Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explored the stories behind the stories in the news.
Speaker 1: I'm Noah Feldman Today some good news. The Yubola outbreak
Speaker 1: in the Democratic Republic of Congo seems to be coming
Speaker 1: to an end finally. Since the outbreak started in August
Speaker 1: twenty eighteen, over two thousand people have died, but now
Speaker 1: infection rates are measurably slowing down. Plus, in other good news,
Speaker 1: a vaccine for yubola is likely to get approved by
Speaker 1: the European Commission very soon. That means that there is
Speaker 1: now a potential prospect of substantial reduction of future outbreaks.
Speaker 1: To learn more about these important developments, I spoke to Pardisa,
Speaker 1: who's a cutting edge biologist at Harvard and at the
Speaker 1: Broad Institute. Partis was actually in West Africa during the
Speaker 1: twenty fourteen Ebola outbreak researching the disease, on which she's
Speaker 1: made important scientific contributions. I started by asking her exactly
Speaker 1: how the ebola vaccine works. Ebola as an RNA virus,
Speaker 1: so some viruses are made of DNA and some are
Speaker 1: made of RNA. RNA is a less stable sort of
Speaker 1: the thing that makes copies of it is has more
Speaker 1: mutations in it. So RNA viruses mutate faster, and flu
Speaker 1: and ebol are both RNA viruses, but then those are
Speaker 1: even within them those there's differences. You know, HIV and
Speaker 1: flu are really hard to develop vaccines for because they
Speaker 1: have a lot of different versions of themselves and they change,
Speaker 1: you know, quickly, and ebola is not quite like that.
Speaker 1: It's actually not as difficult to develop a vaccine for.
Speaker 1: And that's sort of why we've seen such early, really
Speaker 1: good success. We're seeing really good, promising success of the vaccines.
Speaker 1: And why also, you know, so Murk has a lead
Speaker 1: vaccine that's being used in the DRC right now. A
Speaker 1: number of other companies like Johnson and Johnson and GSK
Speaker 1: had one. A lot of people are developing vaccines because
Speaker 1: they know that it's likely to be effective. Was there
Speaker 1: a single breakthrough or development over the last five years
Speaker 1: that made it possible for multiple companies to develop vaccines here?
Speaker 1: I mean, obviously was not really in contemplation when the
Speaker 1: disease was still poorly understood and when just basically characterizing
Speaker 1: it was still the name of the game. Is the
Speaker 1: process sort of what we should expect that over a
Speaker 1: course of five years there was time or is it
Speaker 1: more that there was some particular intervening event or discovery
Speaker 1: that made it possible to develop these vaccines. No. I
Speaker 1: mean the vaccine that Murk is using right now is
Speaker 1: based on VSV, which is a particular type of raptivirus
Speaker 1: that is really easy to engineer. And essentially what they
Speaker 1: do is they take another virus that's less dangerous and
Speaker 1: they put a protein of a bowl of virus that
Speaker 1: is presented to the immune system into that virus, and
Speaker 1: so it allows basically this other virus to bring in
Speaker 1: a piece of a bowl of virus that will allow
Speaker 1: our immune system to get a chance to see it
Speaker 1: and develop immunity to it. It's a pretty well understood
Speaker 1: way of developing a vaccine, and other groups like Johnson
Speaker 1: and Johnson I think, have one that are based on
Speaker 1: an adenovirus as well as another virus. So they have
Speaker 1: got some other things that they're doing to try to
Speaker 1: make vaccines even better. But even the very simple merc
Speaker 1: based vaccine that's based on just one virus engineer to
Speaker 1: carry a protein from e bowl is working very well.
Speaker 1: So I don't think that this is an instance like
Speaker 1: HIV or flu, where we need to do something very
Speaker 1: fancy to get it to work. This is really more
Speaker 1: of a situation in which there was no need to
Speaker 1: invest that kind of money. I mean, I think one
Speaker 1: of the really big issues that we have in vaccine
Speaker 1: development in general is that there's no incentive for big
Speaker 1: companies to put in a lot of effort to develop
Speaker 1: vaccines for anything that might possibly be an outbreak. No
Speaker 1: financial incentive. You mean, there's a there's a strong humanitarian incentive,
Speaker 1: but you mean that there's not. There are for profit
Speaker 1: companies and there's just not enough money to be made
Speaker 1: in a crisis. In a simplest term, Yes, but you know,
Speaker 1: but you could also say, well, we don't we don't
Speaker 1: know what the next big outbreak is, so we can't
Speaker 1: necessarily build vaccines for everything that might be possible. You know,
Speaker 1: before the West African outbreak, it wasn't like a lot
Speaker 1: of people were worried that people was going to be
Speaker 1: something that would infect them. So there's definitely not financial incentive.
