WEBVTT - A Former Surgeon General on the Coronavirus Pandemic 0:00:15.356 --> 0:00:22.116 Pushkin from Pushkin Industries. This is Deep Background the show 0:00:22.156 --> 0:00:25.356 where we explore the stories behind the stories in the news. 0:00:25.716 --> 0:00:30.676 I'm no affeldment. The possibility of a COVID vaccine grows 0:00:30.916 --> 0:00:35.396 greater with each passing day, and yet simultaneously, the danger 0:00:35.476 --> 0:00:39.316 continues to grow that some significant percentage of the population 0:00:39.676 --> 0:00:43.116 will not trust the vaccine. The breakdown of that trust 0:00:43.236 --> 0:00:45.356 has to do with the erosion of our trust in 0:00:45.396 --> 0:00:48.836 all kinds of authority, in government authority generally, and in 0:00:48.916 --> 0:00:53.036 scientific and medical authorities in particular. It also has very 0:00:53.116 --> 0:00:56.156 much to do with a deep partisanship that we're encountering 0:00:56.396 --> 0:01:00.756 in the middle of this pandemic. To discuss trust, how 0:01:00.756 --> 0:01:03.876 it can be rebuilt, and what indeed needs to be 0:01:03.956 --> 0:01:07.596 done to get an efficacious vaccine to the American public. 0:01:07.996 --> 0:01:11.956 I'm joined by doctor Vaveck Murty. Doctor Murty was the 0:01:11.996 --> 0:01:15.156 Surgeon General of the United States from twenty fourteen to 0:01:15.236 --> 0:01:20.436 twenty seventeen during Barack Obama's presidency. Is now advising Democratic 0:01:20.476 --> 0:01:32.076 presidential candidate Joe Biden on his coronavirus response. Vic, thank 0:01:32.116 --> 0:01:33.956 you very much for joining me. I want to start 0:01:34.036 --> 0:01:36.516 with a question that you've spent a huge amount of 0:01:36.556 --> 0:01:39.516 time focused on, and that's a question of trust, public 0:01:39.556 --> 0:01:43.556 trust in science, public trust in medicine. And what's particularly 0:01:43.676 --> 0:01:46.436 driving me to ask you this question is that as 0:01:46.476 --> 0:01:51.796 we move through phase three trials for potential vaccines with 0:01:51.836 --> 0:01:55.916 respect to COVID nineteen, there's a lot of uncertainty about 0:01:55.916 --> 0:01:59.276 how the public will react if and when there's an 0:01:59.316 --> 0:02:03.716 emergency use authorization for these vaccines, or if there's publicity 0:02:03.716 --> 0:02:07.756 around these vaccines. It seems to be politically motivated, and that, 0:02:07.836 --> 0:02:11.676 of course is a question that science. It implicates medicine, 0:02:11.996 --> 0:02:15.716 it implicates approvals, and it implicates politics. So there's a 0:02:15.756 --> 0:02:18.156 lot to be said about this, but intervening it whatever 0:02:18.196 --> 0:02:21.236 you would like to start. So this is a timely question, 0:02:21.596 --> 0:02:25.316 and I think the issue of trust is one that 0:02:25.396 --> 0:02:29.276 has been growing frankly during this pandemic response. Let me 0:02:29.396 --> 0:02:31.636 just say a word about why this is so important. 0:02:31.756 --> 0:02:35.716 It's not just about a vaccine during pandemic responses, and 0:02:35.796 --> 0:02:38.196 I saw this when I served a surgeon general during 0:02:38.196 --> 0:02:41.436 the Zeka outbreak and during Ebola as well. Public trust 0:02:41.596 --> 0:02:44.396 is one of the most important resources you have and 0:02:44.476 --> 0:02:47.756 you have to cultivate it at all costs. That means 0:02:47.796 --> 0:02:51.076 being honest with people even when you've done something wrong. 0:02:51.436 --> 0:02:54.236 It means being open to hard questions, even when you 0:02:54.276 --> 0:02:58.476 don't know the answers to them. It means communicating openly, transparently, 0:02:58.516 --> 0:03:01.676 and regularly with people. And in this moment, it also 0:03:01.716 --> 0:03:05.596 means allowing them to hear directly from the source of information, 0:03:05.676 --> 0:03:08.836 which are scientists. You know, science hastic guide pandemic responses, 0:03:08.876 --> 0:03:12.956 and scientists aren't allowed to speak directly in an unfettered 0:03:12.996 --> 0:03:16.596 way with the public. It's so stubt. What's happening here 0:03:16.636 --> 0:03:19.876 with regarding a vaccine is that we have an unfortunately 0:03:19.956 --> 0:03:23.796 confluence of factors. We have Number one trust, which has 0:03:23.836 --> 0:03:27.796 been I think badly injured over the last several months. 