In the Bubble with Andy Slavitt: Our Shot

How We Avoid the Whole Greek Alphabet (with Jeremy Farrar)

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Listen in as Andy gets a Global Pandemic 101 course from Dr. Jeremy Farrar, director of the Wellcome Trust. Farrar gives a clear picture of the effort and urgency of vaccinating the globe, the vital role of the US on the world stage, and the criticality of the next 270 days. Plus, hear their plans to force the issue with world leaders.


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Andy Slavitt & Jeremy Farrar

Jeremy Farrar  00:00

The end of 22 is way too late. I mean, just think of where we are today, August 21, end of 22 is 18 months away, we’ve only 18 months into this pandemic. And the pandemic is going faster today than it was through much of 2020 and 2021. If we wait till the end of 22, we won’t be on Delta variants will be on some other Greek letter that’s way down the track of Delta variants, remember we’ve had five, pandemic changing variants in the last six to nine months. And that isn’t going to slow down evolutionary. So end of 22, which is what the G7 cobbled together is just way too late. You’d be facing immune escape variants in America. If we wait that long, we’ve got to lay out a much, much more aggressive timetable.

Andy Slavitt  01:04

Welcome to IN THE BUBBLE. I’m your host, Andy Slavitt. And I am really interested to see what you think of today’s episode, actually, is probably the episode where I’ve learned the most and come away with maybe the most an uneasy feeling but certainly guilty feeling. Jeremy Farrar is a wonderful, amazing person to talk to. He’s the director of the Wellcome Trust, which is a global Charitable Foundation. And he really is my source for what’s going on around the globe and how we’re doing vaccinating the world. And we’d be one of those topics that you sit here in the US and say, I get that that’s important. But it’s not the most immediate thing in my mind. And so I’ll be curious, I’ve done not a great job covering what’s going on around the globe. But after listening to Jeremy, it became really abundantly clear to me that the most important thing is to vaccinate the globe as quickly as possible. And Jeremy even put the target date and the timing on it. And we’ve been talking about a plan on this episode of what needs to be done. And I got very focused and very into it, and you’ll hear in this interview.

Andy Slavitt  02:16

We almost forget we’re having a formal interview, and we’re just really planning how to get this done, because he makes it so abundantly clear what’s at stake. And, look, I’ve been saying for a while that the three most important things are vaccinating the unvaccinated pockets here in the US, vaccinating the globe in developing an oral antiviral. Those are I think, still the three right priorities. But we always do talk about the globe as an end. And I’ll tell you that when you think about the countries that are experiencing significant case growth now, many of our poor countries, Bangladesh, Indonesia, and others, those in southern Asia, those in Africa, they’re poor countries, they have very little if any immunity from last year, they have no vaccines, and they have Delta, this is the card they have dealt. This is the card that they have to play. We were in far, far, far better shape here in the US. And it becomes very clear listening to Jeremy that if we aren’t doing the leading, it’s not going to happen. It’s very, very clear. We need to get things done to get them done now. And what happens in September is going to be the whole ballgame.

Andy Slavitt  03:35

Jeremy predicts that whether or not we see the rest of the letters in the Greek alphabet coming to haunt us is going to be a lot dependent on we do over the next nine months. And vaccinating globally makes it very persuasive case. So I do hope that you listen. And I do hope that you, like me come away with a feeling that while we need to learn a lot more about what is going on around the globe, and that we do something about it. Because if it’s not us who it really is in that kind of situation. Just a very brief turn in my sermon today is, you know, a lot of what you end up feeling within this episode is how much you have to learn. Jeremy does a great job teaching and explaining. But it’s sort of where we are right now. The people who are sure themselves on Twitter are playing really silly, dangerous game. Because we don’t it’s very been very clear that we don’t understand Delta and we need to be constantly learning. We just saw our first studies get done here in the US. Two brand new studies on how the vaccines are doing against Delta and the news is good. The news basically says that we’re seeing about a 66% effectiveness of the vaccine against any cases that are symptomatic.

Andy Slavitt  05:02

And we’re seeing, you know, close to 97% effectiveness against hospitalization, something like a 29-fold benefit, by taking the vaccine against getting hospitalized. That’s pretty amazing. That’s pretty great. And you know, Delta is so far the best that has been thrown at us. So we’re learning Delta, we’re learning what works, we’re learning how effective we are against Delta. And look, it is no fun to be part of the group of people who’ve been vaccinated and get sick. So, why we’re telling people now, hey, wear a mask, avoid even getting sick, avoid spreading anything. But it’s abundantly clear that even against Delta, if we vaccinate the globe, and vaccinate the globe quickly, we’ve got something more powerful than this virus. So as long as we keep learning and being intellectually honest, I like our chances against this thing. And even at somewhat reduced effectiveness. 66% is not 90%. It’s not really super close to 90%. It’s kind of far from 90%.

