, and of course is also

619
00:33:26,636 --> 00:33:30,796
Speaker 1: possible the vaccine will be substantially less efficacious than one

620
00:33:30,876 --> 00:33:34,396
Speaker 1: hundred percent, perhaps as low as fifty percent, which is

621
00:33:34,436 --> 00:33:37,276
Speaker 1: the threshold that the FDA has set for approving a

622
00:33:37,356 --> 00:33:41,876
Speaker 1: vaccine at all. The confluence of these factors, that is

623
00:33:41,916 --> 00:33:45,076
Speaker 1: to say, our uncertainty about how effective the vaccine will

624
00:33:45,116 --> 00:33:47,636
Speaker 1: be and our uncertainty about how many people will agree

625
00:33:47,636 --> 00:33:51,516
Speaker 1: to take the vaccine, leads doctor Morty to conclude that

626
00:33:51,596 --> 00:33:54,636
Speaker 1: we may well be in a situation where we have

627
00:33:54,716 --> 00:33:59,356
Speaker 1: to continue with social distancing and masking measures for a

628
00:33:59,396 --> 00:34:03,516
Speaker 1: good long time, even after the vaccine comes to be

629
00:34:03,716 --> 00:34:07,596
Speaker 1: in play. So, notwithstanding my fantasy that perhaps by the

630
00:34:07,636 --> 00:34:09,956
Speaker 1: fall of twenty twenty one, things could be quote back

631
00:34:09,996 --> 00:34:12,996
Speaker 1: to normal, the sense I got from talking to doctor

632
00:34:13,076 --> 00:34:16,676
Speaker 1: Morty is that that is quite unlikely, and that normal,

633
00:34:17,036 --> 00:34:19,716
Speaker 1: in fact is something that will be a new normal,

634
00:34:20,076 --> 00:34:25,116
Speaker 1: and maybe substantially further off into twenty twenty two, or

635
00:34:25,156 --> 00:34:29,036
Speaker 1: perhaps even beyond. I wish that weren't the case, and

636
00:34:29,076 --> 00:34:31,316
Speaker 1: I wish that my fantasy that we could all have

637
00:34:31,356 --> 00:34:34,236
Speaker 1: a vaccine which we could all take and get everything

638
00:34:34,276 --> 00:34:36,476
Speaker 1: back to normal by the fall of twenty twenty one,

639
00:34:36,716 --> 00:34:40,836
Speaker 1: We're not just that a fantasy. But hey, that's why

640
00:34:40,876 --> 00:34:43,516
Speaker 1: we speak to the experts on Deep Background, to make

641
00:34:43,516 --> 00:34:46,796
Speaker 1: sure that the views we hold, including our fantasies, are

642
00:34:46,876 --> 00:34:50,116
Speaker 1: to some important degree informed by what the experts have

643
00:34:50,196 --> 00:34:53,356
Speaker 1: to say and what they know. I promise they will

644
00:34:53,356 --> 00:34:56,716
Speaker 1: continue to cover the question of vaccines and how and

645
00:34:56,876 --> 00:35:00,516
Speaker 1: if and when we return to normal very very closely

646
00:35:00,676 --> 00:35:04,756
Speaker 1: here on Deep Background. It remains at the absolute center

647
00:35:05,236 --> 00:35:08,956
Speaker 1: of how we return our lives to some state of normalcy,

648
00:35:09,156 --> 00:35:12,036
Speaker 1: even as we continue to talk about the election, the

649
00:35:12,076 --> 00:35:16,716
Speaker 1: political environment, and the composition of the Supreme Court. Until

650
00:35:16,756 --> 00:35:19,956
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Speaker 1: Malcolm Clodwell, Jacob Weisberg, and Mia Lobel. I'm Noah Feldman.

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Speaker 1: I also have a new book out called The Arab Winter,

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