1 00:00:15,396 --> 00:00:23,836 Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show 2 00:00:23,836 --> 00:00:26,956 Speaker 1: where we explore the stories behind the stories in the news. 3 00:00:27,276 --> 00:00:31,756 Speaker 1: I'm Noah Feldman. I didn't feel a thing well done. 4 00:00:32,316 --> 00:00:36,796 Speaker 1: That's Vice President Mike Pence last Friday, just after receiving 5 00:00:36,836 --> 00:00:41,836 Speaker 1: a coronavirus vaccine on national television. President elect Joe Biden 6 00:00:41,996 --> 00:00:45,956 Speaker 1: has also been vaccinated. But what about the rest of us? 7 00:00:46,556 --> 00:00:51,116 Speaker 1: The distribution of the coronavirus vaccine raises massive practical and 8 00:00:51,196 --> 00:00:54,476 Speaker 1: ethical questions. Here to walk us through some of them 9 00:00:54,716 --> 00:00:59,476 Speaker 1: is Michelle Mellow. Professor Mellow teaches at the Stanford Law 10 00:00:59,516 --> 00:01:04,116 Speaker 1: School and holds a joint appointment at Stanford's School of Medicine. 11 00:01:04,396 --> 00:01:08,836 Speaker 1: She's an expert on medical liability, public health law, pharmaceuticals 12 00:01:08,836 --> 00:01:14,236 Speaker 1: and vaccines, and importantly ethics and governance associated with all 13 00:01:14,356 --> 00:01:19,796 Speaker 1: of those things. Michelle, thank you so much for joining us. 14 00:01:20,156 --> 00:01:23,596 Speaker 1: I knew the minute that we hit this stage of 15 00:01:23,956 --> 00:01:26,436 Speaker 1: the vaccine process where we have vaccines that appear to 16 00:01:26,476 --> 00:01:29,156 Speaker 1: work and now we have to struggle with the practical 17 00:01:29,156 --> 00:01:32,396 Speaker 1: and ethical questions and the legal questions around distribution, that 18 00:01:32,476 --> 00:01:35,836 Speaker 1: I wanted to hear your input. So let's just dive 19 00:01:35,876 --> 00:01:40,076 Speaker 1: in and I want to start with the priorities that 20 00:01:40,276 --> 00:01:43,636 Speaker 1: different actors have been setting for who gets vaccines when, 21 00:01:44,196 --> 00:01:48,436 Speaker 1: and ask you, what do you think that those priorities 22 00:01:48,596 --> 00:01:53,956 Speaker 1: should be. So, I actually think that the ethical framework 23 00:01:54,076 --> 00:01:57,316 Speaker 1: that the National Academy of Sciences and Engineering Medicine Committee 24 00:01:57,316 --> 00:02:00,956 Speaker 1: came up with is spot on. They start with a 25 00:02:01,076 --> 00:02:05,436 Speaker 1: series of both substantive and procedural ethical principles, and the 26 00:02:05,516 --> 00:02:08,436 Speaker 1: substantive principles are the ones that are most salient for 27 00:02:08,636 --> 00:02:11,836 Speaker 1: figuring out who's in what priority group, and they are 28 00:02:12,036 --> 00:02:18,236 Speaker 1: equity or addressing health inequities, assuring maximum benefit, what they 29 00:02:18,276 --> 00:02:21,716 Speaker 1: call equal concern, which is the idea that every person 30 00:02:21,916 --> 00:02:25,676 Speaker 1: is of equal moral worth and should be protected from discrimination. 31 00:02:26,276 --> 00:02:29,676 Speaker 1: And then there are also a series of these procedural 32 00:02:29,836 --> 00:02:33,316 Speaker 1: ethical principles that they articulate, which include fairness and transparency 33 00:02:33,356 --> 00:02:37,276 Speaker 1: and hewing closely to the evidence. So unpacking those a 34 00:02:37,276 --> 00:02:39,236 Speaker 1: little bit more, you know, what is it. I've talked 35 00:02:39,236 --> 00:02:42,916 Speaker 1: a little bit about what equal concern means. It doesn't, however, 36 00:02:43,036 --> 00:02:46,116 Speaker 1: mean that it's not right to make decisions based on 37 00:02:46,156 --> 00:02:50,036 Speaker 1: a person's societal role, like the instrumental value that they 38 00:02:50,116 --> 00:02:53,996 Speaker 1: bring to fighting COVID, for example. But beyond that, we 39 00:02:54,036 --> 00:02:58,556 Speaker 1: want to protect people from nvidious discrimination. The maximum benefit 40 00:02:58,676 --> 00:03:01,276 Speaker 1: principle I think they did a very good job of 41 00:03:01,356 --> 00:03:06,036 Speaker 1: describing as pertaining both to the reduction of serious comorbidity 42 00:03:06,036 --> 00:03:09,436 Speaker 1: and mortality, so finding people who are especially like they 43 00:03:09,476 --> 00:03:14,156 Speaker 1: get really bad COVID and also eliminating transmission to the 44 00:03:14,156 --> 00:03:18,796 Speaker 1: maximum extent possible. Those are both important elements of maximal benefit. 45 00:03:19,316 --> 00:03:22,996 Speaker 1: They also refer to the fact that people who are 46 00:03:23,036 --> 00:03:27,316 Speaker 1: in roles that are essential for societal functioning should be 47 00:03:27,396 --> 00:03:32,276 Speaker 1: vaccinated because performing their role brings about additional benefits to society. 48 00:03:33,236 --> 00:03:37,276 Speaker 1: In terms of the mitigating inequities, the committee is interested 49 00:03:37,316 --> 00:03:40,556 Speaker 1: in the communities that have been especially hard hit by 50 00:03:40,596 --> 00:03:43,116 Speaker 1: the disease, and then interesting also as their focus on 51 00:03:43,516 --> 00:03:48,116 Speaker 1: respecting tribal sovereignty as a form of respecting vulnerable groups. 52 00:03:48,876 --> 00:03:51,876 Speaker 1: Can I ask a skeptical question, every single principle that 53 00:03:51,916 --> 00:03:56,676 Speaker 1: you just articulated, drawn from this National Academy of Sciences approach, 54 00:03:57,036 --> 00:04:00,756 Speaker 1: Every single principle is a good principle, but it's not 55 00:04:00,796 --> 00:04:03,716 Speaker 1: at all obvious to me how they work together. In fact, 56 00:04:03,756 --> 00:04:05,876 Speaker 1: some of those principles seem like in practice they would 57 00:04:05,876 --> 00:04:09,596 Speaker 1: be in contradiction with other principles. I mean, generally, aiming 58 00:04:09,636 --> 00:04:14,156 Speaker 1: for maximal benefit does mean treating people not as individuals 59 00:04:14,196 --> 00:04:16,956 Speaker 1: on their own, but seeing them in terms of the 60 00:04:17,076 --> 00:04:21,476 Speaker 1: role that their physical bodies will play in transmission. I mean, 61 00:04:21,516 --> 00:04:24,476 Speaker 1: if someone is especially likely to transmit, we should stop 62 00:04:24,516 --> 00:04:28,076 Speaker 1: that person from transmitting by vaccinating that person. The idea 63 00:04:28,116 --> 00:04:31,356 Speaker 1: of moral weight doesn't really come into that. We're thinking 64 00:04:31,356 --> 00:04:33,756 Speaker 1: of the society as a collective and the greatest good 65 00:04:33,756 --> 00:04:37,556 Speaker 1: for the greatest number. But the other principles are to 66 00:04:37,596 --> 00:04:40,396 Speaker 1: a certain degree very much based in a tradition that 67 00:04:40,476 --> 00:04:43,556 Speaker 1: says each human being has equal value and equal weight 68 00:04:43,916 --> 00:04:46,636 Speaker 1: and shouldn't be treated differently from any other person on 69 00:04:46,676 --> 00:04:49,316 Speaker 1: the basis of some quality that's not directly connected to 70 00:04:49,356 --> 00:04:53,516 Speaker 1: their moral worth. So do these principles talk at all 71 00:04:53,556 --> 00:04:57,596 Speaker 1: about how to reconcile the potential conflicts or is this 72 00:04:57,636 --> 00:04:59,196 Speaker 1: one of those cases where you just list a lot 73 00:04:59,236 --> 00:05:01,156 Speaker 1: of good moral principles and then the devil is in 74 00:05:01,156 --> 00:05:04,076 Speaker 1: the details. Well, it's a really important question, and they 75 00:05:04,076 --> 00:05:06,276 Speaker 1: don't go