Speaker 1: But there was not even necessarily of the universe of
Speaker 1: many viruses that you might want to be worried about
Speaker 1: and create a large scale vaccination program. People would one
Speaker 1: might argue which of these viruses are the ones to
Speaker 1: go after? So that's sort of really interesting because the
Speaker 1: point you're making, if I understand correctly, is that you
Speaker 1: know there's a cost benefit that goes into not only
Speaker 1: developing a vaccine, but also in spending all the money
Speaker 1: to go out and get people vaccinated. And to do that,
Speaker 1: you really need to think there's a relatively high probability
Speaker 1: of some event occurring that would have bad consequences. I mean,
Speaker 1: I guess really what you want to do in a
Speaker 1: cost benefit is figure out not only the probability of
Speaker 1: an outbreak, but also the consequences of that outbreak, and
Speaker 1: then multiply the probability by how bad it would be
Speaker 1: and get an expected value, and then that goes into
Speaker 1: your cost benefit analysis. And you're saying that, really, it
Speaker 1: wasn't clear before the twenty fourteen West Africa outbreak that
Speaker 1: ebola was that kind of a virus. Yeah, I mean,
Speaker 1: I mean, obviously it was that kind of a virus,
Speaker 1: But was it more that kind of a virus than
Speaker 1: machupo or judine or haunts of virus or lassa virus.
Speaker 1: I mean, if there is a vaccine that you would
Speaker 1: have a bigger that would kind of hit the buttons
Speaker 1: of being both a really big global sort of pandemic
Speaker 1: threat and also a public health crisis there where veloping
Speaker 1: vaccine now would also help a lot of people. Loss
Speaker 1: of virus might be a better choice. And so it's
Speaker 1: not necessarily that one couldn't make an argument that they
Speaker 1: should have gone after ebola. It's just that there's I
Speaker 1: think of almost four hundred viruses that are known to
Speaker 1: infect humans, which one of those you would choose as
Speaker 1: hard to make a case for. And when you talk
Speaker 1: about the financials, so at least some of these vaccines
Speaker 1: were already developed when the West African outbreak hit, they
Speaker 1: just hadn't been tested in clinical trials. And that's really
Speaker 1: the hard part. The cost of developing a vaccine may
Speaker 1: be relatively reasonable, and then reasonable it means millions within
Speaker 1: the millions of dollars, But once you go to testing
Speaker 1: the first the safety and then the efficacy of the
Speaker 1: vaccines through multiple clinical trials, you're getting up into the
Speaker 1: sort of tens to hundreds of millions of dollars. And
Speaker 1: so when you start to think about that, that's where
Speaker 1: it becomes a whole different ball game. So in the
Speaker 1: when the West African outbreak hit, there were vaccines that
Speaker 1: could be employed, and one of the big things that
Speaker 1: was happening there. At first, people didn't even want to
Speaker 1: do vaccinations because they considered that research. To me is
Speaker 1: sort of to say we're not going to try anything
Speaker 1: is wild that that was such a big deal to
Speaker 1: say we're going to try something when anybody who is
Speaker 1: on the front lines, if asked, would you take a vaccine,
Speaker 1: even if experimental, as long as it's known to be safe,
Speaker 1: you would absolutely do it. But it took a long
Speaker 1: time to even get the community to say we're going
Speaker 1: to try some stuff. And it wasn't really until it
Speaker 1: sort of hit and probably hit Western individuals, that people said, okay,
Speaker 1: let's try these vaccines. And now now I think we
Speaker 1: understand more that we need to try things in real time.
Speaker 1: I want to unpack the many fascinating as you said
Speaker 1: there party. So one is that actually, some of these
Speaker 1: vaccines did exist in twenty fourteen, and we're not used
Speaker 1: because they hadn't been properly tested in a randomized, controlled experiment,
Speaker 1: And that runs very much counter to what the ordinary
Speaker 1: person imagines from watching the movies, namely that you know,
Speaker 1: when people are dying in large numbers in the field,
Speaker 1: that's the moment when you say, Okay, we have this
Speaker 1: untested vaccine, but it has a chance of working, so
Speaker 1: let's get out there and save some lives. I mean,
Speaker 1: there we have this sort of fantasy that when that happens,
Speaker 1: then emergency and measures kick in. And I hear you're
Speaker 1: saying that that's not exactly what happened, or at least
Speaker 1: not what happened. That's just not what happens. It's not
Speaker 1: what happened at all. I mean. And vaccines are kind
Speaker 1: of a you know, are one thing, which is they're preventative,
Speaker 1: and so one might argue, if you don't feel sure
Speaker 1: that it'll be effective, you might not want to take it.
Speaker 1: What's more shocking is treatments. Once you have ebola, would
Speaker 1: you rather take your chances on riding out ebola or
Speaker 1: trying a treatment that is not completely well vetted but
Speaker 1: you know, is confident in given that the fatality rates
Speaker 1: early in the outbreak were about eighty percent, you would say,
Speaker 1: you know, I'll try anything. But even there, I think
Speaker 1: that was the place that it was really even more
Speaker 1: remarkable to see that even there a lot of the
Speaker 1: international community wasn't willing to try treatments. There's some famous
Speaker 1: cases of places where there was battles over trying treatments
Speaker 1: on individuals that were infected, where organizations chose not to
Speaker 1: and the individuals died. They didn't do it until it
Speaker 1: was actually Americans that were infected that they said, well,
Speaker 1: oh now we'll try the treatments. But there were a
Speaker 1: lot of really prominent healthcare workers that were infected and
Speaker 1: they didn't even have it. They were not even given
Speaker 1: the opportunity to take a experimental drug. So willingness to
Speaker 1: try experimental treatments was actually higher when it was Americans
Speaker 1: getting sick than when it was Africans who were getting sick.
