1 00:00:15,356 --> 00:00:23,676 Speaker 1: Pushkin from Pushkin Industries. This is deep background to show 2 00:00:23,676 --> 00:00:26,916 Speaker 1: where we explore the stories behind the stories in the news. 3 00:00:27,236 --> 00:00:31,596 Speaker 1: I'm Noah Feldman. For more than a year we've been 4 00:00:31,636 --> 00:00:36,516 Speaker 1: hearing about the idea of herd immunity. In recent weeks, though, 5 00:00:36,556 --> 00:00:38,996 Speaker 1: it's become very clear that the United States is not 6 00:00:39,076 --> 00:00:42,796 Speaker 1: in the foreseeable future going to reach the threshold for 7 00:00:43,356 --> 00:00:47,396 Speaker 1: herd immunity. There are a range of reasons and causes 8 00:00:47,436 --> 00:00:51,596 Speaker 1: for this, and they go from vaccine hesitancy, to the 9 00:00:51,596 --> 00:00:56,556 Speaker 1: contagiousness of new variants, and beyond to the underlying science. 10 00:00:57,836 --> 00:01:00,836 Speaker 1: As a consequence, we're all trying to figure out what 11 00:01:00,996 --> 00:01:06,276 Speaker 1: this means for what happens next. Will COVID become a manageable, 12 00:01:06,476 --> 00:01:10,196 Speaker 1: self contained disease not unlike the common coal, Will it 13 00:01:10,276 --> 00:01:13,516 Speaker 1: alternatively develop new variants that require us to go back 14 00:01:13,516 --> 00:01:17,116 Speaker 1: to the drawing board and develop new vaccines, or will 15 00:01:17,156 --> 00:01:20,596 Speaker 1: it be something in between. To help us understand these 16 00:01:20,636 --> 00:01:25,356 Speaker 1: pressing questions, we're joined by doctor Mark Lipsitch Our go 17 00:01:25,596 --> 00:01:29,596 Speaker 1: to COVID expert here on the program and indeed throughout 18 00:01:29,636 --> 00:01:33,836 Speaker 1: the country. Mark is a professor of epidemiology at the 19 00:01:33,836 --> 00:01:37,556 Speaker 1: Harvard Shan School of public Health. He's affiliated both with 20 00:01:37,556 --> 00:01:40,516 Speaker 1: the Epidemiology Department and with the Department of Immunology and 21 00:01:40,556 --> 00:01:45,196 Speaker 1: Infectious Disease. He runs the Center for Communicable Disease Dynamics 22 00:01:45,316 --> 00:01:48,956 Speaker 1: at Harvard. Regular listeners of the podcast will know that 23 00:01:48,996 --> 00:01:51,756 Speaker 1: Mark was one of the first voices anywhere in the 24 00:01:51,876 --> 00:01:54,636 Speaker 1: United States or indeed in the world, drawing attention to 25 00:01:54,676 --> 00:01:58,596 Speaker 1: the future trajectory of COVID nineteen. He joined us as 26 00:01:58,596 --> 00:02:00,876 Speaker 1: early as February twenty twenty to tell us where the 27 00:02:00,916 --> 00:02:03,396 Speaker 1: disease was going to go, and he's managed to join 28 00:02:03,516 --> 00:02:07,196 Speaker 1: us intermittently ever since, taking time out of his extraordinarily 29 00:02:07,236 --> 00:02:10,796 Speaker 1: busy schedule to set us right about where COVID is, 30 00:02:11,156 --> 00:02:19,636 Speaker 1: where it's been, and where it's going. Mark, thank you 31 00:02:19,956 --> 00:02:24,836 Speaker 1: as always for joining us. In general, I've tried to 32 00:02:24,956 --> 00:02:27,916 Speaker 1: keep you as a guest, reserved for those moments when 33 00:02:27,956 --> 00:02:31,436 Speaker 1: something really important seems to be shifting in the trajectory 34 00:02:31,596 --> 00:02:35,516 Speaker 1: of COVID nineteen and news reports suggest that maybe we're 35 00:02:35,556 --> 00:02:38,076 Speaker 1: getting there at this moment as well, and that that's 36 00:02:38,076 --> 00:02:41,516 Speaker 1: something has to do with our acknowledgement finally that herd 37 00:02:41,556 --> 00:02:44,276 Speaker 1: immunity may not be coming our way in the United 38 00:02:44,316 --> 00:02:46,476 Speaker 1: States and the feseable future. It's something you have been 39 00:02:46,796 --> 00:02:49,996 Speaker 1: warning about really almost from the start. So I want 40 00:02:49,996 --> 00:02:52,716 Speaker 1: to start by just asking you to remind us, all 41 00:02:52,836 --> 00:02:56,836 Speaker 1: for definitional purposes, of what herd immunity is defined in 42 00:02:56,956 --> 00:03:02,556 Speaker 1: terms of our zero the replication rate of the virus. Sure, 43 00:03:02,756 --> 00:03:05,356 Speaker 1: I think what you're asking is about the herd immunity threshold, 44 00:03:05,356 --> 00:03:07,196 Speaker 1: and I'll come back to that distinction in a minute, 45 00:03:07,196 --> 00:03:10,636 Speaker 1: because I think it's actually helpful to talk about it, 46 00:03:10,916 --> 00:03:14,156 Speaker 1: But because the herd immunity threshold is to find as 47 00:03:14,196 --> 00:03:18,396 Speaker 1: that level of immunity in the population from whatever means, 48 00:03:19,116 --> 00:03:23,996 Speaker 1: usually infection or prior infection or vaccination or a combination, 49 00:03:24,836 --> 00:03:28,876 Speaker 1: that it can't spread widely because there are so many 50 00:03:28,996 --> 00:03:32,316 Speaker 1: immune people that chains of transmission don't sustain themselves and 51 00:03:32,396 --> 00:03:35,156 Speaker 1: they fizzle out before the virus can spread too far. 52 00:03:36,876 --> 00:03:41,116 Speaker 1: That is quantified by the basic reproductive rate or basic 53 00:03:41,156 --> 00:03:45,036 Speaker 1: reproductive number are zero are not, which is the number 54 00:03:45,076 --> 00:03:50,076 Speaker 1: of secondary cases that each case creates, and when everyone 55 00:03:50,116 --> 00:03:52,876 Speaker 1: is susceptible, and when you do a little bit of 56 00:03:52,876 --> 00:03:56,556 Speaker 1: algebra with that expression and try to find a level 57 00:03:56,556 --> 00:04:00,356 Speaker 1: of immunity where instead of infecting, say three or four 58 00:04:00,396 --> 00:04:03,796 Speaker 1: other people, the average case infects less than one other person, 59 00:04:03,956 --> 00:04:05,796 Speaker 1: meaning the number of cases is going to go down 60 00:04:05,916 --> 00:04:08,556 Speaker 1: over time. If you do the math, you end up 61 00:04:08,636 --> 00:04:12,996 Speaker 1: getting the proportion that have to be immune is one 62 00:04:13,396 --> 00:04:17,276 Speaker 1: the reciprocal of that number our zero one one over 63 00:04:17,316 --> 00:04:21,716 Speaker 1: our zero. And so, to give some examples, if our 64 00:04:21,796 --> 00:04:24,436 Speaker 1: zero is three, then that's two thirds. If our zero 65 00:04:24,556 --> 00:04:30,356 Speaker 1: is four, that's three quarters. You've been saying ever since 66 00:04:30,356 --> 00:04:33,476 Speaker 1: people started talking about the possibility of herd immunity being 67 00:04:33,516 --> 00:04:38,196 Speaker 1: created partly through the spread of vaccines, that it would 68 00:04:38,196 --> 00:04:40,596 Speaker 1: be optimistic. I think that's the word you used to 69 00:04:40,716 --> 00:04:44,836 Speaker 1: actually imagine we could get there. As I understand some 70 00:04:44,876 --> 00:04:47,316 Speaker 1: public statements that you've made recently, including the New York Times, 71 00:04:47,356 --> 00:04:50,116 Speaker 1: you're now willing to shift a little bit from it's 72 00:04:50,156 --> 00:04:53,556 Speaker 1: unlikely that we'll get there, too. It seems extraordinarily improbable 73 00:04:53,916 --> 00:04:55,876 Speaker 1: that we're going to get there in the foreseeable future 74 00:04:56,436 --> 00:04:59,196 Speaker 1: in the US, at least not through vaccinations as opposed 75 00:04:59,196 --> 00:05:05,796 Speaker 1: to vaccinations plus natural infections. What has shifted your empirical observation. 76 00:05:05,796 --> 00:05:07,996 Speaker 1: I don't think your theory has changed, but what has 77 00:05:08,436 --> 00:05:13,396 Speaker 1: caused your perical observation to evolve to that point? Well, 78 00:05:13,476 --> 00:05:16,476 Speaker 1: I think I do want to now mention the concept 79 00:05:16,516 --> 00:05:19,396 Speaker 1: that hurt immunity and that threshold are slightly different. The 80 00:05:19,436 --> 00:05:22,196 Speaker 1: threshold is the point where there is so much hurt 81 00:05:22,236 --> 00:05:25,996 Speaker 1: immunity that we don't have ongoing transmission when we return 82 00:05:26,036 --> 00:05:30,236 Speaker 1: to normal behavior. Herd immunity is a quantity, it's between 83 00:05:30,356 --> 00:05:33,236 Speaker 1: zero and one, and we are getting more and more 84 00:05:33,276 --> 00:05:35,596 Speaker 1: of it, So we are getting hurt some hurt immunity. 