Andy Slavitt  06:15

But it’s still really good. But since we don’t want to take the chance that we won’t get COVID, we’ll do all the other things we need to do. But we got to vaccinate to drive this thing out. And I know we’ve been talking about that on the show for a long, long time. And you’re gonna now hear Jeremy Farrar and I talk about it Jeremy Farrar, again from the Wellcome Trust. He’s also a member of The Sage, which is this scientific advisory for emergencies in the UK, he’s been an advisor to Boris Johnson and the pandemic. Got to listen to him. Welcome to Jeremy.

Andy Slavitt  07:02

How are you doing, Jeremy?

Jeremy Farrar  07:03

Yeah, I’m good. Thanks. And you?

Andy Slavitt  07:05

You’re in London today?

Jeremy Farrar  07:07

No, I’m in, Oxford, I was in London yesterday, but I’m in Oxford today.

Andy Slavitt  07:11

Oh, God, it is so kind to get a join. Good to catch up, I want to try to start with a little bit of global pandemic 101. For the audience, I do an absolutely horrible job on this show of painting, a picture of what happened outside the US incredibly detailed job that kind of tried to draw the human portrait of what life is like during the pandemic here in the US. And of course, here in the US, we were faced with a top Maslow’s hierarchy of needs. We’re trying to persuade smaller, smaller parts of the population to get you to get vaccinated. And I think we lose sight of the fact that around the globe, we’ve yet to even give many people that choice. So I’m wondering if maybe you just start by just sort of painting a broad picture of what COVID looks like around the globe, right now and in 2021? Where is it receding? Where is it growing? Where are the biggest areas of concerns? How the wealthy countries look versus the intermediate and low-income countries?

Jeremy Farrar  08:15

Yeah, I think it’s a great perspective to take a global view, because of course, you know, going forward, how the pandemic pans out globally is going to have a massive impact in truth on the US or the UK or wherever else we live, because the greatest risk going forward is that new variants, new strains of this virus emerge somewhere. And as we’ve seen with the Delta variant, wherever they emerge, they’ll spread globally. So this is both sort of altruism and moral and ethical, the important but it’s scientifically critical to reduce transmission everywhere, but if you look at the world today, I mean, I do still think the US as has got a challenge ahead of, of getting to the whole population, because these vaccines are much better at preventing illness and death than they are transmission. And so they’re really protecting the person that gets it rather than the whole population so critical everybody is vaccinated, but globally, the world is on fire. I spent 20 years living in Vietnam, look at Vietnam today, Indonesia, still Brazil, I’m sad to say, Senegal, South Africa, these countries are facing horrific phases of the epidemic where healthcare is stretched. In truth, healthcare has collapsed in some places. If you regard healthcare as being able to, for instance, just deliver basic standard of care, oxygen, fluids, nursing care, then I’m afraid in many of those countries, that is not possible. People are dying in the streets, as we witnessed in India as well. And so I’m afraid large tracts of the world is in the middle of a truly horrific pandemics still.

Andy Slavitt  10:02

it so if you avoided the worst of COVID in 2020, so you had very little protection to population, then you get hit with Delta. And you happen to be in part of the world that has doesn’t have access to vaccines. That seems like the worst possible combination.

Jeremy Farrar  10:18

Yeah, it is. And countries, you know, that did do well, if you like in 2020. And I think of Vietnam again. But also, you know, Australia, New Zealand and other countries that really have managed to avoid a wave in 2020. They’re now battling to contain the Delta variant, which is highly transmissible maybe 4050 60%, more transmissible than the original strain, and causes the identical clinical picture of illness, hospitalizations, and deaths. So on the background of no population immunity, and no vaccination, it’ll just pass through the population. And increasingly across all ages, it’s not just senior people, it’s across all the ages, and these waves will continue. It won’t be one wave. It’ll be sequence of waves until you get population immunity of some description, hopefully, through vaccination, but Indonesia will have this wave, it’ll come down eventually. But it will face another wave at some point. So I’m afraid this is not going away until we provide vaccination globally.

