1 00:00:15,396 --> 00:00:23,796 Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show 2 00:00:23,836 --> 00:00:27,436 Speaker 1: where we explore the stories behind the stories in the news. 3 00:00:27,916 --> 00:00:33,156 Speaker 1: I'm Noah Feldman. In recent weeks, three new variants on 4 00:00:33,316 --> 00:00:37,436 Speaker 1: COVID nineteen have been occupying a lot of attention in 5 00:00:37,476 --> 00:00:41,076 Speaker 1: the news. There's a variant in the UK that is 6 00:00:41,076 --> 00:00:45,836 Speaker 1: apparently more contagious and possibly more harmful. Then there is 7 00:00:45,836 --> 00:00:49,556 Speaker 1: a variant in South Africa and one in Brazil, at 8 00:00:49,636 --> 00:00:52,316 Speaker 1: least one of which and possibly both of which do 9 00:00:52,596 --> 00:00:57,396 Speaker 1: appear to be less responsive to existing vaccines, or two 10 00:00:57,676 --> 00:01:02,636 Speaker 1: antibodies created by people who've already had COVID. How alarmed 11 00:01:02,676 --> 00:01:05,956 Speaker 1: should we be about these developments, How will they affect 12 00:01:05,996 --> 00:01:09,396 Speaker 1: the interaction between the rollout of the vaccine and the 13 00:01:09,436 --> 00:01:12,516 Speaker 1: progress of the disease, and what will it all mean 14 00:01:12,676 --> 00:01:15,836 Speaker 1: for when we can begin to get back to conditions 15 00:01:15,876 --> 00:01:20,636 Speaker 1: resembling normal. Here to talk us through these challenging questions 16 00:01:21,116 --> 00:01:25,676 Speaker 1: is Mark Lipsitch. Mark now qualifies as a friend of 17 00:01:25,676 --> 00:01:28,276 Speaker 1: a Deep Background for his regular appearances on the show 18 00:01:28,556 --> 00:01:32,276 Speaker 1: to help explain the coronavirus pandemic to us, stretching all 19 00:01:32,316 --> 00:01:35,516 Speaker 1: the way back to February of twenty twenty, when he 20 00:01:35,596 --> 00:01:38,876 Speaker 1: was one of the first epidemiologists to sound the alarm 21 00:01:39,116 --> 00:01:43,116 Speaker 1: about the coming pandemic. Mark is Professor of epidemiology at 22 00:01:43,116 --> 00:01:46,196 Speaker 1: the Harvard chan School of Public Health, and he's also 23 00:01:46,236 --> 00:01:50,316 Speaker 1: the director of the Center for Communicable Disease Dynamics. There, 24 00:01:50,836 --> 00:01:54,956 Speaker 1: he has spent years creating and analyzing models that study 25 00:01:55,036 --> 00:01:58,516 Speaker 1: pathogen spread in a population, and he's also studied how 26 00:01:58,516 --> 00:02:01,796 Speaker 1: to effectively communicate this information to decision makers and the 27 00:02:01,796 --> 00:02:05,396 Speaker 1: wider public. All of that study has turned into practical 28 00:02:05,476 --> 00:02:08,716 Speaker 1: reality over the last eleven months. We're very lucky to 29 00:02:08,716 --> 00:02:11,796 Speaker 1: have back to talk about this mutation and its consequences 30 00:02:12,156 --> 00:02:14,956 Speaker 1: and the lessons we've learned from living with COVID now 31 00:02:15,196 --> 00:02:21,156 Speaker 1: for nearly a year, Mark, welcome back today. I want 32 00:02:21,156 --> 00:02:24,196 Speaker 1: to start with the South African variant, which has been 33 00:02:24,236 --> 00:02:27,316 Speaker 1: getting a lot of attention because of the question of 34 00:02:27,716 --> 00:02:30,516 Speaker 1: the extent to which it is or is not susceptible 35 00:02:30,556 --> 00:02:34,036 Speaker 1: to the vaccines that have been created. So I want 36 00:02:34,036 --> 00:02:37,236 Speaker 1: to begin by asking you, how worried are you about 37 00:02:37,236 --> 00:02:40,916 Speaker 1: the South African variant and what are the consequences of 38 00:02:40,916 --> 00:02:42,996 Speaker 1: that worry for your picture in the big sense of 39 00:02:42,996 --> 00:02:46,636 Speaker 1: where we're headed. Well, I think most observers, including me, 40 00:02:46,676 --> 00:02:51,876 Speaker 1: are seriously worried that this will complicate efforts to protect 41 00:02:51,876 --> 00:02:55,876 Speaker 1: people by vaccination and reduce the quality of immunity from 42 00:02:55,916 --> 00:03:00,356 Speaker 1: natural infection. Because there's evidence that for the South African 43 00:03:00,436 --> 00:03:04,436 Speaker 1: variant that both of those things are likely true, the 44 00:03:04,836 --> 00:03:10,876 Speaker 1: extent of the concern is still really matter ulation. Most 45 00:03:10,916 --> 00:03:13,516 Speaker 1: likely is that there will be some degree of immunity, 46 00:03:13,956 --> 00:03:18,036 Speaker 1: maybe more immunity to severe infection than to getting infected 47 00:03:18,076 --> 00:03:21,956 Speaker 1: at all, but it really remains to be seen. It's 48 00:03:21,996 --> 00:03:24,956 Speaker 1: not a good sign. It will certainly make things harder, 49 00:03:25,156 --> 00:03:27,596 Speaker 1: but I think the degree of that is really a 50 00:03:27,676 --> 00:03:31,196 Speaker 1: matter of complete speculation right now, and is the reason. 51 00:03:31,236 --> 00:03:35,596 Speaker 1: The underlying reason for why both vaccine efficacy might be 52 00:03:35,636 --> 00:03:38,956 Speaker 1: reduced as well as why natural immunity might be reduced 53 00:03:39,116 --> 00:03:42,956 Speaker 1: the same, namely, that the variant has some sort of 54 00:03:42,996 --> 00:03:46,516 Speaker 1: evolutionary shift in the spike protein that makes it less 55 00:03:46,556 --> 00:03:48,516 Speaker 1: of a good match for what's been designed for the 56 00:03:48,596 --> 00:03:52,436 Speaker 1: antibodies created in response to the pre existing version of 57 00:03:52,476 --> 00:03:56,316 Speaker 1: the virus. That's right, So the existing vaccines narrowly target 58 00:03:56,476 --> 00:04:00,396 Speaker 1: a very specific part of the spike protein, but also 59 00:04:00,956 --> 00:04:04,556 Speaker 1: are natural antibodies that we respond that we make in 60 00:04:04,596 --> 00:04:08,996 Speaker 1: response to natural infection. Also, in most people heavily target 61 00:04:09,156 --> 00:04:12,076 Speaker 1: that region of the virus, and so in both cases 62 00:04:12,556 --> 00:04:16,396 Speaker 1: the antibuddies do their job less well. Both Fiser and 63 00:04:16,556 --> 00:04:22,036 Speaker 1: Maderna have released highly preliminary in vitro studies where they 64 00:04:22,076 --> 00:04:24,156 Speaker 1: had a sort of good news bad news formulation in 65 00:04:24,196 --> 00:04:26,476 Speaker 1: their In their pr there the good news was supposed 66 00:04:26,476 --> 00:04:29,876 Speaker 1: to be well. They do say that