# Seth Berkley & Eric Topol - Discuss Fair Doses Book

An episode of [Ground Truths](https://invisiblenetwork.ai/podcast/1728526108), 5 Nov 2025, 47 min.

Audio: https://api.substack.com/feed/podcast/177600442/bcdc80663e998a1a3e98a5bda7f17098.mp3

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## Transcript

[0:00] I am just delighted on our new podcast of Ground Truths to
[0:04] welcome Seth Berkley.
[0:07] SPEAKER_01: Seth has been a major force in vaccines around the world,
[0:11] SPEAKER_01: and he has a new book called Fair Doses,
[0:14] SPEAKER_01: which we're going to be discussing today.
[0:16] SPEAKER_01: And if you have questions,
[0:18] SPEAKER_01: you can put them in the message as we go forward,
[0:22] SPEAKER_01: and we're going to get right into it.
[0:24] SPEAKER_01: Seth is a
[0:25] noted physician epidemiologist who has been so active in these
[0:32] international
[0:34] public-private partnerships with the AIDS vaccine and then 12
[0:40] years of Gavi.
[0:42] SPEAKER_01: And in this new book,
[0:44] He describes the story,
[0:46] which I guess we'll start back at Davos,
[0:49] January 2020.
[0:50] SPEAKER_01: You're in the hard rock.
[0:54] SPEAKER_01: Is it a bar?
[0:54] SPEAKER_00: The cafe?
[0:56] SPEAKER_00: It's a bar.
[0:56] SPEAKER_00: As all these stories start in the bar, you know, it has to.
[1:00] SPEAKER_01: This is an incredible story.
[1:03] One that would really be,
[1:04] you know,
[1:04] in the archives of just beyond belief in medicine.
[1:09] SPEAKER_01: So it's January 2020.
[1:11] SPEAKER_01: Most people haven't even acknowledged that there's a pandemic.
[1:14] SPEAKER_01: Right.
[1:15] SPEAKER_01: And you're making some big plans.
[1:17] SPEAKER_01: Tell us about what was going on then.
[1:20] SPEAKER_00: Well,
[1:20] it was a funny time because it was a few weeks after we heard
[1:23] about what was going
[1:24] SPEAKER_00: on in Wuhan.
[1:25] SPEAKER_00: And,
[1:26] SPEAKER_00: you know,
[1:26] SPEAKER_00: initially it was thought to be a transmission from a wet market,
[1:29] SPEAKER_00: you know,
[1:30] SPEAKER_00: to people.
[1:31] There wasn't any well-documented evidence of person-to-person
[1:36] transmission,
[1:37] although...
[1:37] SPEAKER_00: Of course, we were beginning to hear rumors of that going on.
[1:41] And of course,
[1:42] that's what gets you nervous if you're a public health person.
[1:46] SPEAKER_00: And so the question we had at that moment was,
[1:49] SPEAKER_00: is this the big one or is this just a dress rehearsal for the big one?
[1:53] SPEAKER_00: And Richard Hatchett,
[1:54] SPEAKER_00: who runs CEPI,
[1:55] SPEAKER_00: the Coalition for Epidemic Preparedness Innovation,
[1:57] SPEAKER_00: myself and my wife,
[1:58] SPEAKER_00: Cynthia,
[1:59] SPEAKER_00: who's also a physician,
[2:00] SPEAKER_00: were sitting there and having that discussion.
[2:02] SPEAKER_00: Meanwhile,
[2:03] SPEAKER_00: Donald Trump was down the street saying,
[2:05] SPEAKER_00: oh,
[2:06] SPEAKER_00: yeah,
[2:06] SPEAKER_00: some case came to the U.S.,
[2:07] SPEAKER_00: but don't worry about it.
[2:08] SPEAKER_00: There's no problem.
[2:09] SPEAKER_00: It's not going anywhere.
[2:10] SPEAKER_00: We got it completely under control.
[2:12] SPEAKER_00: The system's great.
[2:13] SPEAKER_00: Nothing.
[2:14] SPEAKER_00: And, you know, we were not sure about that at that moment.
[2:19] SPEAKER_00: And so, really, the question was, you know, how do you begin to scale up?
[2:23] SPEAKER_00: And we had at that point no mandate, no money, and no people.
[2:27] SPEAKER_00: Of course,
[2:28] Gavi was a large operation providing vaccines to more than 50%
[2:32] of the world's
[2:33] SPEAKER_00: children—
[2:34] But the board was quite clear that we couldn't take money away
[2:38] from that to do this new work.
[2:42] SPEAKER_00: Richard had money for epidemic vaccine production.
[2:45] SPEAKER_00: So he right away was able to make some grants,
[2:48] SPEAKER_00: including the first gland to Moderna for their clinical lot.
[2:51] And so this was really,
[2:53] you know,
[2:54] we basically sat around and proverbially writing it out on a
[2:58] SPEAKER_00: napkin on what it would look like.
[3:00] SPEAKER_00: And after Davos,
[3:01] SPEAKER_00: I went back and met with all the partners of the alliance,
[3:04] SPEAKER_00: and he went back and began to scale up.
[3:06] SPEAKER_00: And that really was the launch of COVAX,
[3:09] which is ultimately the largest and fastest rollout of vaccine
[3:14] in history,
[3:15] SPEAKER_00: although it had all kinds of problems.
[3:16] SPEAKER_00: And one of the reasons I wrote the book was to try to document that,
[3:21] SPEAKER_00: both the good and bad,
[3:23] SPEAKER_00: because if you don't follow history,
[3:25] SPEAKER_00: you're doomed to repeat it.
[3:26] SPEAKER_00: So that's a little bit of a start.
[3:28] SPEAKER_01: You know,
[3:29] it's just incredible the insight that you all had and the
[3:32] partners like Richard
[3:34] SPEAKER_01: Hatch and Seppi and others that you brought together so early,
[3:39] SPEAKER_01: you know,
[3:39] months before people started to realize that this was a real
[3:43] deal major pandemic.
[3:45] And it's extraordinary because what this led to,
[3:50] I think a lot of people don't know this,
[3:52] Sepp.
[3:53] SPEAKER_01: This led to,
[3:54] SPEAKER_01: as you said,
[3:55] SPEAKER_01: the fastest,
[3:55] SPEAKER_01: but we're talking about 39 days after the very first vaccine.
[3:59] SPEAKER_01: And it's in Ghana with COVAX.
[4:03] SPEAKER_00: It actually isn't in Ghana.
[4:06] SPEAKER_00: Sorry.
[4:06] SPEAKER_00: 39 days, it was in India.
[4:08] SPEAKER_00: And the reason was because...
[4:10] India's regulatory authority had already approved it,
[4:13] but WHO hadn't pre-qualified it.
[4:15] SPEAKER_00: And that's a requirement for us, for countries that have weaker systems.
[4:19] So it was another 43 days after that before it hit Ghana and
[4:26] Cote d'Ivoire.
[4:27] And,
[4:27] you know,
[4:28] we felt bad about that because we had vaccine doses ready to
[4:31] go.
[4:31] And that's one of the lessons is how do we get faster approvals
[4:36] moving forward?
[4:37] SPEAKER_00: But after that launch in Africa...
[4:40] SPEAKER_00: Another 42 days after that, we were in 100 countries.
[4:43] SPEAKER_00: So this was fast rollout.
[4:45] Yeah,
[4:45] what we're talking about,
[4:46] just so everybody knows,
[4:47] 2 billion doses by the end of 2024.
[4:51] SPEAKER_01: 146 countries, 2.7 million lives saved from this effort.
[5:00] And as you say,
[5:01] 39 days to get into India where most of the people in the U.S.
[5:04] SPEAKER_01: hadn't even gotten into the vaccine startup.
[5:07] SPEAKER_01: And you already are expanding around the world.
[5:10] SPEAKER_01: This is just momentous, extraordinary acceleration.
[5:15] SPEAKER_01: And I think the whole idea, if I recall from the book,
[5:20] SPEAKER_01: about this, you know, no one is safe until everyone is safe.
[5:23] SPEAKER_01: This is the vaccinate the world.
[5:26] SPEAKER_01: You know, people weren't thinking about this.
[5:28] SPEAKER_01: And then it brings in all the obstacles because you were dealing with
[5:33] the incredible obstacles of hoarding and nationalism,
[5:38] politics,
[5:39] misinformation.
[5:42] SPEAKER_01: Tell us about the real, these are serious obstacles.
[5:46] SPEAKER_01: It's actually kind of amazing how you did this,
[5:49] SPEAKER_01: considering all the things,
[5:51] SPEAKER_01: the forces against this whole COVAX movement.
[5:55] Yeah,
[5:55] I mean,
[5:56] the first thing was,
[5:57] of course,
[5:57] without any money,
[5:58] we couldn't do anything.
[5:59] SPEAKER_00: So we had to begin to fundraise.
[6:02] And there's a delay from the time you actually get a promise of
[6:05] money till the time you get it.
[6:07] SPEAKER_00: So we ultimately raised $12.5 billion for this.
[6:10] But as we got to the end of 2020,
[6:14] for example,
[6:15] we had commitments of about $2 billion.
[6:16] SPEAKER_00: But
[6:18] SPEAKER_00: We only had $400 million in the bank.