0:03:28.356 --> 0:03:31.316 You have a political cycle which is coming to a 0:03:31.356 --> 0:03:35.396 culmination with this presidential election, and you have a pandemic 0:03:35.516 --> 0:03:39.636 that has not gotten better. In fact, we have the 0:03:39.676 --> 0:03:42.196 most number of cases in the world. We have had 0:03:42.316 --> 0:03:44.516 nearly two hundred thousand people at this point when you 0:03:44.516 --> 0:03:47.156 and I are talking today who have died from COVID 0:03:47.236 --> 0:03:50.036 nineteen to the United States, and we do not see 0:03:50.036 --> 0:03:52.796 a sign of this ending because our response has been poor. 0:03:53.476 --> 0:03:55.636 And so all of these are coming together to make 0:03:55.636 --> 0:04:00.156 people nervous about a decision around a vaccine, and I 0:04:00.196 --> 0:04:04.396 think there's great danger to rushing a vaccine approval or 0:04:04.436 --> 0:04:07.876 an emergency authorization in this environment. The damage is not 0:04:08.036 --> 0:04:11.796 just that people may not take the vaccine. In fact, 0:04:11.916 --> 0:04:16.076 right now from September Kaiser Family Foundation poll, we know 0:04:16.156 --> 0:04:18.756 that fifty four percent of people are saying that they 0:04:18.796 --> 0:04:21.116 would not take the vaccine if it was offered today. 0:04:21.996 --> 0:04:24.876 That's a staggering number, just given the toll that COVID 0:04:24.876 --> 0:04:27.596 has taken, how much it's turned our lives upside down, 0:04:27.596 --> 0:04:30.356 how much people so desperately want this pandemic to be over. 0:04:30.636 --> 0:04:32.636 Yet fifty four percent of people are saying they wouldn't 0:04:32.636 --> 0:04:35.316 take a vaccine if it was approved before the election. 0:04:36.156 --> 0:04:37.636 So what does that tell us? That tells us that 0:04:37.636 --> 0:04:40.396 people are worried about the process, and they have good 0:04:40.436 --> 0:04:43.116 reason to be, because we've seen a couple of processes 0:04:43.156 --> 0:04:46.156 in the FDA which have been driven by politics, the 0:04:46.276 --> 0:04:49.716 issue of an emergency use authorization for hydroxy chloroquine being one. 0:04:50.156 --> 0:04:54.236 The way in which the convalescent plasma emergency authorization was 0:04:54.276 --> 0:04:57.796 issued with false numbers and hype that was political and 0:04:57.876 --> 0:05:01.356 not scientific. So if the administration really wants to ensure 0:05:01.756 --> 0:05:05.356 that people have faith in an emergency authorization. Here's what 0:05:05.396 --> 0:05:07.636 they need to do. They need to, number one, make 0:05:07.676 --> 0:05:11.956 sure that they estab and communicate clearly an explicit standard 0:05:12.356 --> 0:05:15.676 for safety and efficacy that will be met before an 0:05:15.676 --> 0:05:18.836 emergency use authorization is approved. The second thing they have 0:05:18.876 --> 0:05:20.396 to do is they have to make sure that the 0:05:20.516 --> 0:05:24.796 FDA scientists and very importantly it's external Advisory Board which 0:05:24.836 --> 0:05:27.756 is known by the some a clunky acronym VERTPAC which 0:05:27.756 --> 0:05:31.836 stands for a Vaccine and Related Biological Products Advisory Committee. 0:05:31.916 --> 0:05:35.276 Both of these groups of scientists must be able allowed 0:05:35.436 --> 0:05:39.596 to communicate directly with the public and share their assessment 0:05:39.876 --> 0:05:43.396 without a political filter. And finally, the data itself from 0:05:43.436 --> 0:05:45.756 the trial needs to be made available to the public 0:05:45.796 --> 0:05:49.276 so that the external scientific community can assess it, can 0:05:49.276 --> 0:05:52.076 come to their conclusions, and can share their opinions with 0:05:52.156 --> 0:05:55.516 the public. Only when these are done you should have 0:05:55.596 --> 0:05:58.596 a vaccine be considered for emergency authorization, because again the 0:05:58.636 --> 0:06:01.676 consequences is not just people won't take the COVID vaccine, 0:06:01.956 --> 0:06:05.356 but if we allow hesitancy and doubt to be sown 0:06:05.396 --> 0:06:09.196 about the process itself, then people will doubt vaccines, and 0:06:09.276 --> 0:06:12.276 after COVID is over, they'll worry that politics and arts 0:06:12.276 --> 0:06:14.676 science is driving the process, and that will ultimately hurt 0:06:14.716 --> 0:06:17.436 all of us. I have to say, when I heard 0:06:17.436 --> 0:06:19.796 those poll numbers about the number of people who wouldn't 0:06:19.796 --> 0:06:22.356 take a vaccine, at first I felt shocked, but then 0:06:22.396 --> 0:06:24.876 I realized that I myself had a conversation in fact 0:06:24.916 --> 0:06:27.996 with my own parents, who are you. My father's eighty 0:06:28.036 --> 0:06:31.556 and my mothers in her late seventies, and they had 0:06:31.636 --> 0:06:35.236 similar skepticism. And I was actually horrified in the conversation, 0:06:35.236 --> 0:06:37.316 and I took it upon myself to try to convince 0:06:37.316 --> 0:06:42.396 them that, given their age and the bad outcomes that 0:06:42.756 --> 0:06:45.156 happen to people in that age group, if they do 0:06:45.596 --> 0:06:48.556 actually develop a case of COVID, that they were getting 0:06:48.556 --> 0:06:51.436 it rationally wrong. They ought precisely to be prepared to 0:06:51.436 --> 0:06:54.836 take a vaccine again and provided some emergency used to authorization. 0:06:54.876 --> 0:06:58.116 And I think of my parents is superrational and cautious 0:06:58.156 --> 0:07:01.876 and sensible around medical issues. And that leads me to ask, 0:07:02.396 --> 0:07:05.596 even if the administration, the current administration, the Trump administration, 0:07:06.036 --> 0:07:08.396 did all three of the things that you just said, 0:07:09.276 --> 0:07:13.956 if they actually specify clear protocols for what counted his safety. 0:07:14.316 --> 0:07:17.236 And then they left the scientists at the FDA and 0:07:17.436 --> 0:07:20.796 on the advisory committee, the Vaccine Advisory Committee speak directly 0:07:20.836 --> 0:07:25.436 to the public, and they publicized what data existed from 0:07:25.596 --> 0:07:28.996 Phase three trials. And let's just imagine in the scenario 0:07:29.076 --> 0:07:32.476 that sometime between now and the time of the inauguration 0:07:32.476 --> 0:07:35.756 of the next president, that all of those things pointed 0:07:35.836 --> 0:07:38.996 in the direction of an emergency use authorization. Is there 0:07:39.076 --> 0:07:41.996 any credible way that we could get a lot of 0:07:41.996 --> 0:07:45.276 the public, even under those circumstances, to trust the vaccine 0:07:45.636 --> 0:07:48.476 or is the damage that's been done already so deep 0:07:49.036 --> 0:07:52.916 that we couldn't credibly imagine that certainly in any Trump 0:07:52.956 --> 0:07:57.316 authorized emergency use. Well, Noah, the damage that has been 0:07:57.356 --> 0:07:59.676 done is deep and it will take years to repair. 0:08:00.116 --> 0:08:03.756 Because people had a very high degree of confidence across 0:08:03.796 --> 0:08:07.516 the population in the CDC before COVID nineteen, and we've 0:08:07.556 --> 0:08:11.476 seen their credibility damaged. The FDA's credibility has taken a hit. 0:08:12.956 --> 0:08:16.116 Even people like doctor Tony Faucci, you know, who are 0:08:16.236 --> 0:08:19.276 very highly regarded by the scientific community and by the 0:08:19.276 --> 0:08:22.516 majority of the public. You know, even doctor Faucci's credibility 0:08:22.596 --> 0:08:25.076 has taken a hit because of smear jobs and other 0:08:26.076 --> 0:08:29.356 criticism that he's received that has been politically directed, and 0:08:29.396 --> 0:08:32.076 so there's been a lot of hits to trusted sources 0:08:32.116 --> 0:08:34.796 and it will take years for that to recover. Let's 0:08:34.796 --> 0:08:36.996 just say in your scenario that there is in fact 0:08:37.276 --> 0:08:41.196 a good worthy data that tells us that vaccine candidate 0:08:41.236 --> 0:08:43.756 meets the standards for safety and efficacy, and an emergency 0:08:43.836 --> 0:08:46.876 use authorization is issued. What would happen to happen if 0:08:46.876 --> 0:08:49.356 you wanted people to actually be open to taking that 0:08:49.476 --> 0:08:53.116 vaccine as you would need number one, members of the 0:08:53.156 --> 