Andy Slavitt  11:23

So let’s just maybe fixate for a second on the on the waves, it appeared that India’s wave, probably as bad as it could possibly be, went up quite quickly, and then went down quite quickly. Last I’d love to Indonesia’s curve was looking similar, which provides maybe a glimmer of hope. The UK looked like it was beginning to do the same, although it’s unclear to me over the last few days, whether or not that remains the case. What do we know about this particular Delta wave? Is there a pattern there that will anticipate we’ll see the same in the US?

Jeremy Farrar  11:59

Well, the US is struggling with that Delta wave now, of course, but when you look at a country level, the whole of the US the whole of India, you sort of average out in a single wave. The truth is that these are a series of waves. East Coast, West Coast, American Midwest America, same in India, Northern India, the East Coast, the West Coast, the south of India, they go through their own individual waves, urban versus rural. And of course, the big populations are in urban centers. So the numbers go up very quickly. But then it spreads into the rural populations in India, for instance, where healthcare is much more limited and mortality rates, death rates are much higher. Same in Indonesia, it started as so often it does in capital cities, like Jakarta, but then it’s spreading out across all of the islands of Indonesia into very rural populations with very limited health care access. So I think it’s really important to see every country goes through regional sub national waves as well as the average national wave and those of course take longer to pan through. And no country, no country is in the absence of vaccination is anywhere near any level of population immunity.

Jeremy Farrar  13:14

Even in India after the horrific wave of January, February, March, April, is probably still only at about 30%, 40%, 45% of seen infection. That leaves six or 700 million people in India alone. And if you think what is east of India, you’ve got Bangladesh, huge population, you’ve got Myanmar in a dreadful political state. You’ve then got Southeast Asia, Thailand, Vietnam, Indonesia, you’ve got the border with China. And then west of India, you’ve got Pakistan, you’ve got Afghanistan, which is I’m afraid falling apart at the moment. And then you’re into Iran, Iraq, the Middle East, migrant camps, refugee camps. I mean, you know. We have failed collectively, science has done some remarkable things in the last 18 months, but I’m afraid we have failed to grasp the right balance between addressing our own domestic issues UK, US, whilst also ensuring that we move as a world together, and I’m afraid, these great challenges of the 21st century, all of which are transnational, we’re going to have to get better at both coping with our domestic challenges and seeing the importance of working transnationally. And I just hope we step up in terms of global leadership on that in the coming days and weeks.

Andy Slavitt  14:40

You know, it’s interesting, there are some sad parallels here. We talk a lot on the show. What are the themes of the show has been that hard sciences have been winning in all of our soft sciences. The classes we didn’t pay that much attention to when University are failing us, psychology, sociology, all the things  we thought were the less important classes, the human side of things. And the empathy you talk about. I sometimes think we can barely manage it for the poor in our own country, let alone for other countries. And, and I would have to be guilty as well, because as I said, we talk so little about the globe on this show. And when we do, we often have to try to relate it to why it matters to people here in the US, which I, which I try not to do, because, you know, I have just served in the Biden administration at the beginning of the term, I know that the President at least believes that it is part of the moral responsibility of our country, to lead. Now we’ll talk a bit about whether we are and how well we’re doing against that. But that image of us as a country is sort of our image on our best day. And so mustering that empathy, it feels like is one of the things that’s really standing out as a real telltale perspective, at least here in the us about some of the elements of the country, what we’ve turned into.

Jeremy Farrar  16:02

Yeah, I mean, as a non-American, I mean, US global leadership over the last 70 years has been in the main nothing short of staggering, you’ve had the occasional blip of a four-year term occasionally, when I think you looked in a different direction. But I’ve no doubt that this administration is committed to its international leadership and its international responsibilities. And there is no more important time. I mean, in the last 75 years, this outside war, this is the greatest crisis the world has faced. But I think it’s in a way horrific as it is, I think, in a way, it’s a telltale sign of how we’re going to address, frankly, these other transnational challenges of climate change, or migration or inequalities. And this is almost a sort of test case of how we’re going to deal with that. And just as an example of that, a hugely controversial issue, of course, the origins of this virus, I do really worry that the polarization of those debates are making the world very much less safe. International cooperation on these emerging viruses wherever they are in the world, China, Asia, Africa, Central South America, US, Europe. I mean, that’s international cooperation at the moment, it’s largely stopped as a result of the polarized east-west, north-south debates and the world is very unsafe at the moment and very vulnerable to the emergence not just of COVID, but the emergence of other pathogens.