[6:20] SPEAKER_00: So we were living from,
[6:22] SPEAKER_00: you know,
[6:23] one grant to another to be able to make agreements with
[6:27] pharmaceutical companies to
[6:29] SPEAKER_00: put orders in place and also to begin to do technology transfers.
[6:32] SPEAKER_00: So the original idea wasn't.
[6:34] SPEAKER_00: vaccinate the whole world.
[6:36] SPEAKER_00: People were, it was hard during that moment.
[6:38] SPEAKER_00: Everybody was panicked.
[6:40] The original idea was to cover the high risk populations across
[6:44] the world because
[6:45] SPEAKER_00: we understood from a vaccine nationalism point of view,
[6:49] SPEAKER_00: it's every leader's job to vaccinate their population.
[6:53] So,
[6:54] you know,
[6:54] it made sense for countries to say,
[6:56] you know,
[6:56] I want vaccines for us first.
[6:58] SPEAKER_00: But the question is,
[6:59] did they need to cover everybody in the country or could they
[7:01] cover their high
[7:02] SPEAKER_00: risk?
[7:03] SPEAKER_00: And then could we
[7:04] SPEAKER_00: cover other high risk.
[7:05] SPEAKER_00: And for example,
[7:06] SPEAKER_00: I think physicians,
[7:07] SPEAKER_00: nurses,
[7:07] healthcare workers around the world needed to be covered
[7:10] because they were the
[7:11] SPEAKER_00: front lines and the heroes of this in terms of doing it.
[7:14] SPEAKER_00: So that's what we were trying to do.
[7:17] SPEAKER_00: You know,
[7:17] SPEAKER_00: the challenge was not even that people were vaccinating,
[7:21] SPEAKER_00: but when countries begin to buy up doses,
[7:24] SPEAKER_00: they said,
[7:25] SPEAKER_00: we don't know if any of these vaccines are going to work or which one.
[7:28] SPEAKER_00: So the wealthy countries didn't buy one vaccine.
[7:31] SPEAKER_00: they bought five, six, seven vaccines.
[7:34] SPEAKER_00: And so at the end, it was very difficult to get access.
[7:38] And that's why it was important at the same time to put orders
[7:41] in was to begin to
[7:42] SPEAKER_00: do technology transfers to scale up manufacturing in developing country
[7:46] SPEAKER_00: manufacturers,
[7:47] SPEAKER_00: to work with contract manufacturing organizations,
[7:51] SPEAKER_00: et cetera,
[7:51] SPEAKER_00: to try to get as much vaccine produced as possible.
[7:55] SPEAKER_00: And by the way,
[7:56] SPEAKER_00: extraordinary outcome, 327 days.
[7:59] And we,
[8:00] you know,
[8:00] we originally were talking about much longer time periods.
[8:04] SPEAKER_00: You cover this in your book,
[8:05] SPEAKER_00: Super Agers,
[8:07] SPEAKER_00: when you talk about vaccines,
[8:08] SPEAKER_00: you know,
[8:08] SPEAKER_00: the previous fastest vaccine was four years.
[8:11] We said maybe we can do it in,
[8:13] you know,
[8:14] two years,
[8:14] 18 months,
[8:15] 327 days was extraordinary.
[8:20] And obviously we can even do better now because we now have
[8:24] tools like mRNA,
[8:25] SPEAKER_00: although there is a movement to move away from this,
[8:30] SPEAKER_00: which is,
[8:31] SPEAKER_00: you know,
[8:31] SPEAKER_00: I think one of the,
[8:32] SPEAKER_00: you know,
[8:33] really terrible things that are happening now because you want
[8:36] these tools in your
[8:37] armamentarium for it is evolutionarily certain we will have new
[8:42] epidemics and
[8:43] SPEAKER_00: pandemics.
[8:44] SPEAKER_01: Yeah,
[8:44] SPEAKER_01: we're going to get into the mRNA problem that you're bringing up,
[8:48] SPEAKER_01: which is serious with the current administration.
[8:52] But before I do that,
[8:55] framing this,
[8:56] there is two levels of your visionary work here.
[9:00] SPEAKER_01: One was the fact that people didn't even know it was a pandemic yet.
[9:04] SPEAKER_01: They didn't acknowledge it.
[9:05] And the other is,
[9:07] as you mentioned,
[9:08] mumps was the fastest vaccine,
[9:10] four years.
[9:12] SPEAKER_01: And the average vaccine is at least eight to 10 years.
[9:15] SPEAKER_01: And the success rate for vaccines is 7%.
[9:18] SPEAKER_01: So you were basically gearing up somehow,
[9:21] SPEAKER_01: you know,
[9:22] SPEAKER_01: this,
[9:22] SPEAKER_01: what,
[9:23] SPEAKER_01: 327 days from the sequence of the SARS-CoV-2 virus to actually having big
[9:28] SPEAKER_01: randomized placebo-controlled trials finished and,
[9:31] SPEAKER_01: you know,
[9:33] SPEAKER_01: regulatory clearance to give the vaccine.
[9:35] SPEAKER_01: I mean, this is unprecedented and still, I think, stands
[9:39] SPEAKER_01: as one of the most extraordinary medical triumphs in history.
[9:43] SPEAKER_01: But you didn't know that it was going to go that fast.
[9:46] SPEAKER_00: We had no idea.
[9:47] SPEAKER_00: And in fact,
[9:47] SPEAKER_00: you and I had a podcast together where we talked about these things,
[9:50] SPEAKER_00: you know,
[9:51] SPEAKER_00: during this time period.
[9:52] SPEAKER_00: And,
[9:53] SPEAKER_00: you know,
[9:53] SPEAKER_00: the other thing about it is,
[9:55] SPEAKER_00: and this is an important lesson that comes out of the book,
[9:58] SPEAKER_00: is people don't like to talk about risk.
[10:01] SPEAKER_00: And in a pandemic, you have to do things at risk.
[10:04] SPEAKER_00: So,
[10:05] SPEAKER_00: you know,
[10:05] SPEAKER_00: we did see in the U.S.,
[10:07] SPEAKER_00: I mean,
[10:07] SPEAKER_00: I think probably President Trump's,
[10:09] SPEAKER_00: you know,
[10:10] SPEAKER_00: greatest accomplishment in the first term was his,
[10:13] SPEAKER_00: you know,
[10:13] SPEAKER_00: Operation Warp Speed and opening up the U.S.
[10:16] SPEAKER_00: Treasury to say, we'll take that risk.
[10:19] SPEAKER_00: And, you know, that's a big treasury and they can do that for us.
[10:24] SPEAKER_00: We were taking money.
[10:25] SPEAKER_00: We,
[10:25] SPEAKER_00: of course,
[10:26] SPEAKER_00: were transparent with the donors,
[10:27] but we were taking money and investing in things that we had no
[10:30] idea whether they
[10:31] SPEAKER_00: were going to work.
[10:32] So imagine my head would have been on a stake if we had
[10:35] invested billions and
[10:36] SPEAKER_00: billions of dollars in products that ultimately didn't work.
[10:40] SPEAKER_00: And people would say, oh my God, what's happening?
[10:42] SPEAKER_00: And
[10:43] And even the same thing happened on the wastage side,
[10:45] which we talk a lot about in the book.
[10:47] SPEAKER_00: You know, reporters were looking for evidence of wastage.
[10:51] SPEAKER_00: And the truth is there was wastage everywhere,
[10:53] particularly because of the many different types of vaccines
[10:57] countries were
[10:57] SPEAKER_00: developing.
[10:58] But nobody wanted to talk about that because they were worried
[11:00] about the opposition
[11:01] SPEAKER_00: leaders saying,
[11:02] SPEAKER_00: look at all the money that,
[11:03] SPEAKER_00: you know,
[11:04] SPEAKER_00: so-and-so wasted.
[11:05] SPEAKER_00: And so it was like kind of the dirty secret.
[11:08] SPEAKER_00: Switzerland ultimately published its numbers, which I put in the book,
[11:11] SPEAKER_00: And that was, you know, enlightening.
[11:13] SPEAKER_00: But I said to the G7,
[11:15] SPEAKER_00: G20 leaders,
[11:16] SPEAKER_00: it would help enormously if you would just admit that there's wastage.
[11:19] SPEAKER_00: Because in a pandemic, you don't want to go short.
[11:23] SPEAKER_00: You want to go long.
[11:23] SPEAKER_00: You want to have extra doses of vaccine.
[11:27] SPEAKER_00: And obviously, you don't want to waste anything if you can help it.
[11:29] SPEAKER_00: But you don't want to be short.
[11:31] SPEAKER_00: So, you know, we were also in this situation where donors were dead.
[11:36] SPEAKER_00: desperate to not have us waste a single dose.
[11:39] And we ended up having very low wastage,
[11:41] much less actually than we predicted.
[11:43] But this was also one of the processes that had to be worked
[11:46] through during this period.
[11:48] SPEAKER_01: Yeah.
[11:48] SPEAKER_01: And before moving away to the broader picture,
[11:52] SPEAKER_01: you actually had other obstacles we haven't touched on yet.
[11:56] SPEAKER_01: Like, for example, I think it was over 500 million doses in India,
[12:01] SPEAKER_01: that there was a massive supply disruption.
[12:05] You had to deal with the cold chain issues of storage of things
[12:09] like mRNA vaccines.