into great death. But I think the clear 76 00:05:06,316 --> 00:05:11,356 Speaker 1: intent is that when they say it's appropriate to let's 77 00:05:11,436 --> 00:05:13,676 Speaker 1: use the word discriminate, but here it's not in a 78 00:05:13,716 --> 00:05:17,076 Speaker 1: negative way. It's picking out people for priority. It's appropriate 79 00:05:17,116 --> 00:05:21,996 Speaker 1: to do it on that basis when the role concerns 80 00:05:22,076 --> 00:05:26,036 Speaker 1: the virus. So we're not talking about valuing some lives 81 00:05:26,076 --> 00:05:30,236 Speaker 1: more than others because they're not criminals, or they're just 82 00:05:30,316 --> 00:05:33,196 Speaker 1: better citizens, or they pay more taxes where they are 83 00:05:33,276 --> 00:05:36,836 Speaker 1: engaged in industries like I don't know, tech that we 84 00:05:36,916 --> 00:05:40,076 Speaker 1: think bring really innovative products to us. That's not what's 85 00:05:40,076 --> 00:05:42,716 Speaker 1: going on here. They're talking about people who, by dint 86 00:05:42,756 --> 00:05:49,276 Speaker 1: of their social roles, are either big transmitters or serving functions, 87 00:05:49,276 --> 00:05:52,436 Speaker 1: serving professional functions that help us contain the epidemic, or 88 00:05:52,476 --> 00:05:56,436 Speaker 1: that otherwise help us maintain some symblance of normal civil 89 00:05:56,516 --> 00:06:01,436 Speaker 1: life by providing food, transportation, essential infrastructure. So I think 90 00:06:01,476 --> 00:06:04,276 Speaker 1: they've tried to tow the line there by drawing this 91 00:06:04,396 --> 00:06:08,756 Speaker 1: boundary around what they are willing to consider when evaluating 92 00:06:08,796 --> 00:06:12,436 Speaker 1: a person's role. Do teachers come up here, because they 93 00:06:12,436 --> 00:06:14,396 Speaker 1: seem like a fascinating case to me, because on the 94 00:06:14,436 --> 00:06:18,876 Speaker 1: one hand, teachers are fulfilling a fundamental social role. Without them, 95 00:06:18,876 --> 00:06:20,876 Speaker 1: we can't open the schools, at least not in person. 96 00:06:21,836 --> 00:06:25,396 Speaker 1: But then again, they're not frontline health responders. So teachers 97 00:06:25,396 --> 00:06:28,356 Speaker 1: have been one of the most interesting points of discussion 98 00:06:28,396 --> 00:06:31,476 Speaker 1: in the broader debates about vaccine allocation, because you know, 99 00:06:31,796 --> 00:06:35,156 Speaker 1: to a large degree, we're talking about relatively young people 100 00:06:35,276 --> 00:06:40,156 Speaker 1: who are relatively robust and able to withstand this virus, 101 00:06:40,196 --> 00:06:42,956 Speaker 1: and you know, the emerging evidence suggests that at least 102 00:06:43,036 --> 00:06:46,996 Speaker 1: smaller children are not particularly big vectors. So the teachers 103 00:06:47,276 --> 00:06:50,316 Speaker 1: perceive themselves to be at high risk, but actually might 104 00:06:50,356 --> 00:06:53,076 Speaker 1: not be as quite a high risk as they worried 105 00:06:53,116 --> 00:06:56,676 Speaker 1: that they would be early on. Having said that, there's 106 00:06:56,756 --> 00:07:01,156 Speaker 1: no denying the fact that they are the backbone of 107 00:07:01,396 --> 00:07:05,356 Speaker 1: the most critical infrastructure outside of maybe the provision of 108 00:07:05,356 --> 00:07:07,956 Speaker 1: food and housing. You know, the economy does not run 109 00:07:08,196 --> 00:07:11,076 Speaker 1: when kids are not as school and so as a result, 110 00:07:11,156 --> 00:07:14,756 Speaker 1: the Nation Committee and I think most states will put 111 00:07:14,836 --> 00:07:18,636 Speaker 1: teachers in Phase two, behind healthcare workers and nursing home 112 00:07:18,636 --> 00:07:21,556 Speaker 1: residents and perhaps a few others, but toward the front 113 00:07:21,556 --> 00:07:24,276 Speaker 1: of the line, because again they're playing a role in 114 00:07:24,956 --> 00:07:28,516 Speaker 1: making an essential sector work. You just raised an issue 115 00:07:28,556 --> 00:07:30,836 Speaker 1: that's also of great interest to me, and that is 116 00:07:30,876 --> 00:07:33,156 Speaker 1: you mentioned that it's the states that are going to 117 00:07:33,236 --> 00:07:36,276 Speaker 1: be making the actual decision. So first we talked about 118 00:07:36,316 --> 00:07:40,076 Speaker 1: this framework produced by a kind of blue ribbon panel 119 00:07:40,676 --> 00:07:44,596 Speaker 1: of the quasi governmental but not really governmental, National Academy 120 00:07:44,596 --> 00:07:47,076 Speaker 1: of Sciences, so it's not technically part of the government. 121 00:07:47,476 --> 00:07:50,236 Speaker 1: The governments that will be making the decisions about allocation 122 00:07:50,276 --> 00:07:55,196 Speaker 1: of vaccines are state governments. Why isn't this something that 123 00:07:55,236 --> 00:07:59,876 Speaker 1: should have been decided by the federal government. Well, I 124 00:07:59,916 --> 00:08:02,116 Speaker 1: think really the only way one could answer that is 125 00:08:02,156 --> 00:08:04,516 Speaker 1: just by saying, it's always been the states that have 126 00:08:04,596 --> 00:08:08,116 Speaker 1: run immunization programs. It's just kind of always been that way. 127 00:08:08,116 --> 00:08:11,796 Speaker 1: That there are are federal bodies, most prominently the Advisory 128 00:08:11,836 --> 00:08:14,556 Speaker 1: Committee on Immunization and Practices that you might have heard 129 00:08:14,596 --> 00:08:20,036 Speaker 1: referred to as ASIP, that make recommendations, highly informed, expert 130 00:08:20,156 --> 00:08:24,436 Speaker 1: credible recommendations about who to vaccinate, how to vaccinate them, 131 00:08:24,476 --> 00:08:27,396 Speaker 1: when to vaccinate them. And then states pick up the 132 00:08:27,436 --> 00:08:29,796 Speaker 1: ball and they do it, and they can tweak those 133 00:08:29,796 --> 00:08:33,316 Speaker 1: recommendations if they want to, but it's their game. If 134 00:08:33,316 --> 00:08:36,436 Speaker 1: you were to start over here and design yeah, but 135 00:08:36,756 --> 00:08:38,516 Speaker 1: let's make you the czar and design it not for 136 00:08:38,556 --> 00:08:40,876 Speaker 1: this time, but for the next time. You know. I 137 00:08:40,916 --> 00:08:44,756 Speaker 1: think that there are critical logistical differences among the states 138 00:08:44,796 --> 00:08:47,316 Speaker 1: that cause it to make sense to have them in 139 00:08:47,436 --> 00:08:52,156 Speaker 1: charge of implementation. But I don't appreciate a significant reason 140 00:08:52,836 --> 00:08:56,276 Speaker 1: for the prioritization to be different across states. If it's 141 00:08:56,316 --> 00:09:02,356 Speaker 1: evidence based and it reflects very careful deliberation about important 142 00:09:02,396 --> 00:09:05,396 Speaker 1: values that are shared, it's not clear to me why 143 00:09:05,436 --> 00:09:08,436 Speaker 1: it should be tweaked at the state level. That leads 144 00:09:08,436 --> 00:09:10,676 Speaker 1: me to a very practical question. I mean, what I've 145 00:09:10,716 --> 00:09:14,356 Speaker 1: been sort of picturing is, if you're a hospital worker 146 00:09:14,396 --> 00:09:17,356 Speaker 1: or a frontline worker, you'll get the vaccine through your hospital, 147 00:09:17,436 --> 00:09:19,756 Speaker 1: or if you're a policeman or a fireman or a firefighter, 148 00:09:19,836 --> 00:09:22,636 Speaker 1: or you'll get it, you know, at your firehouse or 149 00:09:22,876 --> 00:09:24,796 Speaker 1: you know, in the police department and so forth. But 150 00:09:24,876 --> 00:09:27,516 Speaker 1: I've been picturing for the vast majority of the population 151 