0:08:56.156 scientific community across the country, and not just you know, 0:08:56.276 --> 0:09:00.156 nationally known scientists, but deans of medical schools, doctors and 0:09:00.196 --> 0:09:02.836 local communities who are trusted and respected, nurses who are 0:09:02.876 --> 0:09:05.476 known and respected. He would need them speaking out in 0:09:05.516 --> 0:09:08.956 local communities to help people recognize that people I know, 0:09:09.236 --> 0:09:12.476 people I recognize, institutions that are local to me trust 0:09:12.556 --> 0:09:14.796 is vaccine. The second thing that you would need to 0:09:14.836 --> 0:09:17.836 see is you would need to see community organizations get 0:09:17.876 --> 0:09:21.716 behind it. People would need to hear from non medical 0:09:21.796 --> 0:09:24.196 voices that they trust as well, whether that's the faith 0:09:24.276 --> 0:09:27.756 leader you know, their community, they're church leader, their synagogue leader. 0:09:28.316 --> 0:09:30.596 They would have to hear from friends and family who 0:09:30.596 --> 0:09:33.596 are getting the vaccine. They would have to hear people 0:09:33.596 --> 0:09:36.836 are getting this and they're not having significant side effects. 0:09:36.956 --> 0:09:39.916 All of this mobilization, if you will, all of this 0:09:40.076 --> 0:09:44.076 messaging will take time, and it will take regardless of 0:09:44.076 --> 0:09:48.916 who wins the presidency. One of the most complicated and 0:09:49.156 --> 0:09:52.516 challenging vaccine rollout efforts that this country has ever seen. 0:09:52.996 --> 0:09:57.156 So that is why I often say that while developing 0:09:57.156 --> 0:10:01.076 a vaccine for COVID nineteen is extremely challenging, actually rolling 0:10:01.076 --> 0:10:03.716 it out and administering it to people, getting that shot 0:10:03.756 --> 0:10:05.956 in the arm of a sufficient number of people that 0:10:05.956 --> 0:10:08.236 we can achieve herd immunity, that will be just as 0:10:08.516 --> 0:10:12.556 if not more challenging. You've been advising Joe Biden on 0:10:12.836 --> 0:10:15.996 COVID related issues, and that means that if Joe Biden 0:10:15.996 --> 0:10:19.156 would be elected president and to take office in January, 0:10:19.556 --> 0:10:22.156 you're one of the very small number of people who 0:10:22.196 --> 0:10:25.116 will be in line for the single hardest, most thankless 0:10:25.236 --> 0:10:28.156 job imaginable in the Biden administration, and that would be 0:10:28.596 --> 0:10:32.516 spearheading the actual operation of doing exactly what you're just 0:10:32.556 --> 0:10:36.156 set of, actually getting the vaccine to people So let 0:10:36.196 --> 0:10:39.436 me start by asking you about what plans you have 0:10:39.516 --> 0:10:42.196 been developing. You and the Biden campaign have been developing 0:10:42.796 --> 0:10:46.796 for how to begin that process. Should keep be elected 0:10:46.876 --> 0:10:50.436 and should a vaccine become a safe and available Well, no, 0:10:50.596 --> 0:10:54.836 the Vice President has been really focused on developing and 0:10:54.876 --> 0:10:58.236 thinking about plans. He never takes for granted that he 0:10:58.356 --> 0:11:00.356 is going to win the election, but he wants to 0:11:00.396 --> 0:11:03.116 be prepared to act on day one if he does. 0:11:03.916 --> 0:11:06.836 And what that has meant is not just going about 0:11:06.836 --> 0:11:10.316 the usual process that you have on transition teams, where 0:11:10.356 --> 0:11:12.436 you think about the structure of a department and you 0:11:12.476 --> 0:11:16.076 think about personnel, but it's involved thinking about some very 0:11:16.116 --> 0:11:18.436 specific areas that are going to require a whole lot 0:11:18.476 --> 0:11:21.956 more planning. So, for example, how do you actually expand 0:11:22.156 --> 0:11:25.476 testing sufficiently so that we have enough testing so that 0:11:25.476 --> 0:11:27.596 everyone who needs a test and get one. How do 0:11:27.636 --> 0:11:31.836 we ensure that we actually have enough contact tracing capacity 0:11:31.836 --> 0:11:34.076 in our country. We don't right now, but we really 0:11:34.116 --> 0:11:37.356 need that we have any hopes of getting this under control. 