[12:10] SPEAKER_01: Can you just tell us a bit about that?
[12:12] SPEAKER_01: Sure.
[12:12] So in a sense,
[12:14] we were lucky because we had worked very hard to build up the
[12:18] immunization system
[12:20] SPEAKER_00: before this.
[12:21] SPEAKER_00: So we had built 65,000 new cold chain points.
[12:25] SPEAKER_00: And a lot of it was modern,
[12:28] SPEAKER_00: environmentally sound,
[12:29] solar-based cold chain for countries that didn't have strong
[12:34] electricity systems,
[12:36] SPEAKER_00: et cetera.
[12:37] And we were,
[12:38] of course,
[12:39] vaccines are the most widely distributed health intervention.
[12:43] SPEAKER_00: We went from the 1970s,
[12:45] SPEAKER_00: and I cover this in the book,
[12:46] SPEAKER_00: because there's also a story about vaccine equity,
[12:48] SPEAKER_00: to
[12:49] SPEAKER_00: Less than 5% of people in the world got even a single dose of vaccines,
[12:54] SPEAKER_00: much less all the ones that were available there.
[12:56] SPEAKER_00: And you fast forward to right before the pandemic,
[12:58] SPEAKER_00: it was around 90,
[13:00] 91% were plugged into the routine system and got at least one
[13:05] dose through that.
[13:06] So that meant there were health workers,
[13:08] there were cold chain points,
[13:09] there were supply chains.
[13:11] SPEAKER_00: And what's extraordinary is during the pandemic,
[13:15] SPEAKER_00: routine vaccines went down in 2020 about 4%,
[13:19] SPEAKER_00: and then 2021 another 1%.
[13:22] And that was terrible because it puts at risk the traditional
[13:25] diseases and children's lives.
[13:29] SPEAKER_00: But if you think about it,
[13:30] those health workers delivered three times the number of doses
[13:34] they had ever done
[13:35] SPEAKER_00: in history.
[13:36] SPEAKER_00: And if you said to me,
[13:37] SPEAKER_00: you know,
[13:38] SPEAKER_00: we're going to do this,
[13:39] SPEAKER_00: I would have thought that the drop would have been much higher.
[13:42] SPEAKER_00: So they continued the routine vaccines,
[13:44] plus they brought these new vaccines and delivered them to the
[13:47] elderly and to
[13:48] SPEAKER_00: healthcare workers and to people with comorbidities.
[13:51] SPEAKER_00: On the cold chain stuff, we, of course, didn't have ultra cold chain.
[13:55] SPEAKER_00: The only time we used ultra cold chain before was in Ebola.
[13:59] SPEAKER_00: The Ebola vaccine needed to be an ultra cold chain,
[14:01] SPEAKER_00: and we worked through how to do that and how to do it in
[14:04] SPEAKER_00: in transit,
[14:04] SPEAKER_00: you know,
[14:05] SPEAKER_00: to have carriers,
[14:06] SPEAKER_00: because we had to use it in DRC and the tropics and,
[14:09] SPEAKER_00: you know,
[14:09] SPEAKER_00: places way off the grid,
[14:10] SPEAKER_00: but not to the scale,
[14:12] SPEAKER_00: ultimately,
[14:12] SPEAKER_00: we wanted.
[14:13] SPEAKER_00: So it would have been better for us to roll out,
[14:16] SPEAKER_00: you know,
[14:16] SPEAKER_00: traditional vaccines and traditional cold chain,
[14:19] SPEAKER_00: two to eight degrees,
[14:20] SPEAKER_00: regular refrigerators.
[14:22] But,
[14:23] you know,
[14:23] people wanted mRNA because that was what,
[14:26] you know,
[14:26] the U.S.
[14:27] SPEAKER_00: and other countries were using.
[14:28] SPEAKER_00: And so we did our best.
[14:30] SPEAKER_00: And ultimately, that became the most...
[14:33] SPEAKER_00: The vaccine we distributed the most were mRNA vaccines,
[14:36] which meant we had to all of a sudden scramble and build
[14:38] ultra-cold chain around
[14:40] SPEAKER_00: the world.
[14:40] SPEAKER_00: So there were lots of logistics problems like that.
[14:43] SPEAKER_00: The Pfizer vaccine used a non-standard syringe size,
[14:48] SPEAKER_00: so we had to find people to produce vaccines.
[14:51] SPEAKER_00: you know,
[14:52] SPEAKER_00: tens of millions,
[14:53] hundreds of millions of those size of auto-disabled syringes
[14:57] because we didn't want
[14:58] SPEAKER_00: people to get infected.
[15:00] So it really is a story of,
[15:02] you know,
[15:02] money,
[15:03] political will,
[15:04] logistics,
[15:05] and all of that.
[15:06] SPEAKER_00: The India story,
[15:06] SPEAKER_00: I'm not going to go into detail,
[15:08] SPEAKER_00: but,
[15:09] SPEAKER_00: you know,
[15:09] SPEAKER_00: it was very hard because what happened was India,
[15:12] SPEAKER_00: because they had doses and WHO hadn't pre-qualified,
[15:17] SPEAKER_00: started giving them to countries around and,
[15:20] SPEAKER_00: you know...
[15:20] SPEAKER_00: People love that.
[15:21] SPEAKER_00: It was vaccine diplomacy.
[15:23] SPEAKER_00: And, you know, the president, you know, was getting attention.
[15:26] SPEAKER_00: And then lo and behold,
[15:27] when the Delta epidemic hit India and we saw those horrible
[15:31] pictures of funeral
[15:32] SPEAKER_00: pyres burning everywhere,
[15:34] SPEAKER_00: you know,
[15:34] SPEAKER_00: the opposition said,
[15:35] SPEAKER_00: well,
[15:35] SPEAKER_00: look,
[15:36] SPEAKER_00: here's the prime minister giving out,
[15:38] SPEAKER_00: you know,
[15:39] SPEAKER_00: vaccines to all these people that were Indian vaccines.
[15:42] SPEAKER_00: And they never stopped that.
[15:44] SPEAKER_00: the export officially, but all of a sudden there was no export at all.
[15:49] And that,
[15:50] as you said,
[15:50] led us to be about closer to 600 million doses short.
[15:56] SPEAKER_00: And that's one of the reasons there were such terrible delays.
[15:58] SPEAKER_00: But one statistic,
[15:59] SPEAKER_00: just to finish before we go back to the next question,
[16:02] SPEAKER_00: is at the end,
[16:03] SPEAKER_00: 57% of people
[16:06] SPEAKER_00: In the poorest 92 countries received a primary dose.
[16:10] SPEAKER_00: That compared to about 67% globally.
[16:13] SPEAKER_00: So it wasn't quite equitable.
[16:16] But also there is more high-risk populations in places that
[16:19] have more elderly
[16:20] SPEAKER_00: populations,
[16:21] SPEAKER_00: et cetera.
[16:22] SPEAKER_00: So we don't know what that number exactly should be.
[16:24] SPEAKER_00: But it was very delayed, which is the problem.
[16:28] SPEAKER_00: But ultimately,
[16:29] SPEAKER_00: we were able to get very high coverage,
[16:31] SPEAKER_00: which is,
[16:31] SPEAKER_00: I think,
[16:32] SPEAKER_00: a big positive of this effort.
[16:34] SPEAKER_01: Oh, I mean, it's phenomenal.
[16:35] SPEAKER_01: I mean, it's just how you did this.
[16:37] SPEAKER_01: And this is a story that,
[16:39] SPEAKER_01: you know,
[16:40] SPEAKER_01: I think a lot of people,
[16:41] SPEAKER_01: certainly people listening,
[16:43] SPEAKER_01: would not be familiar with.
[16:45] SPEAKER_01: I mean,
[16:45] SPEAKER_01: people know about OWS Operation Warp Speed,
[16:48] SPEAKER_01: but here on the global front,
[16:50] SPEAKER_01: this one,
[16:51] SPEAKER_01: it started earlier than OWS and it achieved a grand success.
[16:56] SPEAKER_01: impact throughout the world.
[16:57] SPEAKER_01: So, you know, just amazing, despite all obstacles.
[17:00] SPEAKER_01: Now, let's go to vaccines.
[17:03] SPEAKER_01: They've saved about 500 million lives over the years.
[17:07] SPEAKER_01: Every 200 children get a vaccine, it saves each one life.
[17:12] SPEAKER_01: It's amazing statistics, right?
[17:13] SPEAKER_00: That's for the malaria vaccine, particularly.
[17:16] SPEAKER_01: Yeah, yeah.
[17:17] SPEAKER_01: I mean, you know, so today there's a paper on tuberculosis mRNA vaccine.
[17:24] SPEAKER_01: We've made big progress with malaria,
[17:27] all these other pathogens that have been going for decades
[17:29] without a vaccine.
[17:31] SPEAKER_01: So we are in the face of anti-vaccine.
[17:36] SPEAKER_01: We are seeing the withdrawal of support for mRNA,
[17:39] SPEAKER_01: which has implications well beyond,
[17:41] SPEAKER_01: as you well know,
[17:42] SPEAKER_01: infectious disease for cancer and autoimmune diseases,
[17:46] SPEAKER_01: genome disease.
[17:47] SPEAKER_01: editing for rare diseases and on and on.