85 00:05:35,996 --> 00:05:38,756 Speaker 1: But my statements have been about whether we're going to 86 00:05:38,956 --> 00:05:42,236 Speaker 1: reach a level of immunity that means that we can 87 00:05:42,436 --> 00:05:47,196 Speaker 1: expect zero or nearly zero transmission despite pre pandemic types 88 00:05:47,236 --> 00:05:50,076 Speaker 1: of behavior. So, first of all, thanks for that clarification, 89 00:05:50,116 --> 00:05:53,356 Speaker 1: because I and I think most other non scientists have 90 00:05:53,436 --> 00:05:56,596 Speaker 1: been using the term herd immunity when what we should 91 00:05:56,596 --> 00:06:00,316 Speaker 1: have been saying is the threshold of enough hurt immunity. 92 00:06:00,396 --> 00:06:03,236 Speaker 1: So you could say, well, right, it's like the blueness 93 00:06:03,276 --> 00:06:05,036 Speaker 1: of the blue thing. It could be very faintly blue 94 00:06:05,036 --> 00:06:06,796 Speaker 1: and it would still be blue. But the question is 95 00:06:06,796 --> 00:06:08,396 Speaker 1: how blued you need it to be for whatever your 96 00:06:08,436 --> 00:06:14,756 Speaker 1: purpose is. Right, Okay, that's important. That's important for I mean, 97 00:06:15,356 --> 00:06:19,356 Speaker 1: everybody is, including scientists, are sometimes sloppy about using her 98 00:06:19,436 --> 00:06:22,076 Speaker 1: immunity is shorthand for the threshold. The reason I try 99 00:06:22,076 --> 00:06:25,196 Speaker 1: to be very careful about it is that herd immunity 100 00:06:25,396 --> 00:06:27,956 Speaker 1: is a good thing. Even a little bit is good, 101 00:06:28,076 --> 00:06:30,556 Speaker 1: and a little more is a little better. And being 102 00:06:30,596 --> 00:06:33,116 Speaker 1: below the threshold does not mean it's not doing any work. 103 00:06:33,196 --> 00:06:35,796 Speaker 1: It is doing a lot of work. So that's actually 104 00:06:35,796 --> 00:06:38,476 Speaker 1: some of the good news is that we are building 105 00:06:38,556 --> 00:06:41,156 Speaker 1: up a lot of herd immunity. And the reason to 106 00:06:41,236 --> 00:06:45,516 Speaker 1: answer now your question, the reason why I think it's 107 00:06:45,556 --> 00:06:49,396 Speaker 1: extremely unlikely that we will get to the threshold in 108 00:06:49,436 --> 00:06:53,796 Speaker 1: the United States is a few things. One is, when 109 00:06:53,796 --> 00:06:56,916 Speaker 1: we started out, we had no data on whether these 110 00:06:56,996 --> 00:07:03,156 Speaker 1: vaccines were protective against infection and a transmission, and that's 111 00:07:03,196 --> 00:07:06,956 Speaker 1: the part of vaccine effectiveness that matters to her immunity. 112 00:07:07,036 --> 00:07:10,356 Speaker 1: If everybody gets a technis shot, that doesn't protect the 113 00:07:10,356 --> 00:07:12,916 Speaker 1: next person from getting tetanus because it doesn't do anything 114 00:07:12,916 --> 00:07:16,556 Speaker 1: to transmission of the bacteria which comes from the soil. 115 00:07:17,476 --> 00:07:20,716 Speaker 1: If the vaccine isn't stopping transmission, then but it's just 116 00:07:20,716 --> 00:07:24,036 Speaker 1: stopping disease, it's not doing anything for her immunity. These 117 00:07:24,116 --> 00:07:27,596 Speaker 1: vaccines do a lot for her immunity. Initially, it was 118 00:07:27,676 --> 00:07:30,996 Speaker 1: unclear how much the first number I think that was 119 00:07:31,116 --> 00:07:34,356 Speaker 1: meaningful that came out with sixty one percent, but that 120 00:07:34,436 --> 00:07:37,556 Speaker 1: was from one dose and probably an underestimate for technical 121 00:07:37,596 --> 00:07:40,836 Speaker 1: reasons that aren't that interesting for the Maderna vaccine, And 122 00:07:40,956 --> 00:07:44,396 Speaker 1: now the numbers have come out through various sources of evidence. 123 00:07:44,396 --> 00:07:47,636 Speaker 1: It's still uncertain, but it seems like it's probably somewhere 124 00:07:48,116 --> 00:07:51,276 Speaker 1: between about sixty and ninety percent, probably seventy and nine 125 00:07:51,436 --> 00:07:57,636 Speaker 1: protective against the process of transmission. So that's really good news, 126 00:07:58,116 --> 00:08:03,836 Speaker 1: but it's not one hundred percent. And that distinction matters 127 00:08:03,956 --> 00:08:06,956 Speaker 1: because to get to the herd immunity threshold, we have 128 00:08:06,996 --> 00:08:10,556 Speaker 1: to cut transmission to one minus one over our zero, 129 00:08:11,276 --> 00:08:15,196 Speaker 1: not just vaccinate that number of people. So the more 130 00:08:15,836 --> 00:08:18,316 Speaker 1: the closer to one hundred percent effect of the vaccine is, 131 00:08:19,036 --> 00:08:20,956 Speaker 1: the more we can interchange how many people have been 132 00:08:20,996 --> 00:08:23,836 Speaker 1: vaccinated and how many people are totally immune. But we 133 00:08:23,916 --> 00:08:26,596 Speaker 1: can't totally do that yet. It's because we have to 134 00:08:26,676 --> 00:08:28,636 Speaker 1: multiply one by the other. Right, the question is not 135 00:08:29,156 --> 00:08:31,636 Speaker 1: how many people have the vaccine, and it's not how 136 00:08:31,716 --> 00:08:33,876 Speaker 1: much does the vaccine do, it's how much does the 137 00:08:33,956 --> 00:08:35,756 Speaker 1: vaccine do for the number of people who have been 138 00:08:35,796 --> 00:08:39,956 Speaker 1: vaccinated exactly. Yeah, okay, so we now understand that number, 139 00:08:40,036 --> 00:08:44,876 Speaker 1: and though it's surprisingly good seventy nine, it's still not 140 00:08:44,996 --> 00:08:47,036 Speaker 1: going to get us necessarily where we need to go 141 00:08:47,196 --> 00:08:49,756 Speaker 1: when you consider it as a percentage of all of 142 00:08:49,756 --> 00:08:51,836 Speaker 1: the people who've been vaccinated, which is the part that's 143 00:08:51,876 --> 00:08:55,356 Speaker 1: not so high. Right. So the other bit of good 144 00:08:55,396 --> 00:08:58,396 Speaker 1: news that makes it easier to get close to the 145 00:08:58,396 --> 00:09:01,676 Speaker 1: threshold is that children really don't seem to be as 146 00:09:01,716 --> 00:09:05,596 Speaker 1: important for transmission, and so that one one over our 147 00:09:05,716 --> 00:09:09,916 Speaker 1: zero is an average. And as you learn more about 148 00:09:09,916 --> 00:09:12,556 Speaker 1: the population, if you leave out some of the people 149 00:09:12,676 --> 00:09:16,276 Speaker 1: from vaccination who are less important to transmission, that matters 150 00:09:16,356 --> 00:09:19,036 Speaker 1: less than leaving out people who are more important to transmission. 151 00:09:19,076 --> 00:09:21,076 Speaker 1: So that probably buys us a little bit of margin. 152 00:09:21,876 --> 00:09:24,396 Speaker 1: How far did those numbers go mark on kids not 153 00:09:24,476 --> 00:09:26,996 Speaker 1: being involved in transmission? And the reason this is relevant 154 00:09:27,076 --> 00:09:29,676 Speaker 1: is one of the conversations that I've heard repeated a 155 00:09:29,716 --> 00:09:32,316 Speaker 1: lot among all kinds of people is people say, well, 156 00:09:32,316 --> 00:09:35,276 Speaker 1: I'm vaccinated, but my kids aren't vaccinated, and so I'm 157 00:09:35,316 --> 00:09:37,716 Speaker 1: worried that there is some possibility that I might transmit 158 00:09:37,756 --> 00:09:39,636 Speaker 1: to them, or that they might transmit to me, and 159 00:09:39,676 --> 00:09:41,996 Speaker 1: even though they wouldn't get that sick, most probably they 160 00:09:41,996 --> 00:09:44,436 Speaker 1: would nevertheless transmit it. And so if the number of 161 00:09:45,156 --> 00:09:47,716 Speaker 1: kids not transmitting is relatively high, then that worry is 162 00:09:47,796 --> 00:09:51,436 Speaker 1: much less salient. It seems to increase with age, So 163 00:09:51,556 --> 00:09:54,796 Speaker 1: a fifteen year old is probably effectively an adult from 164 00:09:54,836 --> 00:09:59,156 Speaker 1: sars Kovi two's perspective, roughly speaking, and a five year 165 00:09:59,156 --> 00:10:03,116 Speaker 1: old is definitely considerably less I'd say that's the sort 166 00:10:03,156 --> 00:10:06,476 Speaker 1: of rough picture. Okay, So those are the bits of 167 00:10:06,516 --> 00:10:10,596 Speaker 1: good news. Mostly, the bits of bad news that make 168 00:10:10,676 --> 00:10:14,516 Speaker 1: it unlikely that, say, the United States will quickly get 169 00:10:14,516 --> 00:10:17,716 Speaker 1: to the herd immunity threshold are First, that variants are 170 00:10:17,756 --> 00:10:22,996 Speaker 1: more contagious than the original strain of sars Kobe two. 171 00:10:23,636 --> 00:10:27,796 Speaker 1: So everyone agreed pretty much that the original strain had 172 00:10:27,836 --> 00:10:30,476 Speaker 1: a reproductive number of about two and a half or three. 173 00:10:30,556 --> 00:10:33,516 Speaker 1: I think that might have been too simple, and maybe 174 00:10:33,516 --> 00:10:35,916 Speaker 1: it's higher in some places, but let's say for the 175 00:10:35,916 --> 00:10:37,676 Speaker 1: sake of argument, it was two and a half or three. 