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 Noah Feldman. In recent weeks, three new variants on
Speaker 1: COVID nineteen have been occupying a lot of attention in
Speaker 1: the news. There's a variant in the UK that is
Speaker 1: apparently more contagious and possibly more harmful. Then there is
Speaker 1: a variant in South Africa and one in Brazil, at
Speaker 1: least one of which and possibly both of which do
Speaker 1: appear to be less responsive to existing vaccines, or two
Speaker 1: antibodies created by people who've already had COVID. How alarmed
Speaker 1: should we be about these developments, How will they affect
Speaker 1: the interaction between the rollout of the vaccine and the
Speaker 1: progress of the disease, and what will it all mean
Speaker 1: for when we can begin to get back to conditions
Speaker 1: resembling normal. Here to talk us through these challenging questions
Speaker 1: is Mark Lipsitch. Mark now qualifies as a friend of
Speaker 1: a Deep Background for his regular appearances on the show
Speaker 1: to help explain the coronavirus pandemic to us, stretching all
Speaker 1: the way back to February of twenty twenty, when he
Speaker 1: was one of the first epidemiologists to sound the alarm
Speaker 1: about the coming pandemic. Mark is Professor of epidemiology at
Speaker 1: the Harvard chan School of Public Health, and he's also
Speaker 1: the director of the Center for Communicable Disease Dynamics. There,
Speaker 1: he has spent years creating and analyzing models that study
Speaker 1: pathogen spread in a population, and he's also studied how
Speaker 1: to effectively communicate this information to decision makers and the
Speaker 1: wider public. All of that study has turned into practical
Speaker 1: reality over the last eleven months. We're very lucky to
Speaker 1: have back to talk about this mutation and its consequences
Speaker 1: and the lessons we've learned from living with COVID now
Speaker 1: for nearly a year, Mark, welcome back today. I want
Speaker 1: to start with the South African variant, which has been
Speaker 1: getting a lot of attention because of the question of
Speaker 1: the extent to which it is or is not susceptible
Speaker 1: to the vaccines that have been created. So I want
Speaker 1: to begin by asking you, how worried are you about
Speaker 1: the South African variant and what are the consequences of
Speaker 1: that worry for your picture in the big sense of
Speaker 1: where we're headed. Well, I think most observers, including me,
Speaker 1: are seriously worried that this will complicate efforts to protect
Speaker 1: people by vaccination and reduce the quality of immunity from
Speaker 1: natural infection. Because there's evidence that for the South African
Speaker 1: variant that both of those things are likely true, the
Speaker 1: extent of the concern is still really matter ulation. Most
Speaker 1: likely is that there will be some degree of immunity,
Speaker 1: maybe more immunity to severe infection than to getting infected
Speaker 1: at all, but it really remains to be seen. It's
Speaker 1: not a good sign. It will certainly make things harder,
Speaker 1: but I think the degree of that is really a
Speaker 1: matter of complete speculation right now, and is the reason.