Andy Slavitt  17:59

So maybe a good place to launch into some of where we go next is, if you would mind giving us just sort of a brief rundown of all of the bodies, the entities that come together to focus on this problem globally. What role the WHO plays, what role the G7 has, what role the G20 has, and what because we have vaccines from you know, we’re really amassing the world’s vaccines, we’ve got the, you know, cinna farm, obviously, and Sputnik. What role the Vatican is playing and can play, organizations such as Wellcome Trust, the Rockefeller Foundation, could you give us as a bit of a picture on how the world gets organized today around something, as grand scale as this?

Jeremy Farrar  18:48

Yeah. And how you respond in a crisis, I think is largely dependent on how strong those institutions are before the crisis. If you undermine them, if you don’t fund them, if you question their existence, their role in the world, it’s no surprise when you need them. They’re still fragmented, under resourced, undermined and underfunded and therefore can’t deliver what they’re asked to deliver. And I’m afraid that that is how we came into COVID-19 that, in my view, the undermining of those institutions over particularly last four or five years has been one of the reasons why COVID has gripped the world as it has done.

Andy Slavitt  19:31

Well, I think you’ve been, I think you’ve been polite and worse still, for those who watch seek to undermine those agencies, they will then be able to, of course, use this as proof that they were correct.

Jeremy Farrar  19:41

Yeah, exactly. And unfortunately, if you undermine your great institutions, and I, you know, the greatest National Public Health Authority in the world, the Center for Disease Control in the US has, I think, been to some degree undermined over the last few, four or five years and as a result, maybe didn’t performance as well as perhaps it could have done through much of 2020. Similar for Public Health England here in the UK, and similar The World Health Organization. I mean, the critical bodies, the world has to, you know, the world challenges 21st century are all essentially both national and international. And I’ve mentioned some of the climate changes, perhaps the biggest one, but pandemics as well, there has to be an agency, where all the nation’s 190 odd nations come together in a forum that allows that cooperation and essentially, whatever you think of it, that is the United Nations systems, and then within the United Nations, it is the World Health Organization. It’s the World Bank to make sure the financing is available. It’s the International Monetary Fund. And then it’s the agencies like the G7 countries, the seven richest, and perhaps more importantly, now, the G20.

Jeremy Farrar  20:53

Which for all the tensions east west, north south brings in US, Europe, of course, South Africa, Brazil, China, etc. And, essentially, I think the ci 20 has got to be the vehicle of the 20 richest countries, Middle East as well, Saudi Arabia, to bring them together to say these are challenges which faces all. But if we don’t work on them in so called peacetime if we don’t let them have the best leadership, if we elect poor individuals to run those organizations, and then systematically undermine them even withdraw from them, then they won’t be there when you need them. Yeah, look back over the last 40 years of the World Health Organization, you know, some of its greatest achievements, the eradication of smallpox, you know, US contributed massively to the World Health Organization over many, many years. The US essentially structured all of those agencies from the UN to the World Bank, the IMF, it’s the construct that the US with its partners and allies put in place. Yes, they need to reform. But I think they’re going to be more important in the 21st century than they were in the 20th.

Andy Slavitt  22:02

In crises, leadership emerges, sometimes from not the places you expect them to be. Of all the bodies that you mentioned, where is leadership really emerging? You know, what seems to be the body that is really helping us to make progress against fighting this pandemic? And all the things that we’ll talk about in a second, which include, obviously, most importantly, vaccine, equitable vaccine distribution and efficient vaccine distribution, etc.

Jeremy Farrar  22:32

Yeah, I mean, there are a number, I think the International Monetary Fund just recently announced an injection of massive amounts of money into the system to provide stability, I think they’ve remained critical, the World Bank, injecting and making sure that countries do have money on either free money effectively or on loans to inject money so that countries can buy oxygen, buy vaccines, etc. I do think the World Health Organization is actually given the limitations which nation states give to it funding and support, I actually think the World Health Organization is been doing the right things. And then the scientific community, scientific community in the US scientific community in Europe, scientific community around the world, including China and the China Sinopharm vaccines and things. It is those softer skills that we’ve got to integrate that you talked about earlier. You talked about psychology, sociology, social sciences, behavioral sciences, I might add cultural awareness and International Affairs to that. Because in the end, as I keep saying that is going to be the thing that binds us together, and if we all go back to just thinking naturalistically and don’t appreciate how different cultures, different institutions in different parts of the world function, then when we want to work together in a crisis, we’re not going to be able to, I see your list, all of which I agree with, I would add studies of cultural and language and international relations to that, because that’s going to be crucial.