their vaccines are 67 00:04:29,876 --> 00:04:32,436 Speaker 1: still working on the South African variant, but the bad 68 00:04:32,476 --> 00:04:35,236 Speaker 1: news is that it's not working as well as they 69 00:04:35,276 --> 00:04:36,676 Speaker 1: would have liked it to work. I mean, I'm over 70 00:04:36,676 --> 00:04:40,436 Speaker 1: simplifying that a little bit. And Maderna in fact said, 71 00:04:40,636 --> 00:04:43,236 Speaker 1: just out of an abundance of caution, we're going to 72 00:04:43,316 --> 00:04:46,276 Speaker 1: try to rejigger our version of the vaccine, so we'll 73 00:04:46,276 --> 00:04:48,436 Speaker 1: address the South African varenton. We think we should be 74 00:04:48,476 --> 00:04:52,476 Speaker 1: able to pull that off. Tell me about what should 75 00:04:52,516 --> 00:04:56,316 Speaker 1: one think about those public statements. Yeah, I think those 76 00:04:56,356 --> 00:04:59,356 Speaker 1: are accurate. And of course, where it falls on the 77 00:04:59,356 --> 00:05:02,436 Speaker 1: good news bad news spectrum is the part that I 78 00:05:02,476 --> 00:05:06,196 Speaker 1: said a minute ago is a matter of speculation. I mean, 79 00:05:06,236 --> 00:05:09,676 Speaker 1: this is the general picture. When we have a vaccine 80 00:05:09,916 --> 00:05:12,196 Speaker 1: or we have an immune response, we can measure many 81 00:05:12,236 --> 00:05:17,556 Speaker 1: of its properties, and very often the degree to which 82 00:05:17,996 --> 00:05:20,516 Speaker 1: it works in a test tube or in a cell 83 00:05:20,596 --> 00:05:25,916 Speaker 1: culture correlates with how well it works in people, but 84 00:05:26,356 --> 00:05:32,236 Speaker 1: not usually perfectly, and so translating it's in between nothing 85 00:05:32,476 --> 00:05:36,636 Speaker 1: and very effective into where it is on the spectrum 86 00:05:36,676 --> 00:05:40,356 Speaker 1: of epidemiological effectiveness is the part that we just don't 87 00:05:40,356 --> 00:05:43,756 Speaker 1: know yet but should be able to learn more about 88 00:05:43,836 --> 00:05:48,276 Speaker 1: as we see the variant spread and infect people in 89 00:05:48,356 --> 00:05:53,236 Speaker 1: places with more vaccine coverage. All of this is happening 90 00:05:53,676 --> 00:05:58,796 Speaker 1: in this extremely complicated dynamic game. I mean, for most 91 00:05:58,796 --> 00:06:00,716 Speaker 1: of us who don't do what you do for a living, 92 00:06:01,076 --> 00:06:04,916 Speaker 1: we're just slowly gradually beginning to appreciate just how complicated 93 00:06:05,196 --> 00:06:07,196 Speaker 1: it is to keep track of all the moving parts. 94 00:06:07,836 --> 00:06:11,716 Speaker 1: So we already have this very complicated phenomenon of vaccines 95 00:06:11,756 --> 00:06:16,876 Speaker 1: being introduced, social distancing continuing in some places, and then 96 00:06:16,916 --> 00:06:19,796 Speaker 1: the ongoing spread of the virus. And now, in addition 97 00:06:19,836 --> 00:06:22,116 Speaker 1: to those three factors that were already in play, we 98 00:06:22,236 --> 00:06:26,476 Speaker 1: also have an evolutionary twist that may change the game 99 00:06:26,636 --> 00:06:28,316 Speaker 1: as well. So I want to ask you a few 100 00:06:28,356 --> 00:06:31,236 Speaker 1: questions about the interaction of those four factors. And since 101 00:06:31,276 --> 00:06:33,636 Speaker 1: there's so many moving parts, I'm going to go slowly 102 00:06:33,756 --> 00:06:36,676 Speaker 1: so that you can explain it to me in slower terms. 103 00:06:38,556 --> 00:06:43,276 Speaker 1: Start with which vaccines are in play here? So is 104 00:06:43,276 --> 00:06:46,676 Speaker 1: there a reason to think that, even if Fiser and 105 00:06:46,716 --> 00:06:51,716 Speaker 1: Maderna vaccines work all right on the South African variant, 106 00:06:51,996 --> 00:06:53,996 Speaker 1: that other of the vaccines that are out there in 107 00:06:54,036 --> 00:06:56,756 Speaker 1: the world that are more available, let's say, in less 108 00:06:56,796 --> 00:06:59,316 Speaker 1: developed countries where it's harder to get the refrigeration and 109 00:06:59,316 --> 00:07:01,436 Speaker 1: so forth, is there a reason to think that those 110 00:07:01,476 --> 00:07:06,236 Speaker 1: would be even less efficacious than the mr Anda vaccines. 111 00:07:08,036 --> 00:07:10,676 Speaker 1: I think, first of all, it's not just people who 112 00:07:10,676 --> 00:07:12,236 Speaker 1: don't do this for a living who find it hard 113 00:07:12,236 --> 00:07:14,156 Speaker 1: to keep track of the moving parts. It's really hard 114 00:07:14,196 --> 00:07:20,076 Speaker 1: if you do. In answering your question about the other vaccines, 115 00:07:20,876 --> 00:07:23,876 Speaker 1: a recurring theme in this pandemic, as in a lot 116 00:07:23,876 --> 00:07:26,436 Speaker 1: of science, is there's what we have reason to think 117 00:07:26,476 --> 00:07:28,796 Speaker 1: based on scientific precedent, and then there's what we have 118 00:07:28,916 --> 00:07:32,756 Speaker 1: data about the specifically answers the question. We don't have 119 00:07:32,836 --> 00:07:36,436 Speaker 1: data yet as far as I'm aware, on the effectiveness 120 00:07:36,476 --> 00:07:40,636 Speaker 1: of the other vaccines against this. What we have reason 121 00:07:40,716 --> 00:07:45,596 Speaker 1: to think is that the story will be probably quite similar. 122 00:07:45,676 --> 00:07:48,156 Speaker 1: I think all of the vaccines that are far along 123 00:07:48,196 --> 00:07:51,556 Speaker 1: in clinical trials, and virtually all of the vaccines that 124 00:07:51,636 --> 00:07:56,236 Speaker 1: are being developed, a significant part or all of their 125 00:07:56,236 --> 00:08:00,156 Speaker 1: immune response that they're generating is to the spike into 126 00:08:00,156 --> 00:08:04,556 Speaker 1: this particular these particular parts of spike, and even natural infection, 127 00:08:04,636 --> 00:08:08,076 Speaker 1: which is the whole virus that we can respond to, 128 00:08:08,836 --> 00:08:14,196 Speaker 1: is the response is compromised for the South African variant. 