Speaker 1: The underlying reason for why both vaccine efficacy might be
Speaker 1: reduced as well as why natural immunity might be reduced
Speaker 1: the same, namely, that the variant has some sort of
Speaker 1: evolutionary shift in the spike protein that makes it less
Speaker 1: of a good match for what's been designed for the
Speaker 1: antibodies created in response to the pre existing version of
Speaker 1: the virus. That's right, So the existing vaccines narrowly target
Speaker 1: a very specific part of the spike protein, but also
Speaker 1: are natural antibodies that we respond that we make in
Speaker 1: response to natural infection. Also, in most people heavily target
Speaker 1: that region of the virus, and so in both cases
Speaker 1: the antibuddies do their job less well. Both Fiser and
Speaker 1: Maderna have released highly preliminary in vitro studies where they
Speaker 1: had a sort of good news bad news formulation in
Speaker 1: their In their pr there the good news was supposed
Speaker 1: to be well. They do say that their vaccines are
Speaker 1: still working on the South African variant, but the bad
Speaker 1: news is that it's not working as well as they
Speaker 1: would have liked it to work. I mean, I'm over
Speaker 1: simplifying that a little bit. And Maderna in fact said,
Speaker 1: just out of an abundance of caution, we're going to
Speaker 1: try to rejigger our version of the vaccine, so we'll
Speaker 1: address the South African varenton. We think we should be
Speaker 1: able to pull that off. Tell me about what should
Speaker 1: one think about those public statements. Yeah, I think those
Speaker 1: are accurate. And of course, where it falls on the
Speaker 1: good news bad news spectrum is the part that I
Speaker 1: said a minute ago is a matter of speculation. I mean,
Speaker 1: this is the general picture. When we have a vaccine
Speaker 1: or we have an immune response, we can measure many
Speaker 1: of its properties, and very often the degree to which
Speaker 1: it works in a test tube or in a cell
Speaker 1: culture correlates with how well it works in people, but
Speaker 1: not usually perfectly, and so translating it's in between nothing
Speaker 1: and very effective into where it is on the spectrum
Speaker 1: of epidemiological effectiveness is the part that we just don't
Speaker 1: know yet but should be able to learn more about
Speaker 1: as we see the variant spread and infect people in
Speaker 1: places with more vaccine coverage. All of this is happening
Speaker 1: in this extremely complicated dynamic game. I mean, for most
Speaker 1: of us who don't do what you do for a living,
Speaker 1: we're just slowly gradually beginning to appreciate just how complicated
Speaker 1: it is to keep track of all the moving parts.
Speaker 1: So we already have this very complicated phenomenon of vaccines
Speaker 1: being introduced, social distancing continuing in some places, and then
Speaker 1: the ongoing spread of the virus. And now, in addition
Speaker 1: to those three factors that were already in play, we
Speaker 1: also have an evolutionary twist that may change the game
Speaker 1: as well. So I want to ask you a few
Speaker 1: questions about the interaction of those four factors. And since
Speaker 1: there's so many moving parts, I'm going to go slowly
Speaker 1: so that you can explain it to me in slower terms.
Speaker 1: Start with which vaccines are in play here? So is
Speaker 1: there a reason to think that, even if Fiser and
Speaker 1: Maderna vaccines work all right on the South African variant,
Speaker 1: that other of the vaccines that are out there in
Speaker 1: the world that are more available, let's say, in less
Speaker 1: developed countries where it's harder to get the refrigeration and
Speaker 1: so forth, is there a reason to think that those
Speaker 1: would be even less efficacious than the mr Anda vaccines.
Speaker 1: I think, first of all, it's not just people who
Speaker 1: don't do this for a living who find it hard
Speaker 1: to keep track of the moving parts. It's really hard
Speaker 1: if you do. In answering your question about the other vaccines,
Speaker 1: a recurring theme in this pandemic, as in a lot
Speaker 1: of science, is there's what we have reason to think
Speaker 1: based on scientific precedent, and then there's what we have
Speaker 1: data about the specifically answers the question. We don't have
Speaker 1: data yet as far as I'm aware, on the effectiveness
Speaker 1: of the other vaccines against this. What we have reason
Speaker 1: to think is that the story will be probably quite similar.
Speaker 1: I think all of the vaccines that are far along
Speaker 1: in clinical trials, and virtually all of the vaccines that
Speaker 1: are being developed, a significant part or all of their
Speaker 1: immune response that they're generating is to the spike into
Speaker 1: this particular these particular parts of spike, and even natural infection,
Speaker 1: which is the whole virus that we can respond to,
Speaker 1: is the response is compromised for the South African variant.