Andy Slavitt  24:08

That’s a great addition. That’s a really important addition that I’ve noted that. Are those bodies working together in some reasonably coordinated orchestrated fashion? Or inside? Can you give us a just a picture of what you see every day? Because you’re inside of it. Is it absolute chaos? Is there’s some organization to it? I mean, if you close my eyes, I picture Gates run in one direction and WHO running one direction and the Vatican running one direction, and then the Rockefeller and Wellcome and then I’ve got, you’ve got, of course, all of the International Monetary bodies and so like I have a hard time understanding how it’s all organized. And of course, the money comes from G7 and in the power of the G20.

Jeremy Farrar  24:49

Yeah, I think it’s now as we sit in whatever we are August 2021. I think actually the structures are functioning together. So underneath this, sorry, it’s too many acronyms. But underneath this thing called the ACT accelerator, coordinated by who lies, all of those agencies that you talk about, from the World Bank to the Gates Foundation to Wellcome to the Global Fund to GAVI, to […] sorry, far too many acronyms […], and they all come together under that ACT accelerator to ensure that it isn’t just the vaccines, it’s also the oxygen, the personal protective equipment, the drugs that save the lives and the vaccines. In together now, they have been meeting since I think, every Thursday night since May or June of 2020. And it took three or four months in truth where it was chaotic, fragmented, there was not a lot of trust between agencies, I think, I think it took three or four months to sort that out. And now it I would argue it’s working as well as it possibly can do. But those agencies can only function if they have the political backing and the political leadership to deliver.

Jeremy Farrar  26:06

And I’m afraid so far that has still been lacking, because national politicians, understandably, focused on their domestic affairs, but I think to the detriment of the global response. And that’s what I hope changes in the next month or two leading up to the United Nations General Assembly in September. And frankly, the key to that is the US. We’ve missed the US leadership in global health over the last four years, and with other politics, Brexit, Chancellor Merkel moving on from her role in the Germany, countries focused on domestic, it needs the US to step into that lean into it, and provide that leadership, which frankly, I think only the US can provide. And, you know, talking to the Biden administration, and you were in it, I really do believe that they understand that and they’re willing to do that, and the world really needs them.

Andy Slavitt  27:04

Let’s take the next step in the global picture of talking about global vaccinations. And I want to just scope, the size of the challenge first. You know, there’s about what 8 billion people on the globe. And, you know, if we vaccinated every single individual with an mRNA vaccine, which are a couple of assumptions, or that’d be 16 billion doses, I think, far as I know, we’ve manufactured about 4 billion today. But can you give us the rest of the picture? How much needs to be manufactured? How long will it take? You know, before we even talk about the equitable distribution and how that should work? Do we have the money the manufacturing capacity? And the time? What does that picture look like?

Jeremy Farrar  27:47

So you’re right, I think there’s about four, four and a half billion doses manufactured to date. And as you say, there are about 8 billion people globally. Of those 4 billion doses, the vast majority of them have gone to high income countries, a relatively small number, maybe 30/50 of high-income countries, vaccination rates in the US are now I think, single dose at about 60% or 70%, two doses, 40% or 50%. In the UK, it’s 90% 70%, as it is, in much of Europe, the rest of the world is somewhere between 1% and 10%. And many closer to 1%. And 10%. why that’s so important is because it’s a race, the world is on fire at the moment with massive levels of transmission of this virus going around. And the Delta variant just changed everything and the Delta variant won’t be the last variant, there will be new variants that come and new variants that come will potentially escape from the vaccine. So if we allow that to happen, the vaccinations in Europe and North America may not work as they do today. So this is a scientific and public health imperative, as well as a moral and an ethical one. The world needs to up the manufacturing scale. And there’s a lot of discussion for the medium term about intellectual property and all of those things that is important, but it’s not important this year and next.

Jeremy Farrar  29:13

What’s important this year and next is that the companies are incentivized and supported to manufacture as fast as they possibly can, frankly, in sites that have functioning today. And Pfizer, Moderna, AstraZeneca Johnson&Johnson and others I if they’re if everything works well, they will be able to manufacture billions of doses by the first half of next year. I think we need to set a target how many vaccine doses Do we need by end of September the end of December 2021 by March 22 and then set up a roadmap so that all countries can prepare for when those vaccines going to arrive. The logistics are in place the it’s regulated and approved the cold chains fridges freezes, airplanes are in place, needles are in place, you don’t want 100 million doses of vaccine to arrive in Nigeria and find there aren’t any syringes to give them. All of this needs military almost planning. And I think we should, what I would love to see, for instance, the US administration doing with its partners is laying out what that’s going to look like by the end of March 22. Who’s going to be vaccinated where, by which vaccine and who’s responsible and who’s going to be held accountable? And I think that’s the sort of military planning we need, rather than vague promises of a few dozen vaccines here, there and everywhere.