176 00:10:38,836 --> 00:10:41,516 Speaker 1: The B one one seven variant that's now very common 177 00:10:41,596 --> 00:10:44,516 Speaker 1: in many parts of the world is thought to be 178 00:10:44,516 --> 00:10:48,436 Speaker 1: about fifty percent more contagious, more transmissible, so that pushes 179 00:10:48,476 --> 00:10:51,836 Speaker 1: it up to maybe four and a half, and so 180 00:10:51,876 --> 00:10:55,636 Speaker 1: that pushes the herd immunity threshold close to eighty percent. 181 00:10:57,956 --> 00:11:01,956 Speaker 1: So that means that say we need say it's seventy 182 00:11:01,956 --> 00:11:04,516 Speaker 1: five percent, say we need to immunize seventy five percent 183 00:11:04,556 --> 00:11:07,756 Speaker 1: of the population, and say that the vaccine is eighty 184 00:11:07,796 --> 00:11:12,276 Speaker 1: percent of transmission, then we need to get very close 185 00:11:12,356 --> 00:11:15,716 Speaker 1: to whatever seventy five divided by eighty is, so very 186 00:11:15,716 --> 00:11:19,156 Speaker 1: close to one hundred percent coverage in the population in 187 00:11:19,276 --> 00:11:24,476 Speaker 1: order to reach that threshold. And given the combination of 188 00:11:24,476 --> 00:11:28,116 Speaker 1: hesitancy poor access, which I think are two sides of 189 00:11:28,156 --> 00:11:33,476 Speaker 1: the same coin, and so far not vaccinating children under sixteen, 190 00:11:33,556 --> 00:11:36,396 Speaker 1: soon it will probably be under twelve, I think it's 191 00:11:36,476 --> 00:11:41,556 Speaker 1: just very hard to imagine getting to that level. So 192 00:11:41,596 --> 00:11:45,436 Speaker 1: now let's turn to what this means in practical terms. 193 00:11:45,996 --> 00:11:49,956 Speaker 1: There are a few different dimensions. Let's start by thinking 194 00:11:49,996 --> 00:11:52,756 Speaker 1: about modeling, which is one of the things that you 195 00:11:52,836 --> 00:11:55,036 Speaker 1: do for a living and that you've done so skillfully 196 00:11:55,196 --> 00:11:59,836 Speaker 1: in this entire epidemic process. When you think about what 197 00:11:59,916 --> 00:12:06,796 Speaker 1: models might look plausible for how the current COVID virus 198 00:12:07,036 --> 00:12:10,876 Speaker 1: is going to proceed. Circumstances where we're not at the 199 00:12:10,916 --> 00:12:14,636 Speaker 1: threshold of herd immunity. What's the modeling space, as it were, 200 00:12:14,716 --> 00:12:20,876 Speaker 1: What are the possibilities that you see as most plausible. Yeah, 201 00:12:20,996 --> 00:12:25,556 Speaker 1: I think the most plausible scenario, not the only plausible one, 202 00:12:25,556 --> 00:12:27,716 Speaker 1: but really the most plausible one is one that was 203 00:12:27,876 --> 00:12:32,036 Speaker 1: described in science in a paper by Rustamantia and Jenny 204 00:12:32,116 --> 00:12:37,516 Speaker 1: Levine and Autar Bjornstad. And what they do is essentially 205 00:12:37,556 --> 00:12:43,396 Speaker 1: make an analogy to other coronaviruses. So the most important 206 00:12:43,436 --> 00:12:47,036 Speaker 1: difference probably between this coronavirus and other ones is that 207 00:12:47,236 --> 00:12:50,476 Speaker 1: everyone in the world has been infected with the other 208 00:12:50,516 --> 00:12:55,476 Speaker 1: coronaviruses many times by the time they're say a teenager, 209 00:12:56,116 --> 00:12:59,156 Speaker 1: and so people get infected over and over and it 210 00:12:59,236 --> 00:13:02,116 Speaker 1: just circulates. They just circulate. And those are mostly they're 211 00:13:02,156 --> 00:13:03,956 Speaker 1: not all of the common cold viruses, but they are 212 00:13:03,996 --> 00:13:06,476 Speaker 1: within the family of the common cold viruses. They are 213 00:13:07,076 --> 00:13:13,076 Speaker 1: justifiably obscure except virologists because they don't make people very sick. 214 00:13:14,116 --> 00:13:18,116 Speaker 1: And so I think a very likely outcome is that 215 00:13:18,156 --> 00:13:21,236 Speaker 1: this one behaves similarly, and that what vaccines are going 216 00:13:21,236 --> 00:13:23,916 Speaker 1: to do for us is to get us over the 217 00:13:23,996 --> 00:13:27,196 Speaker 1: hump of the period in history, namely the one we're 218 00:13:27,196 --> 00:13:30,436 Speaker 1: living through where there are a lot of people who 219 00:13:31,116 --> 00:13:34,716 Speaker 1: would get very sick from a first exposure to this virus, 220 00:13:34,796 --> 00:13:38,676 Speaker 1: and everybody's getting first exposures because it's a new virus, 221 00:13:39,196 --> 00:13:43,036 Speaker 1: and therefore that's a bad combination. So if the vaccines 222 00:13:43,196 --> 00:13:46,356 Speaker 1: can be used to put us in a position where 223 00:13:46,396 --> 00:13:49,676 Speaker 1: nobody is getting or a few people are getting exposed 224 00:13:49,716 --> 00:13:52,276 Speaker 1: for the first time when they are also old or 225 00:13:52,316 --> 00:13:56,716 Speaker 1: have comorbid conditions, then the vaccines will have prevented a 226 00:13:56,716 --> 00:14:01,036 Speaker 1: lot of illness and death. And then it's quite possible 227 00:14:01,116 --> 00:14:04,756 Speaker 1: that the residual circulation of the virus among the people 228 00:14:04,756 --> 00:14:07,836 Speaker 1: who aren't vaccinated, or among the people in whom the 229 00:14:07,876 --> 00:14:12,876 Speaker 1: vaccine immunity slowly wanes, is going to give us longer 230 00:14:12,996 --> 00:14:17,756 Speaker 1: term protection against severe disease, so that five years from now, 231 00:14:17,836 --> 00:14:21,636 Speaker 1: you and I and our children and our parents will 232 00:14:21,636 --> 00:14:24,676 Speaker 1: have probably been infected by the coronavirus if we don't 233 00:14:24,796 --> 00:14:27,996 Speaker 1: continue to vaccinate very heavily for the next five years, 234 00:14:28,876 --> 00:14:32,436 Speaker 1: but it won't bother us because we will have all 235 00:14:32,476 --> 00:14:35,956 Speaker 1: been vaccinated once and or had it before at an 236 00:14:35,956 --> 00:14:39,836 Speaker 1: age when we were not likely to get very sick, 237 00:14:40,476 --> 00:14:43,396 Speaker 1: and so it will behave much like the other coronaviruses. 238 00:14:44,036 --> 00:14:46,436 Speaker 1: So the good news part of that is that at 239 00:14:46,476 --> 00:14:51,116 Speaker 1: least over time, that describes a kind of normalization where 240 00:14:51,236 --> 00:14:54,036 Speaker 1: childhood infection is protective in a lot of good and 241 00:14:54,116 --> 00:14:56,516 Speaker 1: healthy ways. I assume the downside of that is that 242 00:14:56,556 --> 00:15:00,076 Speaker 1: among those who are not vaccinated and who are more vulnerable, 243 00:15:00,636 --> 00:15:03,396 Speaker 1: a substantial number of people who have not been vaccinated. 244 00:15:03,436 --> 00:15:06,276 Speaker 1: Among that class of people could get very sick and 245 00:15:06,396 --> 00:15:10,436 Speaker 1: even die in the next let's say five who would 246 00:15:10,436 --> 00:15:14,436 Speaker 1: not if they were vaccinated. Right, So the public health 247 00:15:14,796 --> 00:15:16,876 Speaker 1: goal if that scenario is going to play out, is 248 00:15:16,916 --> 00:15:19,996 Speaker 1: to vaccinate as many of the people known to be 249 00:15:20,036 --> 00:15:23,916 Speaker 1: at high risk as possible, and probably also as many 250 00:15:23,996 --> 00:15:27,436 Speaker 1: of the other people as possible, in order to slow 251 00:15:27,476 --> 00:15:32,076 Speaker 1: down transmission and just give people's immune systems a chance 252 00:15:32,076 --> 00:15:35,676 Speaker 1: to catch up. If that scenario plays out, then the 253 00:15:35,796 --> 00:15:39,076 Speaker 1: vaccines are sort of a bridge to a more peaceful 254 00:15:39,116 --> 00:15:42,076 Speaker 1: future rather than something we have to do all the time. 255 00:15:43,476 --> 00:15:47,556 Speaker 1: So that's the vaccine as bridge scenario. And it's not 256 00:15:47,676 --> 00:15:50,036 Speaker 1: so bad relative to the other possibilities, and you think 257 00:15:50,076 --> 00:15:52,556 Speaker 1: it's the most probable, So that's good news. Talk to 258 00:15:52,636 --> 00:15:56,236 Speaker 1: us about some of the other possibilities. Well, the other 259 00:15:56,276 --> 00:16:01,156 Speaker 1: possibilities would be that immunity to severe disease from the 260 00:16:01,236 --> 00:16:06,196 Speaker 1: vaccine and or from natural infection is not long lasting, 261 00:16:06,596 --> 00:16:12,516 Speaker 1: either because the immunefectors wan over time, or because the 262 00:16:12,596 --> 00:16:16,716 