Speaker 1: So I think it would be likely that the story
Speaker 1: will be similar across the board, but there could be
Speaker 1: some variations in the types of immune responses that are
Speaker 1: favored by different vaccines in some subtle way that would
Speaker 1: make it better or worse. Is it right? As I've
Speaker 1: gleaned in a lay person's way, that the mRNA vaccines
Speaker 1: might be more tweakable in the lab and in real
Speaker 1: time than the other vaccines. I mean, that's certainly how again,
Speaker 1: the public relations suggests it to be. Yeah, I think
Speaker 1: the public relations suggests that, and I think it is
Speaker 1: the most straightforward because you're simply generating a sequence of RNA,
Speaker 1: and the sequence can change a little bit, and it's
Speaker 1: those same process as making it the first time was.
Speaker 1: I think a lot of the technologies that are used
Speaker 1: for vaccines have this feature that they take a piece
Speaker 1: of the virus and generate the immune response. So I
Speaker 1: think to a large degree all of the vaccine technologies
Speaker 1: are pretty flexible. I don't know whether mRNA will be
Speaker 1: a whole lot faster. It may be somewhat faster. So
Speaker 1: let's turn then to the first step, as it were,
Speaker 1: of the interaction question. So, even before the South African
Speaker 1: variant was emerging, you've been thinking and writing and speaking
Speaker 1: about the interaction between the rollout of vaccines and the
Speaker 1: question of the trajectory of the pandemic. Would you give us,
Speaker 1: let's say, your prevariant analysis in a nutshell of what
Speaker 1: that interaction looks like, and then we can layer in
Speaker 1: the variant change. If we put aside the variance for
Speaker 1: the moment, then it's clear that for most of the
Speaker 1: world the vaccine is still not a serious factor. For
Speaker 1: the rich countries it is becoming a serious factor, and
Speaker 1: sort of low single digits of percents of people. But
Speaker 1: in most of the developed world it's still a minor factor,
Speaker 1: but is ramping up and the level of coverage is
Speaker 1: likely to be meaningful in a few months well in
Speaker 1: certain rich countries. So you think sort of April May
Speaker 1: and rich countries, it will be meaningful by April May,
Speaker 1: but not necessarily high. I mean, the Biden administration came
Speaker 1: into office saying one hundred million doses in one hundred days.
Speaker 1: The pace has been nearly a million doses a day already,
Speaker 1: and it's been quite quiet from the Biden administration when
Speaker 1: that was reported that this was just a modest increase.
Speaker 1: There was not a statement, Okay, we're going to make
Speaker 1: a two hundred million And I think I don't have
Speaker 1: any particular information, but my sense is there just aren't
Speaker 1: the capacities in the companies to make more doses than
Speaker 1: they're making. And it's not just a matter of saying
Speaker 1: please do it or you must do it. It's just
Speaker 1: that they are at capacity for manufacturing. And one hundred
Speaker 1: million doses means fifty million people vaccinated in a country
Speaker 1: of over three hundreds, so that is still modest prior
Speaker 1: to the variants, and even still, I was saying, I
Speaker 1: don't know when we're going to get to hurt immunity,
Speaker 1: if at all, because we don't know how well the
Speaker 1: vaccines protect against transmission. But at least we can protect
Speaker 1: the most vulnerable people if we can identify them and
Speaker 1: persuade them to be vaccinated. A few tens of millions
Speaker 1: of doses will not quite cover that, but will be
Speaker 1: a very big step towards covering the most vulnerable if
Speaker 1: they're prioritized. Sensibly, can I go back and ask you
Speaker 1: a question about something you just said? Mark, You were
Speaker 1: making the point that we don't know when we'll hit
Speaker 1: hurt immunity with vaccines because we don't know how well
Speaker 1: the vaccines do against transmission. So I guess my first
Speaker 1: question is why don't we know that? It's not just
Speaker 1: a function of the design study that was used in
Speaker 1: testing these vaccines. Yeah, the easiest way to find out
Speaker 1: if someone has gotten the virus is to wait for
Speaker 1: people to get sick from the potentially from the virus,
Speaker 1: and then test them. And so that was the centerpiece
Speaker 1: of the design of all the clinical trials, which for
Speaker 1: very good reasons, were designed to be fast and not
Speaker 1: answer every question, but answer the most important question as