Speaker 1: And that doesn't seem intuitive to me. I mean, you
Speaker 1: sort of imagine that if anything, you know, Western professionals,
Speaker 1: they're not all Western, but many Western professionals would be
Speaker 1: more willing to try out something experimental in Africa. So
Speaker 1: what's the background to that, is that a case of
Speaker 1: bending over backwards to try not to appear to be
Speaker 1: ferimenting with an experimental treatment on people in poorer countries
Speaker 1: and then that's a kind of perverse reversal of our
Speaker 1: deep past and that leads to this kind of strange result.
Speaker 1: Or is it more a story of just valuing American
Speaker 1: lives more highly? Like what's you're deep inside this? So
Speaker 1: what's your theory about how that that happened? Well, I mean,
Speaker 1: actually I was part of the conversations, and I would
Speaker 1: say although I didn't get to I would I did
Speaker 1: not get to witness. So the one the one that
Speaker 1: I got to witness the early conversations and then didn't
Speaker 1: get to witness what happened at the end was with
Speaker 1: doctor Humar Khan, who's a Shikumar Khan, who's the head
Speaker 1: of the clinical ward at Kennema Government Hospital in Siri Leone.
Speaker 1: That's where my lab had worked for many years before
Speaker 1: the Bola outbreak hit. And he was very prominent, very
Speaker 1: heroic Siri Leone in doctor on the front lines of
Speaker 1: first loss of virus and then ebola and of yours
Speaker 1: and a friend of mine and he was he was
Speaker 1: infected and it was actually the first time that the
Speaker 1: international community said now, well, so we were actually banging
Speaker 1: down the doors trying to get experimental drugs and vaccines
Speaker 1: tested early in the outbreak, and that was sort of
Speaker 1: like there was just like not no discussion of that.
Speaker 1: It was it was that was that no one even
Speaker 1: wanted to do it. And then finally actually when doctor
Speaker 1: Khn became ill and people recognize he was very prominent
Speaker 1: and this would be really devastating, there was discussions, but
Speaker 1: even there it was interesting. So I think a lot
Speaker 1: of it has to do with the fact that they
Speaker 1: want to be perceived as testing on Africans. A lot
Speaker 1: of it is see what if something goes wrong, what
Speaker 1: if he gets the drug and dies, would they blame
Speaker 1: the drug? So I think a lot of us around
Speaker 1: that political perception, and some of it is this idea
Speaker 1: that this kind of paternalistic view of like we have
Speaker 1: to protect them, them being being Africans. Africans, yeah, they
Speaker 1: like you know, when I do ethical protocols in Africa,
Speaker 1: I've taken a lot of ethics courses. I got really
Speaker 1: invested in it because I wanted to under stand how
Speaker 1: are we doing these things and thinking about how to
Speaker 1: do things ethically right. And there's a lot of like
Speaker 1: we must protect them or we must be you know,
Speaker 1: their vulnerable populations. We don't want to exploit them, but
Speaker 1: sometimes it's almost infantalizing the way we describe their ability
Speaker 1: to interpret it. And in the case of doctor Khan,
Speaker 1: it was an extreme case of in fact, he's more
Speaker 1: informed than I am to make this decision than any
Speaker 1: than And you know, even though I have an MD
Speaker 1: as well, he's still probably the most informed person on
Speaker 1: the planet to make a really good decision as to
Speaker 1: whether or not he should take the start or not.
Speaker 1: It's like it is like the scenario for a movie,
Speaker 1: isn't it. You know, like the person with the most
Speaker 1: on the ground clinical experience in the disease is now
Speaker 1: infected with the disease and who's going to make the
Speaker 1: decision about his treatment? Yeah, And so out of a
Speaker 1: lot of those conversations that seemed pretty obvious that he
Speaker 1: was the right person, it made a lot of sense,
Speaker 1: and this is the time to try it. You know,
Speaker 1: I wasn't in the situation room. I was just in
Speaker 1: the kind of pre conversations. But when it got to
Speaker 1: the situation room, they got cold feed. And I think
Speaker 1: for these other reasons, these sort of like larger implications,
Speaker 1: And then that part that you asked before, Like I said,
Speaker 1: I want to speculate, but obviously things changed when it
Speaker 1: was Americans on the ground affected. And I think um
Speaker 1: parties before you tell us that what actually happened to
Speaker 1: doctor Khan. Oh, he passed away. He passed away. So
Speaker 1: they chose not they ultimately chose. I mean, I just
Speaker 1: want to make sure that we get the depth of this.