129 00:08:14,276 --> 00:08:17,556 Speaker 1: So I think it would be likely that the story 130 00:08:17,596 --> 00:08:21,116 Speaker 1: will be similar across the board, but there could be 131 00:08:21,156 --> 00:08:23,996 Speaker 1: some variations in the types of immune responses that are 132 00:08:23,996 --> 00:08:27,396 Speaker 1: favored by different vaccines in some subtle way that would 133 00:08:27,396 --> 00:08:30,956 Speaker 1: make it better or worse. Is it right? As I've 134 00:08:31,116 --> 00:08:34,676 Speaker 1: gleaned in a lay person's way, that the mRNA vaccines 135 00:08:34,756 --> 00:08:38,116 Speaker 1: might be more tweakable in the lab and in real 136 00:08:38,156 --> 00:08:41,276 Speaker 1: time than the other vaccines. I mean, that's certainly how again, 137 00:08:41,316 --> 00:08:44,396 Speaker 1: the public relations suggests it to be. Yeah, I think 138 00:08:44,396 --> 00:08:46,796 Speaker 1: the public relations suggests that, and I think it is 139 00:08:46,916 --> 00:08:52,996 Speaker 1: the most straightforward because you're simply generating a sequence of RNA, 140 00:08:53,476 --> 00:08:56,276 Speaker 1: and the sequence can change a little bit, and it's 141 00:08:56,316 --> 00:08:59,916 Speaker 1: those same process as making it the first time was. 142 00:09:00,556 --> 00:09:05,116 Speaker 1: I think a lot of the technologies that are used 143 00:09:05,116 --> 00:09:08,276 Speaker 1: for vaccines have this feature that they take a piece 144 00:09:08,276 --> 00:09:12,796 Speaker 1: of the virus and generate the immune response. So I 145 00:09:12,836 --> 00:09:16,156 Speaker 1: think to a large degree all of the vaccine technologies 146 00:09:16,156 --> 00:09:19,916 Speaker 1: are pretty flexible. I don't know whether mRNA will be 147 00:09:19,956 --> 00:09:23,916 Speaker 1: a whole lot faster. It may be somewhat faster. So 148 00:09:23,996 --> 00:09:26,636 Speaker 1: let's turn then to the first step, as it were, 149 00:09:26,636 --> 00:09:29,596 Speaker 1: of the interaction question. So, even before the South African 150 00:09:29,676 --> 00:09:33,996 Speaker 1: variant was emerging, you've been thinking and writing and speaking 151 00:09:34,596 --> 00:09:39,836 Speaker 1: about the interaction between the rollout of vaccines and the 152 00:09:39,916 --> 00:09:43,996 Speaker 1: question of the trajectory of the pandemic. Would you give us, 153 00:09:44,156 --> 00:09:49,396 Speaker 1: let's say, your prevariant analysis in a nutshell of what 154 00:09:49,436 --> 00:09:52,116 Speaker 1: that interaction looks like, and then we can layer in 155 00:09:52,156 --> 00:09:55,596 Speaker 1: the variant change. If we put aside the variance for 156 00:09:55,836 --> 00:09:59,196 Speaker 1: the moment, then it's clear that for most of the 157 00:09:59,236 --> 00:10:02,396 Speaker 1: world the vaccine is still not a serious factor. For 158 00:10:02,516 --> 00:10:06,156 Speaker 1: the rich countries it is becoming a serious factor, and 159 00:10:06,396 --> 00:10:10,316 Speaker 1: sort of low single digits of percents of people. But 160 00:10:10,436 --> 00:10:14,596 Speaker 1: in most of the developed world it's still a minor factor, 161 00:10:14,676 --> 00:10:18,196 Speaker 1: but is ramping up and the level of coverage is 162 00:10:18,236 --> 00:10:23,916 Speaker 1: likely to be meaningful in a few months well in 163 00:10:24,356 --> 00:10:27,756 Speaker 1: certain rich countries. So you think sort of April May 164 00:10:27,756 --> 00:10:31,516 Speaker 1: and rich countries, it will be meaningful by April May, 165 00:10:31,636 --> 00:10:36,196 Speaker 1: but not necessarily high. I mean, the Biden administration came 166 00:10:36,236 --> 00:10:38,956 Speaker 1: into office saying one hundred million doses in one hundred days. 167 00:10:39,516 --> 00:10:44,236 Speaker 1: The pace has been nearly a million doses a day already, 168 00:10:44,316 --> 00:10:49,516 Speaker 1: and it's been quite quiet from the Biden administration when 169 00:10:49,516 --> 00:10:52,676 Speaker 1: that was reported that this was just a modest increase. 170 00:10:53,396 --> 00:10:55,116 Speaker 1: There was not a statement, Okay, we're going to make 171 00:10:55,116 --> 00:10:58,076 Speaker 1: a two hundred million And I think I don't have 172 00:10:58,236 --> 00:11:02,516 Speaker 1: any particular information, but my sense is there just aren't 173 00:11:02,556 --> 00:11:05,996 Speaker 1: the capacities in the companies to make more doses than 174 00:11:06,036 --> 00:11:09,076 Speaker 1: they're making. And it's not just a matter of saying 175 00:11:09,316 --> 00:11:11,916 Speaker 1: please do it or you must do it. It's just 176 00:11:11,956 --> 00:11:15,956 Speaker 1: that they are at capacity for manufacturing. And one hundred 177 00:11:15,956 --> 00:11:19,796 Speaker 1: million doses means fifty million people vaccinated in a country 178 00:11:19,836 --> 00:11:25,676 Speaker 1: of over three hundreds, so that is still modest prior 179 00:11:25,716 --> 00:11:28,756 Speaker 1: to the variants, and even still, I was saying, I 180 00:11:28,756 --> 00:11:30,956 Speaker 1: don't know when we're going to get to hurt immunity, 181 00:11:30,996 --> 00:11:33,396 Speaker 1: if at all, because we don't know how well the 182 00:11:33,476 --> 00:11:38,156 Speaker 1: vaccines protect against transmission. But at least we can protect 183 00:11:38,996 --> 00:11:41,556 Speaker 1: the most vulnerable people if we can identify them and 184 00:11:41,596 --> 00:11:46,116 Speaker 1: persuade them to be vaccinated. A few tens of millions 185 00:11:46,116 --> 00:11:49,076 Speaker 1: of doses will not quite cover that, but will be 186 00:11:49,156 --> 00:11:51,636 Speaker 1: a very big step towards covering the most vulnerable if 187 00:11:51,676 --> 00:11:55,196 Speaker 1: they're prioritized. Sensibly, can I go back and ask you 188 00:11:55,196 --> 00:11:57,156 Speaker 1: a question about something you just said? Mark, You were 189 00:11:57,196 --> 00:11:59,956 Speaker 1: making the point that we don't know when we'll hit 190 00:12:00,036 --> 00:12:03,956 Speaker 1: hurt immunity with vaccines because we don't know how well 191 00:12:03,996 --> 00:12:07,036 Speaker 1: the vaccines do against transmission. So I guess my first 192 00:12:07,116 --> 00:12:08,636 Speaker 1: question is why don't we know that? It's not just 193 00:12:08,676 --> 00:12:11,516 Speaker 1: a function of the design study that was used in 194 00:12:11,516 --> 00:12:16,316 Speaker 1: testing these vaccines. Yeah, the easiest way to find out 195 00:12:16,316 --> 00:12:19,756 Speaker 1: if someone has gotten the virus is to wait for 196 00:12:19,756 --> 00:12:22,196 Speaker 1: people to get sick from the potentially from the virus, 197 00:12:22,196 --> 00:12:24,876 Speaker 1: and then test them. And so that was the centerpiece 198 00:12:24,916 --> 00:12:26,956 Speaker 1: of the design of all the clinical trials, which for 199 00:12:27,076 --> 00:12:30,956 Speaker 1: very good reasons, were designed to be fast