Andy Slavitt  30:37

Yes, incredibly complicated. And I got a little bit of a sense of the picture of how complicated Didn’t you didn’t even mention, safety laws, regulatory laws, shipping laws, obstacles that are put in place for a very good reason for it other times that have not been taken down yet. We’ve not yet figured out all of those things. And it took us I just didn’t we tried to ship a couple million doses to South Korea. And it was, it would sound simple, wouldn’t it, right? Ship a couple million doses South Korea step one step two, say You’re welcome. Well, guess what it was, there’s about 500 steps in there that we learned about. And so the world’s got to go on this curve. Maybe it’s one of the things slowing us down. So we had Albert Bourla on the podcast a week or two ago. And he said, I think if I’m remembering correctly, that Pfizer, over the course of the second half of 2021, was going to produce about 2 billion doses. And over the course of 20 to another 4 billion doses. I don’t know what too soon, but that’s certainly a big bite out of the total global need over the course of 21 and 22. What’s your sense of where we can be in terms of production capability and distribution by the end of 2022,

Jeremy Farrar  32:00

I think it’s the end of 22 is way too late. I mean, just think of where we are today, August 21, end of 22 is 18 months away, we’ve only 18 months into this pandemic. And the pandemic is going faster today than it was through much of 2020 and 2021. If we wait till the end of 2022, we won’t be on Delta variants will be on some other Greek letter that’s way down the track of Delta variants. Remember, we’ve had five pandemic changing variants in the last 6 to 9 months, and that isn’t going to slow down evolutionary. So end of 22, which is what the G7, cobbled together is just way too late. You’d be facing immune escape variants in America, if we wait that long. We’ve got to lay out a much, much more aggressive timetable, I do believe Pfizer, Moderna, J&J, AstraZeneca. And the rest will actually be able to produce the volume of vaccines that we need in the time between now and the end of March 2022. It is all those other things that you mentioned, regulatory pathways, freight to get vaccines from A to B, cold change, the Pfizer and Moderna vaccines do need to be stored in very cold freezers that isn’t available in every rural community. The logistics for planning a vaccine campaign in the Democratic Republic of Congo are not straightforward. That’s what we need to be planning now. And it’s that sort of military precision, which is what’s so critical logistics, you know, boring bureaucracy that just has to get done. And we need to do that now. So that on the first of October, when we have 100 million doses for Central Africa, within a week, they get to where they need to get to.

Andy Slavitt  33:45

So what do you believe is possible by the end of March 2020. To date, the best possible case, if we really execute with, as you say, military precision, and we have flawless manufacturing?

Jeremy Farrar  33:58

I think you could by the end of March 2022. I believe you could have 70% of the world’s population with have received at least their first dose of vaccine. That’s got to be the target.

Andy Slavitt  34:39

How’re we doing monitoring variants beyond Delta? And what pictures emerging? What are you seeing? Are there any variants out there specifically that are of concern right now I’m not using the term very enough concern in its precise definition, but from what you’ve seen?

Jeremy Farrar  34:56

Yeah, it was too slow to get going in. Many countries, but it is much better today the surveillance around the world for new variants. And the Delta has obviously taken over the world within the space of what two or three months first emerged probably on in India at some point in January, February, March of this year, and within two or three months, he was in every country and dominating the pandemic. There are other variants, the so-called beta variant that was first described in South Africa remains a problem. And beater and delta are a very different virus, in fact, quite different viruses. And so, and then there are Lambda variants. You know, the Greek alphabet has a lot of letters in but if we don’t reduce transmission, we may end up using all of them. And of course, in 2020, well, not of course, but in 2020, the virus was evolving and, and trying to get a better a better grip in so humanity in 2021, it’s also meeting some immunity and vaccination, and it’s evolving, I would argue it’s probably evolving faster in 21, than it did in 2020. So because of vaccination. Yeah, the virus came across into humans in the last quarter of 2019. And adapted to humans, it evolved to be a better virus at transmitting, but it wasn’t seeing any immunity and no vaccines now, we’ve put an additional pressure for evolution to happen. And I think we can imagine that there will be more variants coming in the future. The answer to that, and the way of preventing it is to drive down transmission everywhere and make vaccines available everywhere. It’s the same bring it all brings you back to the same point,

Andy Slavitt  36:34

Right. Yeah, I think we have a, there’s a set of we need to do three things no matter what that I’ve said before on the show, no matter what the circumstances are. So to certain extent, puzzling about what might happen in the future doesn’t change the fact that we need to vaccinate the globe, we need to vaccinate pockets in the US. And we need a cheap oral antiviral. I mean, those are the three things, among many others, that are the things to bring this more to its knees. What are you seeing with Lambda? is Lambda of concern? Can it have compete? Delta?