00:09:27,516 --> 00:09:30,196 Speaker 1: that doesn't fit into one of those categories lining up 152 00:09:30,236 --> 00:09:34,676 Speaker 1: in big numbers outside of some large facility, sort of 153 00:09:34,716 --> 00:09:37,396 Speaker 1: the way that testing is sort of happening in some 154 00:09:37,436 --> 00:09:41,676 Speaker 1: places now. Is that wrong? The allocation frameworks mostly are 155 00:09:41,676 --> 00:09:45,476 Speaker 1: putting healthcare workers, nursing home residents, and a few others 156 00:09:45,476 --> 00:09:47,956 Speaker 1: at the front of the line phase one A or 157 00:09:47,516 --> 00:09:50,676 Speaker 1: one B, and then we get down to people with 158 00:09:50,796 --> 00:09:54,196 Speaker 1: significant comorbidities, and then we get down to a phase two, 159 00:09:54,316 --> 00:09:58,556 Speaker 1: where we're dealing with other important people for infrastructure and 160 00:09:58,596 --> 00:10:01,356 Speaker 1: people who have milder comorbidities. And if that's how we 161 00:10:01,396 --> 00:10:03,716 Speaker 1: get to a phase three where there's wide availability the 162 00:10:03,796 --> 00:10:07,156 Speaker 1: vaccine that it starts to penetrate the general population and 163 00:10:07,196 --> 00:10:11,236 Speaker 1: eventually reach younger adults and children. And at that stage, yeah, 164 00:10:11,236 --> 00:10:14,156 Speaker 1: I think we're talking about mass vaccination clinics. But in 165 00:10:14,156 --> 00:10:16,796 Speaker 1: the early stages, when we're trying to identify people who 166 00:10:16,836 --> 00:10:21,396 Speaker 1: are eligible for vaccination under these allocation frameworks, it has 167 00:10:21,436 --> 00:10:25,516 Speaker 1: to work through organizations that already have that information. We're 168 00:10:25,556 --> 00:10:29,836 Speaker 1: not going to have a corner Kiosk vaccinating people asking 169 00:10:29,876 --> 00:10:32,876 Speaker 1: them to show proof of diabetes. And it's not because 170 00:10:32,916 --> 00:10:35,436 Speaker 1: we just don't have enough vaccine yet to reach the 171 00:10:35,516 --> 00:10:37,956 Speaker 1: larger numbers of people. I mean, presumably the moment there 172 00:10:37,996 --> 00:10:41,756 Speaker 1: are enough doses to start lining people up. We want 173 00:10:41,756 --> 00:10:43,796 Speaker 1: to do that. We want to do that, but you 174 00:10:43,836 --> 00:10:46,516 Speaker 1: have to understand the logistical hurdles involved in getting this 175 00:10:46,596 --> 00:10:50,396 Speaker 1: vaccine out and administering it, particularly for the fiser vaccine 176 00:10:50,436 --> 00:10:51,956 Speaker 1: that has to be stored, as you know, at this 177 00:10:52,116 --> 00:10:55,476 Speaker 1: extremely cold temperature, and if your facility doesn't have one 178 00:10:55,476 --> 00:10:58,796 Speaker 1: of those freezers, you're out now. With MADERNA coming online, 179 00:10:58,796 --> 00:11:01,116 Speaker 1: it'll be a little easier. But that's just one example 180 00:11:01,156 --> 00:11:04,796 Speaker 1: of the kind of logistical challenges in scaling this program up. 181 00:11:05,556 --> 00:11:07,716 Speaker 1: So it is going to take some time. Even if 182 00:11:07,756 --> 00:11:11,236 Speaker 1: all of these doses were warehouse right now, not all 183 00:11:11,276 --> 00:11:13,556 Speaker 1: states would be ready to give them to all people. 184 00:11:14,636 --> 00:11:17,116 Speaker 1: Do you have I realized that nobody knows a definitive 185 00:11:17,156 --> 00:11:18,556 Speaker 1: answer to this, and I don't mean to put you 186 00:11:18,596 --> 00:11:21,196 Speaker 1: on the spot, but do you have an instinctive answer 187 00:11:21,716 --> 00:11:23,836 Speaker 1: as to how long this is going to take in 188 00:11:23,836 --> 00:11:26,516 Speaker 1: the different phases? I have heard people say with some 189 00:11:26,636 --> 00:11:30,996 Speaker 1: confidence that at least they speak with confidence that by 190 00:11:31,156 --> 00:11:34,076 Speaker 1: next end of next August beginning of next September, when 191 00:11:34,476 --> 00:11:39,036 Speaker 1: the twenty one twenty two school year begins, people should 192 00:11:39,156 --> 00:11:42,596 Speaker 1: overwhelmingly have been vaccinated. But do you think that is 193 00:11:42,676 --> 00:11:47,276 Speaker 1: actually unrealistically optimistic? I mean, that's consistent with what I'm hearing. 194 00:11:47,276 --> 00:11:50,116 Speaker 1: I don't have any inside information about this. I think 195 00:11:50,356 --> 00:11:54,076 Speaker 1: that's realistic, probably for adults. Kids are the big question 196 00:11:54,116 --> 00:11:56,516 Speaker 1: mark at this point, because, as I'm sure you know, 197 00:11:56,676 --> 00:11:59,076 Speaker 1: you have to have a separate set of clinical trials 198 00:11:59,116 --> 00:12:02,276 Speaker 1: to demonstrate the safety and effectiveness of the vaccine for 199 00:12:02,396 --> 00:12:05,196 Speaker 1: children Right now, I think no trial has gone below 200 00:12:05,196 --> 00:12:09,236 Speaker 1: age sixteen, so those trials are just getting underway. And 201 00:12:09,556 --> 00:12:12,116 Speaker 1: as you probably remember, there is a debate about whether 202 00:12:12,196 --> 00:12:15,476 Speaker 1: to end the adult trials early. There will be similar 203 00:12:15,516 --> 00:12:17,636 Speaker 1: debates for these trials as to how long to run 204 00:12:17,676 --> 00:12:20,396 Speaker 1: them before you get the initial approval for children. So 205 00:12:20,636 --> 00:12:24,956 Speaker 1: there's just a lot more uncertainty about when approval will 206 00:12:24,996 --> 00:12:27,356 Speaker 1: come through. You know, once it does come through, I 207 00:12:27,356 --> 00:12:30,436 Speaker 1: would expect things to happen relatively quickly because we will 208 00:12:30,476 --> 00:12:33,316 Speaker 1: have experience at that point with supply chain and with 209 00:12:33,556 --> 00:12:36,076 Speaker 1: setting things up in clinics, and we will have providers 210 00:12:36,196 --> 00:12:38,796 Speaker 1: enrolled in the program and so forth. But it could 211 00:12:38,796 --> 00:12:40,756 Speaker 1: take some time. And then, of course there's going to 212 00:12:40,796 --> 00:12:44,676 Speaker 1: be the inevitable resistance when we talk about vaccinating children. 213 00:12:45,796 --> 00:12:48,116 Speaker 1: That brings us to the resistance question, which I really 214 00:12:48,156 --> 00:12:52,276 Speaker 1: want to explore with you. So let's start by just 215 00:12:52,396 --> 00:12:58,396 Speaker 1: asking whether you think there are justifiable reasons that individuals 216 00:12:58,436 --> 00:13:01,876 Speaker 1: could use to say I don't want to be vaccinated 217 00:13:02,156 --> 00:13:05,396 Speaker 1: or I don't want my kids to be vaccinated. What 218 00:13:05,556 --> 00:13:09,716 Speaker 1: distinguishes this vaccine from other vaccines that we choir for 219 00:13:09,876 --> 00:13:13,556 Speaker 1: kids is that it's new and not only is it new, 220 00:13:13,596 --> 00:13:15,876 Speaker 1: but it is for some of the makers based on 221 00:13:15,916 --> 00:13:20,196 Speaker 1: a new kind of approach to making vaccines, this mRNA approach. 