and not 200 00:12:31,076 --> 00:12:34,516 Speaker 1: answer every question, but answer the most important question as 201 00:12:34,556 --> 00:12:39,996 Speaker 1: quickly as possible. Two of the three major vaccine Western vaccines, 202 00:12:40,756 --> 00:12:44,956 Speaker 1: the Maderna one and the astrosenica one, had aspects of 203 00:12:44,996 --> 00:12:47,156 Speaker 1: the trial that gave us a bit of a hint 204 00:12:47,236 --> 00:12:51,116 Speaker 1: about transmission. The Astrosenica trial looked at people in the 205 00:12:51,236 --> 00:12:54,556 Speaker 1: UK part of the trial who were not sick and 206 00:12:54,636 --> 00:12:56,596 Speaker 1: asked them to come in any way and get swabbed 207 00:12:57,356 --> 00:13:00,716 Speaker 1: so they could compare vaccine to posebo and the Maderna 208 00:13:00,756 --> 00:13:04,836 Speaker 1: trial when they had people come in for their second shot, 209 00:13:05,476 --> 00:13:08,436 Speaker 1: swabbed their noses and so we're able to estimate the 210 00:13:08,436 --> 00:13:11,916 Speaker 1: impact of the shot on whether you get infected, even 211 00:13:11,956 --> 00:13:15,876 Speaker 1: if you weren't sick. So each of those gave some data, 212 00:13:16,276 --> 00:13:18,316 Speaker 1: not very much data, but a little bit of data 213 00:13:18,436 --> 00:13:21,116 Speaker 1: that suggests that both of those vaccines do have some 214 00:13:21,196 --> 00:13:25,236 Speaker 1: impact on transmission, which is really good. Question is how much, 215 00:13:25,476 --> 00:13:27,796 Speaker 1: And that's the part where we just don't have enough 216 00:13:27,996 --> 00:13:31,316 Speaker 1: data or enough high quality data to really say. In 217 00:13:31,476 --> 00:13:33,716 Speaker 1: light of that, and again leaving out the variance, which 218 00:13:33,716 --> 00:13:37,116 Speaker 1: will come back to in a moment, do you read 219 00:13:37,196 --> 00:13:41,836 Speaker 1: the situation presently as in the rich countries we're headed 220 00:13:41,836 --> 00:13:44,836 Speaker 1: for a kind of endemic pandemic that never goes away 221 00:13:45,396 --> 00:13:48,236 Speaker 1: fully and is more like the flu, or do you 222 00:13:48,316 --> 00:13:51,476 Speaker 1: read it as again leaving out for a moment the 223 00:13:51,556 --> 00:13:54,996 Speaker 1: variance as something where at least in the rich countries 224 00:13:55,556 --> 00:13:57,836 Speaker 1: eventually maybe it's not going to be in April or May, 225 00:13:57,876 --> 00:13:59,836 Speaker 1: but maybe it's in June or July and August, or 226 00:13:59,836 --> 00:14:03,276 Speaker 1: when more doses become available in a higher percentage of 227 00:14:03,316 --> 00:14:06,716 Speaker 1: the population has been vaccinated, where we might actually be 228 00:14:06,756 --> 00:14:10,636 Speaker 1: able to say COVID is not really a danger in 229 00:14:10,716 --> 00:14:15,956 Speaker 1: these rich countries anymore. I think that would be quite 230 00:14:15,996 --> 00:14:18,956 Speaker 1: surprising to get to the point where we have essentially 231 00:14:18,956 --> 00:14:21,916 Speaker 1: no transmission. I think it's not out of the realm 232 00:14:21,916 --> 00:14:25,876 Speaker 1: of possibility, but I think other scenarios are more likely. 233 00:14:25,916 --> 00:14:28,636 Speaker 1: There was a paper in Science by a group from 234 00:14:28,676 --> 00:14:32,716 Speaker 1: Memory that suggested that it would over time evolve into 235 00:14:32,996 --> 00:14:36,356 Speaker 1: a situation more like a common cold, maybe up to 236 00:14:36,396 --> 00:14:40,796 Speaker 1: influence a severity, but not pose the same danger, and 237 00:14:40,876 --> 00:14:43,476 Speaker 1: I do think that that is the most likely. I 238 00:14:43,476 --> 00:14:47,116 Speaker 1: think vaccines will accelerate that insofar as they protect the 239 00:14:47,156 --> 00:14:50,476 Speaker 1: most vulnerable. But I think when a virus is this 240 00:14:50,596 --> 00:14:56,356 Speaker 1: widespread in most of the world, and when the capacity 241 00:14:56,356 --> 00:15:00,116 Speaker 1: to vaccinate heavily will remain limited for several years at 242 00:15:00,196 --> 00:15:03,556 Speaker 1: least at a global scale, that the right things are going. 243 00:15:04,276 --> 00:15:07,596 Speaker 1: And also, given that the first generation of vaccines probably 244 00:15:07,636 --> 00:15:11,556 Speaker 1: are not super effective against transmission, they probably are quite 245 00:15:11,596 --> 00:15:14,556 Speaker 1: effective if I had to bet on a number, I 246 00:15:14,596 --> 00:15:17,716 Speaker 1: would say they probably reduce it by about two thirds, 247 00:15:17,756 --> 00:15:21,436 Speaker 1: but I could be off maybe maybe eighty percent, which 248 00:15:21,476 --> 00:15:24,876 Speaker 1: would be a lot, but would not be enough to 249 00:15:24,916 --> 00:15:28,356 Speaker 1: get rid of the virus from circulation. And in those numbers, 250 00:15:28,396 --> 00:15:31,796 Speaker 1: even with a very high percentage of the population vaccinated, 251 00:15:31,836 --> 00:15:35,276 Speaker 1: you think there would still be enough transmission going on 252 00:15:36,156 --> 00:15:39,276 Speaker 1: that we're looking at something that fits that that paper 253 00:15:39,316 --> 00:15:42,996 Speaker 1: you were talking about, something more like the common cold. Yeah, 254 00:15:43,036 --> 00:15:47,596 Speaker 1: I mean eighty percent effectiveness and one hundred percent coverage 255 00:15:47,916 --> 00:15:51,836 Speaker 1: might just eliminate it, or nearly eliminate it, but but 256 00:15:51,996 --> 00:15:56,076 Speaker 1: maybe not in all the most densely populated places, which 257 00:15:56,116 --> 00:16:00,276 Speaker 1: could then recede other places. And maybe not. Maybe it 258 00:16:00,316 --> 00:16:02,996 Speaker 1: won't be eighty percent effective, and probably there won't be 259 00:16:03,036 --> 00:16:07,716 Speaker 1: total coverage because everywhere it's been tried so far, there's 260 00:16:07,756 --> 00:16:12,356 Speaker 1: significant vaccine has been so that combination of things makes 261 00:16:12,396 --> 00:16:15,876 Speaker 1: me think a lot of uncertainties would have to go 262 00:16:15,956 --> 00:16:23,076 Speaker 1: our way for elimination to be a realistic possibility. Presumably, 263 00:16:23,476 --> 00:16:26,756 Speaker 1: it's also the case that even in this best case scenario, 264 00:16:26,836 --> 00:16:29,916 Speaker 1: the very small probability one that you're describing, it would 265 00:16:29,996 --> 00:16:33,236 Speaker 1: take years because