Speaker 1: quickly as possible. Two of the three major vaccine Western vaccines,
Speaker 1: the Maderna one and the astrosenica one, had aspects of
Speaker 1: the trial that gave us a bit of a hint
Speaker 1: about transmission. The Astrosenica trial looked at people in the
Speaker 1: UK part of the trial who were not sick and
Speaker 1: asked them to come in any way and get swabbed
Speaker 1: so they could compare vaccine to posebo and the Maderna
Speaker 1: trial when they had people come in for their second shot,
Speaker 1: swabbed their noses and so we're able to estimate the
Speaker 1: impact of the shot on whether you get infected, even
Speaker 1: if you weren't sick. So each of those gave some data,
Speaker 1: not very much data, but a little bit of data
Speaker 1: that suggests that both of those vaccines do have some
Speaker 1: impact on transmission, which is really good. Question is how much,
Speaker 1: And that's the part where we just don't have enough
Speaker 1: data or enough high quality data to really say. In
Speaker 1: light of that, and again leaving out the variance, which
Speaker 1: will come back to in a moment, do you read
Speaker 1: the situation presently as in the rich countries we're headed
Speaker 1: for a kind of endemic pandemic that never goes away
Speaker 1: fully and is more like the flu, or do you
Speaker 1: read it as again leaving out for a moment the
Speaker 1: variance as something where at least in the rich countries
Speaker 1: eventually maybe it's not going to be in April or May,
Speaker 1: but maybe it's in June or July and August, or
Speaker 1: when more doses become available in a higher percentage of
Speaker 1: the population has been vaccinated, where we might actually be
Speaker 1: able to say COVID is not really a danger in
Speaker 1: these rich countries anymore. I think that would be quite
Speaker 1: surprising to get to the point where we have essentially
Speaker 1: no transmission. I think it's not out of the realm
Speaker 1: of possibility, but I think other scenarios are more likely.
Speaker 1: There was a paper in Science by a group from
Speaker 1: Memory that suggested that it would over time evolve into
Speaker 1: a situation more like a common cold, maybe up to
Speaker 1: influence a severity, but not pose the same danger, and
Speaker 1: I do think that that is the most likely. I
Speaker 1: think vaccines will accelerate that insofar as they protect the
Speaker 1: most vulnerable. But I think when a virus is this
Speaker 1: widespread in most of the world, and when the capacity
Speaker 1: to vaccinate heavily will remain limited for several years at
Speaker 1: least at a global scale, that the right things are going.
Speaker 1: And also, given that the first generation of vaccines probably
Speaker 1: are not super effective against transmission, they probably are quite
Speaker 1: effective if I had to bet on a number, I
Speaker 1: would say they probably reduce it by about two thirds,
Speaker 1: but I could be off maybe maybe eighty percent, which
Speaker 1: would be a lot, but would not be enough to
Speaker 1: get rid of the virus from circulation. And in those numbers,
Speaker 1: even with a very high percentage of the population vaccinated,
Speaker 1: you think there would still be enough transmission going on
Speaker 1: that we're looking at something that fits that that paper
Speaker 1: you were talking about, something more like the common cold. Yeah,
Speaker 1: I mean eighty percent effectiveness and one hundred percent coverage
Speaker 1: might just eliminate it, or nearly eliminate it, but but
Speaker 1: maybe not in all the most densely populated places, which
Speaker 1: could then recede other places. And maybe not. Maybe it
Speaker 1: won't be eighty percent effective, and probably there won't be
Speaker 1: total coverage because everywhere it's been tried so far, there's
Speaker 1: significant vaccine has been so that combination of things makes
Speaker 1: me think a lot of uncertainties would have to go
Speaker 1: our way for elimination to be a realistic possibility. Presumably,
Speaker 1: it's also the case that even in this best case scenario,
Speaker 1: the very small probability one that you're describing, it would
Speaker 1: take years because it would require something like a global
Speaker 1: spread of the vaccine unless you had isolation of the
Speaker 1: rich countries, and you're probably not going to get total
Speaker 1: isolation of those countries. It is not realistic, right right,
Speaker 1: And it wouldn't be justifiable, even for someone like me
Speaker 1: who's been an advocate of control measures for a long time.