[17:50] SPEAKER_01: And so we have things that don't make any sense.
[17:54] SPEAKER_01: They're irrational.
[17:55] SPEAKER_01: Can you help frame all this?
[17:58] SPEAKER_00: Well,
[17:58] SPEAKER_00: I certainly,
[17:59] SPEAKER_00: I can frame it,
[18:00] SPEAKER_00: but I certainly can't make it make sense because it makes no sense.
[18:03] SPEAKER_00: Yeah.
[18:03] Just to say that,
[18:04] you know,
[18:05] the progress on vaccines has been extraordinary.
[18:08] SPEAKER_00: So,
[18:08] SPEAKER_00: you know,
[18:09] we went from having six basic vaccines to having vaccines
[18:12] against the largest
[18:12] SPEAKER_00: killers of children,
[18:13] SPEAKER_00: diarrhea and pneumonia.
[18:14] SPEAKER_00: We began to have vaccines against common cancers.
[18:17] SPEAKER_00: So we rolled out in China, for example, a vaccine against liver cancer.
[18:22] SPEAKER_00: They had 350,000 cases a year of this disease.
[18:26] And,
[18:26] you know,
[18:26] you can't do liver transplants in those days,
[18:29] you know,
[18:29] for that population.
[18:30] SPEAKER_00: So terrible death rates from hepatitis B where there was transmission.
[18:35] SPEAKER_00: And cervical cancer,
[18:36] SPEAKER_00: again,
[18:36] SPEAKER_00: we're in the process of rolling that out worldwide to get women,
[18:40] SPEAKER_00: because this is in many countries the largest cancer killer of women,
[18:43] SPEAKER_00: and now parasitic diseases.
[18:45] And to your point,
[18:46] we're beginning to now have vaccines against primer tumor
[18:50] antigens.
[18:51] SPEAKER_00: And so, you know, we're going to have immunotherapy for cancer.
[18:55] cancers and prevention for cancers and prevention for other
[19:00] infectious diseases that antecede.
[19:02] And we'll have vaccines,
[19:03] I predict,
[19:04] also for chronic diseases and immune diseases,
[19:08] etc.
[19:09] SPEAKER_00: So, a lot of stuff is happening.
[19:10] SPEAKER_00: Now, meanwhile...
[19:12] SPEAKER_00: We have two different problems.
[19:13] SPEAKER_00: We have vaccine hesitancy, and that's existed from the beginning.
[19:17] SPEAKER_00: You know,
[19:17] SPEAKER_00: smallpox time,
[19:18] they had a woodcut with people having cows' horns growing out
[19:22] of their heads
[19:23] SPEAKER_00: because it came from cows.
[19:25] SPEAKER_00: And, you know, there's always been misinformation.
[19:27] And the difference,
[19:28] by the way,
[19:28] between misinformation is what Aunt Holly might do.
[19:31] SPEAKER_00: say, and not knowing what she's talking about.
[19:34] SPEAKER_00: And you can correct that with knowledge.
[19:36] SPEAKER_00: Disinformation is somebody intentionally putting out information.
[19:39] SPEAKER_00: And that is a big problem now.
[19:41] SPEAKER_00: But on top of that,
[19:42] SPEAKER_00: we have this politicization where we've had more,
[19:46] SPEAKER_00: for example,
[19:47] SPEAKER_00: Republicans per capita die in the U.S.
[19:51] SPEAKER_00: during the COVID pandemic because of not getting vaccinated.
[19:54] SPEAKER_00: And
[19:55] SPEAKER_00: Again, the vaccine shouldn't be political.
[19:57] SPEAKER_00: They should be based upon your risk and getting them for everyone.
[20:02] SPEAKER_00: So this has become a huge problem going forward.
[20:05] The mRNA story is a crazy one because if you believe
[20:10] fundamentally that the mRNA
[20:12] SPEAKER_00: isn't safe enough,
[20:13] SPEAKER_00: and by the way,
[20:14] we've had now billions and billions of observations because
[20:17] they've been used.
[20:18] everywhere in the world but if you believe that what we do in
[20:21] science is we do more
[20:22] research we do following what's happening there and and and and
[20:27] that would be the
[20:28] right solution but instead what we've done is pulled the
[20:30] research we've pulled out
[20:32] the efforts that are on that and you know the truth is we may
[20:36] maybe someday we'll
[20:37] have something better but today if we had another pandemic and
[20:40] maybe it wouldn't be
[20:40] SPEAKER_00: one and a half percent mortality rate
[20:42] SPEAKER_00: You know, we have pathogens that are 30, 40, 50% mortality rate.
[20:46] SPEAKER_00: Every minute counts in those moments to try to move towards something.
[20:50] SPEAKER_00: And nothing is as fast as mRNA.
[20:52] SPEAKER_00: So, in this case, we had not used mRNA before.
[20:57] SPEAKER_00: It's not licensed, you know.
[20:58] SPEAKER_00: So, people were slower than it could be.
[21:00] But if I remember the numbers correctly,
[21:03] we had it from the time the genome was published.
[21:06] SPEAKER_00: We had it in 42 days in a vial and 63 days the first injection.
[21:11] SPEAKER_00: you know, and that could now be compressed down.
[21:14] SPEAKER_00: There is nothing else can move at that speed.
[21:16] SPEAKER_00: So I don't know about,
[21:18] SPEAKER_00: you know,
[21:18] SPEAKER_00: what the policymakers are thinking,
[21:20] SPEAKER_00: but I want that in my armamentarium and I want to,
[21:23] SPEAKER_00: you know,
[21:24] SPEAKER_00: optimize it as best as possible.
[21:26] SPEAKER_00: Meanwhile,
[21:26] SPEAKER_00: China is shooting ahead now,
[21:29] SPEAKER_00: you know,
[21:29] trying to optimize this and move this forward as are now some
[21:33] other countries.
[21:34] SPEAKER_01: Well, there's so much to talk about on the mRNA front.
[21:37] SPEAKER_01: I mean,
[21:38] SPEAKER_01: I wrote a Substack about how this recent paper,
[21:41] SPEAKER_01: extraordinary,
[21:42] that only the mRNA vaccines with people with cancer rev up
[21:48] immunotherapy by
[21:50] SPEAKER_01: stimulating interferon,
[21:51] SPEAKER_01: not seen with the non-mRNA vaccines,
[21:55] so that people that got these shots along the way with COVID
[21:59] who had cancer had a
[22:00] SPEAKER_01: huge benefit that otherwise wouldn't have been realized.
[22:03] SPEAKER_01: So there's benefits.
[22:04] SPEAKER_01: But what gets me, Seth, is that
[22:06] SPEAKER_01: We have sat stagnant.
[22:08] SPEAKER_01: We know these mRNA vaccines could be better.
[22:11] SPEAKER_01: The nanoparticles can be improved.
[22:13] SPEAKER_01: They're amplifying mRNA vaccines in Japan that are approved.
[22:17] SPEAKER_01: We've done nothing to make these better.
[22:20] SPEAKER_01: We just have frozen from, you know, 2020.
[22:24] SPEAKER_00: Why don't we see... But that's all politics.
[22:26] SPEAKER_00: I mean,
[22:27] SPEAKER_00: and that's not my point is,
[22:28] SPEAKER_00: you know,
[22:30] SPEAKER_00: if you just had the worst pandemic in the last hundred years,
[22:33] SPEAKER_00: which we did,
[22:36] SPEAKER_00: What should be the reaction?
[22:38] SPEAKER_00: Okay, I understand.
[22:38] After the 1918 pandemic,
[22:40] people said,
[22:41] you know,
[22:41] I don't want to talk about flu anymore,
[22:43] etc.
[22:43] SPEAKER_00: We didn't have the same science then.
[22:45] SPEAKER_00: What should be the reaction?
[22:46] SPEAKER_00: Okay,
[22:46] SPEAKER_00: people don't have to talk about it,
[22:48] SPEAKER_00: but the science community should be funded to make,
[22:51] SPEAKER_00: for example,
[22:52] SPEAKER_00: universal coronavirus vaccines.
[22:55] SPEAKER_00: And they should be optimizing the technology.
[22:57] SPEAKER_00: As you wrote in your book,
[22:59] SPEAKER_00: Super Agers,
[23:01] one of the challenges with mRNA vaccines is they didn't seem to
[23:03] have really long
[23:04] SPEAKER_00: duration of protection.
[23:06] SPEAKER_00: This is a solvable problem.
[23:07] SPEAKER_00: It just takes some more research and some more design work, et cetera.
[23:11] SPEAKER_00: And so we should have continued that work,
[23:14] continued the investment to get us to a place where we had
[23:17] these tools because
[23:18] SPEAKER_00: frankly,
[23:19] SPEAKER_00: COVID is still around.
[23:21] SPEAKER_00: It's still causing deaths.
[23:22] SPEAKER_00: And we could have a strain that appears,
[23:25] of either COVID-19 that is much more a disease-causing and may
[23:31] escape from some of
[23:32] SPEAKER_00: the protection,
[23:33] or we could have another coronavirus pop out of a bat somewhere
[23:36] in the world.
[23:37] SPEAKER_00: And so why we're not doing this just seems to me to be crazy.
[23:41] And the last point I'd make on this is I just wrote a paper a
[23:44] couple of days ago,
[23:45] SPEAKER_00: and I made this observation.