it would require something like a global 266 00:16:33,276 --> 00:16:36,556 Speaker 1: spread of the vaccine unless you had isolation of the 267 00:16:36,716 --> 00:16:39,956 Speaker 1: rich countries, and you're probably not going to get total 268 00:16:39,996 --> 00:16:42,556 Speaker 1: isolation of those countries. It is not realistic, right right, 269 00:16:42,596 --> 00:16:46,476 Speaker 1: And it wouldn't be justifiable, even for someone like me 270 00:16:46,556 --> 00:16:49,916 Speaker 1: who's been an advocate of control measures for a long time. 271 00:16:49,996 --> 00:16:53,956 Speaker 1: Once we have high vaccination coverage in the most vulnerable groups, 272 00:16:54,596 --> 00:16:58,036 Speaker 1: it would not be economically or otherwise justifiable to say 273 00:16:58,596 --> 00:17:02,596 Speaker 1: we're going to try to keep the economy hobbled for 274 00:17:02,716 --> 00:17:07,476 Speaker 1: months or years just to stop this one virus. I'm 275 00:17:07,476 --> 00:17:09,516 Speaker 1: glad you brought up the control measures because that was 276 00:17:09,516 --> 00:17:13,236 Speaker 1: going to be my next question. Again, once more with 277 00:17:13,316 --> 00:17:16,316 Speaker 1: the caveat of that we don't know enough yet about 278 00:17:16,356 --> 00:17:20,316 Speaker 1: the variants, but again, assuming the variants are relatively controllable 279 00:17:21,116 --> 00:17:24,476 Speaker 1: using the vaccine, where do you think is the right 280 00:17:24,516 --> 00:17:28,516 Speaker 1: inflection point on the control measures? Where in the inflection point, 281 00:17:28,556 --> 00:17:31,476 Speaker 1: what percentage of people need to be vaccinated in a 282 00:17:31,516 --> 00:17:35,236 Speaker 1: country or a region for control measures to be substantially 283 00:17:35,396 --> 00:17:40,396 Speaker 1: pulled back. Well, I think, that's of course a very 284 00:17:40,396 --> 00:17:44,396 Speaker 1: hard question. I think that the first indicator that I'd 285 00:17:44,436 --> 00:17:49,156 Speaker 1: be looking to, or indicators would be in places with 286 00:17:49,316 --> 00:17:54,756 Speaker 1: high vaccine coverage, is there a substantial drop in the 287 00:17:54,796 --> 00:18:01,316 Speaker 1: mortality rate and in the hospitalization or hospital capacity use, 288 00:18:01,876 --> 00:18:05,356 Speaker 1: because those are the two things that are most damaging 289 00:18:05,396 --> 00:18:08,916 Speaker 1: about this virus. It kills people, and it overwhelms healthcare 290 00:18:09,436 --> 00:18:13,396 Speaker 1: indirectly harms people's health. It's going to be hard but 291 00:18:13,596 --> 00:18:18,196 Speaker 1: necessary for us as epidemiologists to try to disentangle how 292 00:18:18,276 --> 00:18:21,236 Speaker 1: much of that is directly protecting the most vulnerable, how 293 00:18:21,276 --> 00:18:24,716 Speaker 1: much of that is reducing transmission through the vaccine, and 294 00:18:24,716 --> 00:18:27,276 Speaker 1: how much of that is reducing transmission through control measures. 295 00:18:27,756 --> 00:18:32,156 Speaker 1: And we'll all be working hard at that, and it 296 00:18:32,236 --> 00:18:34,956 Speaker 1: will be a challenging thing to separate out. But I 297 00:18:34,996 --> 00:18:41,716 Speaker 1: think the scenario that I imagine unfolding and I hope 298 00:18:41,836 --> 00:18:45,876 Speaker 1: is correct, is that as vaccine gets rolled out to 299 00:18:45,916 --> 00:18:50,196 Speaker 1: the people over sixty five and over seventy five, people 300 00:18:50,196 --> 00:18:53,236 Speaker 1: on nursing homes, and people in other of the highest 301 00:18:53,276 --> 00:18:58,476 Speaker 1: risk groups, you'll see still a lot of cases, but 302 00:18:58,596 --> 00:19:02,476 Speaker 1: not nearly so much damage from those cases. You'll have 303 00:19:02,516 --> 00:19:06,556 Speaker 1: a lot of continuing diagnoses, but a dropping ratio of 304 00:19:07,036 --> 00:19:11,316 Speaker 1: hospitalizations and deaths cases. And that would be a sign 305 00:19:11,356 --> 00:19:14,196 Speaker 1: to me that we're doing what we are trying to 306 00:19:14,236 --> 00:19:17,716 Speaker 1: do that, which is to defang the virus by protecting 307 00:19:17,716 --> 00:19:21,156 Speaker 1: the people whom it is most likely to harm. Exactly 308 00:19:21,156 --> 00:19:24,596 Speaker 1: where you then draw the line. You know, it's very 309 00:19:24,636 --> 00:19:27,196 Speaker 1: hard to say, well, we can tolerate this many deaths, 310 00:19:27,196 --> 00:19:30,196 Speaker 1: but we can't tolerate that many deaths. But we tolerate 311 00:19:30,196 --> 00:19:32,476 Speaker 1: deaths from influenza, and we tolerate deaths from a lot 312 00:19:32,516 --> 00:19:35,676 Speaker 1: of other infections. And at some point we will draw 313 00:19:35,756 --> 00:19:48,836 Speaker 1: that line. We'll be back in a moment. Mark, I 314 00:19:48,836 --> 00:19:51,516 Speaker 1: want to ask you a kind of big picture what 315 00:19:51,596 --> 00:19:55,516 Speaker 1: will the world look like question? And let's fast forward 316 00:19:55,596 --> 00:20:00,156 Speaker 1: to September twenty twenty one, when at least in the 317 00:20:00,236 --> 00:20:04,516 Speaker 1: United States, Canada, maybe Mexico, schools are supposed to be 318 00:20:04,556 --> 00:20:10,236 Speaker 1: back in session. And again, let's assume relatively good uptake 319 00:20:10,276 --> 00:20:14,436 Speaker 1: of the vaccine and relatively good efficacy of the vaccine, 320 00:20:14,876 --> 00:20:18,916 Speaker 1: not against transmission but against serious illness. First of all, 321 00:20:18,956 --> 00:20:21,476 Speaker 1: do people go back to school? Our schools open pretty 322 00:20:21,556 --> 00:20:26,276 Speaker 1: much everywhere. And second of all, what does ordinary life 323 00:20:26,916 --> 00:20:31,516 Speaker 1: look like with respect to different control measures ranging from 324 00:20:31,596 --> 00:20:37,596 Speaker 1: masks to social distancing, to closings or openings of retail 325 00:20:37,636 --> 00:20:45,476 Speaker 1: and restaurants. It's just having this exact conversation with people 326 00:20:46,076 --> 00:20:49,116 Speaker 1: at our common University to try to think through all 327 00:20:49,156 --> 00:20:53,836 Speaker 1: of these contingencies. I think under that relatively optimistic scenario 328 00:20:53,996 --> 00:20:58,236 Speaker 1: of high vaccine uptake, particularly among teachers, would be an 329 00:20:58,236 --> 00:21:06,756 Speaker 1: important qualification there for the reopening of schools and continued 330 