Speaker 1: Once we have high vaccination coverage in the most vulnerable groups,
Speaker 1: it would not be economically or otherwise justifiable to say
Speaker 1: we're going to try to keep the economy hobbled for
Speaker 1: months or years just to stop this one virus. I'm
Speaker 1: glad you brought up the control measures because that was
Speaker 1: going to be my next question. Again, once more with
Speaker 1: the caveat of that we don't know enough yet about
Speaker 1: the variants, but again, assuming the variants are relatively controllable
Speaker 1: using the vaccine, where do you think is the right
Speaker 1: inflection point on the control measures? Where in the inflection point,
Speaker 1: what percentage of people need to be vaccinated in a
Speaker 1: country or a region for control measures to be substantially
Speaker 1: pulled back. Well, I think, that's of course a very
Speaker 1: hard question. I think that the first indicator that I'd
Speaker 1: be looking to, or indicators would be in places with
Speaker 1: high vaccine coverage, is there a substantial drop in the
Speaker 1: mortality rate and in the hospitalization or hospital capacity use,
Speaker 1: because those are the two things that are most damaging
Speaker 1: about this virus. It kills people, and it overwhelms healthcare
Speaker 1: indirectly harms people's health. It's going to be hard but
Speaker 1: necessary for us as epidemiologists to try to disentangle how
Speaker 1: much of that is directly protecting the most vulnerable, how
Speaker 1: much of that is reducing transmission through the vaccine, and
Speaker 1: how much of that is reducing transmission through control measures.
Speaker 1: And we'll all be working hard at that, and it
Speaker 1: will be a challenging thing to separate out. But I
Speaker 1: think the scenario that I imagine unfolding and I hope
Speaker 1: is correct, is that as vaccine gets rolled out to
Speaker 1: the people over sixty five and over seventy five, people
Speaker 1: on nursing homes, and people in other of the highest
Speaker 1: risk groups, you'll see still a lot of cases, but
Speaker 1: not nearly so much damage from those cases. You'll have
Speaker 1: a lot of continuing diagnoses, but a dropping ratio of
Speaker 1: hospitalizations and deaths cases. And that would be a sign
Speaker 1: to me that we're doing what we are trying to
Speaker 1: do that, which is to defang the virus by protecting
Speaker 1: the people whom it is most likely to harm. Exactly
Speaker 1: where you then draw the line. You know, it's very
Speaker 1: hard to say, well, we can tolerate this many deaths,
Speaker 1: but we can't tolerate that many deaths. But we tolerate
Speaker 1: deaths from influenza, and we tolerate deaths from a lot
Speaker 1: of other infections. And at some point we will draw
Speaker 1: that line. We'll be back in a moment. Mark, I
Speaker 1: want to ask you a kind of big picture what
Speaker 1: will the world look like question? And let's fast forward
Speaker 1: to September twenty twenty one, when at least in the
Speaker 1: United States, Canada, maybe Mexico, schools are supposed to be
Speaker 1: back in session. And again, let's assume relatively good uptake
Speaker 1: of the vaccine and relatively good efficacy of the vaccine,
Speaker 1: not against transmission but against serious illness. First of all,
Speaker 1: do people go back to school? Our schools open pretty
Speaker 1: much everywhere. And second of all, what does ordinary life
Speaker 1: look like with respect to different control measures ranging from
Speaker 1: masks to social distancing, to closings or openings of retail
Speaker 1: and restaurants. It's just having this exact conversation with people
Speaker 1: at our common University to try to think through all