Jeremy Farrar  37:11

I think not. At the moment, it’s very early. You know, I think at the moment, the one to worry about is delta. And whether we call it delta or lambda or any future variant, as you absolutely right, this app still brings you back to that same point. It is critically important to know Delta, where is Lambda going? What’s happening to the Beta variant etc, what’s happening to new variants? But the answer to all of them is the same. It’s testing, it’s clinical care, it’s vaccination, it’s an oral antiviral, as soon as we can get it. So we shouldn’t get sort of, we shouldn’t hide behind the variance in a sense, and pretend that they will lead us in a different direction, the answers are the same, whatever the variance called.

Andy Slavitt  37:55

Let’s go back to the hard science stuff for a second, because we’re doing better at that. Do we think that its variants, mutate, and I begin to escape vaccines that we’ll be able to adapt our technology, our vaccine technology to meet those variants?

Jeremy Farrar  38:11

I do, I think the RNA technology has been nothing short of staggering. But what you just described is very complex. It just imagine if we had to now switch the whole global manufacturing over to a new vaccine, you the factories couldn’t just turn on a Monday to a Tuesday and produce the new vaccine. The regulatory environment wouldn’t just approve a new construct of a vaccine immediately, quite, quite rightly. So we can’t think that we could just seamlessly move from one week to another to having the new vaccine and the new variant. technologically, scientifically, as again, we could do it. Yes. But we should avoid having to do it. is the better way forward?

Andy Slavitt  38:51

Oh, absolutely. And I think if this were different than a different audience on this show, we would have kept keep making that point. But I assure you, this is an audience that is well vaccinated. And gets it and is hungry to know what it can do. But I think that’s important to just fixate on, which is the target here, even as it mutates and evolves from, from a very logic standpoint. So far, scientists say this is a pretty easy target to shoot at. Yeah, because of the spike protein and because of where, where mutations occur, and because, you know, and, and, you know, my very laypersons understanding, and part of why I’m good host of the show is I’m dumber than my audience. So I asked the really basic questions, but part of my understanding is that, you know, so long as you have something that the body can create an immune response to, that we’ll be able to find it. The really troubling of course, viruses, like HIV from a vaccination standpoint, are those where, you know, you can’t, you can’t find a way to attack it and create an immune response.

Jeremy Farrar  39:56

Yeah, exactly. You Right. I mean, this virus has been I’m much better in many ways, we’ve been able to make vaccines within 12 months that have given us remarkable protection against getting sick. That you know, 4050 years on with HIV, you know, that’s proved incredibly difficult true with malaria true with tuberculosis, as well. But on an optimistic note, I would say that the technological hard science advances of the last 12 months, actually open now the doors to whole new disruptive technology, which might have taken five or 10 years out the quickest to develop in the absence of COVID. It’s, it’s not an it’s not a good reason for having had COVID, of course. But it does mean I think that the whole field of vaccines, vaccine development, R&D, manufacturing, indeed, engineering will move forward far faster. And I would be much more optimistic that during the 2020s, we will actually have vaccines, certainly for each for tuberculosis and malaria, I believe. Whether it for HIV, I think that’s a much tougher, tougher virus.`

Andy Slavitt  41:04

Well, that would be wonderful news. Yeah, I’d look, I would say this, and I haven’t talked about this much on the show, because it’s out there in the future. But a lot of the stuff that at least I was working on the Biden ministration was really fixating on how to get the regulatory processes, the manufacturing processes, and everything to line up so that we had 90-day cycles for new releases to be able to end and so far, I think, people seem to think that that’s an achievable goal. Look, I’ve kept you for probably longer than you bargained for. But that’s what I do. I tell you the best, the best episodes, Jeremy are the ones where I learn during the podcast episode, because that really means that the audience does as well. And you’ve been incredibly interesting and fascinating and clear, you know, and your voice happens to be one that is just so consistent with, I think, the messages that we try to think about on this show. But so I’m wondering if we if we wrap up a bit, you can help the US public, think about the right way to think about what needs to be done next, what the US can do, you referenced it earlier that the US is critical in this. And as specific as you feel comfortable being around? Who, what, where, when, why how you mentioned, there’s the upcoming United Nations summit in May. So maybe you can speak a little bit about what you’d like to see happen now so that we can be where we want to be in March.