Speaker 1: So he there, he was, and in the end, the
Speaker 1: relevant people in the room were not prepared to try
Speaker 1: the experimental treatment and he died. Yeah, And the experimental
Speaker 1: treatment was at the site, so there it was just
Speaker 1: you know, feet away Frore it was, he was, it was,
Speaker 1: it was there, it was ready, it could have been used,
Speaker 1: and it wasn't. And when they tried that treatment later
Speaker 1: on others they took that exact that exact dose, and
Speaker 1: they gave it to two Americans, Nancy Warble and Kent Brandley,
Speaker 1: and they both survived. Wow. Wow. Yeah. So I mean,
Speaker 1: when you can never say with one hundred percent certainty,
Speaker 1: but there's very very strong reason to believe that had
Speaker 1: doctor Khan received that treatment that was right there in
Speaker 1: the in the building with him, he would have lived it. Definitely.
Speaker 1: That was the risk I'm sure he know, his family knows,
Speaker 1: and I know if he was never given the choice.
Speaker 1: If he was given the choice, he certainly would have
Speaker 1: he would have ruled the dice with the drug. Can
Speaker 1: I ask because this is a bit opaque to the
Speaker 1: ordinary person. Definitely to me, And I'm not asking you
Speaker 1: to name any names, of course, but institutionally, who gets
Speaker 1: to make that call? You mentioned that you had only
Speaker 1: been in the preliminary conversations. But when the decision is
Speaker 1: ultimately being made. Are we talking about international organizations? Are
Speaker 1: we talking about local government? Are we talking about US government?
Speaker 1: Is at the who like who is at the private
Speaker 1: companies that control these things? Who is in the room
Speaker 1: when the decision is made. In this particular case, it
Speaker 1: was the MSF, And they have talked about it themselves.
Speaker 1: That's the med Sandstone Frontier, the International NGEO, Doctors Without Borders. Yeah,
Speaker 1: and and they I have a lot of sympathy for
Speaker 1: them and their decision, So I often say it's not
Speaker 1: the decision I would have made. But I do think,
Speaker 1: at least in the early conversations I was part of,
Speaker 1: they're being thoughtful, They're being mindful, and there's a number
Speaker 1: of things that kind of came into play, and they
Speaker 1: made a choice, and they certainly regretted that choice. So
Speaker 1: in that case, it was, yeah, it's this particular organization
Speaker 1: and they were in charge of his care and they
Speaker 1: are making a choice about what to do with his care.
Speaker 1: So I wrote a book called Outbreak Culture, and it
Speaker 1: talks about sort of what can become a toxic culture
Speaker 1: that emerges amidst the crucible of an outbreak. And the
Speaker 1: reason I wrote it, and I wrote it with Lara
Speaker 1: Salahia journalist, a fantastic journalist, was that I'm not trying
Speaker 1: to blame a particular person. I have deep sympathy for
Speaker 1: MSF and deep respect for everything that they're trying to do.
Speaker 1: I'm trying to understand the different the kind of complexity
Speaker 1: of considerations that these matter organizations have. It's the suspicion
Speaker 1: and paranoia and you know, perverse incentives that emerge in
Speaker 1: the middle of a completely banana situation. Is how do
Speaker 1: we make better decisions given the many, many complexities of
Speaker 1: an outbreak. In your book that you just mentioned, Outbreak Culture,
Speaker 1: you go through in a lot of systematic detail things
Speaker 1: that went wrong in the West African outbreak and in
Speaker 1: the response to the outbreak. And I'm wondering, as you
Speaker 1: look at the responses that are happening right now in
Speaker 1: the Democratic Republic of Congo, which is obviously a different
Speaker 1: geographical location, different political circumstances, do you think to yourself, Oh,
Speaker 1: my god, here we go again. You know, here are
Speaker 1: the mistakes that I just pointed out in a book,
Speaker 1: you know, published just last year, you know, for everybody
Speaker 1: to see, like, don't do this wrong. People could die,
Speaker 1: and then those things are happening. Or maybe there are
Speaker 1: examples where there are lessons learned that you pointed out
Speaker 1: that are being taken into acount WHI would be more optimistic,
Speaker 1: we're thinking better, or maybe it's both. I would really
Speaker 1: love to hear from your perspective, how are we doing
Speaker 1: this time relative to the last time. The thing is,
Speaker 1: these books have been written time and time again. In fact,
Speaker 1: when Laura and I kind of talk about these are recommendations,
Speaker 1: we actually don't give specific recommendations because so many people
Speaker 1: have given them before. What we try instead to do
Speaker 1: is to give a framework of how we should think
Speaker 1: about responding to outbreaks, and specifically we talk about organizational justice.
Speaker 1: You know, the idea of organizational justice is that people
Speaker 1: believe that there's due process, there's a meritocracy, there's cooperation,
Speaker 1: there's transparency, and you know there. I think we're getting
Speaker 1: better at recognizing that we need to work with the
Speaker 1: communities allow them to understand what we're doing. But I'd
Speaker 1: say that there's a move towards that being important, but
Speaker 1: not necessarily that we've learned how to do it right,
Speaker 1: because there's still a challenge of getting people vaccinated when
Speaker 1: there's a lack of trust. A lot of the treatment
Speaker 1: centers are being burned down because we haven't effectively communicated
Speaker 1: with the communities in which we're working, and so we
Speaker 1: haven't given them a sense of organizational justice, even if
Speaker 1: we may be developing it ourselves. And how much of
Speaker 1: that is dependent on the government that's in play. I mean,
Speaker 1: in the case of Democratic Republic of Congo, you're working
Speaker 1: in a place that has a history of serious civil
Speaker 1: war autocracy of a totalitarian type before the civil war
Speaker 1: disorder that arguably was even worse than the totalitarian dictatorship.