222 00:13:20,716 --> 00:13:24,276 Speaker 1: So I think it's not unreasonable that people are voicing 223 00:13:24,396 --> 00:13:29,636 Speaker 1: concerns or having questions about safety. It's very unusual, for example, 224 00:13:29,676 --> 00:13:32,916 Speaker 1: for US to require children to accept a vaccine that 225 00:13:33,036 --> 00:13:35,716 Speaker 1: is novel on the market. Obviously take a very extraordinary 226 00:13:35,716 --> 00:13:38,956 Speaker 1: set of circumstances. The other thing, of course, that makes 227 00:13:38,996 --> 00:13:42,676 Speaker 1: these fears not unreasonable is the process through which the 228 00:13:42,796 --> 00:13:46,036 Speaker 1: vaccines have been approved. You know, I think two months 229 00:13:46,036 --> 00:13:47,996 Speaker 1: ago I would have said it's very reasonable for people 230 00:13:48,036 --> 00:13:50,556 Speaker 1: to have concerns about that. Since then, I've personally been 231 00:13:50,596 --> 00:13:53,836 Speaker 1: reassured by the process that has emerged from FDA, the 232 00:13:53,876 --> 00:13:59,116 Speaker 1: director asserting his independence, the transparency around the basis for 233 00:13:59,236 --> 00:14:02,996 Speaker 1: approval that have certainly not heard anyone who has independently 234 00:14:03,036 --> 00:14:06,036 Speaker 1: reviewed those data packages voicing concerns about well, were they 235 00:14:06,036 --> 00:14:09,796 Speaker 1: careful enough or was this the right standard? Their decision 236 00:14:09,876 --> 00:14:11,836 Speaker 1: was also made a lot easier by the fact that 237 00:14:11,876 --> 00:14:15,636 Speaker 1: these were not close cases in terms of efficacy. You know, 238 00:14:15,676 --> 00:14:17,436 Speaker 1: they had set this initial bar it has to be 239 00:14:17,476 --> 00:14:21,356 Speaker 1: fifty percent or more effective, and these things just absolutely 240 00:14:21,436 --> 00:14:24,476 Speaker 1: vaulted over that bar. So I think there's a lot 241 00:14:24,556 --> 00:14:27,316 Speaker 1: to feel good about now relative to where we were 242 00:14:27,356 --> 00:14:30,676 Speaker 1: a couple of months ago, and my own personal apprehensions 243 00:14:30,716 --> 00:14:33,356 Speaker 1: about this I think have been relieved by what I've 244 00:14:33,396 --> 00:14:37,156 Speaker 1: seen over those months. Having said that, anybody who's hesitant 245 00:14:37,196 --> 00:14:40,396 Speaker 1: about regular vaccines is definitely gonna be hesitant about this 246 00:14:40,436 --> 00:14:43,076 Speaker 1: one because it's new. What I think we have going 247 00:14:43,116 --> 00:14:44,956 Speaker 1: for us again is that by the time we get 248 00:14:44,956 --> 00:14:48,556 Speaker 1: to kids, there will be millions and millions and millions 249 00:14:48,556 --> 00:14:51,356 Speaker 1: of doses having been delivered to adults, and we will 250 00:14:51,676 --> 00:14:53,716 Speaker 1: know a lot. So even though it will be new 251 00:14:53,876 --> 00:14:57,716 Speaker 1: in terms of months or years, in terms of doses delivered, 252 00:14:57,996 --> 00:15:00,316 Speaker 1: it might look a lot more like the knowledge base 253 00:15:00,396 --> 00:15:13,316 Speaker 1: that we have about older vaccines. We'll be right back, Michelle. 254 00:15:13,316 --> 00:15:18,236 Speaker 1: You're a highly rational, logical thinking person, and your description 255 00:15:18,396 --> 00:15:22,316 Speaker 1: of what count as reasons to be concerned we're all 256 00:15:22,356 --> 00:15:26,436 Speaker 1: derived from logic and reason there but I presume that 257 00:15:26,916 --> 00:15:29,836 Speaker 1: you share my view. Maybe I shouldn't that some of 258 00:15:29,876 --> 00:15:32,836 Speaker 1: the reasons that people are skeptical of vaccines generally may 259 00:15:32,876 --> 00:15:36,716 Speaker 1: be grounded in formal logical reason, but others are grounded 260 00:15:36,716 --> 00:15:39,956 Speaker 1: in other features. You know, whether that's religious faith, which 261 00:15:39,996 --> 00:15:43,356 Speaker 1: sometimes by its own self description, is grounded in something 262 00:15:43,436 --> 00:15:46,676 Speaker 1: other than logic or reason, not for everybody but for some, 263 00:15:47,476 --> 00:15:52,356 Speaker 1: or in paranoia or structural distrust of science or of 264 00:15:52,356 --> 00:15:56,196 Speaker 1: the government. So what about people who say, you know, 265 00:15:56,236 --> 00:15:58,956 Speaker 1: I don't like vaccines in general, forget about for my kids, 266 00:15:58,956 --> 00:16:02,756 Speaker 1: but for me, and I don't want to be vaccinated. 267 00:16:03,196 --> 00:16:07,156 Speaker 1: Here how tolerant in your view? Should the government be 268 00:16:08,076 --> 00:16:11,156 Speaker 1: of the kind of a response, And then from government 269 00:16:11,156 --> 00:16:13,676 Speaker 1: will move on to private businesses and so forth. Yeah, 270 00:16:13,716 --> 00:16:15,876 Speaker 1: I mean, look, I'm very familiar with the range of 271 00:16:15,876 --> 00:16:19,676 Speaker 1: different concerns. I get lots of mail from folks in 272 00:16:19,716 --> 00:16:22,156 Speaker 1: the anti vACC community expressing their hopes and dreams for 273 00:16:22,236 --> 00:16:25,596 Speaker 1: my family and my own health and safety, and so 274 00:16:25,796 --> 00:16:28,796 Speaker 1: I'm aware all of them very positive, a certain very sweet. 275 00:16:28,836 --> 00:16:31,636 Speaker 1: As a recipient of occasional hate mail myself, I'm sure 276 00:16:31,676 --> 00:16:34,156 Speaker 1: that the loving spirit that pervades all hate mail is 277 00:16:34,196 --> 00:16:37,516 Speaker 1: present in yours too. So I know that people who 278 00:16:37,596 --> 00:16:41,196 Speaker 1: are hesitant or resistant of vaccines really run the gamut 279 00:16:41,236 --> 00:16:43,796 Speaker 1: in terms of how well informed their beliefs are, what 280 00:16:43,876 --> 00:16:46,796 Speaker 1: their beliefs are, why they have these concerns. So the 281 00:16:46,876 --> 00:16:49,156 Speaker 1: question is, what do we do about it. I guess 282 00:16:49,196 --> 00:16:52,116 Speaker 1: my own feeling is that one thing we have going 283 00:16:52,156 --> 00:16:55,636 Speaker 1: for us here is that we don't need ninety percent vaccination. 284 00:16:55,676 --> 00:16:59,236 Speaker 1: We don't need ninety five percent. The best estimates are 285 00:16:59,276 --> 00:17:02,196 Speaker 1: somewhere in the sixty to eighty percent range, probably seventy 286 00:17:02,196 --> 00:17:05,116 Speaker 1: to eighty percent coverage in order to really kill this 287 00:17:05,236 --> 00:17:07,796 Speaker 1: thing because the vaccine is so effective. I mean, we're 288 00:17:07,796 --> 00:17:10,236 Speaker 1: actually getting lucky there. If theaccine we're less effective, we 289 00:17:10,236 --> 00:17:12,356 Speaker 1: would need more people to take it. But even more 290 00:17:12,356 --> 00:17:14,236 Speaker 1: critical than that is what we call the ar not, 291 00:17:14,356 --> 00:17:17,716 Speaker 1: the reproductive number for this virus, which you know, as 292 00:17:17,716 --> 00:17:20,436 Speaker 1: you probably know, is around one somewhere right now in 293 00:17:20,476 --> 00:17:22,876 Speaker 1: most parts of the country. In California here, I think 294 00:17:22,916 --> 00:17:24,476 Speaker 1: it's at one point two right now, which is the 295 00:17:24,516 --> 00:17:27,396 Speaker 1: worst it's been in a while. Compare that to measles, 296 00:17:27,436 --> 00:17:29,916 Speaker 1: where we've got an ar not of twelve to fifteen. 297 00:17:30,036 --> 00:17:32,276 Speaker 1: That means for every person with measles, they're going to 298 00:17:32,356 --> 00:17:36,836 Speaker 1: infect on average, twelve to fifteen additional people. And because 299 00:17:36,876 --> 00:17:39,356 Speaker 1: of that, we have to have close to ninety five 300 00:17:39,396 --> 00:17:43,796 Speaker 1: percent vaccine coverage in order to kill measles in the population. 