00:21:06,996 --> 00:21:11,556 Speaker 1: high vaccine efficacy at least again severe disease. I think 331 00:21:11,996 --> 00:21:15,276 Speaker 1: the amount of damage done by the closing those schools 332 00:21:15,796 --> 00:21:19,516 Speaker 1: to kids education is going to be something people won't 333 00:21:19,516 --> 00:21:22,676 Speaker 1: continue to tolerate, and that there will be very very 334 00:21:22,756 --> 00:21:27,036 Speaker 1: much social pressure, societal pressure to reopen schools, and that 335 00:21:27,156 --> 00:21:32,556 Speaker 1: if teachers have access to vaccination in a fairly universal way, 336 00:21:32,676 --> 00:21:36,436 Speaker 1: that will be the likely outcome. For the same reasons, 337 00:21:36,476 --> 00:21:39,636 Speaker 1: I think other things will start to open up under 338 00:21:39,676 --> 00:21:42,556 Speaker 1: such a scenario. And I think if we really have 339 00:21:43,116 --> 00:21:45,476 Speaker 1: if we go a million doses a day for that 340 00:21:45,556 --> 00:21:48,076 Speaker 1: amount of time, all the way through September, we're still 341 00:21:48,076 --> 00:21:51,516 Speaker 1: going to have very low overall vaccine coverage. But if 342 00:21:51,596 --> 00:21:54,956 Speaker 1: other vaccines come on and are highly effective, and or 343 00:21:54,996 --> 00:21:58,996 Speaker 1: if we get more manufacturing capacity for the existing vaccines, 344 00:21:59,596 --> 00:22:03,636 Speaker 1: then we will start to have some reasonable level of 345 00:22:03,676 --> 00:22:07,156 Speaker 1: coverage and the population and with it, I would expect 346 00:22:07,276 --> 00:22:12,556 Speaker 1: some reduction and transmission. I think the one caveat to 347 00:22:12,676 --> 00:22:17,796 Speaker 1: that is that the seasonal changes that we saw last 348 00:22:17,796 --> 00:22:21,236 Speaker 1: summer will probably happen again this summer, So everything will 349 00:22:21,236 --> 00:22:23,596 Speaker 1: look better in the summer as it did last summer, 350 00:22:23,716 --> 00:22:27,396 Speaker 1: because people will be outside more, the virus will transmit 351 00:22:27,476 --> 00:22:31,516 Speaker 1: less well, and we may have a sense of security 352 00:22:31,516 --> 00:22:34,116 Speaker 1: as we did last summer. That's partially due to the 353 00:22:34,196 --> 00:22:37,636 Speaker 1: vaccine and partially due to seasonal factors, and so I 354 00:22:37,636 --> 00:22:41,276 Speaker 1: think we're going to have to try to again separate 355 00:22:41,316 --> 00:22:46,676 Speaker 1: out that contribution and make sure that as things reopen, 356 00:22:46,716 --> 00:22:48,956 Speaker 1: which there will be great pressure to do, and we're 357 00:22:48,956 --> 00:22:52,276 Speaker 1: not setting up for another bad winter like the one 358 00:22:52,316 --> 00:22:54,916 Speaker 1: we've had here. But I think if we continue with 359 00:22:55,076 --> 00:22:59,196 Speaker 1: continued high coverage and continued high efficacy in the most 360 00:22:59,236 --> 00:23:01,916 Speaker 1: at risk groups, it should be a very different winter 361 00:23:02,036 --> 00:23:07,996 Speaker 1: next year. You mentioned vaccinating teachers before us potential fall reopening. 362 00:23:08,156 --> 00:23:10,596 Speaker 1: I know that in the debate about whether teachers should 363 00:23:10,636 --> 00:23:13,076 Speaker 1: come first, or whether professions should really be our basis 364 00:23:13,756 --> 00:23:17,236 Speaker 1: for vaccination as opposed to the people most vulnerable and 365 00:23:17,276 --> 00:23:20,316 Speaker 1: most at risk, you have been more unvaccinate the vulnerable 366 00:23:20,876 --> 00:23:24,836 Speaker 1: rather than identify a professional class like teachers. But it 367 00:23:24,876 --> 00:23:27,476 Speaker 1: sounds like maybe as we get more vaccine out to 368 00:23:27,516 --> 00:23:29,996 Speaker 1: the population, you think it would make sense to target 369 00:23:30,036 --> 00:23:33,036 Speaker 1: teachers in order to achieve the social goal of reopening schools, 370 00:23:33,116 --> 00:23:35,316 Speaker 1: or at least an acknowledgement of the fact that people 371 00:23:35,316 --> 00:23:37,356 Speaker 1: are going to want it anyway. I have been very 372 00:23:37,436 --> 00:23:41,556 Speaker 1: much in favor of trying to vaccinate first those who 373 00:23:41,636 --> 00:23:44,596 Speaker 1: would be most likely to die. I do think that 374 00:23:45,756 --> 00:23:49,836 Speaker 1: of all the professions, apart from healthcare workers, teachers play 375 00:23:49,996 --> 00:23:53,916 Speaker 1: a truly fundamental role in our society for a whole 376 00:23:54,076 --> 00:23:57,156 Speaker 1: variety of complicated reasons. But one of them is that they, 377 00:23:57,796 --> 00:24:01,036 Speaker 1: through their childcare role, they make it possible for other 378 00:24:01,076 --> 00:24:03,876 Speaker 1: adults to work. And another one, which we think of 379 00:24:03,916 --> 00:24:07,996 Speaker 1: as the primary one, and it is, but it's not 380 00:24:08,076 --> 00:24:11,836 Speaker 1: the only one, is that they create human capital and 381 00:24:11,876 --> 00:24:15,836 Speaker 1: they and they educate our children to move on with 382 00:24:15,956 --> 00:24:19,796 Speaker 1: their lives. And those are two really, really fundamental roles 383 00:24:19,836 --> 00:24:24,596 Speaker 1: that are different from those of many other important occupations. 384 00:24:24,756 --> 00:24:31,316 Speaker 1: And I think there will be appropriate demand to vaccinate 385 00:24:31,356 --> 00:24:35,676 Speaker 1: teachers at least in time for fall reopening, which in 386 00:24:35,716 --> 00:24:40,956 Speaker 1: practice means starting probably in the late spring. Mark you 387 00:24:41,076 --> 00:24:47,716 Speaker 1: describe that scenario, that September scenario as optimistic. I grant 388 00:24:47,716 --> 00:24:50,996 Speaker 1: you that it's optimistic. How optimistic I mean, does it 389 00:24:50,996 --> 00:24:54,036 Speaker 1: seem to you when you really check your gut pretty 390 00:24:54,116 --> 00:24:58,556 Speaker 1: darn unlikely that by September again in the United States 391 00:24:58,556 --> 00:25:02,716 Speaker 1: will have enough vaccine uptake, declining mortality among the most vulnerable, 392 00:25:02,756 --> 00:25:04,836 Speaker 1: and be able to begin the process of really getting 393 00:25:04,836 --> 00:25:07,676 Speaker 1: back to normal. Or when you think in singularly, you say, yeah, 394 00:25:07,716 --> 00:25:09,756 Speaker 1: that could be, but we have to be honest. Things 395 00:25:09,756 --> 00:25:11,836 Speaker 1: are more things, things are changing, and it might will 396 00:25:11,836 --> 00:25:13,396 Speaker 1: come out of different ways, so we should be prepared 397 00:25:13,396 --> 00:25:17,916 Speaker 1: for something different. I think if I had to put 398 00:25:17,996 --> 00:25:21,756 Speaker 1: my that's on the most probable scenario, it would be 399 00:25:21,876 --> 00:25:26,076 Speaker 1: of a September that we would all be reasonably happy 400 00:25:26,116 --> 00:25:29,596 Speaker 1: with in terms of our lives being something like what 401 00:25:29,716 --> 00:25:32,396 Speaker 1: we want them to be. I think people will still 402 00:25:32,396 --> 00:25:36,036 Speaker 1: be wearing masks in places where they have been and 403 00:25:36,116 --> 00:25:39,516 Speaker 1: I think, you know, air filters will continue to do 404 00:25:39,636 --> 00:25:43,236 Speaker 1: a brisk business and people will continue to be cautious, 405 00:25:43,716 --> 00:25:48,996 Speaker 1: but that that there will be My best guess is 406 00:25:49,036 --> 00:25:52,156 Speaker 1: that we will have a school year that is recognizable 407 00:25:52,196 --> 00:25:55,356 Speaker 1: as a normal school year. But I think there are, 408 00:25:55,596 --> 00:25:57,836 Speaker 1: as you say, ways that could that that could go 409 00:25:57,916 --> 00:26:00,476 Speaker 1: wrong that are just hard to predict until we have 410 00:26:01,356 --> 00:26:06,316 Speaker 1: more data on the variants and their consequences for immunity 411 00:26:06,556 --> 00:26:11,076 Speaker 1: and on any other surprises that lion store Mark, what 412 00:26:11,356 --> 00:26:13,836 Speaker 1: am I not asking you that I should be asking you? Here? 413 00:26:19,156 --> 00:26:21,436 Speaker 1: We didn't get to talk about the variants actually all 414 00:26:21,476 --> 00:26:23,636 Speaker 1: that much. We talked more about if they don't become 415 00:26:23,636 --> 00:26:26,236 Speaker 1: a big problem. But well, let's talk a little bit 416 00:26:26,276 --> 00:26:28,796 Speaker 1: for a moment then about what you know, what you 417 00:26:28,796 --> 00:26:30,316 Speaker 1: think would be the case if they do become a 418 00:26:30,316 --> 00:26:34,596 Speaker 1: big problem. Yeah, well, I think in the period between 419 00:26:35,036 --> 00:26:39,476 Speaker 1: now and when the vaccine is protecting the vulnerable, there 420 00:26:39,476 --> 00:26:42,316 Speaker 1: could be a period where we have a really hard 421 00:26:42,316 --> 00:26:45,476 Speaker 1: time controlling the virus. We also haven't talked about the 422 00:26:45,556 --> 00:26:51,836 Speaker 1: UK variant, which almost certainly is more contagious. Conflicting data 423 00:26:51,876 --> 00:26:56,636 Speaker 1: about whether the vaccines are less effective. Nothing that shows 424 00:26:56,676 --> 00:27:00,276 Speaker 1: suggests that they're wildly less effective, but some suggestions that 425 00:27:00,276 --> 00:27:03,476 Speaker 1: they're somewhat less effective depending on whose data you read, 426 00:27:04,276 --> 00:27:09,876 Speaker 1: and some hints but from very preliminary studies, that the 427 00:27:09,956 --> 00:27:14,276 Speaker 1: UK variant is more lethal. Mark, was there a moment 428 00:27:15,116 --> 00:27:17,196 Speaker 1: as the data began to come out about the UK 429 00:27:17,356 --> 00:27:20,556 Speaker 1: variant where you started to buy the view that it 430 00:27:20,636 --> 00:27:23,836 Speaker 1: was in fact substantially more transmissible, because the very earliest 431 00:27:24,476 --> 00:27:28,396 Speaker 1: data was pretty loosely associational. So what was the thing 432 00:27:28,476 --> 00:27:31,516 Speaker 1: that pushed you to say, yes, it's almost certainly, I think, 433 00:27:31,516 --> 00:27:33,796 Speaker 1: which is your formulation a moment or two ago. Almost 434 00:27:33,836 --> 00:27:37,916 Speaker 1: certainly more transmissible? Yeah, I think the fact that it's 435 00:27:37,996 --> 00:27:43,676 Speaker 1: been seen to spread more effectively than the prior variants 436 00:27:43,716 --> 00:27:46,996 Speaker 1: in multiple places in the UK. And it's not just 437 00:27:47,076 --> 00:27:49,476 Speaker 1: that people are moving around so fast that every place 438 00:27:49,596 --> 00:27:52,956 Speaker 1: is connected perfectly to every place else. It's that in 439 00:27:53,076 --> 00:27:56,756 Speaker 1: multiple parts of the country the frequency was going up 440 00:27:57,036 --> 00:28:01,516 Speaker 1: at a rapid rate. Okay, so the UK variant reason 441 00:28:01,596 --> 00:28:05,796 Speaker 1: for serious concern there? What about the other variants Brazilian 442 00:28:06,076 --> 00:28:08,036 Speaker 1: or South African? What are the other big warriors we 443 00:28:08,076 --> 00:28:11,436 Speaker 1: should have about those? Well? I think the big worries 444 00:28:11,476 --> 00:28:15,276 Speaker 1: with those or we don't know how much the escape 445 00:28:16,356 --> 00:28:18,756 Speaker 1: from immunity in the lab will translate into escape from 446 00:28:18,756 --> 00:28:23,796 Speaker 1: immunity in populations of people, but that means to be seen. 447 00:28:24,516 --> 00:28:27,516 Speaker 1: And if the thing that we're worried about were to transpire, 448 00:28:28,356 --> 00:28:32,076 Speaker 1: we would be signing up then for a longer period 449 00:28:32,076 --> 00:28:35,796 Speaker 1: of time, slower progress because the vaccines would be less 450 00:28:35,796 --> 00:28:40,236 Speaker 1: efficacious more social distancing sort of more of what we're 451 00:28:40,236 --> 00:28:47,036 Speaker 1: dealing with, more mortality, presumably more risk to vulnerable populations. Yeah, 452 00:28:47,076 --> 00:28:49,196 Speaker 1: I think that's the worst case, and I don't think 453 00:28:49,236 --> 00:28:52,476 Speaker 1: that's the likely case. Now we're really in the realm 454 00:28:52,516 --> 00:28:55,316 Speaker 1: of speculation because we've just never watched this process happen 455 00:28:55,356 --> 00:29:00,236 Speaker 1: with a coronavirus, But with influenza, we know that it 456 00:29:00,236 --> 00:29:04,076 Speaker 1: involves to escape our immunity. It does so every few 457 00:29:04,196 --> 00:29:08,396 Speaker 1: years it makes a substantial bit of progress against our 458 00:29:08,436 --> 00:29:12,356 Speaker 1: immune system, and we don't have a flu pandemic and 459 00:29:12,636 --> 00:29:17,356 Speaker 1: lockdowns every three or four years. Even though it's we're 460 00:29:17,476 --> 00:29:20,516 Speaker 1: racing it with our immune systems, we keep up to 461 00:29:20,556 --> 00:29:24,636 Speaker 1: some degree, and we don't have huge tolls of mortality 462 00:29:24,956 --> 00:29:28,756 Speaker 1: and hospital use in almost any season outside of pandemics. 