0:11:37.676 --> 0:11:40.116 And of course it involves how to think about the 0:11:40.276 --> 0:11:43.516 deployment of a vaccine. So these have been the topic 0:11:43.596 --> 0:11:46.636 of countless discussions that I and others have had with 0:11:46.836 --> 0:11:50.636 Vice President Biden where he asked very specific questions. He's 0:11:50.836 --> 0:11:53.636 thinking about very specific plans. But a key parts of 0:11:53.676 --> 0:11:58.076 these plans, certainly for the Vaccine Distribution Fund, include thinking 0:11:58.116 --> 0:12:01.356 about who the trusted partners are that we will need 0:12:01.476 --> 0:12:04.636 in communities, like for example, if you think about the partners, 0:12:04.636 --> 0:12:07.476 it's not just a medical establishment, but it's also schools 0:12:07.476 --> 0:12:10.996 and employers. We know that schools and workplaces or sites 0:12:11.036 --> 0:12:14.956 where a vaccine could be administered, and having partners in 0:12:14.996 --> 0:12:18.236 those spheres is going to be absolutely essential. We know 0:12:18.276 --> 0:12:21.316 that local government and states are going to be extremely 0:12:21.356 --> 0:12:23.996 important partners. But here's the way I think the Vice 0:12:24.036 --> 0:12:27.916 President would approach that partnership differently. In the early part 0:12:27.956 --> 0:12:31.476 of this COVID response, what we saw is a transfer 0:12:31.516 --> 0:12:35.316 of responsibility from the federal government to the states, saying, 0:12:35.316 --> 0:12:39.036 you take care of this, and we will lead behind 0:12:39.156 --> 0:12:41.396 lead from a different place. We will step back. I 0:12:41.396 --> 0:12:43.596 think the Vice President realizes that you need to give 0:12:43.676 --> 0:12:46.036 states the ability to craft their own response, but you 0:12:46.076 --> 0:12:48.676 also have to lead as a federal government, and one 0:12:48.676 --> 0:12:50.676 of the places in which you have to lead is 0:12:50.676 --> 0:12:53.076 in the allocation of resources. So just think about the 0:12:53.116 --> 0:12:55.676 following question, how do you decide how much vaccine goes 0:12:55.716 --> 0:13:00.916 to Georgia or Florida, or Massachusetts or California. You can't 0:13:00.956 --> 0:13:03.556 have that driven by politics. That has to be driven 0:13:03.596 --> 0:13:06.316 by science and by need. So which raises a second 0:13:06.356 --> 0:13:08.476 issue that he's been working on, not just partnerships, but 0:13:08.556 --> 0:13:12.676 thinking about data systems right for understanding where the need 0:13:12.756 --> 0:13:14.436 is and making sure that we can meet that need 0:13:14.516 --> 0:13:18.556 right now. I'm worried that we don't have strong, robust 0:13:18.636 --> 0:13:21.196 data systems that are integrated in our country such that 0:13:21.276 --> 0:13:23.996 if we administered and rolled out of vaccine today, we 0:13:24.036 --> 0:13:26.756 would automatically know where it was being delivered, who was 0:13:26.796 --> 0:13:29.316 getting them, so that we could target our follow up 0:13:29.356 --> 0:13:32.676 activities appropriately. We have to fix those data systems. So 0:13:32.716 --> 0:13:35.076 he's been thinking about a number of areas like this 0:13:35.476 --> 0:13:39.196 and bringing experts together, well beyond myself, you know, experts 0:13:39.196 --> 0:13:41.236 from really around the country who have done this before. 0:13:41.796 --> 0:13:44.436 He wants to assemble the best team possible because he 0:13:44.436 --> 0:13:46.276 knows this is going to be a once in a 0:13:46.316 --> 0:13:49.796 generation challenge. Let me press you on this. I think 0:13:49.836 --> 0:13:52.436 you're right from what I know that the data systems 0:13:52.476 --> 0:13:56.316 that we presently have aren't sufficiently robust to even have 0:13:56.396 --> 0:14:00.476 a clear sense of what prevalence looks like. And that's 0:14:00.516 --> 0:14:02.676 before you get to the substantive question, which is, if 0:14:02.676 --> 0:14:05.676 you're new prevalence, where should you focus resources. Because it's 0:14:05.716 --> 0:14:07.876 not immediately obvious that you want to focus a vaccine 0:14:08.036 --> 0:14:10.876 immediately on the heartest areas. There are actually arguments for 0:14:10.996 --> 0:14:13.156 