301 00:17:44,476 --> 00:17:47,036 Speaker 1: So what this all means is we can let a 302 00:17:47,036 --> 00:17:49,356 Speaker 1: few go, we can let more than a few go, 303 00:17:50,036 --> 00:17:52,036 Speaker 1: And in fact, I think we're going to have to 304 00:17:52,076 --> 00:17:55,476 Speaker 1: because there's going to be enough vaccine to get to 305 00:17:55,556 --> 00:17:59,436 Speaker 1: that place of ninety plus percent coverage for quite a 306 00:17:59,436 --> 00:18:02,676 Speaker 1: long time. So what's been interesting to me and having 307 00:18:02,716 --> 00:18:07,116 Speaker 1: conversations about this topic is how much we pivot back 308 00:18:07,156 --> 00:18:09,796 Speaker 1: and forth from talking about who get to get it, 309 00:18:09,956 --> 00:18:11,876 Speaker 1: who gets to be in the line to get it too, 310 00:18:12,116 --> 00:18:14,396 Speaker 1: who has to get it? We're having like these both 311 00:18:14,436 --> 00:18:17,316 Speaker 1: of these conversations at the same time, and the reality 312 00:18:17,436 --> 00:18:19,356 Speaker 1: is that's not going to take place at the same time. 313 00:18:19,356 --> 00:18:21,556 Speaker 1: There's going to be a long time where the question 314 00:18:21,676 --> 00:18:24,676 Speaker 1: is only who gets to get it, and way down 315 00:18:24,716 --> 00:18:27,676 Speaker 1: the line where everybody who would like to get it 316 00:18:27,716 --> 00:18:29,996 Speaker 1: has gotten it, then we can talk about whether there's 317 00:18:30,036 --> 00:18:33,196 Speaker 1: a need to do anything about the remaining whatever it 318 00:18:33,276 --> 00:18:37,236 Speaker 1: is ten twenty percent, thirty percent, forty percent, we'll see. 319 00:18:37,956 --> 00:18:41,676 Speaker 1: But at that point we'll know a lot more about 320 00:18:41,796 --> 00:18:45,716 Speaker 1: the effect of population vaccination on the spread of this virus, 321 00:18:45,756 --> 00:18:47,836 Speaker 1: and my expectation is we won't have to do a 322 00:18:47,836 --> 00:18:50,236 Speaker 1: lot of chasing people that we will get to where 323 00:18:50,236 --> 00:18:54,956 Speaker 1: we need to be with voluntary vaccination as long as 324 00:18:55,236 --> 00:18:57,796 Speaker 1: we do a decent job on two things. One is 325 00:18:57,916 --> 00:19:00,716 Speaker 1: bringing the vaccine to people where they are at zero cost, 326 00:19:00,756 --> 00:19:04,236 Speaker 1: with zero logistical barriers, and the second is learning how 327 00:19:04,276 --> 00:19:06,716 Speaker 1: to talk to people about this vaccine in a way 328 00:19:06,876 --> 00:19:09,956 Speaker 1: that resonates with them. Do you think there might actually 329 00:19:09,956 --> 00:19:13,116 Speaker 1: be an interesting cultural effect of this sequencing that you're describing, 330 00:19:13,636 --> 00:19:16,636 Speaker 1: where if a lot of people really really want the 331 00:19:16,716 --> 00:19:19,876 Speaker 1: vaccine and are trying to get it, that might actually 332 00:19:20,036 --> 00:19:23,276 Speaker 1: create a norm that the vaccine is desirable and reduce 333 00:19:23,396 --> 00:19:25,756 Speaker 1: some of the objections. Because the way many people say 334 00:19:25,756 --> 00:19:29,116 Speaker 1: experience vaccines is you know, they're saying their kids to school, 335 00:19:29,196 --> 00:19:31,116 Speaker 1: or their kids have just been born, or at the 336 00:19:31,116 --> 00:19:34,756 Speaker 1: relevant check up age, and then the government or or 337 00:19:34,796 --> 00:19:36,836 Speaker 1: the doctors speaking on behalf the government says it's time 338 00:19:36,836 --> 00:19:39,316 Speaker 1: for the vaccine. So people see it as a coercive structure. 339 00:19:39,716 --> 00:19:42,516 Speaker 1: And what's more, because those vaccine programs are on the 340 00:19:42,516 --> 00:19:46,196 Speaker 1: whole relatively successful, people don't really see the diseases that 341 00:19:46,236 --> 00:19:49,716 Speaker 1: they would be getting, you know, if they weren't vaccinated. Here, 342 00:19:49,796 --> 00:19:53,116 Speaker 1: we've all seen the effects of COVID. We've seen most 343 00:19:53,116 --> 00:19:55,236 Speaker 1: of us in the United States now, no people who've 344 00:19:55,276 --> 00:19:57,796 Speaker 1: gotten sick and in many cases we know people who 345 00:19:57,796 --> 00:20:00,956 Speaker 1: have unfortunately died, So there's a kind of you know, 346 00:20:01,036 --> 00:20:04,836 Speaker 1: maybe if everyone wants one, it will reduce the likelihood 347 00:20:04,836 --> 00:20:07,716 Speaker 1: that people will be skeptical of taking it. I mean, 348 00:20:07,756 --> 00:20:10,636 Speaker 1: they're probably a certain people in the population who think 349 00:20:10,636 --> 00:20:13,396 Speaker 1: in those terms. I think what will be more influential 350 00:20:13,596 --> 00:20:15,756 Speaker 1: is just the experience of seeing with your own eyes 351 00:20:15,876 --> 00:20:20,716 Speaker 1: friends and family getting vaccinated, being fine, shedding tears of relief, 352 00:20:21,076 --> 00:20:23,516 Speaker 1: and being able to resume their lives in ways that you, 353 00:20:23,596 --> 00:20:27,996 Speaker 1: as an unvaccinated person can't or shouldn't. So what is 354 00:20:27,996 --> 00:20:29,836 Speaker 1: scary about this vaccine, as I mentioned to a lot 355 00:20:29,876 --> 00:20:32,316 Speaker 1: of people, is that it is new, it's unknown, and 356 00:20:32,556 --> 00:20:34,916 Speaker 1: quite understandably, they don't want to be in line first 357 00:20:34,996 --> 00:20:37,836 Speaker 1: for something that they have concerns about. But one hundred 358 00:20:37,876 --> 00:20:40,796 Speaker 1: million doses later, I think people will start to feel differently. 359 00:20:41,076 --> 00:20:44,236 Speaker 1: It's going to take special outreach to certain populations to 360 00:20:44,276 --> 00:20:48,156 Speaker 1: be sure, including racial and minority communities who need to 361 00:20:48,196 --> 00:20:51,596 Speaker 1: hear this from particular kinds of messengers. And then also 362 00:20:51,636 --> 00:20:54,156 Speaker 1: this time around people on the right who you know, 363 00:20:54,236 --> 00:20:59,836 Speaker 1: quite curiously, given the President's investment in vaccine development, share 364 00:21:00,156 --> 00:21:05,076 Speaker 1: the vaccine skepticism of many in the vaccine resistance community, 365 00:21:05,076 --> 00:21:09,316 Speaker 1: which have traditionally been more left leaning women. So there's 366 00:21:09,316 --> 00:21:12,996 Speaker 1: this bizarre concentration or constellation of people who have concerns 367 00:21:13,036 --> 00:21:15,196 Speaker 1: about the vaccine that we're going to have to figure 368 00:21:15,236 --> 00:21:17,996 Speaker 1: out how to reach. But you know, there will be 369 00:21:17,996 --> 00:21:20,876 Speaker 1: people that it will be pretty tough for. My stepmom 370 00:21:21,036 --> 00:21:24,916 Speaker 1: is a retired corrections officer. She lives in rural Iowa, 371 00:21:24,996 --> 00:21:27,716 Speaker 1: and she's you know, elderly and at some risk for 372 00:21:28,076 --> 00:21:31,156 Speaker 1: serious cummorbidities. And when I talk to her about the vaccine, 373 00:21:31,676 --> 00:21:35,276 Speaker 1: she says, hell, no, I'm not getting no vaccine full stop. 374 00:21:35,316 --> 00:21:37,316 Speaker 1: There's not a lot to work with there in terms 375 00:21:37,356 --> 00:21:39,756 Speaker 1: of you know, we talked about with rational reasons. There's 376 00:21:39,796 --> 00:21:42,956 Speaker 1: there's just not a lot there other than distrust. And 377 00:21:43,156 --> 00:21:44,676 Speaker 1: you know, we're going to have to figure out how 378 00:21:44,676 --> 00:21:47,116 Speaker 1: to turn some of the messaging around to reach out 379 00:21:47,156 --> 00:21:51,436 Speaker 1: to people who see vaccination as part of a broader 380 00:21:51,996 --> 00:21:56,636 Speaker 1: set of intrusive measures perpetrated on the public by left 381 00:21:56,716 --> 00:22:00,436 Speaker 1: leaning public health officials and governors. Can you imagine a 382 00:22:00,476 --> 00:22:04,356 Speaker 1: scenario where we actually aren't able to vaccinate enough people 383 00:22:04,396 --> 00:22:08,636 Speaker 1: to reach her community because of widespread skepticism. I mean 384 00:22:08,676 --> 00:22:10,956 Speaker 1: that would be massive crisis. I mean, here we are, 385 00:22:11,116 --> 00:22:13,996 Speaker 1: people like us are sitting around in universities, and the 386 00:22:14,036 --> 00:22:16,756 Speaker 1: moment that the vaccines were reported as working, we all 387 00:22:16,836 --> 00:22:20,876 Speaker 1: breathed an enormous sigh of relief. Right, I mean science worked. 