463 00:29:29,396 --> 00:29:32,316 Speaker 1: So by that analogy, it's not perfect because it's a 464 00:29:32,316 --> 00:29:35,116 Speaker 1: different type of virus, but by that analogy, we can 465 00:29:35,156 --> 00:29:39,156 Speaker 1: certainly imagine a similar thing happening with this coronavirus. It 466 00:29:39,236 --> 00:29:45,396 Speaker 1: would really be unprecedented to have two or three or 467 00:29:45,396 --> 00:29:49,956 Speaker 1: four years of really bad circulation of the same virus 468 00:29:50,276 --> 00:29:54,236 Speaker 1: causing the same amount of destruction, especially with good vaccines. 469 00:29:55,396 --> 00:29:57,836 Speaker 1: I think it's irresponsible to totally rule it out, but 470 00:29:57,876 --> 00:30:02,236 Speaker 1: it's also irresponsible or it's inappropriate to describe that as 471 00:30:02,316 --> 00:30:06,676 Speaker 1: a likely outcome at this point. Well, that's a relatively 472 00:30:06,956 --> 00:30:09,756 Speaker 1: cautiously optimistic note on which to add. And I hope 473 00:30:09,756 --> 00:30:12,516 Speaker 1: that by the next time we speak again, Mark, that 474 00:30:13,156 --> 00:30:15,276 Speaker 1: there will be good progress on some of these things. 475 00:30:15,276 --> 00:30:24,596 Speaker 1: Thank you so much. Thank you. Speaking with Mark is 476 00:30:24,636 --> 00:30:29,356 Speaker 1: always bracing and clarifying, and it always provides some central takeaways. 477 00:30:30,156 --> 00:30:34,316 Speaker 1: Here's the first. Mark is seriously concerned about the new 478 00:30:34,516 --> 00:30:38,236 Speaker 1: variants that are coming, especially from South Africa. He says 479 00:30:38,276 --> 00:30:40,996 Speaker 1: it's too soon to make determinative statements because the data 480 00:30:41,116 --> 00:30:42,996 Speaker 1: is not there yet, but he wants us to watch 481 00:30:43,036 --> 00:30:47,076 Speaker 1: this very closely, and in particular, he's concerned to make 482 00:30:47,156 --> 00:30:50,836 Speaker 1: sure that vaccines as they currently exist, are able to 483 00:30:50,876 --> 00:30:56,636 Speaker 1: function as effectively as possible against these variants. Second, Mark 484 00:30:56,676 --> 00:31:00,316 Speaker 1: continues to sound serious concerns about our goal of reaching 485 00:31:00,316 --> 00:31:05,476 Speaker 1: the most vulnerable population with vaccines. That remains his priority, 486 00:31:05,676 --> 00:31:09,636 Speaker 1: and to achieve that goal, we need more vaccine, faster, 487 00:31:10,196 --> 00:31:13,716 Speaker 1: producing just enough doses to provide one million a day. 488 00:31:13,876 --> 00:31:15,996 Speaker 1: Mark points out, even in a rish country like the 489 00:31:16,076 --> 00:31:18,356 Speaker 1: United States, is not going to get us there. Because 490 00:31:18,396 --> 00:31:21,636 Speaker 1: two doses of the vaccine are required per person, and 491 00:31:21,676 --> 00:31:24,796 Speaker 1: we have three hundred million plus people in the United States. 492 00:31:25,556 --> 00:31:29,356 Speaker 1: Another important and perhaps more optimistic takeaway from Mark is 493 00:31:29,356 --> 00:31:32,836 Speaker 1: that all else being equal, it should, in principle be 494 00:31:32,996 --> 00:31:37,836 Speaker 1: possible by September of twenty twenty one to begin to 495 00:31:37,836 --> 00:31:41,676 Speaker 1: open schools and return to something very much more closely 496 00:31:41,676 --> 00:31:45,236 Speaker 1: resembling normal than anything we've seen in the last year. 497 00:31:45,596 --> 00:31:47,596 Speaker 1: Mark says there will still be masks in lots of 498 00:31:47,636 --> 00:31:51,436 Speaker 1: public places, but ultimately, if things go well, and if 499 00:31:51,476 --> 00:31:54,236 Speaker 1: it turns out that the vaccines do work at least 500 00:31:54,276 --> 00:31:58,756 Speaker 1: basically against the emerging variance of the virus, he thinks 501 00:31:58,796 --> 00:32:01,116 Speaker 1: we will be able to get back to normal. He 502 00:32:01,156 --> 00:32:04,356 Speaker 1: does add a caveat, which is that if seasonally we 503 00:32:04,436 --> 00:32:07,916 Speaker 1: begin to see declines in the spread of the virus 504 00:32:08,036 --> 00:32:10,036 Speaker 1: in the summer of twenty twenty one, we need to 505 00:32:10,116 --> 00:32:13,156 Speaker 1: remember that there is a seasonal variation. We saw it 506 00:32:13,316 --> 00:32:15,716 Speaker 1: last summer, and we should be very careful to be 507 00:32:15,796 --> 00:32:18,396 Speaker 1: sure that what we're seeing is a reduction that is 508 00:32:18,516 --> 00:32:26,836 Speaker 1: caused by vaccination, not simply a seasonal reduction, so serious concerns, 509 00:32:26,876 --> 00:32:31,756 Speaker 1: but a guarded optimism for the future that's what Mark 510 00:32:31,916 --> 00:32:34,116 Speaker 1: has to say, and I think we should be very 511 00:32:34,116 --> 00:32:38,996 Speaker 1: grateful to him for his always cogent analysis. Until the 512 00:32:39,036 --> 00:32:42,636 Speaker 1: next time I speak to you, all, be careful, be safe, 513 00:32:42,956 --> 00:32:46,716 Speaker 1: and be well. Deep Background is brought to you by 514 00:32:46,756 --> 00:32:50,916 Speaker 1: Pushkin Industries. Our producer is Mo laboord, our engineer is 515 00:32:50,956 --> 00:32:54,316 Speaker 1: Martin Gonzalez, and our shore runner is Sophie Crane mckibbon. 516 00:32:54,796 --> 00:32:58,676 Speaker 1: Editorial support from noahm Osband. Theme music by Luis Guerra 517 00:32:59,156 --> 00:33:03,116 Speaker 1: at Pushkin. Thanks to Mia Lobell, Julia Barton, Lydia Jean Cott, 518 00:33:03,356 --> 00:33:08,276 Speaker 1: Heather Faine, Carl Vigliori, Maggie Taylor, Eric Xander, and Jacob Weisberg. 519 00:33:08,636 --> 00:33:10,996 Speaker 1: You can find me on Twitter at Noah R. Feldman. 520 00:33:11,396 --> 00:33:13,756 Speaker 1: I also write a column for Bloomberg Opinion, which you 521 00:33:13,796 --> 00:33:17,476 Speaker 1: can find at Bloomberg dot com slash Feldman. To discover 522 00:33:17,556 --> 00:33:20,796 Speaker 1: Bloomberg's original slate of podcasts, go to Bloomberg dot com 523 00:33:20,836 --> 00:33:23,756 Speaker 1: slash Podcasts, and if you liked what you heard today, 524 00:33:24,156 --> 00:33:26,996 Speaker 1: please write a review or tell a friend. This is 525 00:33:27,036 --> 00:33:27,796 Speaker 1: Deep Background.