Speaker 1: virus changes and is not as strongly affected by the immunity, 263 00:16:16,836 --> 00:16:20,636 Speaker 1: or both, And so then it's a sort of more 264 00:16:20,676 --> 00:16:24,396 Speaker 1: ongoing war because we have to keep trying to protect 265 00:16:24,476 --> 00:16:28,236 Speaker 1: people from infection, not only from their first infection, but 266 00:16:28,356 --> 00:16:33,876 Speaker 1: from their second, third, fourth infections. And is possible. I 267 00:16:33,916 --> 00:16:38,996 Speaker 1: think infection immunity very likely will wane, But the question 268 00:16:39,116 --> 00:16:42,716 Speaker 1: is whether there is this long term, relatively long term 269 00:16:42,716 --> 00:16:45,956 Speaker 1: immunity that gets you from infection to infection and then 270 00:16:45,956 --> 00:16:51,796 Speaker 1: gets boosted again against getting really sick. So that's one 271 00:16:51,836 --> 00:16:54,436 Speaker 1: of the two subpossibilies that you just describe, that infection 272 00:16:54,476 --> 00:16:58,196 Speaker 1: immunity itself WANs, whether from natural infection or from the vaccine, 273 00:16:58,196 --> 00:17:01,276 Speaker 1: and as you say, whether that's a disaster or not 274 00:17:01,356 --> 00:17:04,596 Speaker 1: really depends on whether the virus is circulating in enough 275 00:17:04,676 --> 00:17:08,276 Speaker 1: quantity that you can get a natural booster from being exposed. 276 00:17:09,356 --> 00:17:12,876 Speaker 1: Then there's the possibility that you mentioned that there might 277 00:17:12,916 --> 00:17:17,836 Speaker 1: actually be an evolutionary process in which the virus evolves 278 00:17:17,916 --> 00:17:21,596 Speaker 1: to the point where it is vaccine resistant. And I 279 00:17:21,596 --> 00:17:24,356 Speaker 1: guess what I want to ask you about is you've 280 00:17:24,396 --> 00:17:28,916 Speaker 1: done plenty of modeling of other viruses that have evolved 281 00:17:28,916 --> 00:17:31,516 Speaker 1: to be vaccine resistant, presumably, and there are lots of 282 00:17:31,516 --> 00:17:35,276 Speaker 1: bacteria where this has happened over time where there's pretty 283 00:17:35,276 --> 00:17:38,276 Speaker 1: good data I think on trying to figure out that, 284 00:17:38,356 --> 00:17:41,236 Speaker 1: and so there must be familiar and available models to 285 00:17:41,276 --> 00:17:44,476 Speaker 1: you when you think about vaccine resistance. Is there any 286 00:17:44,516 --> 00:17:47,516 Speaker 1: way to think intelligently about the probability of something like 287 00:17:47,556 --> 00:17:52,356 Speaker 1: that happening? Yeah, I mean flu certainly is the sort 288 00:17:52,396 --> 00:17:55,116 Speaker 1: of classic example of a viral infection that changes over 289 00:17:55,156 --> 00:17:59,036 Speaker 1: time to resist our natural immunity, and at the same 290 00:17:59,076 --> 00:18:03,596 Speaker 1: time it happens to also escape from existing vaccines, and 291 00:18:03,636 --> 00:18:06,876 Speaker 1: that's why we keep changing the flu vaccine. So I 292 00:18:06,916 --> 00:18:13,196 Speaker 1: think that's the example or the analog. The viruses are 293 00:18:13,236 --> 00:18:17,396 Speaker 1: different and they evolve differently, and I'm not sure how 294 00:18:17,396 --> 00:18:20,316 Speaker 1: to put a probability a sort of how far the virus, 295 00:18:20,476 --> 00:18:24,156 Speaker 1: this virus can go in escaping our immunity. It's like 296 00:18:24,196 --> 00:18:26,076 Speaker 1: we've chased it down an alley, and the question is 297 00:18:26,076 --> 00:18:27,756 Speaker 1: at the end of that alley, is there a brick wall, 298 00:18:27,756 --> 00:18:30,596 Speaker 1: and it's stuck and we've got it. It's escaped as 299 00:18:30,596 --> 00:18:32,516 Speaker 1: far as it can escape, and now there's nowhere more 300 00:18:32,556 --> 00:18:34,436 Speaker 1: for it to go, or is there a big vista 301 00:18:34,476 --> 00:18:38,996 Speaker 1: of other things for it to do? And I don't 302 00:18:39,516 --> 00:18:42,276 Speaker 1: I don't know any way to put probabilities on that. 303 00:18:42,556 --> 00:18:46,316 Speaker 1: I think the best way to know it probably would 304 00:18:46,316 --> 00:18:48,556 Speaker 1: be to try to do it in the lab and 305 00:18:48,636 --> 00:18:51,476 Speaker 1: see where it goes from the variance we've already seen, 306 00:18:53,036 --> 00:18:55,196 Speaker 1: which is itself a somewhat dangerous thing to do, but 307 00:18:55,276 --> 00:19:00,436 Speaker 1: probably a very valuable one. That's a fascinating topic, which 308 00:19:00,436 --> 00:19:01,796 Speaker 1: I would like to come to in just a second, 309 00:19:01,836 --> 00:19:04,916 Speaker 1: but before we do, I'm sort of surprised to hear 310 00:19:04,956 --> 00:19:07,636 Speaker 1: you say that there isn't a kind of ability to 311 00:19:07,716 --> 00:19:10,716 Speaker 1: make a prediction about probability of evolution, especially in light 312 00:19:10,756 --> 00:19:14,476 Speaker 1: of the fact that we've now observed the virus evolving 313 00:19:14,516 --> 00:19:18,396 Speaker 1: pretty quickly with respect to the variants that are out there. 314 00:19:18,436 --> 00:19:19,796 Speaker 1: I mean, is there no I guess there isn't a 315 00:19:19,916 --> 00:19:24,236 Speaker 1: really way to extrapolate from the virus's capacity to evolve, 316 00:19:24,876 --> 00:19:28,916 Speaker 1: to evolve these new variants that are more capable of 317 00:19:28,916 --> 00:19:32,436 Speaker 1: infection than the kind before. To extrapolate from that to 318 00:19:32,796 --> 00:19:34,756 Speaker 1: whether it would be able to evolve in ways that 319 00:19:34,796 --> 00:19:38,796 Speaker 1: would escape the vaccine, Well, I think there are a 320 00:19:38,796 --> 00:19:42,196 Speaker 1: few things. One is, it can mutate. I mean it's 321 00:19:42,356 --> 00:19:45,356 Speaker 1: generating mutations all the time, and the existing variants are 322 00:19:45,396 --> 00:19:49,436 Speaker 1: generating new variants that are more different from the original 323 00:19:50,356 --> 00:19:53,716 Speaker 1: strain than the say B one one seven itself. So 324 00:19:53,876 --> 00:19:56,676 Speaker 1: B one one seven is making new versions of itself 325 00:19:56,676 --> 00:19:59,796 Speaker 1: that are further mutated. So that's not in doubt. That's 326 00:19:59,836 --> 00:20:03,796 Speaker 1: just RNA viruses do that. The question is what will 327 00:20:03,836 --> 00:20:08,036 Speaker 1: the impact be on escaping our immune responses, and even 328 00:20:08,076 --> 00:20:12,116 Speaker 1: for the existing variants, that remains a little bit unclear. 329 00:20:12,196 --> 00:20:15,996 Speaker 1: It is very clear that they escape neutralizing antibodies to 330 00:20:16,076 --> 00:20:18,956 Speaker 1: varying degrees depending on the variant you're talking about. But 331 00:20:19,116 --> 00:20:22,316 Speaker 1: whether that means that they totally escape our ability to 332 00:20:22,356 --> 00:20:27,956 Speaker 1: control them. That's mostly unobserved and still being documented. So 333 00:20:29,276 --> 00:20:31,836 Speaker 1: they can change, that's not in doubt. But whether they 334 00:20:31,836 --> 00:20:35,876 Speaker 1: can change in ways that really get around to a 335 00:20:35,996 --> 00:20:39,796 Speaker 1: large degree, our ability to fight them off with our 336 00:20:39,836 --> 00:20:42,916 Speaker 1: antibodies and other forms of immunity, I think is still 337 00:20:42,956 --> 00:20:46,156 Speaker 1: an open question. Even for the existing to maybe one 338 00:20:46,196 --> 00:20:49,356 Speaker 1: three five one the South African variant or the Brazilian 339 00:20:49,396 --> 00:20:52,116 Speaker 1: variant or the Indian variant. So that's a question. It's 340 00:20:52,116 --> 00:20:54,036 Speaker 1: not whether they can evolve, it's whether how far can 341 00:20:54,076 --> 00:20:59,476 Speaker 1: they go in their biological properties, And that's something that 342 00:20:59,636 --> 00:21:02,916 Speaker 1: you can't really answer, mostly because evolution is not a 343 00:21:02,956 --> 00:21:05,876 Speaker 1: perfectly modelable process, right, I mean, it has contingent features, 344 00:21:05,996 --> 00:21:09,676 Speaker 1: and you know there aren't necessarily absolute is that will 345 00:21:09,716 --> 00:21:13,516 Speaker 1: tell you in relation to both the underlying biology and 346 00:21:13,516 --> 00:21:16,556 Speaker 1: then the way it interacts with the world outside what's 347 00:21:16,596 --> 00:21:18,436 Speaker 1: going to happen. If it were, we could do a 348 00:21:18,476 --> 00:21:21,156 Speaker 1: lot more predictive work on evolution than we actually are 349 00:21:21,196 --> 00:21:24,396 Speaker 1: able to do. Yeah. Yeah, I mean there