388 00:22:21,036 --> 00:22:23,916 Speaker 1: You know what a relief. Life will return to normal. 389 00:22:23,996 --> 00:22:27,516 Speaker 1: What a relief. And I don't think I've heard serious 390 00:22:27,556 --> 00:22:30,556 Speaker 1: discussion in the last few weeks, let's say, since the 391 00:22:31,356 --> 00:22:35,316 Speaker 1: good numbers came in, of oh, what if we just 392 00:22:35,516 --> 00:22:38,876 Speaker 1: cannot convince a sufficient number of people to take it, 393 00:22:38,956 --> 00:22:41,796 Speaker 1: to get the R not down below one. I mean, 394 00:22:41,996 --> 00:22:44,556 Speaker 1: I look that. I think those discussions are happening. There's 395 00:22:44,596 --> 00:22:48,276 Speaker 1: still so much interest. I'm hearing and talking about mandates 396 00:22:48,316 --> 00:22:51,596 Speaker 1: and you can employers required and can schools require it? 397 00:22:51,996 --> 00:22:54,196 Speaker 1: This is not, to be clear, something that state officials 398 00:22:54,196 --> 00:22:56,676 Speaker 1: are talking about, or even many employers. There's very little 399 00:22:56,676 --> 00:22:58,836 Speaker 1: appetite for that among the employers that I know of, 400 00:22:59,316 --> 00:23:01,596 Speaker 1: but reporters want to talk about it. People are curious 401 00:23:01,636 --> 00:23:05,116 Speaker 1: about that, And my answer is always, I just don't 402 00:23:05,116 --> 00:23:07,196 Speaker 1: think we need to go there right now. I think 403 00:23:07,236 --> 00:23:10,596 Speaker 1: we have massive challenge over the next six months in 404 00:23:10,676 --> 00:23:12,676 Speaker 1: getting this to the people who want to get it, 405 00:23:13,476 --> 00:23:17,196 Speaker 1: and at that point, when we've done that, I think 406 00:23:17,236 --> 00:23:19,636 Speaker 1: it will be less of a crisis atmosphere. We will 407 00:23:19,676 --> 00:23:23,036 Speaker 1: know a lot more about the safety profile of the vaccine. 408 00:23:23,556 --> 00:23:26,396 Speaker 1: People will know more people who've gotten the vaccine and 409 00:23:26,436 --> 00:23:29,356 Speaker 1: feel a little bit more personally comfortable with it. And 410 00:23:29,476 --> 00:23:31,556 Speaker 1: so while it's possible that at that time we might 411 00:23:31,596 --> 00:23:34,196 Speaker 1: have to revisit this conversation about can we make people 412 00:23:34,236 --> 00:23:36,636 Speaker 1: get it, I don't think it does the effort any 413 00:23:36,676 --> 00:23:39,116 Speaker 1: good to go there now. We don't need to do it, 414 00:23:39,156 --> 00:23:41,476 Speaker 1: and it's just going to foment the concerns that are 415 00:23:41,556 --> 00:23:46,236 Speaker 1: causing a problem. I hear the pragmatics behind what you're saying. 416 00:23:46,636 --> 00:23:49,796 Speaker 1: If you and I are you with other journalists have 417 00:23:49,876 --> 00:23:53,396 Speaker 1: conversations about the ethics of coercion by the government or 418 00:23:53,436 --> 00:23:56,396 Speaker 1: by private employers, as you say, that will just rile 419 00:23:56,556 --> 00:24:00,076 Speaker 1: up the opponents. So I get it. What I wonder, though, 420 00:24:00,436 --> 00:24:02,916 Speaker 1: is whether it might not be a mistake not to 421 00:24:02,956 --> 00:24:05,996 Speaker 1: start talking about it now for the following reason. I 422 00:24:06,076 --> 00:24:09,876 Speaker 1: take it that one of the big differences between eighty 423 00:24:09,956 --> 00:24:12,636 Speaker 1: or ninety percent of the population getting a vaccine and 424 00:24:13,036 --> 00:24:15,756 Speaker 1: fifty or sixty percent getting a vaccine, even a very 425 00:24:15,756 --> 00:24:22,556 Speaker 1: effective vaccine is whether COVID nineteen is eliminated altogether, or 426 00:24:22,596 --> 00:24:29,236 Speaker 1: whether it becomes a recurring but relatively low likelihood disease 427 00:24:29,316 --> 00:24:34,436 Speaker 1: that's out there. It's still circulating and flares up every 428 00:24:34,516 --> 00:24:37,876 Speaker 1: so often and kills of you know, a handful of 429 00:24:37,916 --> 00:24:41,196 Speaker 1: people here there or in the other place. And that 430 00:24:41,356 --> 00:24:43,316 Speaker 1: that does seem to be a huge difference. And I 431 00:24:43,676 --> 00:24:46,636 Speaker 1: wonder if maybe we would do ourselves a disservice by 432 00:24:46,676 --> 00:24:51,196 Speaker 1: not laying out the case now for actually eliminating the 433 00:24:51,276 --> 00:24:55,396 Speaker 1: disease the way that smallpox was, at least in principle eliminated. 434 00:24:56,036 --> 00:24:58,156 Speaker 1: You know, it's not that it's not worth thinking about, 435 00:24:58,236 --> 00:24:59,996 Speaker 1: and I think people have thought about it. I've written 436 00:25:00,036 --> 00:25:02,196 Speaker 1: about it, you know, I've written a list of trigger 437 00:25:02,276 --> 00:25:04,276 Speaker 1: criteria that I think would have to be satisfied in 438 00:25:04,356 --> 00:25:06,796 Speaker 1: order for us to be able to justify a mandate 439 00:25:06,836 --> 00:25:09,556 Speaker 1: for adults. And only you know certain adults. What kinds 440 00:25:09,556 --> 00:25:12,156 Speaker 1: of criteria are in your trigger list, Christia? Number one 441 00:25:12,236 --> 00:25:14,796 Speaker 1: is you tried the voluntary thing and it didn't work right. 442 00:25:15,436 --> 00:25:17,516 Speaker 1: And not only did you try it, you set up 443 00:25:17,596 --> 00:25:21,276 Speaker 1: a vaccination program that has a high likelihood of success, 444 00:25:21,436 --> 00:25:24,436 Speaker 1: meaning that you have the vaccine is free, and it 445 00:25:24,516 --> 00:25:26,876 Speaker 1: is brought to people where they can access it physically 446 00:25:26,956 --> 00:25:30,556 Speaker 1: and logistically, and there is a compensation program in place 447 00:25:30,596 --> 00:25:33,516 Speaker 1: for healthcare workers who are injured by the vaccine, and 448 00:25:33,636 --> 00:25:35,756 Speaker 1: you know, and others who are as a practical matter 449 00:25:35,796 --> 00:25:38,476 Speaker 1: required to have it who are injured. And then beyond that, 450 00:25:38,556 --> 00:25:41,596 Speaker 1: you know, there's an assessment that that program, having run 451 00:25:41,636 --> 00:25:43,556 Speaker 1: for a limited period of time, has not produced the 452 00:25:43,836 --> 00:25:47,636 Speaker 1: necessary levels of population immunity. And there are certain other 453 00:25:47,836 --> 00:25:51,636 Speaker 1: criterion places as well, like transparent communication with the public, 454 00:25:52,156 --> 00:25:55,916 Speaker 1: sufficient supply of vaccine, and so forth. I think it'll 455 00:25:55,956 --> 00:25:58,916 Speaker 1: be really interesting to see where Donald Trump himself comes 456 00:25:58,916 --> 00:26:02,796 Speaker 1: down on this. So far, because the vaccine was developed 457 00:26:02,796 --> 00:26:05,516 Speaker 1: while he was president, he seems eager to take credit 458 00:26:05,516 --> 00:26:08,236 Speaker 1: for it. Just recently. There was a big public to 459 00:26:08,276 --> 00:26:11,396 Speaker 