Speaker 1: of these contingencies. I think under that relatively optimistic scenario
Speaker 1: of high vaccine uptake, particularly among teachers, would be an
Speaker 1: important qualification there for the reopening of schools and continued
Speaker 1: high vaccine efficacy at least again severe disease. I think
Speaker 1: the amount of damage done by the closing those schools
Speaker 1: to kids education is going to be something people won't
Speaker 1: continue to tolerate, and that there will be very very
Speaker 1: much social pressure, societal pressure to reopen schools, and that
Speaker 1: if teachers have access to vaccination in a fairly universal way,
Speaker 1: that will be the likely outcome. For the same reasons,
Speaker 1: I think other things will start to open up under
Speaker 1: such a scenario. And I think if we really have
Speaker 1: if we go a million doses a day for that
Speaker 1: amount of time, all the way through September, we're still
Speaker 1: going to have very low overall vaccine coverage. But if
Speaker 1: other vaccines come on and are highly effective, and or
Speaker 1: if we get more manufacturing capacity for the existing vaccines,
Speaker 1: then we will start to have some reasonable level of
Speaker 1: coverage and the population and with it, I would expect
Speaker 1: some reduction and transmission. I think the one caveat to
Speaker 1: that is that the seasonal changes that we saw last
Speaker 1: summer will probably happen again this summer, So everything will
Speaker 1: look better in the summer as it did last summer,
Speaker 1: because people will be outside more, the virus will transmit
Speaker 1: less well, and we may have a sense of security
Speaker 1: as we did last summer. That's partially due to the
Speaker 1: vaccine and partially due to seasonal factors, and so I
Speaker 1: think we're going to have to try to again separate
Speaker 1: out that contribution and make sure that as things reopen,
Speaker 1: which there will be great pressure to do, and we're
Speaker 1: not setting up for another bad winter like the one
Speaker 1: we've had here. But I think if we continue with
Speaker 1: continued high coverage and continued high efficacy in the most
Speaker 1: at risk groups, it should be a very different winter
Speaker 1: next year. You mentioned vaccinating teachers before us potential fall reopening.
Speaker 1: I know that in the debate about whether teachers should
Speaker 1: come first, or whether professions should really be our basis
Speaker 1: for vaccination as opposed to the people most vulnerable and
Speaker 1: most at risk, you have been more unvaccinate the vulnerable
Speaker 1: rather than identify a professional class like teachers. But it
Speaker 1: sounds like maybe as we get more vaccine out to
Speaker 1: the population, you think it would make sense to target
Speaker 1: teachers in order to achieve the social goal of reopening schools,
Speaker 1: or at least an acknowledgement of the fact that people
Speaker 1: are going to want it anyway. I have been very
Speaker 1: much in favor of trying to vaccinate first those who
Speaker 1: would be most likely to die. I do think that
Speaker 1: of all the professions, apart from healthcare workers, teachers play
Speaker 1: a truly fundamental role in our society for a whole
Speaker 1: variety of complicated reasons. But one of them is that they,
Speaker 1: through their childcare role, they make it possible for other
Speaker 1: adults to work. And another one, which we think of
Speaker 1: as the primary one, and it is, but it's not
Speaker 1: the only one, is that they create human capital and
Speaker 1: they and they educate our children to move on with
Speaker 1: their lives. And those are two really, really fundamental roles
Speaker 1: that are different from those of many other important occupations.