Speaker 1: It's not credible or realistic to think that the government
Speaker 1: would have popular legitimacy as delivering justice and in those
Speaker 1: places definitely where the outbreak is occurring. So given that,
Speaker 1: is it at all credible to even imagine that local
Speaker 1: people will say, oh, well, you know that might be true,
Speaker 1: but this international health organization that's looking to help us,
Speaker 1: they're you know, full of justice. You know, absolutely agree,
Speaker 1: And I think that that's a major shoe is obviously
Speaker 1: that in a society in which there's always been corruption
Speaker 1: and injustice, it's really hard to get anybody to believe
Speaker 1: in anything. At the same time, I don't like kind
Speaker 1: of pointing to that being in a shoe because it's
Speaker 1: so easy. We're so good at anthropomorphizing other cultures and
Speaker 1: sort of saying that's that's their problem, that's not us.
Speaker 1: That we don't look to see what we're doing, what
Speaker 1: we could be doing better, and essentially we kind of
Speaker 1: throw everything up to oh, those are corrupt governments, so
Speaker 1: you know, so there, But ultimately, like you know, I
Speaker 1: witnessed it personally, we are bad actors ourselves. We can
Speaker 1: be what's an example of where you saw we in
Speaker 1: the sense by which I assume you mean the international
Speaker 1: community of scientists and healthcare workers who are trying to
Speaker 1: help What's an instance where you saw that that we
Speaker 1: being bad actors. Oh, I mean a million different ways.
Speaker 1: And again I'm not going to name any names, but
Speaker 1: I'll say that there are a number of people there
Speaker 1: in the West effering an outbreak that we're all. I
Speaker 1: mean you, We actually saw public fighting between number of
Speaker 1: major international organizations. People were trying to throw the people
Speaker 1: out because they wanted to be the ones to like
Speaker 1: do the first diagnosis or get the first paper out
Speaker 1: or they We got kicked out of multiple sites. I
Speaker 1: got kicked out of participating. They said you have no
Speaker 1: business being here. And so there you are on the ground,
Speaker 1: the person who's been doing the most groundwork in the
Speaker 1: field scientifically for the previous several years, and they're like, leave,
Speaker 1: we don't want you here. Yeah, my team was told
Speaker 1: to leave. They were told they were not to return.
Speaker 1: We had no business here. And you know, our colleagues
Speaker 1: were the only ones doing diagnosis. They had a you know,
Speaker 1: a diagnostic that was working, and they're the only ones
Speaker 1: doing diagnosis in a particular site, and an individual for
Speaker 1: a major organization kicked us out because they didn't want us.
Speaker 1: We were doing it for free. We weren't doing it
Speaker 1: for credit, but they didn't want us doing it, and
Speaker 1: our partner there and our African partner there kind of
Speaker 1: fought with this person and said, but you recognize that
Speaker 1: we're the only ones that can do it. If we leave,
Speaker 1: there's there's nothing, and he said, I don't care. I
Speaker 1: want you, I want you out. And then the amount
Speaker 1: of libel that gets thrown out and everybody gets it.
Speaker 1: Like essentially, I had multiple ceases and assists. I had,
Speaker 1: you know, before my paper we got published in a
Speaker 1: major journal, got out, we had somebody send a basically
Speaker 1: a scathing letter to the journal to say that we
Speaker 1: were criminals. I mean, it's endless. It's literally eighty percent
Speaker 1: of my time during that time was fighting off attacks,
Speaker 1: not actually doing positive work. I mean, that's it's genuinely astonishing.
Speaker 1: I mean, you know what, you and I have spoken
Speaker 1: about this a little bit before, and so I know
Speaker 1: a little bit about it. But what you're describing is
Speaker 1: something really really pervasive of competition under conditions about break
Speaker 1: for credit and for I guess the point of the
Speaker 1: credit is to get future funding. Yeah, to get future funding,
Speaker 1: to get recognition. Now all of those things, I have
Speaker 1: to say, it's a depressing picture that you're painting, but
Speaker 1: depressing well. But the thing is, I mean it's not
Speaker 1: different from I mean, have you been seeing what's happening
Speaker 1: in Washington right now? I mean, ultimately everything is about that.
Speaker 1: I mean, I think the people, that's what people right.