1: do when the vice president was vaccinated, and so if 460 00:26:11,396 --> 00:26:15,556 Speaker 1: the president, when he's no longer president, continues that narrative, 461 00:26:16,236 --> 00:26:18,836 Speaker 1: that might be a plus from the standpoint of convincing 462 00:26:19,316 --> 00:26:22,796 Speaker 1: people who follow him to be vaccinated. There is of course, 463 00:26:22,836 --> 00:26:25,756 Speaker 1: always some danger with Donald Trump that he'll flip and say, 464 00:26:25,796 --> 00:26:27,516 Speaker 1: you know, the vaccine was great when I was president, 465 00:26:27,516 --> 00:26:29,196 Speaker 1: but now that I'm not president. There's reasons to be 466 00:26:29,276 --> 00:26:32,196 Speaker 1: skeptical about how it's being implemented, and therefore my followers 467 00:26:32,476 --> 00:26:34,796 Speaker 1: shouldn't take it. I mean, I pray that he doesn't 468 00:26:34,796 --> 00:26:36,476 Speaker 1: do that, but you know, you can never say never 469 00:26:36,516 --> 00:26:39,236 Speaker 1: with Donald Trump. Do you have some sense of how 470 00:26:39,236 --> 00:26:40,836 Speaker 1: the politics that are going to play out? I mean, 471 00:26:40,876 --> 00:26:43,916 Speaker 1: you mentioned that there is now a meaningful component of 472 00:26:43,996 --> 00:26:46,796 Speaker 1: right wing anti vaxxers to go alongside with left wing 473 00:26:46,796 --> 00:26:49,836 Speaker 1: anti vaxers. Yeah, I do think it would be helpful. 474 00:26:49,876 --> 00:26:52,716 Speaker 1: They have more key opinion leaders in the Republican Party, 475 00:26:52,756 --> 00:26:55,716 Speaker 1: including the President, talking not only about the vaccine, but 476 00:26:55,756 --> 00:26:59,236 Speaker 1: about vaccination. And to me, the President's actually being curiously 477 00:26:59,316 --> 00:27:02,276 Speaker 1: muted on this point. Given the magnitude of the achievement 478 00:27:02,316 --> 00:27:06,076 Speaker 1: of his Operation Warp Speed, you'd think he'd want to 479 00:27:06,076 --> 00:27:08,596 Speaker 1: take credit for getting the vaccine into people, not just 480 00:27:08,636 --> 00:27:11,076 Speaker 1: to get it through the FDA. Well, that's what I'm 481 00:27:11,116 --> 00:27:13,116 Speaker 1: worried about. I mean, I'm worried that, as is always 482 00:27:13,116 --> 00:27:15,396 Speaker 1: the case the Trump he's keeping his options open, and 483 00:27:15,436 --> 00:27:17,196 Speaker 1: that if he thinks that his base is going to 484 00:27:17,236 --> 00:27:19,956 Speaker 1: be anti vax then he doesn't want to be too 485 00:27:20,036 --> 00:27:22,636 Speaker 1: connected to the vaccine, and that's why he sent out 486 00:27:22,676 --> 00:27:24,636 Speaker 1: Mike Pence and didn't have the picture of himself being 487 00:27:24,676 --> 00:27:26,756 Speaker 1: vaccinated apart from the fact that he's already been infected. 488 00:27:26,956 --> 00:27:29,716 Speaker 1: So I think what's more, much more helpful is, for example, 489 00:27:29,756 --> 00:27:33,676 Speaker 1: what Mitch McConnell said recently about vaccination, which is, you know, 490 00:27:33,796 --> 00:27:36,316 Speaker 1: first of all going to do it, Secondly you should 491 00:27:36,356 --> 00:27:38,116 Speaker 1: do it too, and third you know, we all kind 492 00:27:38,116 --> 00:27:40,116 Speaker 1: of owe this to one another. And it's not a 493 00:27:40,156 --> 00:27:42,916 Speaker 1: difficult message for those on the right to say to people, Look, 494 00:27:42,956 --> 00:27:45,476 Speaker 1: you don't like the economy being shut down, you don't 495 00:27:45,476 --> 00:27:48,316 Speaker 1: like being told to stay home. There's a fix, now, 496 00:27:48,756 --> 00:27:52,036 Speaker 1: do it. I want to close with that question of 497 00:27:52,116 --> 00:27:55,116 Speaker 1: communal responsibility and what we owe to one another with 498 00:27:55,156 --> 00:27:58,116 Speaker 1: respect to a vaccine, because we have a tendency to 499 00:27:58,156 --> 00:28:01,676 Speaker 1: think about issues of government coercion solely in terms of 500 00:28:01,716 --> 00:28:06,156 Speaker 1: the individual's right to resist a government mandate, and to 501 00:28:06,236 --> 00:28:09,396 Speaker 1: forget that when it comes to vaccines, the mandate isn't 502 00:28:09,436 --> 00:28:11,636 Speaker 1: just that the government wants you to be healthy, but 503 00:28:11,716 --> 00:28:14,556 Speaker 1: that the government doesn't want you to infect others, and 504 00:28:14,596 --> 00:28:18,476 Speaker 1: that the presence of disease in a population has generally 505 00:28:18,476 --> 00:28:22,156 Speaker 1: harmful effects. Because even a vaccine that's ninety five percent efficacious. 506 00:28:22,236 --> 00:28:24,636 Speaker 1: That means that you know, one in twenty people who 507 00:28:24,756 --> 00:28:29,156 Speaker 1: have the vaccine could still potentially be infected under the 508 00:28:29,236 --> 00:28:32,116 Speaker 1: right set of circumstances. So when you think about the 509 00:28:32,156 --> 00:28:36,436 Speaker 1: ethics of vaccination, do you start with the collective or 510 00:28:36,436 --> 00:28:39,236 Speaker 1: do you start with the individual? I do start with 511 00:28:39,316 --> 00:28:42,276 Speaker 1: the collective, because that is the purpose of vaccinations. That 512 00:28:42,356 --> 00:28:45,636 Speaker 1: it is to produce true heard immunity, not the kind 513 00:28:45,716 --> 00:28:48,396 Speaker 1: where we let everybody get infected and hope for the best, 514 00:28:48,436 --> 00:28:51,236 Speaker 1: but the kind where your body is trained to become 515 00:28:51,276 --> 00:28:54,076 Speaker 1: immune to the virus. That's what the purpose of vaccines is. 516 00:28:54,156 --> 00:28:58,676 Speaker 1: And and no vaccination or you know, outside extraordinarily high 517 00:28:58,756 --> 00:29:03,316 Speaker 1: risk context, is ever an individually rational decision. You know, 518 00:29:03,356 --> 00:29:07,636 Speaker 1: all vaccines have risks of some side effects. For most diseases, 519 00:29:07,676 --> 00:29:09,876 Speaker 1: we've more or less wiped them out as long as 520 00:29:09,916 --> 00:29:12,436 Speaker 1: everybody stays vaccinated. So for any one of us, it 521 00:29:12,516 --> 00:29:14,676 Speaker 1: makes more sense not to get vaccinated than to get 522 00:29:14,756 --> 00:29:17,756 Speaker 1: vaccinated from a risk benefit standpoint. But we do it 523 00:29:17,836 --> 00:29:21,156 Speaker 1: because we know, like any collective action problem, if everybody 524 00:29:21,196 --> 00:29:23,836 Speaker 1: acted that way, we'd all be worse off because the 525 00:29:23,916 --> 00:29:26,836 Speaker 1: disease would search And we know that it happens over 526 00:29:26,996 --> 00:29:30,196 Speaker 1: and over again. When we have dips in coverage for 527 00:29:30,476 --> 00:29:34,796 Speaker 1: diseases like measles, mumps, and pertusses, we see outbreaks every year. 528 00:29:35,516 --> 00:29:37,916 Speaker 1: So that's the way we have to think about it, 529 00:29:37,956 --> 00:29:41,156 Speaker 1: is that every individual is doing their part to maintain 530 00:29:41,196 --> 00:29:44,676 Speaker 1: this collective good. That we all benefit enormously from the 531 00:29:44,676 --> 00:29:46,796 Speaker 1: collective good, albeit in ways that, as you said, are 532 00:29:46,876 --> 00:29:50,916 Speaker 1: usually invisible. Now, where does individual liberty come into this. 533 00:29:51,916 --> 00:29:54,796 Speaker 1: The courts, as you know, have been very clear that 534 00:29:54,836 --> 00:29:57,716 Speaker 1: the reasons that people can opt out of mandated vaccinations 535 00:29:57,756 --> 00:30:00,636 Speaker 1: are pretty narrow. There's no question that a valid medical 536 00:30:00,676 --> 00:30:04,676 Speaker 1: condraindication is a valid reason to opt out. Religious bases 537 00:30:04,716 --> 00:30:07,996 Speaker 1: for opting out are tougher. The Supreme Court has never 538 00:30:08,036 --> 00:30:10,956 Speaker 1: held that states a acquired to offer that many states 539 00:30:11,036 --> 00:30:14,756 Speaker 1: choose to do it, but increasingly they're choosing to restrict those. 