beginning in more moderately hit areas, and so forth and 0:14:13.156 --> 0:14:15.036 so on. So, I mean, this is a complex topic 0:14:15.076 --> 0:14:18.156 in its own right, But given that the data systems 0:14:18.436 --> 0:14:21.836 almost certainly are not in place, how is it realistic 0:14:21.916 --> 0:14:25.436 to think that a Biden administration could take the time 0:14:25.516 --> 0:14:29.116 to build up these data systems in order to then 0:14:29.356 --> 0:14:31.796 make an informed decision. I mean, if you are doing this, 0:14:31.956 --> 0:14:33.956 you and a team and people are doing this, you 0:14:33.996 --> 0:14:35.836 are going to be doing it in media's race. You 0:14:35.876 --> 0:14:39.316 are going to be inheriting the mess that you have inherited, 0:14:39.556 --> 0:14:43.676 and you will be under enormous pressure to act quickly. Again, 0:14:43.796 --> 0:14:47.396 assuming that there is a safe and available vaccine. So 0:14:47.876 --> 0:14:49.436 I guess I want to say that sounds nice in 0:14:49.476 --> 0:14:52.116 the abstract, like let's solve the data systems, but there's 0:14:52.156 --> 0:14:54.156 no way that there's going to be the time that 0:14:54.196 --> 0:14:55.756 it would take to do that. So how do you 0:14:55.796 --> 0:15:00.276 make decisions under radical uncertainty without the data systems? So 0:15:00.436 --> 0:15:03.076 it's a great question, and you're right, we can't wait 0:15:03.156 --> 0:15:05.476 until the perfect systems are built. You can't wait until 0:15:05.516 --> 0:15:08.596 all the partners are assembled around the table either, because 0:15:08.596 --> 0:15:11.356 if thereccine truly is safe and effective, that means that 0:15:11.596 --> 0:15:15.036 every day you lose our lives that are potentially lost. 0:15:15.276 --> 0:15:18.156 So what we would have to do is we'd have 0:15:18.156 --> 0:15:19.596 to do the best we can in the beginning to 0:15:19.676 --> 0:15:22.076 use the data we have and go to areas that 0:15:22.116 --> 0:15:24.796 we have great need and start to point the vaccine 0:15:24.796 --> 0:15:28.476 through existing partners. We also have, thankfully, through the National 0:15:28.476 --> 0:15:32.796 Academies of Medicine, recommendations on what the priority population should 0:15:32.836 --> 0:15:35.756 be that we should target. So we know that healthcare 0:15:35.796 --> 0:15:38.596 workers and other workers in the front line are critical. 0:15:38.636 --> 0:15:40.596 We know the people at higher risk because of their 0:15:40.676 --> 0:15:43.756 age or other medical conditions they have, are at higher risk. 0:15:43.836 --> 0:15:45.996 So we can go to nursing homes, we can go 0:15:46.036 --> 0:15:49.356 to other locations where high risk populations are and preferentially 0:15:49.756 --> 0:15:52.636 vaccinate there. There is a lot of low hanging fruit, 0:15:52.676 --> 0:15:54.516 if you will, in terms of actions that can be 0:15:54.556 --> 0:15:57.636 taken in the very beginning, even while you're trying to 0:15:57.836 --> 0:16:00.716 build up systems and build up partners. But all of 0:16:00.756 --> 0:16:04.396 this is going to be infinitely harder if people are skeptical, 0:16:04.436 --> 0:16:07.196 if they're doubtful, if they don't trust what you're doing. 0:16:07.236 --> 0:16:09.796 And that's why the other plank of this so essential 0:16:10.156 --> 0:16:13.076 that we've been talking about is the importance of communicating 0:16:13.436 --> 0:16:16.356 openly honesty about what our plans are and what progress 0:16:16.356 --> 0:16:19.076 we're making from day one. This is a kind of 0:16:19.116 --> 0:16:22.956 crisis communication that has been deployed by Republican and democratic 0:16:22.996 --> 0:16:27.156 administrations alike in prior pandemics. It's not the purview of 0:16:27.156 --> 0:16:30.196 one party, but it hasn't been done well in this response, 0:16:30.196 --> 0:16:31.636 and that's why we have a lot of ground to 0:16:31.676 --> 0:16:44.436 make up. We'll be back in a moment. I'm deeply 0:16:44.436 --> 0:16:47.636 worried that, regardless of the outcome of the election, if 0:16:47.676 --> 0:16:51.756 a vaccine becomes available and safe under a Republican administration, 0:16:51.836 --> 0:16:54.516 a lot of Democrats won't trust