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