Speaker 1: But the thing, the difference there is that people are
Speaker 1: in this instance that you're describing, people are dying of
Speaker 1: disease in real time. Yeah, you know, I mean Washington
Speaker 1: is bad. I'm not defending it for goodness sakes, but
Speaker 1: by the same token, we sort of expect that. I mean,
Speaker 1: maybe it's to do with our expectations. I mean we
Speaker 1: sort of expect politicians to be politicians, but then here
Speaker 1: are scientists and public health workers and physicians. Almost everyone
Speaker 1: swore in the Hippocratic oath. You know, they're they've devoted
Speaker 1: their lives to do this and not to making billions
Speaker 1: of dollars because they wanted to help people. You know,
Speaker 1: they're willing to take significant risks by being in country
Speaker 1: as you were, in the middle of an outbreak. I mean,
Speaker 1: we sort of expect. Maybe I don't expect everyone to
Speaker 1: be quite Albert Schwitzer, but we at least expect people
Speaker 1: to be better than Congress. Yeah, in that situation. Yeah,
Speaker 1: I mean it's a low standard. But you know so,
Speaker 1: and and I should say, I want to make very
Speaker 1: clear there are some of those people there, right, you
Speaker 1: see the best of of humanity and the worst of
Speaker 1: humanity is what you see, right you see, I mean
Speaker 1: you see these frontline workers who are who are just
Speaker 1: doing everything they can anonymously, you know, just to help
Speaker 1: their fellow you know, fellow man. You see all of that.
Speaker 1: It's it's tremendous um. It's actually it's that so I
Speaker 1: call it a crucible. It is truly a crucible. It's
Speaker 1: a melting pot of insane for upon you in which
Speaker 1: like all of these emotions happened. But two, the thing
Speaker 1: is people expect that suddenly we'd all behave really well.
Speaker 1: But even even when people make Hollywood characterizations of what
Speaker 1: happens during an outbreak, people are like punching each other
Speaker 1: in the grocery store for food. And I mean it's
Speaker 1: a crazy environment. I mean, there are legitimate reasons to
Speaker 1: be just frightened, as suspicious and concerned, and so it
Speaker 1: definitely like amps up the paranoia level a lot that
Speaker 1: I can't believe I mean, I you know, it was
Speaker 1: not as extreme, but when I was in Iraq, you know,
Speaker 1: in the period of time immediately following the US invasion
Speaker 1: and occupation there, you could just sort of see the
Speaker 1: kind of amped up cortisol levels in everybody leads to
Speaker 1: bad decision making. It leads to paranoia. One person shoots
Speaker 1: at you, and now you think everyone's shooting at you, right,
Speaker 1: you know, there's no question that decision making. And I
Speaker 1: imagine that people who were on a battlefield, the literal battlefield,
Speaker 1: people soldiers serving in war, and that they do in
Speaker 1: their writing explore this same sort of idea that there
Speaker 1: is is you know, there are a whole series of
Speaker 1: forces that kick in and make it very difficult to
Speaker 1: exercise excellent judgment, to do things right, to look out
Speaker 1: for for anybody other than your team. Right, That's very
Speaker 1: much what's going on there as well. I mean, the
Speaker 1: virus is actually just a backdrop to what's happening, the
Speaker 1: politics happening between people. It's like you, in a way,
Speaker 1: the virus is the thing that people are the least
Speaker 1: worried about. Um, they're really worried about who's slandering them,
Speaker 1: who's trying to take them out of their position. Who's
Speaker 1: and it's kind of that's really people taking their eye
Speaker 1: off the ball, right, and and there's this huge existential threat,
Speaker 1: and everybody's just worried about you know, they're the office politics.
Speaker 1: We're primates, We like we worry a lot about hierarchy. Yeah,
Speaker 1: let's do I want to ask when you look at
Speaker 1: the upside of the current outbreak, you know, namely the
Speaker 1: successes least preliminary successes of the vaccine and preliminary successes
Speaker 1: of the treatments, do you think, Look, it took a
Speaker 1: little while, but science broadly speaking is working. You know,
Speaker 1: we're getting to a place where when we hear about
Speaker 1: an ebola outbreak, we're no longer going to feel sitting
Speaker 1: here in the United States existential dread, you know, worry
Speaker 1: about a global pandemic. We're going to increasingly think, Okay,
Speaker 1: you know, like this is rough, and it's going to
Speaker 1: be difficult, and no doubt some people will die, but
Speaker 1: this is going to be fixable and manageable. And if so,
Speaker 1: is that is that a win for really for science broadly,
Speaker 1: you know, a vindication of the kind of work that
Speaker 1: you've been doing. Yeah, I think that we have the
Speaker 1: technology and the technological capabilities to likely be able to
Speaker 1: respond to any virus that's circulating. You know, I feel
Speaker 1: pretty confident that we can, you know, even the really
Speaker 1: hard things like flu and HIV we're starting to figure out,
Speaker 1: or hepatitis C, like, we're starting to see breakthroughs. The
Speaker 1: technology is there to be able to respond. I think
Speaker 1: the thing that's still looming is, you know, one of
Speaker 1: the reasons why flu is such a concern is that,
Speaker 1: you know, the Spanish flu of nineteen eighteen was able
Speaker 1: to likely you estimated to have taken out twenty five
Speaker 1: million people in twenty five weeks. We you know, we're
Speaker 1: still not moving fast enough where a significant percentage of