[23:48] SPEAKER_00: We're cutting global health.
[23:49] SPEAKER_00: We're cutting health investments.
[23:52] SPEAKER_00: And at the same time, we're increasing defense investments.
[23:54] SPEAKER_00: So we're talking about a 12% increase to a trillion dollars.
[23:57] SPEAKER_00: I can't comment on whether that's a good use of money or not.
[24:00] SPEAKER_00: But if you ask the question,
[24:02] SPEAKER_00: and this is a little apathy than oranges,
[24:04] SPEAKER_00: but it just puts it into perspective,
[24:06] SPEAKER_00: how many Americans died during COVID?
[24:10] SPEAKER_00: So more Americans died during COVID than died in all wars today.
[24:16] SPEAKER_00: After the Civil War till today.
[24:19] SPEAKER_00: So when you start talking about security,
[24:21] SPEAKER_00: you can't have security without global health security.
[24:25] SPEAKER_00: And today with synthetic biology and AI,
[24:28] SPEAKER_00: we are at enormous risk,
[24:29] SPEAKER_00: not just for naturally occurring infections or laboratory accidents,
[24:32] SPEAKER_00: but also for bioterrorism.
[24:35] SPEAKER_00: It will happen.
[24:36] SPEAKER_00: We're overdue for it.
[24:37] SPEAKER_00: And again,
[24:37] the same preparations are going to need to be there to make
[24:41] vaccines quickly,
[24:42] SPEAKER_00: to have distribution system,
[24:43] SPEAKER_00: to have surveillance systems.
[24:44] SPEAKER_00: So we should be preparing for that.
[24:47] SPEAKER_00: And instead, we're just pulling away from it, which seems just stupid.
[24:50] SPEAKER_01: It really is.
[24:51] SPEAKER_01: I mean, I can't fathom it because we talked about the mRNA in particular.
[24:57] SPEAKER_01: That could be made so much better even than what we already saw.
[25:01] We haven't seen the non-shot world develop like patches and
[25:06] nasal vaccine.
[25:07] SPEAKER_01: I mean, nasal vaccines have so much promise.
[25:10] SPEAKER_01: And of course, it would be a lot easier to get out distributing.
[25:13] SPEAKER_01: um, for mass use.
[25:16] SPEAKER_01: Now,
[25:17] SPEAKER_01: um,
[25:17] SPEAKER_01: we're going to have another pandemic,
[25:19] SPEAKER_01: as you say,
[25:20] SPEAKER_01: we still could face another Omicron-like event,
[25:23] SPEAKER_01: even with this virus.
[25:25] SPEAKER_01: But as you say,
[25:26] SPEAKER_01: it could be influenza,
[25:27] SPEAKER_01: it could be another coronavirus,
[25:29] SPEAKER_01: and many other viruses on the list here that could do us in.
[25:32] SPEAKER_01: And we're doing nothing.
[25:33] SPEAKER_01: We've eliminated this administration, the pandemic preparedness, uh,
[25:40] SPEAKER_01: And we're, you're basically taking out any cap CDC.
[25:44] SPEAKER_00: I mean, completely, you know?
[25:45] SPEAKER_00: Yeah.
[25:46] SPEAKER_01: I'm actually going to talk tomorrow with Susan Moneris,
[25:50] SPEAKER_01: the first live interview after,
[25:52] SPEAKER_01: uh,
[25:53] SPEAKER_01: her rapid,
[25:55] SPEAKER_01: um,
[25:56] tenure of 39 days at CDC with the gutting of one third of the
[26:00] workforce of CDC,
[26:02] SPEAKER_01: no less the budget.
[26:03] So I'll talk to her about it,
[26:05] but obviously,
[26:05] you know,
[26:06] you have a lot of insight here too.
[26:08] We are seeing just the opposite of what we would be thinking
[26:12] would be rational,
[26:13] SPEAKER_01: that what we went through,
[26:15] SPEAKER_01: this horrendous century worst pandemic and learning nothing from it,
[26:22] SPEAKER_01: And all the success that we've seen,
[26:25] SPEAKER_01: like what you had with COVAX,
[26:27] SPEAKER_01: Operation Worksheet,
[26:28] SPEAKER_01: we should be building on it.
[26:29] SPEAKER_01: And it's incredible to me.
[26:34] SPEAKER_01: I must be frustrating to you, but how do you deal with the frustrations?
[26:38] Well,
[26:39] I mean,
[26:39] at the end of the day,
[26:40] you know,
[26:40] you got to keep moving forward.
[26:42] SPEAKER_00: And so,
[26:43] SPEAKER_00: you know,
[26:43] I'm prophetizing for people to understand why this is important
[26:48] and to ultimately
[26:49] SPEAKER_00: make changes.
[26:49] SPEAKER_00: Because at the end,
[26:51] SPEAKER_00: if we had one of these worst pandemics,
[26:53] SPEAKER_00: and by the way,
[26:54] SPEAKER_00: I believe we're entering an era of polyepidemics.
[26:56] SPEAKER_00: Why do I believe that?
[26:58] SPEAKER_00: we've got still increasing populations worldwide.
[27:00] I know that's going to slow down,
[27:02] but we've also got,
[27:03] you know,
[27:04] intense urbanization.
[27:05] SPEAKER_00: We've got climate change, refugees that are moving.
[27:09] SPEAKER_00: We're going to have climate disasters.
[27:10] SPEAKER_00: We're having vectors of disease that are now moving into new areas.
[27:14] So we're going to see more and more outbreaks and pandemics,
[27:18] you know,
[27:19] in the future.
[27:19] SPEAKER_00: And therefore, this stuff becomes even more important than it was before.
[27:24] SPEAKER_00: And
[27:24] SPEAKER_00: And,
[27:25] SPEAKER_00: you know,
[27:25] SPEAKER_00: the other thing about this,
[27:26] SPEAKER_00: Eric,
[27:26] SPEAKER_00: is if you go back in time,
[27:28] the natural death rate without any interventions is about 350
[27:33] per thousand
[27:34] SPEAKER_00: children.
[27:35] SPEAKER_00: That's what it was back before we had all these interventions.
[27:38] SPEAKER_00: And,
[27:39] SPEAKER_00: you know,
[27:39] SPEAKER_00: clean water and sanitation made a big difference,
[27:41] SPEAKER_00: better housing,
[27:42] SPEAKER_00: a bunch of things.
[27:42] SPEAKER_00: But vaccines really were the big thing that have driven that down.
[27:46] SPEAKER_00: And now here in the U.S., it's about five per thousand.
[27:50] SPEAKER_00: You know, gone from 350, 350 deaths per thousand to five per thousand.
[27:54] SPEAKER_00: But the best places in the world are around 0.9 per thousand.
[27:58] SPEAKER_00: And as a society,
[27:59] what we should be doing is making no parent have to lose a
[28:03] child or have a child
[28:05] SPEAKER_00: with,
[28:06] SPEAKER_00: you know,
[28:07] SPEAKER_00: disabilities because of infections that we can prevent.
[28:11] And so,
[28:11] again,
[28:12] I just don't understand the logic on the routine side as well,
[28:15] not just on the –
[28:16] SPEAKER_00: pandemic side of demonizing MMR vaccines,
[28:20] SPEAKER_00: of,
[28:20] SPEAKER_00: you know,
[28:20] SPEAKER_00: pulling away from existing antigens,
[28:22] SPEAKER_00: of talking about not,
[28:23] SPEAKER_00: you know,
[28:24] SPEAKER_00: not giving them in the recommended dose schedules.
[28:28] SPEAKER_00: These are all things that are going to have an effect.
[28:30] SPEAKER_00: And by the way,
[28:31] if the rest of the world has these diseases raging because
[28:34] we've caught our,
[28:35] SPEAKER_00: you know,
[28:36] SPEAKER_00: development aid,
[28:37] SPEAKER_00: then that increased the risks of importations back in the U.S.
[28:40] SPEAKER_00: I mean, the U.S.
[28:41] SPEAKER_00: has eliminated measles, 2,000, eliminated measles.
[28:44] The big outbreak we have now,
[28:46] the largest since 2000,
[28:48] because somebody brought it back in.
[28:50] And if we now have polio running wildly and measles and
[28:54] diphtheria and pertussis,
[28:56] SPEAKER_00: that is going to come back and have an effect on us.
[28:59] SPEAKER_00: So we ought to do it because it's the right thing,
[29:00] SPEAKER_00: but we ought to do it for cell protection as well.
[29:03] SPEAKER_01: Well,
[29:04] SPEAKER_01: for your mental health,
[29:06] SPEAKER_01: by being based,
[29:07] SPEAKER_01: living in Geneva,
[29:09] SPEAKER_01: Switzerland,
[29:09] does that help you because knowing that at least the country
[29:13] there is working
[29:15] SPEAKER_01: unlike the one here?
[29:18] SPEAKER_00: It's not helpful because,
[29:20] SPEAKER_00: you know,
[29:20] SPEAKER_00: I care so much about the world,
[29:24] SPEAKER_00: and the effects right now on the world are so dramatic.
[29:26] SPEAKER_00: I mean, you know, the fact that the U.S.