Speaker 1: And I think there will be appropriate demand to vaccinate
Speaker 1: teachers at least in time for fall reopening, which in
Speaker 1: practice means starting probably in the late spring. Mark you
Speaker 1: describe that scenario, that September scenario as optimistic. I grant
Speaker 1: you that it's optimistic. How optimistic I mean, does it
Speaker 1: seem to you when you really check your gut pretty
Speaker 1: darn unlikely that by September again in the United States
Speaker 1: will have enough vaccine uptake, declining mortality among the most vulnerable,
Speaker 1: and be able to begin the process of really getting
Speaker 1: back to normal. Or when you think in singularly, you say, yeah,
Speaker 1: that could be, but we have to be honest. Things
Speaker 1: are more things, things are changing, and it might will
Speaker 1: come out of different ways, so we should be prepared
Speaker 1: for something different. I think if I had to put
Speaker 1: my that's on the most probable scenario, it would be
Speaker 1: of a September that we would all be reasonably happy
Speaker 1: with in terms of our lives being something like what
Speaker 1: we want them to be. I think people will still
Speaker 1: be wearing masks in places where they have been and
Speaker 1: I think, you know, air filters will continue to do
Speaker 1: a brisk business and people will continue to be cautious,
Speaker 1: but that that there will be My best guess is
Speaker 1: that we will have a school year that is recognizable
Speaker 1: as a normal school year. But I think there are,
Speaker 1: as you say, ways that could that that could go
Speaker 1: wrong that are just hard to predict until we have
Speaker 1: more data on the variants and their consequences for immunity
Speaker 1: and on any other surprises that lion store Mark, what
Speaker 1: am I not asking you that I should be asking you? Here?
Speaker 1: We didn't get to talk about the variants actually all
Speaker 1: that much. We talked more about if they don't become
Speaker 1: a big problem. But well, let's talk a little bit
Speaker 1: for a moment then about what you know, what you
Speaker 1: think would be the case if they do become a
Speaker 1: big problem. Yeah, well, I think in the period between
Speaker 1: now and when the vaccine is protecting the vulnerable, there
Speaker 1: could be a period where we have a really hard
Speaker 1: time controlling the virus. We also haven't talked about the
Speaker 1: UK variant, which almost certainly is more contagious. Conflicting data
Speaker 1: about whether the vaccines are less effective. Nothing that shows
Speaker 1: suggests that they're wildly less effective, but some suggestions that
Speaker 1: they're somewhat less effective depending on whose data you read,
Speaker 1: and some hints but from very preliminary studies, that the
Speaker 1: UK variant is more lethal. Mark, was there a moment
Speaker 1: as the data began to come out about the UK
Speaker 1: variant where you started to buy the view that it
Speaker 1: was in fact substantially more transmissible, because the very earliest
Speaker 1: data was pretty loosely associational. So what was the thing
Speaker 1: that pushed you to say, yes, it's almost certainly, I think,
Speaker 1: which is your formulation a moment or two ago. Almost
Speaker 1: certainly more transmissible? Yeah, I think the fact that it's
Speaker 1: been seen to spread more effectively than the prior variants
Speaker 1: in multiple places in the UK. And it's not just
Speaker 1: that people are moving around so fast that every place
Speaker 1: is connected perfectly to every place else. It's that in
Speaker 1: multiple parts of the country the frequency was going up
Speaker 1: at a rapid rate. Okay, so the UK variant reason
Speaker 1: for serious concern there? What about the other variants Brazilian
Speaker 1: or South African? What are the other big warriors we
Speaker 1: should have about those? Well? I think the big worries
Speaker 1: with those or we don't know how much the escape
Speaker 1: from immunity in the lab will translate into escape from
Speaker 1: immunity in populations of people, but that means to be seen.
Speaker 1: And if the thing that we're worried about were to transpire,
Speaker 1: we would be signing up then for a longer period
Speaker 1: of time, slower progress because the vaccines would be less
Speaker 1: efficacious more social distancing sort of more of what we're
Speaker 1: dealing with, more mortality, presumably more risk to vulnerable populations. Yeah,
Speaker 1: I think that's the worst case, and I don't think
Speaker 1: that's the likely case. Now we're really in the realm
Speaker 1: of speculation because we've just never watched this process happen
Speaker 1: with a coronavirus, But with influenza, we know that it
Speaker 1: involves to escape our immunity. It does so every few
Speaker 1: years it makes a substantial bit of progress against our
Speaker 1: immune system, and we don't have a flu pandemic and
Speaker 1: lockdowns every three or four years. Even though it's we're
Speaker 1: racing it with our immune systems, we keep up to
Speaker 1: some degree, and we don't have huge tolls of mortality
Speaker 1: and hospital use in almost any season outside of pandemics.