are a 350 00:21:24,476 --> 00:21:27,516 Speaker 1: number of us, including our group with bacteria, trying to 351 00:21:27,556 --> 00:21:30,396 Speaker 1: chip away at this problem. But this is a major 352 00:21:30,876 --> 00:21:34,556 Speaker 1: hard problem in biology, and we aren't there yet. We 353 00:21:34,596 --> 00:21:36,876 Speaker 1: don't know what the space of possibilities is and how 354 00:21:36,876 --> 00:21:40,356 Speaker 1: it relates to the sequence. Talk to me about what 355 00:21:40,516 --> 00:21:42,676 Speaker 1: in the real world it would look like in this 356 00:21:42,716 --> 00:21:45,836 Speaker 1: scenario where let's call it the flu like scenario. If 357 00:21:45,876 --> 00:21:48,756 Speaker 1: we started with the vaccines as a bridge, this is 358 00:21:48,796 --> 00:21:50,956 Speaker 1: the flu like scenario where we have to go back 359 00:21:51,436 --> 00:21:55,036 Speaker 1: and try to get a new vaccine each time a 360 00:21:55,156 --> 00:22:00,196 Speaker 1: dangerous new variant emerges. Why do we do as poorly 361 00:22:00,236 --> 00:22:02,956 Speaker 1: as we do with respect to the flu vaccine, which 362 00:22:03,196 --> 00:22:05,876 Speaker 1: I guess only prevents about forty to sixty percent of 363 00:22:05,916 --> 00:22:11,436 Speaker 1: the flu each time it's redvised. Yeah, it's a good question. 364 00:22:11,596 --> 00:22:14,556 Speaker 1: I think that in itself is a scientific discussion that 365 00:22:14,996 --> 00:22:18,196 Speaker 1: isn't totally resolved. Why the flu vaccines have been so 366 00:22:18,236 --> 00:22:22,556 Speaker 1: hard to make as good as say, these existing coronavirus vaccines. 367 00:22:23,356 --> 00:22:27,156 Speaker 1: Partly it's about predicting which sequence to use, but even 368 00:22:27,196 --> 00:22:30,076 Speaker 1: when it's well matched, it's not always very good. So 369 00:22:30,116 --> 00:22:33,356 Speaker 1: I think there's some reason for optimism here that the 370 00:22:33,476 --> 00:22:36,516 Speaker 1: first guests at what to do about a coronavirus vaccine 371 00:22:36,516 --> 00:22:39,916 Speaker 1: turned out to be as much as ninety five percent effective, 372 00:22:39,996 --> 00:22:44,396 Speaker 1: and that's much better than flu vaccines. So it may 373 00:22:44,436 --> 00:22:48,796 Speaker 1: be that coronaviruses are easier. But this coronavirus may continue 374 00:22:48,836 --> 00:22:53,476 Speaker 1: to change, And then again, the question is whether it 375 00:22:53,556 --> 00:22:56,756 Speaker 1: changes in a way that evads our infection immunity, which 376 00:22:56,756 --> 00:23:02,356 Speaker 1: would mean that we have to consider trying to control it, 377 00:23:02,516 --> 00:23:07,596 Speaker 1: or whether it evades our severe disease immunity, which would 378 00:23:07,636 --> 00:23:10,516 Speaker 1: be a much bigger deal. And what I mean by 379 00:23:10,556 --> 00:23:13,916 Speaker 1: that is if we didn't have flu vaccines, as most 380 00:23:13,956 --> 00:23:17,716 Speaker 1: of the world doesn't use flu vaccines, there are people, 381 00:23:17,916 --> 00:23:20,636 Speaker 1: many people who die because they don't get flu vaccines, 382 00:23:21,196 --> 00:23:24,556 Speaker 1: but it is not the same kind of global catastrophe 383 00:23:24,716 --> 00:23:29,876 Speaker 1: as this has been. And that's because existing immunity to flu, 384 00:23:30,196 --> 00:23:33,476 Speaker 1: even though the flu viruses are changing, is still protecting 385 00:23:33,476 --> 00:23:36,436 Speaker 1: people to a large degree against getting very sick and dying. 386 00:23:37,556 --> 00:23:41,116 Speaker 1: So the sort of flu analogy is a worse scenario, 387 00:23:41,236 --> 00:23:43,556 Speaker 1: and we probably would try to make better vaccines that 388 00:23:43,716 --> 00:23:46,476 Speaker 1: keep up with the new strains, but it's still not 389 00:23:47,076 --> 00:23:49,756 Speaker 1: a new pandemic every year. It's in the realm of 390 00:23:50,756 --> 00:23:55,476 Speaker 1: public health problem rather than public health catastrophe. We'll be 391 00:23:55,556 --> 00:24:09,116 Speaker 1: right back mark. When you see the virus running maybe 392 00:24:09,196 --> 00:24:11,876 Speaker 1: checked is the wrong word, but running hard and fast 393 00:24:12,116 --> 00:24:14,396 Speaker 1: through a population, as seems to be happening right now 394 00:24:14,436 --> 00:24:18,876 Speaker 1: in India, Apart from the understandable concern about the human 395 00:24:18,916 --> 00:24:23,636 Speaker 1: suffering that that's going to entail, do you think to yourself, oh, boy, 396 00:24:23,676 --> 00:24:27,596 Speaker 1: that raises the probability of new variance emerging that could 397 00:24:27,596 --> 00:24:32,076 Speaker 1: be ultimately vaccine resistant, or do you think, rather, look, 398 00:24:32,156 --> 00:24:34,916 Speaker 1: this is what the virus was always going to do. 399 00:24:35,076 --> 00:24:38,636 Speaker 1: If not restrained and people are catching it, and so 400 00:24:38,716 --> 00:24:41,036 Speaker 1: there's no particular reason to think that it would need 401 00:24:41,116 --> 00:24:45,196 Speaker 1: to evolve new forms of resistance, because, after all, it's 402 00:24:45,196 --> 00:24:48,556 Speaker 1: spreading successfully through the population with whichever variant that it 403 00:24:48,636 --> 00:24:53,476 Speaker 1: presently has. Yeah, I mean, I think it's a fairly 404 00:24:53,716 --> 00:24:57,116 Speaker 1: central principle of evolution that large populations give rise to 405 00:24:57,156 --> 00:25:02,156 Speaker 1: more variation and select the most fit variants more effectively 406 00:25:02,276 --> 00:25:07,156 Speaker 1: than small populations. And in infections, that means lots of 407 00:25:07,196 --> 00:25:10,876 Speaker 1: infected people are both more of a breeding ground and 408 00:25:10,956 --> 00:25:14,716 Speaker 1: more of a efficient filter for variants that are good 409 00:25:14,716 --> 00:25:20,876 Speaker 1: at transmitting. So having virus spreading widely in any place 410 00:25:20,996 --> 00:25:24,276 Speaker 1: is not good for any place else, even places that 411 00:25:24,756 --> 00:25:29,036 Speaker 1: have vaccine access, and that is one of many reasons 412 00:25:29,076 --> 00:25:33,596 Speaker 1: why trying to help India to control the virus is 413 00:25:33,796 --> 00:25:37,476 Speaker 1: in the interest of other countries, in addition to being 414 00:25:37,516 --> 00:25:41,436 Speaker 1: the humanitarian thing to do. When you're wearing your public 415 00:25:41,476 --> 00:25:46,756 Speaker 1: health recommendations, hat, what sensible recommendations do you think policy 416 00:25:46,756 --> 00:25:50,076 Speaker 1: regulators should be considering, Leaving aside the question whether they 417 00:25:50,076 --> 00:25:53,196 Speaker 1: can practically be adopted or not for a world where 418 00:25:53,996 --> 00:25:56,556 Speaker 1: the virus seems to be more or less calming down 419 00:25:56,676 --> 00:26:01,756 Speaker 1: in places with relatively higher vaccination rates, while it's simultaneously 420 00:26:01,796 --> 00:26:04,596 Speaker 1: spreading pretty rapidly through places in the world which have 421 00:26:04,756 --> 00:26:07,836 Speaker 1: very low vaccination rates. I mean, what's the picture of 422 00:26:08,276 --> 00:26:12,076 Speaker 1: what kinds of opening are appropriate, in what kinds aren't, 423 00:26:12,156 --> 00:26:14,956 Speaker 1: and can we really sustain and tolerate a world where 424 00:26:15,636 --> 00:26:18,396 Speaker 1: you know, Westerners would be saying, well, in our countries 425 00:26:18,436 --> 00:26:21,156 Speaker 1: where we've got reasonable amount of vaccination, we're more or 426 00:26:21,236 --> 00:26:25,236 Speaker 1: less reopening. But we're urging you India, Brazil, you know, 427 00:26:25,356 --> 00:26:28,756 Speaker 1: we're urging you to engage in serious lockdowns. I mean, so, 428 00:26:28,796 --> 00:26:30,476 Speaker 1: first of all, is that the sensible thing to be 429 00:26:30,556 --> 00:26:33,236 Speaker 1: saying to them? And second of all, is it plausibly 430 00:26:33,276 --> 00:26:37,196 Speaker 1: sustainable to say that, even even if it's true. Wow, 431 00:26:37,236 --> 00:26:40,916 Speaker 1: that's way way above my pay grade. I mean, I 432 00:26:40,956 --> 00:26:44,156 Speaker 1: think in reality, it is the decision of the countries 433 00:26:44,916 --> 00:26:49,356 Speaker 1: what to do, and if we're not forthcoming as a 434 00:26:49,396 --> 00:26:55,156 Speaker 1: global community with aid to blunt the impacts of having 435 00:26:55,916 --> 00:27:01,236 Speaker 1: to close your societies and vaccine doses in the quantities 436 00:27:01,276 --> 00:27:03,876 Speaker 1: that would make