it, and that if 0:16:54.556 --> 0:16:57.516 a vaccine becomes available and safe under a democratic administration, 0:16:57.916 --> 0:17:00.196 a lot of Republicans won't trust it. In other words, 0:17:00.436 --> 0:17:04.196 my worry is that the profound political partisan differences that 0:17:04.236 --> 0:17:10.316 we have are fully bleeding into people's trust in scientific 0:17:10.316 --> 0:17:15.516 institutions and medical institutions. What's our long run societal solution 0:17:16.076 --> 0:17:18.236 to that problem. I mean, I'm not asking you to 0:17:18.236 --> 0:17:20.796 solve the problem of partisan division. Nobody can do that, 0:17:20.876 --> 0:17:24.716 and it's been with us in certain respects, although waning 0:17:24.716 --> 0:17:27.196 and waxing throughout our history. I'm talking about the very 0:17:27.276 --> 0:17:31.036 concrete problem, much closer to your area of expertise, which 0:17:31.076 --> 0:17:35.156 is that people's trust in science and medicine is coming 0:17:35.156 --> 0:17:38.676 to be deeply inflected by their partisan views. How do 0:17:38.796 --> 0:17:43.316 we break that linkage no matter who's president. Yeah. And 0:17:43.756 --> 0:17:46.116 the reason to be concerned because we've seen that on 0:17:46.196 --> 0:17:49.996 a number of measures, whether it's people's views of the 0:17:50.116 --> 0:17:53.316 masks and whether they're appropriate or not and useful, or 0:17:53.556 --> 0:17:55.876 people's view of other precautions related to COVID. There has 0:17:55.956 --> 0:17:58.836 been a partisan divide here. But what's interesting, as a 0:17:58.916 --> 0:18:00.796 side note, is if you look at this data on 0:18:00.956 --> 0:18:04.796 vaccines and specially the COVID nineteen vaccine. I mentioned that 0:18:04.836 --> 0:18:06.876 fifty four percent of people are saying they would not 0:18:07.356 --> 0:18:10.156 take the vaccine if it was available for election day. 0:18:10.236 --> 0:18:14.156 That actually includes forty eight percent of Democrats, but sixty 0:18:14.196 --> 0:18:17.516 percent of Republicans. So in a very interesting way, we're 0:18:17.556 --> 0:18:21.156 finding that both Democrats and Republicans have deep worries about 0:18:21.156 --> 0:18:25.116 the vaccine. But the larger point around polarization and affecting 0:18:25.116 --> 0:18:27.356 how we take in information and what we trust is 0:18:27.396 --> 0:18:29.876 absolutely true and it will be deadly as it has 0:18:29.916 --> 0:18:33.916 been to date regards to coronavirus. I think one critical strategy, 0:18:33.956 --> 0:18:35.476 and there are many here, but the one I'll mention 0:18:36.036 --> 0:18:38.036 is that we have to go local in terms of 0:18:38.076 --> 0:18:41.636 mobilizing information sources. Typically, people think, well, if you get 0:18:41.676 --> 0:18:44.156 somebody on a major network in terms of news, or 0:18:44.156 --> 0:18:46.516 a national radio station, that's how you get the message out. 0:18:46.756 --> 0:18:49.396 But I think increasingly in this polarized world where people 0:18:49.396 --> 0:18:52.276 are listening to their own sources, you actually have to 0:18:52.316 --> 0:18:54.236 go much more local. You have to think, how do 0:18:54.276 --> 0:18:59.516 I ensure that an individual's doctor actually knows that the 0:18:59.636 --> 0:19:02.236 truth about this vaccine so they can recommend them. How 0:19:02.236 --> 0:19:05.236 do I ensure that other people who are trusted members 0:19:05.236 --> 0:19:07.236 of a community, like faith leaders, know the truth about 0:19:07.316 --> 0:19:10.516 this vaccine so they can advise people. Because when you 0:19:10.676 --> 0:19:13.196 have doubts about whether people are telling you to truth, 0:19:13.516 --> 0:19:15.556 all of us as human beings go to the people 0:19:15.596 --> 0:19:18.356 we know and that we have trusted for a long time, 0:19:18.556 --> 0:19:22.396 that our friends, our family, our nurses and doctors, are 0:19:22.756 --> 0:19:25.796 faith leaders and other trusted populations like this. So I 0:19:25.796 --> 0:19:28.716 think if ultimately we want to convince people that the 0:19:28.796 --> 0:19:31.916 vaccines is safe and effective, if indeed the evidence backs 0:19:31.956 --> 0:19:34.076 that up, we've got to