Speaker 1: the world's population might not die if a new outbreak
Speaker 1: came out that we weren't ready for. And so it's
Speaker 1: one of those places where we actually have all the
Speaker 1: technological capabilities to make this move faster, but we just
Speaker 1: need to put the resources behind making it possible to
Speaker 1: move fast enough to be ready for any threat. It's
Speaker 1: why folks like Bill Gates are on the front line
Speaker 1: saying this is the thing I'm most worried about in
Speaker 1: the history of humanity. Infectious diseases have been one of
Speaker 1: the most major killers. They're really effective at doing what
Speaker 1: they do. And we're not even talking yet about the
Speaker 1: fact that there's such a thing as suicide biobombers, there's
Speaker 1: such a thing as biothreats. There are You may have
Speaker 1: an index case who doesn't want to be found, and
Speaker 1: that changes everything as well. Right, So when we talk
Speaker 1: about bad actors, we're talking about bad actors who just
Speaker 1: want to paper. What about the bad actors who are
Speaker 1: actually trying to spread the virus and infect as many
Speaker 1: people as possible. So we have to be ready for that,
Speaker 1: the rise of deviant culture and the power that we
Speaker 1: can give them. I heard two different messages in there,
Speaker 1: and I want to disentangle them because I hear an
Speaker 1: optimistic message that says, you know, we've really made scientifically,
Speaker 1: I should say you, but you know you the scientific
Speaker 1: community who work on this really have made huge strides
Speaker 1: in studying and responding to viruses. And in that sense,
Speaker 1: it sounds like you're saying that the danger of global
Speaker 1: pandemic as sort of high on the list of things
Speaker 1: that could go very wrong for the world, which was
Speaker 1: certainly in the curriculum that I was taught as a
Speaker 1: as a kid is declining relative to some of the
Speaker 1: other threats, which say are still there, like global warming,
Speaker 1: which you know, with the topic for another day, but
Speaker 1: we don't have all the answers there. But it sounds
Speaker 1: like you're saying in an optimistic way that when it
Speaker 1: comes to the threat of pandemic by virus, that we
Speaker 1: were actually in a way better place today than we
Speaker 1: were even a short time ago. But then at the
Speaker 1: same time, I also hear you saying that because of
Speaker 1: speed and the danger of terrorists intentionally spreading disease and
Speaker 1: a hiding index cases that actually that danger remains about
Speaker 1: as pressing as it ever was. So am I hearing
Speaker 1: you right? Which is? Oh? I think it's I mean,
Speaker 1: I think both can be true. I mean, I think
Speaker 1: that's right. That the same science that made it possible
Speaker 1: for us to have a vaccine for ebola very very
Speaker 1: quickly and to be able to launch it and have
Speaker 1: it be very effective, is the same science that makes
Speaker 1: it possible for one to synthesize ebola and for you know,
Speaker 1: people to understand how it works and how it goes forth.
Speaker 1: So we are in that point where we have the
Speaker 1: capabilities to do tremendous good, but we have to be
Speaker 1: very committed, and we have to be very collaborative, and
Speaker 1: we have to move forward so that we navigate very
Speaker 1: treacherous waters. I can only tell you that it makes
Speaker 1: me feel a lot better to know that you're out
Speaker 1: there working on that partdis So go forth, please and
Speaker 1: solve some more solve some more diseases while you're at it,
Speaker 1: and we'll all be extremely grateful. Pride, thank you so
Speaker 1: much for your time. I really appreciate it. Thanks though
Speaker 1: it's always a pleasure to talk to you. The story
Speaker 1: of Ebola is going to go down in the history
Speaker 1: of medicine as a fascinating case study of how a
Speaker 1: very contagious, extremely dangerous disease can draw intense global scrutiny,
Speaker 1: can highlight tremendous inequalities, can emphasize the irrationality and difficulty
Speaker 1: of our attempts to treat disease, and yet eventually lead
Speaker 1: to important treatment interventions and potentially even a vaccine that
Speaker 1: renders the disease obsolete. It's important to keep in mind, then,
Speaker 1: that the story of Ebola has two sides. It will
Speaker 1: have the side of the story, which we've heard about
Speaker 1: very clearly from Pardis, in which there are dysfunctional elements,
Speaker 1: unnecessary competition, the wrong incentives, even bias of the most
Speaker 1: fundamental kind that stand in the way of effective cures
Speaker 1: and effective treatment. Some of those biases and problems might
Speaker 1: even have led to the deaths of researchers and medical
Speaker 1: care workers, to say nothing of ordinary people who contracted
Speaker 1: the disease. Yet nevertheless, the alternative story, the heroic story
Speaker 1: of how those sacrifices ultimately led to real improvements, is
Speaker 1: a crucial element of this tale. I hope and look
Speaker 1: forward to a day when we'll only hear the word
Speaker 1: ebola in the history books. When that happens, those histories
Speaker 1: will include appreciation for the work of scientists like Pardis
Speaker 1: who've tried to use reason and logic in the attempt
Speaker 1: to address this deeply serious problem of disease. And now
Speaker 1: our sound of the week. Last night, the United States
Speaker 1: brought the world's number one terroist leader to justice. Abu
Speaker 1: Bakar Albeg is dead. That's President Donald Trump, of course.