them, make the rest of the world 437 00:27:03,956 --> 00:27:08,876 Speaker 1: able to close. Speaking as a sort of citizen and 438 00:27:09,316 --> 00:27:13,156 Speaker 1: someone who's married to a philosopher, I would say that 439 00:27:13,196 --> 00:27:17,316 Speaker 1: seems very unfair to say our public health is at 440 00:27:17,396 --> 00:27:19,436 Speaker 1: risk because of your virus, so why don't you close 441 00:27:19,476 --> 00:27:22,596 Speaker 1: your society down. I think there are many things in 442 00:27:22,636 --> 00:27:29,196 Speaker 1: between neglecting and telling people what to do. But I 443 00:27:29,236 --> 00:27:32,596 Speaker 1: don't think that our desire to keep variants from emerging 444 00:27:32,836 --> 00:27:35,796 Speaker 1: is or should be a very compelling argument to countries 445 00:27:35,836 --> 00:27:39,516 Speaker 1: that are not receiving or able to generate on their 446 00:27:39,556 --> 00:27:43,436 Speaker 1: own the resources to control the virus in a humane way. 447 00:27:43,676 --> 00:27:45,356 Speaker 1: I mean, I don't think it would be framed that way. 448 00:27:45,396 --> 00:27:48,516 Speaker 1: It would be framed as, look, you still have not 449 00:27:48,556 --> 00:27:51,036 Speaker 1: that many people vaccinated, so you should be engaging in 450 00:27:51,076 --> 00:27:54,156 Speaker 1: the same kinds of lockdowns as we were engaged in 451 00:27:54,236 --> 00:27:57,716 Speaker 1: until now. I mean that is presumably the line coupled 452 00:27:57,756 --> 00:28:00,716 Speaker 1: with and by the way, we'll give you more vaccines 453 00:28:00,796 --> 00:28:04,316 Speaker 1: or will enable you to make more vaccines. Yeah, this 454 00:28:04,396 --> 00:28:08,836 Speaker 1: is where I think, as a scientist, I find myself 455 00:28:08,836 --> 00:28:10,756 Speaker 1: at a of a loss because these are not really 456 00:28:10,756 --> 00:28:14,996 Speaker 1: scientific problems. These really are problems of global equity and 457 00:28:15,596 --> 00:28:18,916 Speaker 1: disparate impact, and I think I will pass on trying 458 00:28:18,916 --> 00:28:21,476 Speaker 1: to solve them. Fair enough, I mean, I guess what 459 00:28:21,516 --> 00:28:23,676 Speaker 1: I wanted to say is that they are classically social 460 00:28:23,716 --> 00:28:27,036 Speaker 1: scientific questions in that well, they of course require some 461 00:28:27,076 --> 00:28:29,876 Speaker 1: normative assessment. But that normative assessment, you know, of what 462 00:28:29,916 --> 00:28:32,556 Speaker 1: we ought to do is based a little bit on facts. 463 00:28:33,396 --> 00:28:34,956 Speaker 1: But in any case, I won't press you. Let me 464 00:28:34,956 --> 00:28:37,156 Speaker 1: ask one more question mark before I close by going 465 00:28:37,236 --> 00:28:40,436 Speaker 1: back to your mention of lab experiments, and the question 466 00:28:40,556 --> 00:28:43,676 Speaker 1: is basically this, when you look at where the US 467 00:28:43,836 --> 00:28:46,556 Speaker 1: is now and where it plausibly will be in the 468 00:28:46,596 --> 00:28:49,996 Speaker 1: next six months as we vaccinate twelve to fifteen year olds, 469 00:28:49,996 --> 00:28:54,796 Speaker 1: how much prophylactics shouldn't remain in place in your view? 470 00:28:54,836 --> 00:28:57,396 Speaker 1: I mean, at what point will it be plausible to 471 00:28:57,396 --> 00:29:00,596 Speaker 1: say we no longer need to mask up when we're indoors, 472 00:29:00,716 --> 00:29:03,876 Speaker 1: or we no longer need to maintain social distancing in schools. 473 00:29:05,316 --> 00:29:08,716 Speaker 1: I think that is a great question. I think what's 474 00:29:08,716 --> 00:29:10,236 Speaker 1: going to happen is that we're going to sort of 475 00:29:10,236 --> 00:29:13,196 Speaker 1: feel our way in that direction, and there's going to 476 00:29:13,276 --> 00:29:18,556 Speaker 1: be a lot of variation across any given rich country 477 00:29:18,716 --> 00:29:23,076 Speaker 1: in how fast people go, and we'll get some sense 478 00:29:23,156 --> 00:29:28,316 Speaker 1: from those experiments, those non planned experiments as to what works. 479 00:29:28,996 --> 00:29:32,356 Speaker 1: I mean, in trying to frame how to think about it, 480 00:29:32,396 --> 00:29:37,236 Speaker 1: I would say the goal is that when there are 481 00:29:37,556 --> 00:29:41,436 Speaker 1: very very few people at high risk still in the 482 00:29:41,476 --> 00:29:46,436 Speaker 1: line of the virus and unvaccinated, then permitting more spread 483 00:29:46,756 --> 00:29:50,276 Speaker 1: is a much safer thing to do. It's not totally safe, 484 00:29:50,316 --> 00:29:55,356 Speaker 1: but it becomes a reasonable trade off with the fact 485 00:29:55,356 --> 00:29:58,916 Speaker 1: that we all want to have economic, social, educational, and 486 00:29:59,476 --> 00:30:03,316 Speaker 1: cultural lives back. But to give a number at this stage, 487 00:30:03,356 --> 00:30:07,516 Speaker 1: I'm not really sure. I mean, in some ways, one 488 00:30:07,516 --> 00:30:13,036 Speaker 1: of the more optimistic, the most optimistic information is coming 489 00:30:13,036 --> 00:30:15,516 Speaker 1: out of Israel right now in the sense that they 490 00:30:15,556 --> 00:30:20,396 Speaker 1: have when you talk to people really reopened to a 491 00:30:20,436 --> 00:30:23,676 Speaker 1: striking degree, and their cases continue to go down, and 492 00:30:23,716 --> 00:30:28,156 Speaker 1: their hospitalizations and desks to stay at low levels, and 493 00:30:28,276 --> 00:30:31,876 Speaker 1: they have not gotten anywhere close to what seems to 494 00:30:31,876 --> 00:30:35,716 Speaker 1: be the herd immunity threshold. And so to me, that's 495 00:30:36,596 --> 00:30:39,316 Speaker 1: to go back to our earlier discussion, that might be 496 00:30:39,396 --> 00:30:47,596 Speaker 1: the evidence that some of these concerns are overblown, that 497 00:30:47,676 --> 00:30:50,356 Speaker 1: we can actually control spread with a little bit lower 498 00:30:50,436 --> 00:30:53,596 Speaker 1: levels of vaccination. But what I think is also happening 499 00:30:53,596 --> 00:30:56,996 Speaker 1: in Israel, as I understand it, is that if you're vaccinated, 500 00:30:57,036 --> 00:31:00,076 Speaker 1: you have lots of opportunities to go to the theater 501 00:31:00,236 --> 00:31:04,156 Speaker 1: and to go to crowd indoor events and whatever, and 502 00:31:04,236 --> 00:31:09,036 Speaker 1: if you are unvaccinated, you have fewer of those privileges, 503 00:31:09,996 --> 00:31:14,436 Speaker 1: and or you might well be someone who was in 504 00:31:14,436 --> 00:31:17,396 Speaker 1: a high risk group for infection before and are benefiting 505 00:31:17,396 --> 00:31:21,356 Speaker 1: from natural immunity. So I'm wondering to what extent Israel 506 00:31:21,436 --> 00:31:23,956 Speaker 1: really is an example of reopening, and to what extent 507 00:31:23,996 --> 00:31:27,316 Speaker 1: it's partial reopening. But I think they will set a 508 00:31:27,356 --> 00:31:29,516 Speaker 1: pace that we can sort of watch and see what 509 00:31:29,676 --> 00:31:33,836 Speaker 1: works and what doesn't. Mark before I let you go, 510 00:31:33,956 --> 00:31:37,196 Speaker 1: you made an intriguing comment about the scientific value of 511 00:31:37,196 --> 00:31:40,876 Speaker 1: doing in lab experiments and trying to see what happens 512 00:31:40,956 --> 00:31:46,156 Speaker 1: to COVID nineteen in the lab, And obviously there's a 513 00:31:46,196 --> 00:31:51,156 Speaker 1: lot of nervousness around this, especially given the ongoing belief. 514 00:31:51,796 --> 00:31:53,196 Speaker 1: I don't know if I would call it a paranoid 515 00:31:53,236 --> 00:31:55,516 Speaker 1: fantasy or not. That might be too strong formulation, but 516 00:31:55,556 --> 00:31:59,316 Speaker 1: the ongoing, let's call it unsubstantiated belief among some that 517 00:31:59,396 --> 00:32:03,836 Speaker 1: perhaps COVID nineteen originated itself in a lab and then 518 00:32:04,036 --> 00:32:10,516 Speaker 1: unintentionally escape from that lab. How much could laboratory based, 519 00:32:10,876 --> 00:32:16,156 Speaker 1: responsible careful research reveal and what would make it worth 520 00:32:16,196 --> 00:32:22,556 Speaker 1: doing given the presumably existing risks of an accidental leak 521 00:32:22,676 --> 00:32:29,636 Speaker 1: or outbreak. Well, I think the beliefs on all theories 522 00:32:30,036 --> 00:32:33,236 Speaker 1: are all hypotheses for the origin are unsubstantiated right now, 523 00:32:33,836 --> 00:32:36,356 Speaker 1: And I've said publicly and continue to say that I 524 00:32:36,396 --> 00:32:41,836 Speaker 1: think investigating the Lab league hypothesis is the responsible thing 525 00:32:41,876 --> 00:32:44,356 Speaker 1: to do, as has for example, the head of the 526 00:32:44,356 --> 00:32:47,516 Speaker 1: World Health Organization, the group that put out the report, 527 00:32:48,236 --> 00:32:51,516 Speaker 1: downplaying that theory. That's quite helpful actually, by the way, 528 00:32:51,556 --> 00:32:54,916 Speaker 1: So what I'm reading in code is that people like 529 00:32:54,996 --> 00:32:57,516 Speaker 1: me shouldn't say, oh, that's crazy. It might or might 530 00:32:57,556 --> 00:33:00,436 Speaker 1: not be We don't have the data. Yeah, it's not crazy, 531 00:33:00,476 --> 00:33:03,956 Speaker 1: it might be wrong. But the arguments put out so 532 00:33:03,996 --> 00:33:09,956 Speaker 1: far to say that a LAB leak is way less 533 00:33:09,956 --> 00:33:13,236 Speaker 1: likely than the competing hypothesis I think don't hold any water. 