[29:28] walked away from funding Gavi because of some crazy conspiracy
[29:32] theory,
[29:32] not for any valid reason—
[29:34] SPEAKER_00: you know,
[29:34] SPEAKER_00: there's going to be 75 million less kids vaccinated,
[29:38] SPEAKER_00: and it's estimated to be another 1.2 million kids may die from this.
[29:42] SPEAKER_00: I mean, again, is that what we should be doing?
[29:45] SPEAKER_00: So, yes, there is the rule of law in Switzerland.
[29:48] SPEAKER_00: Yes,
[29:48] SPEAKER_00: there is a attention to science and respect for academia and expertise,
[29:54] SPEAKER_00: but,
[29:55] SPEAKER_00: you know,
[29:55] SPEAKER_00: we need to get that back across the world.
[29:57] Well,
[29:57] I mean,
[29:58] I know you think globally,
[29:59] but at least from a day-to-day standpoint,
[30:01] you're in a
[30:03] SPEAKER_01: a land that is functioning by the,
[30:05] SPEAKER_01: the old ways of respecting data,
[30:08] SPEAKER_01: evidence,
[30:08] SPEAKER_01: science,
[30:09] SPEAKER_01: and the power of vaccines,
[30:12] SPEAKER_01: the most tool we have in all of public health.
[30:16] SPEAKER_00: I'm in Boston right now though.
[30:17] SPEAKER_00: So,
[30:17] SPEAKER_00: you know,
[30:18] SPEAKER_00: the first public health department was and,
[30:20] SPEAKER_00: and where I worked years ago in the state,
[30:23] SPEAKER_00: you know,
[30:23] epidemiology department among other places and taught at the
[30:26] Harvard school of
[30:27] SPEAKER_00: public health.
[30:27] SPEAKER_01: So, you know, familiar grounds for you now.
[30:31] SPEAKER_01: Um,
[30:32] SPEAKER_01: You led Gavi for 12 years and obviously culminated in this COVAX effort.
[30:41] SPEAKER_01: Then you decided to move on, I guess.
[30:44] Was there anything about the move from leading Gavi that was
[30:48] just 12 years enough?
[30:49] SPEAKER_01: Or what were your thoughts about that one?
[30:51] SPEAKER_00: So,
[30:52] SPEAKER_00: in general,
[30:53] SPEAKER_00: these types of jobs are desirable because,
[30:55] SPEAKER_00: you know,
[30:55] SPEAKER_00: it's a big international job.
[30:57] SPEAKER_00: And I went there to do three years, actually, originally.
[31:00] SPEAKER_00: And then they liked me and they said, we want to show you we like you.
[31:04] SPEAKER_00: Can you do four years?
[31:06] SPEAKER_00: And then they...
[31:07] SPEAKER_00: They liked me and did another four years.
[31:10] SPEAKER_00: And then they finally said, well, you know, it's COVID and all that.
[31:13] SPEAKER_00: Maybe you can do another year.
[31:15] SPEAKER_00: But I think at that point it was, you know, I had done my service.
[31:19] SPEAKER_00: And, you know, it's an amazing organization.
[31:22] SPEAKER_00: It vaccinated more than 1.2 billion additional children,
[31:27] SPEAKER_00: introduced more than 700 novel vaccines,
[31:30] SPEAKER_00: you know,
[31:31] contributed to this effect of a 70% reduction in
[31:34] vaccine-preventable diseases,
[31:35] SPEAKER_00: which contributed to the 50% reduction in under-five-child mortality.
[31:39] SPEAKER_00: So I love the organization.
[31:41] SPEAKER_00: I still do.
[31:42] SPEAKER_00: But its goal is to just help countries.
[31:45] SPEAKER_00: It's not really charity.
[31:47] It's,
[31:47] you know,
[31:48] the poorest countries,
[31:49] they pay something for the doses,
[31:51] but just a little.
[31:51] SPEAKER_00: We work to drive the prices down.
[31:54] SPEAKER_00: We work to help them get vaccines out, to help build their systems.
[31:57] And over time,
[31:57] as they get richer,
[31:58] they pay more and more until they graduate out of Gabi.
[32:01] SPEAKER_00: So it's some of the best type of development aid.
[32:03] SPEAKER_00: And it's interesting because, as I said, the U.S.
[32:07] SPEAKER_00: administration has stopped funding it now.
[32:09] SPEAKER_00: But during the first administration of the Trump administration,
[32:12] they actually gave Gavi a 5 percent increase because they said
[32:15] this is exactly the
[32:17] SPEAKER_00: type of development aid we should be doing.
[32:19] SPEAKER_00: It helps protect Americans by controlling disease.
[32:21] SPEAKER_00: It helps countries, you know, have a step up strategy.
[32:25] SPEAKER_00: You know, instead of charity, it allows them to then take over the cost.
[32:29] SPEAKER_00: And U.S.
[32:30] SPEAKER_00: was one of many funders.
[32:32] SPEAKER_00: It wasn't carrying, you know, an unproportional burden.
[32:35] SPEAKER_00: So I just don't understand.
[32:37] And this is the problem when you put people in leadership roles
[32:40] who have fixed,
[32:42] SPEAKER_00: you know,
[32:42] day fix on these issues and come in with bias against them
[32:46] rather than trying to
[32:48] SPEAKER_00: drive forward using the best science.
[32:50] And science is all we have when we deal with epidemics and
[32:53] pandemics,
[32:53] you know.
[32:54] SPEAKER_00: It may change during it.
[32:55] SPEAKER_00: We may learn new things.
[32:57] SPEAKER_00: But if we can't trust science, then what can we trust?
[33:01] SPEAKER_00: You know,
[33:01] SPEAKER_00: it can't be the biggest influencers on social media because,
[33:06] SPEAKER_00: you know,
[33:06] SPEAKER_00: they're not going to have the knowledge and wisdom to move forward.
[33:11] SPEAKER_01: Yeah, so there's another part of what we're trying to...
[33:16] probe here about why that we get into this situation where
[33:20] we're not going to be
[33:21] SPEAKER_01: prepared unless something drastic shakes things up as we stand right now.
[33:26] SPEAKER_01: And one of those, of course, is denialism.
[33:28] SPEAKER_01: That is, after going through what this horrific situation
[33:34] SPEAKER_01: pandemic for years.
[33:35] SPEAKER_01: It's just like, who needs to deal with it anymore?
[33:38] Just denying that there's even the virus out there that
[33:41] although,
[33:41] oh,
[33:42] it's just a cold.
[33:43] I mean,
[33:43] all this kind of stuff,
[33:44] even though we got hundreds of people dying every day,
[33:47] SPEAKER_01: every week.
[33:48] SPEAKER_00: And long-term effects that,
[33:49] SPEAKER_00: you know,
[33:50] SPEAKER_00: I mean,
[33:50] SPEAKER_00: you've written about this and,
[33:51] SPEAKER_00: you know,
[33:52] SPEAKER_00: the effects of getting COVID on your cardiovascular system,
[33:56] SPEAKER_00: on your renal system,
[33:57] SPEAKER_00: on your neurologic system,
[33:58] SPEAKER_00: it's not just a cold.
[33:59] SPEAKER_00: And obviously, you know, we want to try to avoid that.
[34:03] SPEAKER_00: That's why we need better vaccines, by the way.
[34:05] We need vaccines to prevent infection,
[34:07] not just,
[34:07] you know,
[34:08] mitigate disease.
[34:09] And that's why the research should be screaming ahead right now
[34:12] rather than being pulled back.
[34:14] And that's what I wanted to get into is if we weren't in this
[34:17] denial mode.
[34:18] SPEAKER_01: And by the way,
[34:19] SPEAKER_01: we did just start a very large,
[34:21] SPEAKER_01: the largest yet long COVID trial with terzepatide last week.
[34:25] SPEAKER_01: And we've had incredible interest in enrollment.
[34:29] SPEAKER_01: It's a thousand participant trial.
[34:31] I think we had half as many of a thousand in the first couple
[34:35] of few days.
[34:36] SPEAKER_01: So there's great interest in getting a treatment for long COVID.
[34:40] SPEAKER_01: And obviously, even better would be preventing it, which we're not doing.
[34:44] But this universal vaccine is the other topic I wanted to
[34:49] discuss with you over the
[34:51] SPEAKER_01: course of the pandemic.
[34:53] maybe 25 different academic institutions came up with ways to
[34:58] develop a universal vaccine.
[35:01] That is coming up with whether it's cryptic antigens or various
[35:08] strategies,
[35:09] SPEAKER_01: even with fostering T cell immunity,
[35:12] SPEAKER_01: whatever.
[35:14] SPEAKER_01: And these have not gone forward in any significant way, no less.
[35:19] SPEAKER_01: The nasal vaccines,
[35:20] SPEAKER_01: of which there have been many,
[35:22] SPEAKER_01: again,
[35:22] by academic labs like Washington University that sold the
[35:26] license out to India,
[35:28] SPEAKER_01: and many others too,
[35:30] SPEAKER_01: Emory,
[35:30] SPEAKER_01: Yale.
[35:33] SPEAKER_01: So we have the brainpower to come up with much better vaccines.
[35:37] SPEAKER_01: But unlike what you did in COVAX or Operation Warp Feet,
[35:42] SPEAKER_01: finding the funding when there was none and developing this,
[35:47] is there any chance that all this great science that's been
[35:51] published on from,
[35:52] SPEAKER_01: you know,
[35:53] SPEAKER_01: great labs all throughout,
[35:54] SPEAKER_01: actually throughout the world that we're actually going to act on this?