540 00:30:15,076 --> 00:30:18,316 Speaker 1: And then there are these other sort of philosophical reasons 541 00:30:18,356 --> 00:30:21,276 Speaker 1: why people object to vaccines, which is maybe the most 542 00:30:21,316 --> 00:30:25,276 Speaker 1: trenchant avenue to focus on in this context, because although 543 00:30:25,276 --> 00:30:27,676 Speaker 1: we've heard a lot about certain religious communities, and during 544 00:30:27,676 --> 00:30:30,916 Speaker 1: COVID nineteen, it's actually pretty hard to find a religious 545 00:30:31,036 --> 00:30:35,876 Speaker 1: faith then rejects vaccines outright. They tend to when you 546 00:30:35,916 --> 00:30:38,036 Speaker 1: sort of scratch below the surface, most of those religious 547 00:30:38,036 --> 00:30:40,356 Speaker 1: beliefs are more a set of philosophical beliefs about the 548 00:30:40,356 --> 00:30:44,196 Speaker 1: body and about the spirit and the body healing itself. 549 00:30:44,196 --> 00:30:46,076 Speaker 1: It doesn't tend to be connected to what the courts 550 00:30:46,116 --> 00:30:49,476 Speaker 1: think about as religions. So the liberties that are being 551 00:30:49,476 --> 00:30:52,956 Speaker 1: implicated here are mostly of this last variety here, of 552 00:30:53,036 --> 00:30:55,476 Speaker 1: this idea that simply I just don't believe in vaccines 553 00:30:55,596 --> 00:30:58,116 Speaker 1: or I just don't want it, and for a disease 554 00:30:58,156 --> 00:31:00,716 Speaker 1: like COVID or any of the other even more serious 555 00:31:00,716 --> 00:31:04,396 Speaker 1: diseases for which we require vaccinations, it's just really hard 556 00:31:04,436 --> 00:31:08,716 Speaker 1: to square that as a weighty interest against what's at 557 00:31:08,756 --> 00:31:11,636 Speaker 1: stake here. On the whole, I think the story you're 558 00:31:11,636 --> 00:31:14,956 Speaker 1: telling is a relatively optimistic one, and I'm grateful for that. 559 00:31:15,036 --> 00:31:19,996 Speaker 1: This might be the first genuinely optimistic COVID related episode 560 00:31:19,996 --> 00:31:21,836 Speaker 1: of a deep background that we've had in the last 561 00:31:22,156 --> 00:31:24,316 Speaker 1: nine or ten months. But at the same time, you 562 00:31:24,316 --> 00:31:26,436 Speaker 1: gave us a very realistic account of what the ongoing 563 00:31:26,476 --> 00:31:28,596 Speaker 1: challenges are. So thank you very much for that, and 564 00:31:28,676 --> 00:31:30,436 Speaker 1: thank you for your time, and thank you for the 565 00:31:30,436 --> 00:31:32,716 Speaker 1: amazing work you're doing. Thanks very much for having me 566 00:31:39,356 --> 00:31:43,396 Speaker 1: listening to Professor Mellow made me realize that things are 567 00:31:43,396 --> 00:31:46,196 Speaker 1: both simpler and more complicated when it comes to the 568 00:31:46,236 --> 00:31:50,636 Speaker 1: distribution and implementation of the COVID vaccines than I had 569 00:31:50,676 --> 00:31:55,076 Speaker 1: previously thought. In a sense, they're simpler because the frameworks 570 00:31:55,156 --> 00:31:59,436 Speaker 1: expressed by the National Academy of Medicine are mostly being 571 00:31:59,596 --> 00:32:03,316 Speaker 1: followed by most of the states, and they're does not 572 00:32:03,476 --> 00:32:06,796 Speaker 1: seem to be at least thus far, any major public 573 00:32:06,796 --> 00:32:11,276 Speaker 1: outcry objecting to them. They're more complicated because the values 574 00:32:11,316 --> 00:32:15,236 Speaker 1: and principles laid out in those standards are actually pretty 575 00:32:15,476 --> 00:32:19,356 Speaker 1: under specific with respect to what to do in situations 576 00:32:19,356 --> 00:32:24,236 Speaker 1: of conflict. The values expressed are all wonderful values, but 577 00:32:24,276 --> 00:32:27,436 Speaker 1: if you really drill down, there probably would be tensions 578 00:32:27,476 --> 00:32:30,156 Speaker 1: between them. But it may well be that no one 579 00:32:30,196 --> 00:32:34,716 Speaker 1: fundamentally objects to the process by which vaccines are being distributed, 580 00:32:34,956 --> 00:32:37,956 Speaker 1: and that enough vaccine may soon be available that people 581 00:32:37,996 --> 00:32:40,996 Speaker 1: who want to get the vaccine can get their hands 582 00:32:41,036 --> 00:32:44,636 Speaker 1: on it. If we don't have a moment of shortage, 583 00:32:44,996 --> 00:32:48,836 Speaker 1: then there need not be any intense public debate over 584 00:32:48,876 --> 00:32:52,636 Speaker 1: the question of who gets the vaccine first. That, of 585 00:32:52,636 --> 00:32:55,076 Speaker 1: course leads to the question of what will happen when 586 00:32:55,196 --> 00:32:58,516 Speaker 1: lots of people have gotten the vaccine and some begin 587 00:32:58,596 --> 00:33:01,116 Speaker 1: to say that they don't want to take it. And 588 00:33:01,236 --> 00:33:05,436 Speaker 1: here Professor Mellow's view is, let's not worry about that 589 00:33:05,516 --> 00:33:08,916 Speaker 1: problem yet. Let's focus in the short term on getting 590 00:33:08,916 --> 00:33:11,916 Speaker 1: the vaccine to as many people as possible and encouraging 591 00:33:11,916 --> 00:33:14,196 Speaker 1: people to take it. And then if we get into 592 00:33:14,236 --> 00:33:19,196 Speaker 1: circumstances where the government or schools or private actors want 593 00:33:19,236 --> 00:33:22,396 Speaker 1: to obligate people to have vaccines, we will deal with 594 00:33:22,436 --> 00:33:25,396 Speaker 1: that problem when we come to it. That's a highly 595 00:33:25,556 --> 00:33:29,236 Speaker 1: sensible attitude, and I promise that if and when the 596 00:33:29,316 --> 00:33:32,956 Speaker 1: question of coercing people to get vaccines does arise, we 597 00:33:33,036 --> 00:33:38,356 Speaker 1: will revisit the issue. Here on Deep Background. We at 598 00:33:38,356 --> 00:33:41,556 Speaker 1: Deep Background are going to take a short holiday break now, 599 00:33:41,716 --> 00:33:45,156 Speaker 1: and we hope you'll be able to also until I 600 00:33:45,196 --> 00:33:48,996 Speaker 1: speak to you next time. Get some rest, Be careful, 601 00:33:49,516 --> 00:33:53,956 Speaker 1: be safe, and be well. Deep Background is brought to 602 00:33:53,956 --> 00:33:57,596 Speaker 1: you by Pushkin Industries. Our producer is Lydia Gencott, our 603 00:33:57,636 --> 00:34:01,476 Speaker 1: engineer is Martin Gonzalez, and our showrunner is Sophie Crane mckibbeck. 604 00:34:01,716 --> 00:34:04,876 Speaker 1: Theme music by Luis Kara at Pushkin. Thanks to Mia 605 00:34:04,916 --> 00:34:08,836 Speaker 1: Lobell Julia Barton, Heather Fain, Carlie mcgliori, Mackie Taylor, Eric 606 00:34:09,356 --> 00:34:11,996 Speaker 1: and Jacob Weisberg. You can find me on Twitter at 607 00:34:12,076 --> 00:34:15,236 Speaker 1: Noah Rfeld. I also write a column for Bloomberg Opinion, 608 00:34:15,356 --> 00:34:18,556 Speaker 1: which you can find at bloomberg dot com slashfeld. To 609 00:34:18,636 --> 00:34:22,076 Speaker 1: discover Bloomberg's original slate of podcasts, go to Bloomberg dot 610 00:34:22,076 --> 00:34:25,556 Speaker 1: com slash podcasts, and if you liked what you heard today, 611 00:34:25,596 --> 00:34:28,316 Speaker 1: please write a review or tell a friend. This is 612 00:34:28,356 --> 00:34:29,116 Speaker 1: deep background