Speaker 1: Last Sunday, describing a military operation that is arguably one
Speaker 1: of the most significant of his presidency, the one which
Speaker 1: led to the death of the leader of the Islamic State,
Speaker 1: Abubakhara al Bakhdadi, the self declared caliph of the organization
Speaker 1: that managed to conquer substantial amounts of territory in Syria
Speaker 1: and Iraq, and along the way combined an extraordinary capacity
Speaker 1: to murder, to rape and to kill with a remarkable
Speaker 1: ability to attract followers from around the Muslim world who
Speaker 1: came to the Islamic State with the aspiration of participating
Speaker 1: in a millennial, idealistic and to them utopian community. What
Speaker 1: will happen to the Islamic State in the aftermath of
Speaker 1: Bahdadi's death and in the aftermath of the collapse of
Speaker 1: his caliphate. To understand how Islamic State is likely to develop,
Speaker 1: what's crucial to realize is that ultimately Islamic State turned
Speaker 1: out to be a very different kind of movement than
Speaker 1: al Qaeda, the terrorist organization from which it originally grew.
Speaker 1: Recall that Al Kaieda defined itself globally as a movement
Speaker 1: designed to fight the jihad by Muslims against Western occupiers,
Speaker 1: those people who were perceived and in some cases actually
Speaker 1: were occupying Muslim lands on behalf of non Muslim countries.
Speaker 1: Those people who joined al Qaida were signing up to be,
Speaker 1: in their own minds, warriors, and in most instances they
Speaker 1: knew they would die. They engaged in terrorist activities all
Speaker 1: over the world, always with the theoretical aspiration of using
Speaker 1: those terrorist interventions to make change in Western policy. But
Speaker 1: at no point in its history was al Kaieda effective
Speaker 1: for more than a few days in a few places
Speaker 1: at a time in actually achieving sovereign government over substantial
Speaker 1: amounts of territory. What made the Islamic State different from
Speaker 1: al Qaeda, and indeed unique in the annals of Islamic
Speaker 1: jihadi terrorism, is that the Islamic State did manage to
Speaker 1: conquer a large swath of territory in which they actually
Speaker 1: created a functioning government. Using their reign of terror, but
Speaker 1: also using the ordinary bureaucratic tools of regular, everyday municipal governance,
Speaker 1: they manage to run the show. The end of Islamic
Speaker 1: State and the death of Baghdadi himself capture the reality
Speaker 1: that the Islamic State is no longer distinct or different.
Speaker 1: It does not govern territory in any meaningful way anywhere
Speaker 1: in the areas of Sirah and Iraq, where it had
Speaker 1: its heart. It's true that in a few places around
Speaker 1: the world, various terrorists jihadi groups have used the brand
Speaker 1: name of Islamic State to try to claim for themselves
Speaker 1: the authority to govern in small enclaves. That will probably
Speaker 1: continue to be the case. It will probably still be
Speaker 1: the case that if you're the leader of jihadi group
Speaker 1: and you actually managed to grab some land and you
Speaker 1: want to legitimate what you're doing, you may say I
Speaker 1: am the local branch of the Islamic State. But as
Speaker 1: that becomes rarer and rarer, and as there is no
Speaker 1: substantive caliphate of the Islamic State to which such an
Speaker 1: oath of allegiance could refer, what's going to happen into
Speaker 1: Islamic State, overwhelmingly likely is that it will gradually morph
Speaker 1: back into the organization from which it came in the
Speaker 1: first place, namely Al Qaida. Ultimately, historians will look at
Speaker 1: the Islamic State and conclude that it represented a distinct
Speaker 1: moment where there was an attempt to instantiate in real
Speaker 1: life a set of old, indeed medievil ideas about utopian
Speaker 1: Islamic governance and that that effort failed. The death of
Speaker 1: Abu Bakhar al Baghdadi is therefore significant as a kind
Speaker 1: of endpoint to the aspirational ideal of the Islamic State
Speaker 1: as a real world state. As a terrorist organization like
Speaker 1: al Qaeda, the Islamic State can continue to exist without
Speaker 1: a caliph, but in its character as a distinct aspirational
Speaker 1: caliphate trying to govern space, it can't do without a
Speaker 1: leader at the top, and in that sense, Bahdadi's death
Speaker 1: is historically significant. Deep Background is brought to you by
Speaker 1: Pushkin Industries. Our producer is Lydia Genecott, with engineering by
Speaker 1: Jason Gambrell and Jason Roskowski. Our showrunner is Sophie mckibbon.
Speaker 1: Our theme music is composed by Luis Gara. Special thanks
Speaker 1: for the Pushkin Brass, Malcolm Gladwell, Jacob Weisberg, and Mia Lobel.
Speaker 1: I'm Noah Feldman. You can follow me on Twitter at
Speaker 1: Noah R. Feldman. This is Deep Background.