[35:58] SPEAKER_00: I mean, you open up exactly what the problem is.
[36:02] SPEAKER_00: And I'm here in Boston in flagship pioneering.
[36:07] SPEAKER_00: I'm executive vice chair of a company called Apriori Bio.
[36:11] They actually,
[36:12] one of the companies that actually made a solution for COVID.
[36:15] SPEAKER_00: They were able to
[36:16] produce vaccines that were looking using AI and machine
[36:19] learning to where the virus
[36:21] SPEAKER_00: was going,
[36:22] SPEAKER_00: predicting what mutations could occur,
[36:24] SPEAKER_00: what would structurally work,
[36:26] SPEAKER_00: and then producing antigens that would cover those in the future.
[36:29] So you could make vaccines that were at least starting with a
[36:32] couple of years of coverage.
[36:34] SPEAKER_00: And you could make
[36:35] SPEAKER_00: extra vaccines for things that might come in the future,
[36:38] SPEAKER_00: so you have them structurally made,
[36:40] SPEAKER_00: there's no interest in COVID.
[36:42] So,
[36:42] you know,
[36:43] it's shifted over now to doing the same thing in flu and doing
[36:46] that on H5.
[36:47] SPEAKER_00: And even on H5,
[36:48] SPEAKER_00: again,
[36:49] SPEAKER_00: they pulled out,
[36:49] SPEAKER_00: despite the fact that it was,
[36:51] SPEAKER_00: you know,
[36:52] SPEAKER_00: in California,
[36:52] SPEAKER_00: it was national,
[36:54] SPEAKER_00: it was a state emergency.
[36:55] SPEAKER_00: I mean, 20% of the milk at one point was infected with virus.
[36:59] SPEAKER_01: Oh, but we can drink milk, right?
[37:01] SPEAKER_01: Yeah.
[37:02] SPEAKER_01: Yeah.
[37:02] SPEAKER_00: Yes, no, but this is the point.
[37:03] SPEAKER_00: So we're not investing in these.
[37:05] SPEAKER_00: And the environment,
[37:06] SPEAKER_00: the problem is,
[37:07] SPEAKER_00: is that when the government,
[37:09] SPEAKER_00: and you have to understand from an investor point of view,
[37:12] SPEAKER_00: people are saying,
[37:13] SPEAKER_00: okay,
[37:13] SPEAKER_00: well,
[37:13] I don't know what the return's going to be because people don't
[37:15] care about this.
[37:16] SPEAKER_00: But the other side of it is,
[37:17] SPEAKER_00: you got to get these things through regulatory agencies.
[37:20] SPEAKER_00: And if the regulatory agencies are hostile to,
[37:23] SPEAKER_00: you know,
[37:24] SPEAKER_00: technologies like mRNA,
[37:25] SPEAKER_00: et cetera,
[37:26] SPEAKER_00: then you may have delays,
[37:28] SPEAKER_00: which,
[37:28] SPEAKER_00: you know,
[37:28] SPEAKER_00: delays in biotech is money.
[37:31] SPEAKER_00: So, you've got academic investigators really doing exciting work.
[37:34] Those need to be converted into,
[37:37] you know,
[37:37] trying to turn it into real products.
[37:40] SPEAKER_00: And there's not a lot of appetite right now for that.
[37:42] SPEAKER_00: And
[37:43] SPEAKER_00: So,
[37:44] SPEAKER_00: I mean,
[37:45] SPEAKER_00: in the area of AI crossover,
[37:47] SPEAKER_00: there is some interest because,
[37:48] SPEAKER_00: of course,
[37:48] SPEAKER_00: there's a lot of funding available for AI,
[37:50] SPEAKER_00: and you can do really amazing things,
[37:53] SPEAKER_00: AI for good,
[37:54] SPEAKER_00: by using it for these types of technologies.
[37:56] SPEAKER_00: But even then, you still have to turn them into vaccine products.
[38:00] SPEAKER_00: And mucosal vaccines, the same thing.
[38:04] SPEAKER_00: I mean,
[38:05] SPEAKER_00: the barrier is potentially high on the regulatory side,
[38:09] SPEAKER_00: but we need to work through that.
[38:11] SPEAKER_00: Yeah.
[38:12] And today with AI,
[38:13] you can begin to do much better predictions of what's
[38:16] happening.
[38:16] SPEAKER_00: You can understand toxicities in silico.
[38:19] You can begin to drive towards having,
[38:22] you know,
[38:23] really understanding exactly what you're doing.
[38:26] And let's just remind people that the reason we had COVID
[38:30] vaccines in 327 days was because...
[38:34] SPEAKER_00: We had 20 years of research on mRNA vaccines.
[38:37] SPEAKER_00: And we had research on two previous COVID vaccines.
[38:42] SPEAKER_00: We had, not COVID, sorry, coronavirus vaccines.
[38:48] SPEAKER_00: We had MERS and we had SARS.
[38:51] SPEAKER_00: And those vaccines, you know, vaccines were...
[38:55] SPEAKER_00: built,
[38:56] SPEAKER_00: people solve the problem of how to get a spike protein,
[39:00] SPEAKER_00: how to stabilize it,
[39:01] SPEAKER_00: how to do all that.
[39:02] SPEAKER_00: So, you know, when the pandemic hit, people knew exactly what to do.
[39:07] SPEAKER_00: And that's why the yield wasn't 7%,
[39:09] SPEAKER_00: as you said before,
[39:10] SPEAKER_00: you know,
[39:11] SPEAKER_00: on the success rate for new vaccines.
[39:13] Most of the vaccines ended up working because we had all that
[39:17] science basis.
[39:18] SPEAKER_00: So when we kill basic science,
[39:20] SPEAKER_00: this is a real problem.
[39:22] SPEAKER_00: You know, you won't feel it today, but you will feel it in the future.
[39:25] SPEAKER_00: And if we don't have young people going into science,
[39:28] SPEAKER_00: how are we going to create the next generation for this?
[39:31] So I,
[39:32] you know,
[39:32] I don't see how that makes America healthy again or makes
[39:35] America great again.
[39:36] It seems to me we ought to be doubling down on the great
[39:39] academic institutions,
[39:40] SPEAKER_00: the great,
[39:41] SPEAKER_00: you know,
[39:41] SPEAKER_00: scientists we have in supporting that research as an engine because,
[39:44] SPEAKER_00: you
[39:44] SPEAKER_00: If you don't have your health, you don't have anything.
[39:46] SPEAKER_00: We're all going to get older.
[39:48] Lifespan is,
[39:49] as you describe in super ages,
[39:50] lifespan is going to increase.
[39:52] SPEAKER_00: We're going to need new innovations.
[39:55] SPEAKER_00: And so we ought to be investing in that.
[39:58] SPEAKER_01: I couldn't agree more.
[39:59] SPEAKER_01: I mean,
[40:00] SPEAKER_01: just to touch on that mucosal nasal vaccine or oral vaccine,
[40:05] SPEAKER_01: this is so promising,
[40:07] SPEAKER_01: all the data that we have.
[40:09] SPEAKER_01: And yet,
[40:11] SPEAKER_01: this was dropped by the current administration,
[40:14] the money that was coming through BARDA and other sources that
[40:19] was put together to
[40:21] SPEAKER_01: support both nasal and universal vaccines.
[40:26] SPEAKER_01: So we just abandon it.
[40:27] SPEAKER_01: Whereas we need to block infections.
[40:30] SPEAKER_01: And that's, of course, the biggest.
[40:32] All these people that are anti-vaccine because it says COVID
[40:35] vaccine because,
[40:36] SPEAKER_01: oh,
[40:36] SPEAKER_01: it doesn't block infections.
[40:37] SPEAKER_01: Well, yeah, it did really well until we had these variants pop out.
[40:41] SPEAKER_01: And we could also get back to it doing really well if we were...
[40:45] SPEAKER_01: invest and take the nasal vaccine story forward.
[40:49] Part of that is also figuring out how to better understand the
[40:54] immune system,
[40:55] SPEAKER_00: how to understand the stimulation of it,
[40:57] SPEAKER_00: how to measure it in mucosal surfaces and standardize it.
[41:00] SPEAKER_00: How do you measure it in the lung?
[41:01] SPEAKER_00: How do you measure it?
[41:02] SPEAKER_00: So there,
[41:03] SPEAKER_00: again,
[41:04] SPEAKER_00: are efforts to better understand the immune system,
[41:07] SPEAKER_00: to understand the human immunode,
[41:08] SPEAKER_00: to
[41:09] SPEAKER_00: to look at mucosal-based knowledge,
[41:11] SPEAKER_00: and that will have effects for what we're just talking about,
[41:14] SPEAKER_00: better vaccines,
[41:15] but it'll have broader effects for understanding allergens and
[41:21] dealing with
[41:24] SPEAKER_00: reactive airway disease,
[41:25] SPEAKER_00: et cetera,
[41:25] SPEAKER_00: et cetera.
[41:25] SPEAKER_00: So,
[41:26] SPEAKER_00: I think,
[41:26] SPEAKER_00: you know,
[41:27] the important point here is that we don't know where the
[41:29] knowledge will take us.