Jeremy Farrar  42:45

Yeah, I think there are moments when leadership really counts. And at the moment where we are, I’m afraid globally in danger of losing control of the pandemic. It may not seem like that setting in Oxford, or, or Washington or London, but the truth is, the pandemic is expanding still. And that puts us all at risk. So I think I do think the rest of August, September, the United Nations General Assembly is the moment for and essentially I think this can only come from the United States to say we’re going to get there by the end of March, this is what we’re going to do, we’re going to corral the world together financially, scientifically manufacturing, logistics distribution. And these are the answers to all of them on your 90 plus 90 plus 90 days, that would be 270. That’ll get us to the end of March. And it could be done. And I think this leadership can only come from the United States. It’s not just money, it’s not really money at all. It’s that moral leadership that says we can do it, and we’re going to do it. And this is how we’re going to do it. And it’s within our grasp. That’s the sort of frustrating thing. We can get the manufacturing of the vaccines done. We need to find a mechanism for making sure we turn vaccines into vaccination. And we do that on a global level. And this is where global leadership’s critical. And I think at the moment this can only come from United States.

Jeremy Farrar  43:16

Ss somebody put on paper what that 270-day plan would look like, at a high level.

Jeremy Farrar  44:17

Yeah, we have through this thing called the act accelerator. But maybe that’s a good stimulus for me to actually write that down. It’s your 90,90, 90 days. Maybe we could do it together and write an op-ed because I think it’s at 270, which really off the top my head gets us to about the end of March and 270 days to get 70% of the world’s population vaccinated, how would we do it? And who would do it? Because I think it’s achievable.

Andy Slavitt  44:47

So I’ll tell you what, I’ll make a deal if this sounds like a good partnership, if we use your brains, to, I’ll co-author it with you, if we use your brains and my I was gonna say good looks, but that doesn’t quite get us very far. But I would, I would be glad to help carry that mantle here in the US. And it certainly put my name on something, but to put a very specific paper out there and get it visibility, which says, you know, look, here’s the solution, here’s how we play our best game, we got to start now, milestones on the what has to happen before the UN what needs to happen? Here, you know, a little bit of what needs to happen from the manufacturers, what needs to happen from the global bodies and agencies, what needs to happen from a financing standpoint, who needs to play what role not in a fantasy way, but in a way of look, here’s a roadmap, it can be done, and send it to every feature, every world leader has access to it so that they are and is forced to read it in their local national papers. So that they have to answer questions about what and why did all journalists on it. Yeah, that’s something I’ll tell you. That’s the part. That’s the part, the media and public part of it is probably the part I could contribute more than certainly any of the content.

Jeremy Farrar  46:04

Well, you could certainly help with the content. But I but I think why it’s would be very persuasive, is because at the moment, everybody is sort of not running around knowing quite what to do. But when you’re caught in the moment of a crisis, it’s very hard to stand back from it and say, where do we want to be at the end of March or the end of April or something, right. But if somebody could map that out and say, these are the bits that we can answer, these are the bits that are not yet answerable, but we’re going to make sure that group answer it, so that by the end of the March, you’ve met the target, I think that would be a very constructive and positive way, instead of just seeing the doom and the gloom and running around saying what on earth we’re going to do to actually map out what it would look like what it would cost and who would be accountable for delivering which bit of it. That’s I think, would be that is what we need rather than vague statements of some point at the end of next year.

Andy Slavitt  46:56

Well, and without it, it’s harder because no one knows what we’re shooting it but just sign me up. Sign me up. I am 100% in, committed whatever is on my plate. The team’s gonna take off my plate make this more important. Thank you so much. I’m so grateful that you joined today.

Jeremy Farrar  47:14

Great, great pleasure. Keep in touch and if we can help let us know.

Andy Slavitt  47:31

Thank you, Jeremy. Okay, you gotta hear the shows that are coming up. You ready? These are incredible shows one, how COVID effects kids. The real story with Dr. David Kimberlin, two what the heck’s going on in Florida with Ron de Santos, along with David Hogg, the activist from Parkland, who knows a thing or two about Florida and Ron DeSantis and kids and schools. David is a survivor of a 2018 shooting at Stoneman Douglas High School in Florida. He’s really an incredible guy, young man. And then we have Dr. Anthony Fauci, Dr. Anthony Fauci, which will be phenomenal. We have lots of other great shows coming up. So stay tuned for those, enjoy the rest of your week. I will talk to you soon here and on Twitter. Take care.


Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.

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