Speaker 1: So by that analogy, it's not perfect because it's a
Speaker 1: different type of virus, but by that analogy, we can
Speaker 1: certainly imagine a similar thing happening with this coronavirus. It
Speaker 1: would really be unprecedented to have two or three or
Speaker 1: four years of really bad circulation of the same virus
Speaker 1: causing the same amount of destruction, especially with good vaccines.
Speaker 1: I think it's irresponsible to totally rule it out, but
Speaker 1: it's also irresponsible or it's inappropriate to describe that as
Speaker 1: a likely outcome at this point. Well, that's a relatively
Speaker 1: cautiously optimistic note on which to add. And I hope
Speaker 1: that by the next time we speak again, Mark, that
Speaker 1: there will be good progress on some of these things.
Speaker 1: Thank you so much. Thank you. Speaking with Mark is
Speaker 1: always bracing and clarifying, and it always provides some central takeaways.
Speaker 1: Here's the first. Mark is seriously concerned about the new
Speaker 1: variants that are coming, especially from South Africa. He says
Speaker 1: it's too soon to make determinative statements because the data
Speaker 1: is not there yet, but he wants us to watch
Speaker 1: this very closely, and in particular, he's concerned to make
Speaker 1: sure that vaccines as they currently exist, are able to
Speaker 1: function as effectively as possible against these variants. Second, Mark
Speaker 1: continues to sound serious concerns about our goal of reaching
Speaker 1: the most vulnerable population with vaccines. That remains his priority,
Speaker 1: and to achieve that goal, we need more vaccine, faster,
Speaker 1: producing just enough doses to provide one million a day.
Speaker 1: Mark points out, even in a rish country like the
Speaker 1: United States, is not going to get us there. Because
Speaker 1: two doses of the vaccine are required per person, and
Speaker 1: we have three hundred million plus people in the United States.
Speaker 1: Another important and perhaps more optimistic takeaway from Mark is
Speaker 1: that all else being equal, it should, in principle be
Speaker 1: possible by September of twenty twenty one to begin to
Speaker 1: open schools and return to something very much more closely
Speaker 1: resembling normal than anything we've seen in the last year.
Speaker 1: Mark says there will still be masks in lots of
Speaker 1: public places, but ultimately, if things go well, and if
Speaker 1: it turns out that the vaccines do work at least
Speaker 1: basically against the emerging variance of the virus, he thinks
Speaker 1: we will be able to get back to normal. He
Speaker 1: does add a caveat, which is that if seasonally we
Speaker 1: begin to see declines in the spread of the virus
Speaker 1: in the summer of twenty twenty one, we need to
Speaker 1: remember that there is a seasonal variation. We saw it
Speaker 1: last summer, and we should be very careful to be
Speaker 1: sure that what we're seeing is a reduction that is
Speaker 1: caused by vaccination, not simply a seasonal reduction, so serious concerns,
Speaker 1: but a guarded optimism for the future that's what Mark
Speaker 1: has to say, and I think we should be very
Speaker 1: grateful to him for his always cogent analysis. Until the
Speaker 1: next time I speak to you, all, be careful, be safe,
Speaker 1: and be well. Deep Background is brought to you by
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Speaker 1: at Pushkin. Thanks to Mia Lobell, Julia Barton, Lydia Jean Cott,
Speaker 1: Heather Faine, Carl Vigliori, Maggie Taylor, Eric Xander, and Jacob Weisberg.
Speaker 1: You can find me on Twitter at Noah R. Feldman.
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