[41:30] SPEAKER_00: You know, 20 years ago, we did the human genome.
[41:34] It's only now that we're really using that knowledge to create
[41:39] therapeutics to do
[41:40] SPEAKER_00: the types of interventions we're talking about.
[41:42] SPEAKER_01: No, I couldn't agree with you more about that.
[41:43] SPEAKER_01: I mean, we need this human immunom work.
[41:46] There's a project that started at Yale,
[41:48] but it doesn't have that much funding.
[41:50] SPEAKER_01: but to understand this complex system,
[41:53] SPEAKER_01: we're going to start to see in the beginning of next year,
[41:55] these so-called immune system clocks that will tell us the pace
[41:59] of a person's
[42:00] SPEAKER_01: immune system aging,
[42:01] SPEAKER_01: which is important in people who are older,
[42:03] SPEAKER_01: just because some of them are immunosenescent already.
[42:06] SPEAKER_01: And it's good to know that,
[42:08] especially when you're giving them a vaccine and you're hoping
[42:10] they're going to
[42:11] SPEAKER_01: work really well,
[42:12] SPEAKER_01: but lots of other reasons as well.
[42:13] SPEAKER_01: So last to close before I
[42:16] ask you for this one note of optimism,
[42:20] because we got to end with some optimism.
[42:22] I want to say what you did with Kovacs is just,
[42:26] you know,
[42:27] it's so beyond belief.
[42:29] SPEAKER_01: And a lot of people don't know the story.
[42:31] Fair doses is really a way to tell a story that is just quite
[42:37] extraordinary.
[42:38] SPEAKER_01: For those who really want to know what happened here,
[42:41] SPEAKER_01: all the ins and outs,
[42:42] SPEAKER_01: the inside story,
[42:43] SPEAKER_01: if you will,
[42:44] SPEAKER_01: who came together, how it all worked, all the obstacles.
[42:47] SPEAKER_01: I couldn't recommend the book more.
[42:50] So,
[42:50] Seth,
[42:51] can you leave us with some type of optimistic note as we finish
[42:55] up here?
[42:56] SPEAKER_00: Yeah,
[42:56] SPEAKER_00: I mean,
[42:57] SPEAKER_00: you know,
[42:57] SPEAKER_00: my optimism comes from science and science and technology,
[43:01] SPEAKER_00: as does yours.
[43:02] SPEAKER_00: And, you know, it is amazing the tools.
[43:05] SPEAKER_00: If you had to think and go back at where we were,
[43:08] SPEAKER_00: in fact,
[43:09] SPEAKER_00: in the epilogue of the book,
[43:12] SPEAKER_00: I kind of,
[43:14] SPEAKER_00: you know,
[43:14] SPEAKER_00: make this point,
[43:15] SPEAKER_00: you know,
[43:16] SPEAKER_00: because my career is long.
[43:19] SPEAKER_00: Had this outbreak occurred, had this pandemic occurred,
[43:23] SPEAKER_00: You know,
[43:23] SPEAKER_00: 40 years ago when I started my career,
[43:25] SPEAKER_00: we wouldn't have any of the tools we needed to be able to do this.
[43:28] SPEAKER_00: I mean,
[43:28] SPEAKER_00: by the way,
[43:29] we didn't talk about the fact that we had to organize the whole
[43:31] bloody campaign and
[43:32] SPEAKER_00: raise the $12.5 billion in work across the world operating virtually,
[43:37] SPEAKER_00: you know,
[43:37] SPEAKER_00: because we were in lockdown.
[43:39] SPEAKER_00: And so, you know, it's not just the tools in this.
[43:43] SPEAKER_00: biologic science.
[43:44] SPEAKER_00: It was, you know, the computational tools.
[43:46] SPEAKER_00: It was, you know, video conferencing.
[43:49] SPEAKER_00: It was the internet.
[43:49] It was,
[43:50] you know,
[43:50] all of these things came together,
[43:53] you know,
[43:53] to give us this.
[43:54] SPEAKER_00: So my optimism is exactly, you know, like in your book.
[43:59] SPEAKER_00: We've been on a pathway of better health
[44:03] SPEAKER_00: you know,
[44:04] SPEAKER_00: longer lifespans,
[44:06] SPEAKER_00: you know,
[44:06] SPEAKER_00: better cognition,
[44:07] SPEAKER_00: hopefully,
[44:08] SPEAKER_00: you know,
[44:09] SPEAKER_00: as people get older,
[44:10] SPEAKER_00: et cetera,
[44:10] SPEAKER_00: et cetera.
[44:11] And we can do better on that,
[44:13] but we're going to have to continue to work on that science.
[44:16] SPEAKER_00: And if we do that, I think, you know, the sky's the limit.
[44:19] I know there's some biological limits,
[44:21] but,
[44:22] you know,
[44:22] the goal here is to have a health span.
[44:25] SPEAKER_00: You want people to, you know...
[44:28] SPEAKER_00: start, live their lives healthy, have no mortality in childhood.
[44:32] You want no chronic diseases and you want people to die in
[44:34] their sleep when
[44:35] SPEAKER_00: whatever that age is,
[44:36] SPEAKER_00: you know,
[44:37] SPEAKER_00: you know better that than I do.
[44:39] SPEAKER_00: And, you know, we want to get as close as we can to that square curve.
[44:43] SPEAKER_00: To me, that's the optimism.
[44:45] SPEAKER_00: And,
[44:45] SPEAKER_00: you know,
[44:45] SPEAKER_00: the reason I think it's a problem to ignore health,
[44:48] SPEAKER_00: we've laid all the different reasons.
[44:50] SPEAKER_00: But at the end,
[44:52] SPEAKER_00: you know,
[44:52] SPEAKER_00: when you see,
[44:53] SPEAKER_00: you know,
[44:53] SPEAKER_00: the billionaire who all of a sudden gets,
[44:56] SPEAKER_00: you know,
[44:57] SPEAKER_00: a bad disease,
[44:58] SPEAKER_00: you know,
[44:59] SPEAKER_00: they'll do anything.
[45:00] for trying to restore their health and and what we want is not
[45:04] to restore health we
[45:05] want to have health be there throughout time we want to have
[45:09] prevention and that to
[45:10] me is is the most optimistic thing that we can possibly do for
[45:14] for families for
[45:15] parents for loved ones and um you know i think we've got a long
[45:19] runway there if we
[45:20] SPEAKER_01: keep at it well i would just add to your optimism that um
[45:25] SPEAKER_01: the human achievement,
[45:26] the potential that you actualize with COVAX and tell the story
[45:31] on fair doses,
[45:32] SPEAKER_01: as we saw with the Operation Warp Speed,
[45:34] SPEAKER_01: we can do big things if we set our mind.
[45:37] And I have to also say that we're in a lull is a nice word
[45:42] right now for what we're
[45:43] SPEAKER_01: going through.
[45:44] SPEAKER_01: It's much worse than that.
[45:45] SPEAKER_01: We will come back.
[45:47] We will see,
[45:48] I hope,
[45:49] a reactive hyperemia of the science of evidence and data to
[45:53] drive
[45:53] SPEAKER_01: great human achievement.
[45:55] SPEAKER_01: And sure, we'll have some help with AI along the way.
[45:58] SPEAKER_01: But that's what I think the story of Fair Doses tells me.
[46:02] Doing big things for the planet,
[46:04] for the whole billions of people that inhabit it.
[46:08] SPEAKER_01: When you
[46:09] SPEAKER_01: don't even know that there's a pandemic,
[46:11] SPEAKER_01: when you don't even know there's going to be a vaccine in a year.
[46:16] SPEAKER_01: That's a story that, you know, will go down for the ages.
[46:19] SPEAKER_01: So Seth,
[46:20] SPEAKER_01: thank you,
[46:20] SPEAKER_01: not just for the book and for,
[46:22] SPEAKER_01: you know,
[46:23] SPEAKER_01: our friendship,
[46:23] SPEAKER_01: but for telling this story and discussing it with us today.
[46:27] SPEAKER_01: I think a lot of people didn't know anything about it.
[46:30] SPEAKER_01: And now we're learning and hopefully we will get back to
[46:35] you know,
[46:35] where we were when you launched this,
[46:38] you know,
[46:39] extraordinary effort.
[46:41] SPEAKER_00: Thank you so much for having me, Eric, and for all that you're doing.
[46:44] SPEAKER_00: And,
[46:44] SPEAKER_00: you know,
[46:45] let's continue to drive all the listeners that are going to
[46:48] listen to this,
[46:49] SPEAKER_00: help us drive forward to a return to science and truth and,
[46:55] SPEAKER_00: you know,
[46:55] SPEAKER_00: trust,
[46:56] SPEAKER_00: because these are the things we need.
[46:57] SPEAKER_01: We will get there someday.
[46:59] SPEAKER_01: I'm sure of it.
[47:00] SPEAKER_01: Thanks so much, Seth.
[47:01] SPEAKER_01: Thanks so much.
[47:02] SPEAKER_01: All right.
[47:03] SPEAKER_01: Bye-bye.
[47:04] SPEAKER_01: Thanks everyone for joining.
[47:06] SPEAKER_01: And please join tomorrow with Susan Moneris,
[47:09] SPEAKER_01: her first live exclusive interview about her tenure at the CDC.

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