534 00:33:14,916 --> 00:33:17,476 Speaker 1: Very good to hear. Okay, so that's a very helpful corrective. 535 00:33:17,916 --> 00:33:22,956 Speaker 1: But to answer your specific question, I spent much of 536 00:33:22,996 --> 00:33:26,636 Speaker 1: the decade of the twenty tens working very hard in 537 00:33:26,676 --> 00:33:30,636 Speaker 1: the sort of science policy arena on an effort to 538 00:33:31,716 --> 00:33:35,836 Speaker 1: curtail experiments so called gain a function of concern, experiments 539 00:33:35,876 --> 00:33:39,396 Speaker 1: that make at that time it was mostly influenza viruses 540 00:33:40,756 --> 00:33:45,556 Speaker 1: more contagious or more deadly and the basis of that 541 00:33:45,716 --> 00:33:50,076 Speaker 1: concern or of that activity was a calculation of risk 542 00:33:50,116 --> 00:33:54,436 Speaker 1: and benefit that the science doesn't save enough lives in 543 00:33:54,996 --> 00:33:58,116 Speaker 1: expectation to be worth the possibility of creating a novel 544 00:33:58,156 --> 00:34:00,876 Speaker 1: pandemic pathogen that could get out of a lab by 545 00:34:00,916 --> 00:34:06,196 Speaker 1: mistake and spread, not to mention the possibility of fading 546 00:34:06,716 --> 00:34:12,196 Speaker 1: deliberate attempts, the possibility that experiments like dangerous experiments could 547 00:34:12,236 --> 00:34:17,676 Speaker 1: also aid deliberate attempts to misuse biological agents as weapons. 548 00:34:18,516 --> 00:34:22,676 Speaker 1: But I was focused more on the safety aspect. And 549 00:34:23,956 --> 00:34:26,556 Speaker 1: one of the people who was in some ways supportive 550 00:34:26,596 --> 00:34:30,356 Speaker 1: of my efforts and those of my other colleagues was 551 00:34:30,516 --> 00:34:34,556 Speaker 1: Jesse Bloom, who was one of the several groups that 552 00:34:35,396 --> 00:34:38,476 Speaker 1: did experiments with this coronavirus to see what would happen 553 00:34:38,596 --> 00:34:42,356 Speaker 1: when you asked the virus to escape human serum, to 554 00:34:42,516 --> 00:34:45,556 Speaker 1: escape the immunity and human theorem, the antibody immunity and 555 00:34:45,636 --> 00:34:50,396 Speaker 1: human sorem. And what they found was that you generate 556 00:34:50,476 --> 00:34:53,396 Speaker 1: mutations very much the ones that we have been seeing 557 00:34:53,436 --> 00:34:57,756 Speaker 1: in the variants that have become globally famous, for example, 558 00:34:57,756 --> 00:35:02,396 Speaker 1: the four four K mutation. And that was incredibly valuable 559 00:35:02,436 --> 00:35:06,796 Speaker 1: information because it allowed vaccine developers to understand that this 560 00:35:06,876 --> 00:35:09,796 Speaker 1: was not just a freak that happened in one or 561 00:35:09,836 --> 00:35:13,476 Speaker 1: two variants, but was actually the sort of typical thing 562 00:35:13,516 --> 00:35:17,596 Speaker 1: that happens even in a laboratory. And other mutations were 563 00:35:17,636 --> 00:35:23,036 Speaker 1: also identified, so you could ask the question, would it 564 00:35:23,076 --> 00:35:25,356 Speaker 1: be a good idea to now take the existing variants 565 00:35:25,476 --> 00:35:29,676 Speaker 1: that have those mutations and do that again. I would 566 00:35:29,796 --> 00:35:32,476 Speaker 1: very much expect that people are doing those experiments as 567 00:35:32,556 --> 00:35:35,916 Speaker 1: we speak, if they haven't already done them, And in 568 00:35:35,916 --> 00:35:38,796 Speaker 1: this case, I would be supportive of doing that kind 569 00:35:38,796 --> 00:35:44,076 Speaker 1: of potentially dangerous experiment because first, it has a very 570 00:35:44,116 --> 00:35:47,716 Speaker 1: clear public health rationale that it's not just scientific curiosity 571 00:35:47,756 --> 00:35:51,916 Speaker 1: that would be satisfied, but it would help to prepare 572 00:35:52,036 --> 00:35:57,636 Speaker 1: us for vaccination and other countermeasures. And also that we 573 00:35:57,756 --> 00:35:59,956 Speaker 1: have a big problem in front of us. It's not 574 00:36:00,036 --> 00:36:06,396 Speaker 1: that the virus being created there is utterly novel. The 575 00:36:06,836 --> 00:36:09,076 Speaker 1: analog of that experiment is being done in people's body 576 00:36:09,196 --> 00:36:15,276 Speaker 1: these around the world. So I think the incremental risk 577 00:36:15,316 --> 00:36:18,396 Speaker 1: of doing the experiment is smaller and the incremental benefit 578 00:36:18,396 --> 00:36:21,316 Speaker 1: of doing it is greater than those other experiments that 579 00:36:21,396 --> 00:36:26,876 Speaker 1: I was very much against. That's extremely helpful. You've given 580 00:36:26,916 --> 00:36:30,076 Speaker 1: us some good news and some bad news, and as always, 581 00:36:30,196 --> 00:36:33,876 Speaker 1: you're the soul of balance. Can I ask you, if 582 00:36:33,876 --> 00:36:37,036 Speaker 1: you think back to where we were in February of 583 00:36:37,076 --> 00:36:41,476 Speaker 1: twenty twenty, is the overall picture worse than you thought 584 00:36:41,476 --> 00:36:43,716 Speaker 1: it was going to be slightly better than you thought 585 00:36:43,716 --> 00:36:48,596 Speaker 1: it was going to be more or less the same. Well, 586 00:36:48,636 --> 00:36:53,316 Speaker 1: I'll give you a balanced answer. So the part that 587 00:36:53,476 --> 00:36:57,476 Speaker 1: is much better than I think anybody believed was possible 588 00:36:57,596 --> 00:37:00,596 Speaker 1: in February of last year is that we have in 589 00:37:01,356 --> 00:37:03,876 Speaker 1: large parts of the world, though not enough of the world, 590 00:37:04,276 --> 00:37:08,556 Speaker 1: substantial supplies of very effective vaccines. I mean, I saw 591 00:37:08,676 --> 00:37:15,276 Speaker 1: a prediction from April from a university research group that 592 00:37:15,436 --> 00:37:19,356 Speaker 1: said absolute best case scenario as of April last year 593 00:37:19,596 --> 00:37:22,756 Speaker 1: was that we would be beginning around now to start 594 00:37:22,956 --> 00:37:27,596 Speaker 1: rolling out vaccines, and we began rolling out vaccines four 595 00:37:27,676 --> 00:37:31,276 Speaker 1: or five months ahead of that. And the vaccines are 596 00:37:31,636 --> 00:37:34,196 Speaker 1: not just fifty percent effective, which was the floor set 597 00:37:34,196 --> 00:37:36,836 Speaker 1: by the FDA, but up to ninety five percent effective. 598 00:37:37,716 --> 00:37:42,156 Speaker 1: That's all just stunningly good news. And to be fair, 599 00:37:42,396 --> 00:37:44,356 Speaker 1: part of the reason for that good news is that 600 00:37:45,116 --> 00:37:49,556 Speaker 1: the US, Brazil and the UK created a global public 601 00:37:49,556 --> 00:37:52,836 Speaker 1: good by having rampaging epidemics that allowed vaccine trials to 602 00:37:52,876 --> 00:37:56,596 Speaker 1: go quickly, and the whole world has us to thank 603 00:37:56,676 --> 00:38:00,316 Speaker 1: for not controlling our virus very well, with the consequence 604 00:38:00,316 --> 00:38:02,876 Speaker 1: that we were able to get quick answers about how 605 00:38:02,876 --> 00:38:06,356 Speaker 1: well the vaccines worked, So that part, I think is 606 00:38:07,156 --> 00:38:10,916 Speaker 1: much better than expected. I think the speed with which 607 00:38:10,996 --> 00:38:13,756 Speaker 1: variants have come up is a little worse than expected, 608 00:38:14,316 --> 00:38:18,396 Speaker 1: and the fact that they probably do have significant consequences 609 00:38:18,396 --> 00:38:21,596 Speaker 1: for immunity, even if they don't totally defeat it. And 610 00:38:21,636 --> 00:38:26,236 Speaker 1: then the most confusing part is in February, everybody was 611 00:38:26,276 --> 00:38:31,796 Speaker 1: saying that the sorts of disparities we see within rich 612 00:38:31,876 --> 00:38:35,116 Speaker 