think about how to mobilize 0:19:34.116 --> 0:19:36.156 those voices, and I think those will end up being 0:19:36.276 --> 0:19:40.036 much much more important than getting people on cable news 0:19:40.196 --> 0:19:43.676 and on national radio. That raises the really hard question 0:19:43.756 --> 0:19:45.756 of how do you reach the local leaders that you're 0:19:45.756 --> 0:19:49.716 talking about. We live in an era where local newspapers, 0:19:49.756 --> 0:19:51.596 which at one time would have been a standard way 0:19:51.596 --> 0:19:53.436 to reach people locally, because you can have a local 0:19:53.436 --> 0:19:57.796 newspaper article about the local physician or faith leader who says, 0:19:57.916 --> 0:20:00.836 you know, the vaccine is great, but they're in retreat, 0:20:01.196 --> 0:20:03.476 or in many parts of the country they're already gone. 0:20:04.116 --> 0:20:06.716 And one of the ways that people now increasingly communicate 0:20:06.796 --> 0:20:09.636 with their trusted sources, whether it's family or friends or 0:20:09.716 --> 0:20:13.836 local leaders, is actually through social media. And in that environment, 0:20:14.276 --> 0:20:17.116 authority isn't quite as powerful as it once was in 0:20:17.196 --> 0:20:20.756 historical terms, and things can go the other way relatively 0:20:20.996 --> 0:20:25.716 quickly there can be a decentralized distribution of distrustful information. 0:20:26.316 --> 0:20:28.156 I agree with you that we want to get people 0:20:28.156 --> 0:20:30.036 to hear an important and true message from people who 0:20:30.076 --> 0:20:32.796 may trust. But how do you at a national level 0:20:32.916 --> 0:20:36.956 think about reaching those people if it's not through going 0:20:36.996 --> 0:20:39.956 on CNN and MSNBC, which you do so frequently and 0:20:39.996 --> 0:20:44.956 so skillfully. Well, no, I think this is not easy work. 0:20:45.116 --> 0:20:47.476 It's a hard grind, if you will, because it requires 0:20:47.476 --> 0:20:50.596 a lot of conversations. This is I think why people 0:20:50.636 --> 0:20:54.116 have gravitated so much toward national news and national media. 0:20:54.156 --> 0:20:56.996 It has the illusion that seeming to be more efficient, right, 0:20:57.036 --> 0:20:59.556 you reach more people, Hey, why wouldn't that be better? 0:21:00.196 --> 0:21:03.116 The problem is it comes with a heavy filter that 0:21:03.236 --> 0:21:06.276 people don't necessarily trust. And so the way that I 0:21:06.596 --> 0:21:08.676 would think about this is that we would need to 0:21:08.716 --> 0:21:12.356 reach out, for example, to local organizations that bring together 0:21:12.436 --> 0:21:14.676 faith leaders. We need to reach out to the YMCAs, 0:21:14.676 --> 0:21:16.756 to the rotary clubs. We'll need to reach out to 0:21:16.756 --> 0:21:20.316 associations of librarians. We'll need to reach out to groups 0:21:20.316 --> 0:21:22.396 where we can get in front of people, talk to 0:21:22.436 --> 0:21:25.796 them and then start engaging their local chapters. And if 0:21:25.796 --> 0:21:30.356 that sounds like really tough, tedious, tenuous work. It is. 0:21:30.676 --> 0:21:33.956 It's not easy to do because what we're really talking about, Noah, 0:21:34.436 --> 0:21:36.196 even though we haven't used this word before, is we're 0:21:36.196 --> 0:21:40.436 talking about relationship building, right, and relationship building can take time. 0:21:40.676 --> 0:21:42.756 But I think that it doesn't mean that we'll never 0:21:42.796 --> 0:21:44.756 be able to get a vaccine out for months and months. 0:21:44.756 --> 0:21:46.996 I think that there are enough people who believe that 0:21:46.996 --> 0:21:49.756 this is an urgent crisis and will understand the science 0:21:49.796 --> 0:21:51.916 behind it, that we will have some uptake of the vaccine. 0:21:52.276 --> 0:21:54.476 The question is how to sustain that and get to 0:21:54.476 --> 0:21:57.196 a sufficient level where we have her in immunity. There's 0:21:57.236 --> 0:21:59.196 one other point I want to raise here, though, if 0:21:59.196 --> 0:22:02.116 this is indeed about relationships, and if what we need 0:22:02.156 --> 0:22:04.636 our organizations that have a lot of relationships in the 0:22:04.636 --> 0:22:07.956