1: countries where the worst off are hit harder by the virus, 613 00:38:35,476 --> 00:38:39,916 Speaker 1: would be true globally and the sub Sharan Africa, India, etc. 614 00:38:41,196 --> 00:38:44,476 Speaker 1: Basically the global South would be hit much harder and 615 00:38:44,596 --> 00:38:49,916 Speaker 1: it would be a catastrophe. And then that didn't happen 616 00:38:50,156 --> 00:38:53,916 Speaker 1: for the first year or so, and everyone started scratching 617 00:38:53,916 --> 00:38:56,836 Speaker 1: their head trying to understand whether it was a reporting 618 00:38:56,876 --> 00:39:00,716 Speaker 1: artifact or not true, or really was true, and if so, why, 619 00:39:01,476 --> 00:39:04,716 Speaker 1: And now we see South Asia, not just India but 620 00:39:04,796 --> 00:39:09,356 Speaker 1: its neighbors as well, really really struggling under a renewed epidemick, 621 00:39:09,916 --> 00:39:12,396 Speaker 1: and I would say that part is just puzzling and 622 00:39:12,476 --> 00:39:16,716 Speaker 1: sort of gives a real humility to scientists who thought 623 00:39:16,756 --> 00:39:19,076 Speaker 1: we understood what would happen, then it turned out not 624 00:39:19,116 --> 00:39:20,996 Speaker 1: to happen, and now it's turned out to happen a 625 00:39:21,116 --> 00:39:27,556 Speaker 1: year after everybody else, and I just I can't explain it. Mark, 626 00:39:27,756 --> 00:39:31,436 Speaker 1: thank you as always for your clarity, your rationality, your judgment, 627 00:39:31,876 --> 00:39:34,116 Speaker 1: and for putting us in the picture. I'm really grateful 628 00:39:34,156 --> 00:39:37,516 Speaker 1: to you. Thank you. It's nice to talk to us. Ever, 629 00:39:44,716 --> 00:39:47,876 Speaker 1: doctor Mark lipsych is always the reasonable man. He gives 630 00:39:47,876 --> 00:39:50,076 Speaker 1: you the good news as well as the bad news, 631 00:39:50,116 --> 00:39:52,836 Speaker 1: and in this conversation with him, he gave us a 632 00:39:52,876 --> 00:39:57,236 Speaker 1: reasonable dose of each. To start with. His top line 633 00:39:57,236 --> 00:40:00,116 Speaker 1: observation is that we are really not going to reach 634 00:40:00,156 --> 00:40:02,596 Speaker 1: the threshold for her immunity in the United States in 635 00:40:02,636 --> 00:40:06,556 Speaker 1: the foreseeable future. Mark had warned of that possibility, indeed 636 00:40:06,556 --> 00:40:10,396 Speaker 1: that probability over the last year plus, and now he 637 00:40:10,476 --> 00:40:13,636 Speaker 1: says that it's pretty certain that that's the outcome that 638 00:40:13,716 --> 00:40:17,596 Speaker 1: we've reached. What does that mean in practice? Mark lays 639 00:40:17,596 --> 00:40:20,556 Speaker 1: out several scenarios, the first, which he thinks is the 640 00:40:20,636 --> 00:40:23,196 Speaker 1: most likely and is not a bad scenario as these 641 00:40:23,196 --> 00:40:26,236 Speaker 1: things go at all is it. Vaccines function as a 642 00:40:26,316 --> 00:40:29,716 Speaker 1: bridge for us, protecting those people who would be badly 643 00:40:29,796 --> 00:40:34,156 Speaker 1: harmed by a first exposure to the coronavirus, while simultaneously 644 00:40:34,196 --> 00:40:36,996 Speaker 1: allowing young people to be exposed to the virus for 645 00:40:37,036 --> 00:40:39,396 Speaker 1: the first time at an age where it's very very 646 00:40:39,476 --> 00:40:42,676 Speaker 1: unlikely to harm them. As a consequence, we would all 647 00:40:42,676 --> 00:40:47,956 Speaker 1: eventually develop our own immunities to the coronavirus, and over time, 648 00:40:48,156 --> 00:40:51,436 Speaker 1: assuming that we are exposed frequently enough without it harming us, 649 00:40:51,756 --> 00:40:55,876 Speaker 1: COVID nineteen would become very much like other coronaviruses out 650 00:40:55,916 --> 00:40:59,036 Speaker 1: there in the world, but not much remarked because not 651 00:40:59,116 --> 00:41:03,516 Speaker 1: doing anybody very much harm. Yet, Mark also recognizes the 652 00:41:03,516 --> 00:41:08,396 Speaker 1: possibility of another much more worrisome scenario in which either 653 00:41:09,196 --> 00:41:11,356 Speaker 1: the immunity that we get from being exposed to the 654 00:41:11,436 --> 00:41:14,196 Speaker 1: vaccine or to the virus doesn't last very long, or 655 00:41:14,636 --> 00:41:18,956 Speaker 1: still worse, in which the virus mutates and evolves to 656 00:41:19,036 --> 00:41:22,036 Speaker 1: a point where it escapes the vaccines that we have 657 00:41:22,236 --> 00:41:25,916 Speaker 1: for it. In those circumstances, COVID nineteen would start to 658 00:41:25,916 --> 00:41:29,116 Speaker 1: look a lot more like the flu, and as we know, 659 00:41:29,356 --> 00:41:32,996 Speaker 1: our flu vaccines are a bit of a challenge because 660 00:41:33,196 --> 00:41:36,516 Speaker 1: they face a moving target in addressing the flu as 661 00:41:36,556 --> 00:41:38,996 Speaker 1: it evolves each year, and as a result they don't 662 00:41:39,036 --> 00:41:42,796 Speaker 1: successfully suppress the flu. Given that covid can be much 663 00:41:42,836 --> 00:41:49,036 Speaker 1: more harmful than the flu, that is a genuinely worrisome scenario. Ultimately, 664 00:41:49,276 --> 00:41:51,636 Speaker 1: even when I pressed Mark to be a little less balanced, 665 00:41:51,676 --> 00:41:55,036 Speaker 1: he gave us the reasonable balanced analysis that says that 666 00:41:55,116 --> 00:41:57,596 Speaker 1: in certain respects we've done much better in this vaccine 667 00:41:57,596 --> 00:42:00,356 Speaker 1: than anyone could have expected, but in other respects we've 668 00:42:00,396 --> 00:42:04,196 Speaker 1: done really pretty badly, especially with reference to the fairness 669 00:42:04,236 --> 00:42:07,836 Speaker 1: and justice of where the disease has harmed people and 670 00:42:07,876 --> 00:42:10,796 Speaker 1: where it's likely to continue to harm people going forward 671 00:42:10,956 --> 00:42:15,316 Speaker 1: into the future. My main takeaway from listening to Mark 672 00:42:15,516 --> 00:42:18,156 Speaker 1: now and the past is that we have to continue 673 00:42:18,156 --> 00:42:20,956 Speaker 1: to be cautious in thinking about where we're going with 674 00:42:20,996 --> 00:42:24,996 Speaker 1: respect to this disease. We might be seeing the light 675 00:42:25,036 --> 00:42:27,596 Speaker 1: at the end of the tunnel, but we cannot know 676 00:42:27,716 --> 00:42:30,836 Speaker 1: for sure that we are. We might be able to 677 00:42:30,876 --> 00:42:33,956 Speaker 1: say that we're on our way to a return to normal, 678 00:42:34,156 --> 00:42:38,756 Speaker 1: but we still cannot be utterly certain of that. Ongoing 679 00:42:38,836 --> 00:42:42,076 Speaker 1: vigilance is still going to be necessary. The challenge for 680 00:42:42,116 --> 00:42:44,356 Speaker 1: all of us is to live as near to normal 681 00:42:44,436 --> 00:42:47,956 Speaker 1: as we can, as little based on fear as we can, 682 00:42:48,316 --> 00:42:52,156 Speaker 1: while simultaneously being rational about the risks and challenges that 683 00:42:52,276 --> 00:42:55,196 Speaker 1: lie ahead. Until the next time I speak to you, 684 00:42:55,676 --> 00:42:58,236 Speaker 1: I guess I'm afraid we have to continue to be 685 00:42:58,276 --> 00:43:00,876 Speaker 1: a little bit safe, we have to continue to be 686 00:43:00,876 --> 00:43:03,516 Speaker 1: a little bit careful, and I really hope that we 687 00:43:03,556 --> 00:43:08,596 Speaker 1: can all continue to be well. Deep background is brought 688 00:43:08,636 --> 00:43:11,836 Speaker 1: to you by Pushkin Industries. Our producer is Mola Board, 689 00:43:12,076 --> 00:43:15,436 Speaker 1: our engineer is Ben Tolliday, and our showrunner is Sophie 690 00:43:15,436 --> 00:43:20,316 Speaker 1: Crane mckibbon. Editorial support from noahm Osband. Theme music by 691 00:43:20,356 --> 00:43:23,916 Speaker 1: Luis Gara at Pushkin. Thanks to Mia Lobell, Julia Barton, 692 00:43:24,236 --> 00:43:28,836 Speaker 1: Lydia Jeancott, Heather Faine, Carlie Migliori, Maggie Taylor, Eric Sandler, 693 00:43:28,996 --> 00:43:32,276 Speaker 1: and Jacob Weisberg. You can find me on Twitter at 694 00:43:32,276 --> 00:43:35,556 Speaker 1: Noah R. Feldman. I also write a column for Bloomberg Opinion, 695 00:43:35,676 --> 00:43:38,636 Speaker 1: which you can find at Bloomberg dot com slash Feldman. 696 00:43:39,116 --> 00:43:42,516 Speaker 1: To discover Bloomberg's original slate of podcasts, go to Bloomberg 697 00:43:42,596 --> 00:43:45,476 Speaker 1: dot com slash podcasts, and if you like what you 698 00:43:45,556 --> 00:43:48,476 Speaker 1: heard today. Please write a review or tell a friend. 699 00:43:49,076 --> 00:43:50,796 Speaker 1: This is deep background