In the Bubble with Andy Slavitt: Our Shot

Immune-Evasive Variants: Explained (with Laurie Garrett)

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Andy gets back to basics with Pulitzer Prize-winning science journalist Laurie Garrett. They get into how and why viruses mutate, why the variants don’t seem to be causing too much trouble for the mRNA vaccines, and how our actions are, as Laurie puts it, “aiding and abetting” COVID. Plus, her big takeaways for how a little empathy at home and in our systemic approach can change the trajectory of the pandemic.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Laurie @Laurie_Garrett on Twitter.

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Andy Slavitt, Laurie Garrett

Laurie Garrett  00:00

My message to unvaccinated Americans is this. What more is there to wait for? What more do you need to see? We’ve made vaccinations free, safe and convenient. The vaccine is FDA approved. Over 200 million Americans have gotten at least one shot. Even patient, but our patience is wearing thin. And your refusal has caused all of us. So please do the right thing. But just to take it from me listen to the voices of unvaccinated Americans who are lying in hospital beds, taking their final breath saying If only I’d gotten vaccinate. If only, it’s a tragedy. Please don’t let it become yours.

Andy Slavitt 

Welcome to IN THE BUBBLE. I’m your host, Andy Slavitt. And yes, the President is running low on patience. As one text I got said, it’s time for him to turn the car around, pull over and have words with us. And you just heard some of those words. So let me get into what’s happening before I introduce our guest today, Laurie Garrett. And of course, talk about my shoulder which I know you all cared so deeply about. And of course, our 25th anniversary, thank you for all the well wishes. So by the end of this summer, the US is going to have the lowest vaccination rate of every wealthy democracy in the world. At the beginning of the summer, we were on top. Now, I don’t want to remind you who was in the administration, the beginning of summer. And what’s happened since then, and I don’t want to chide Tony Fauci at all for their performance. They’re doing the best they can without me, as Tony said, it’s been a struggle.

Andy Slavitt  02:10

But no, this has been nothing to do with the administration, of course, as much as it is running against public sentiment that has large levels of people saying, no, I don’t want to get vaccinated. And I have some fascinating insights for what happens on the trying to share them in a second, when you ask people to get vaccinated. It turns out, most of them who aren’t vaccinated when you put it to them in this way, say yes, I just talked with the head of a company that had 70% of its company vaccinated. And now he’s got 95% of vaccinated and the other 25%. He said, almost all of them said, well, other people were getting vaccinated. So I didn’t think I had to, or I was planning and getting around to it, but I never did. Now, of course, there was some real resistance. So don’t want to pretend that there isn’t. But for the most part, getting vaccinated is not an idea that people really hate. In fact, requiring people to get vaccinated to participate in certain activities, also has big public support.

Andy Slavitt

And the CEO of this company, thanked me because he said, look, I did this weeks ago, and others weren’t playing by the same rules. And it was really, really hard. And now, it’s a big, big help because everybody’s playing by the same rules. Now, of course, I want to put my heart out to someone who’s really been suffering throughout this, and that’s JD Vance. JD is running for Senate. And he’s had a really, really difficult time with these requirements. He’s fallen into near hysterics. He’s called for an insurrection. He is beside himself with anger. He’s wet himself. And he’s the kid in the diaper. That’s wet, that hasn’t been changed for a long time. And it doesn’t feel good. And he’s acting out. He’s taking all of the toys that around him in the stroller, and he’s throwing them. If you give him food, he says, no, I don’t want it. He’s going on Fox News. And he’s whining, he’s going on to Twitter. And he’s really facing a tough time. So I think we should, you know, I’ll have a moment where we just kind of recognize how hard this is on JD, that other people are being asked to keep people safe that other people are being asked to, you know, go to work and take a test once a week to show, hey, I don’t have COVID I’m not infectious, so I come to work. And not infect people

Andy Slavitt  04:35

I think it’s important that we recognize that that request stretches JD’s understanding of the Constitution, because I think JD believes as the weather governors apparently who are suing that the constitution makes it so that people should not have to be inconvenienced for others. That’s really what this is all about. About this is about the right to not be inconvenienced, and I read the bill of rights. And I read the Constitution. And JD Vance, you got no standing buddy. You got no standing. You got no standing and someday I’ll read the email you sent me on air and in the podcast, that would be enjoyable. I kid JD, I kid him because he’s a moron. Honestly, he’s really, he’s really kind of like, occasionally our country produces someone like JD, who basically kind of inhaled the worst of like, what it means to get attention and try to be famous, and to do more and more irresponsible things in order to hang on to that. And, you know, that’s what we’re up against. We’re up against, I think not so much people with legitimate concerns. There are people legitimate concerns.

Andy Slavitt 

But we’re up against hysterical, political showboating and performing. And then when it comes to people, legitimate concerns, we should hear them out, as always. Now, when we hear them out, we’re going to learn I think, what the data says is that 80% of people with less serious concerns, believe one to five falsehoods about the vaccine. So we got to do a good job explaining things. And one of the reasons why we do this podcast and we have people like Ed Yong and Tony Fauci and today, Laurie Garrett, who won an award for explanatory journalism, same award that had Ed Yong won. She won this for worksheet chronicling the Ebola virus outbreak in Zaire in 1996. So 24 years before Ed Yong, but they’re linked by two days, two days apart in podcast episodes. Isn’t that amazing? I will also tell you that had a great anniversary with Lana. It was nice. And I whined the entire time because of my poor shoulder.

Andy Slavitt  06:57

Which I thought was, had a rotator cuff injury turns out that the doctor I saw was not great. It’s not great. It turns out I have cartilage in my shoulder, which is caused me to be whining, you know, there’s a direct line between a man’s shoulder pain and the whiny gland. Because I was whining all weekend. And then yesterday, something miraculous happened, I went to a different doctor, and I got a cortisone shot. And I can even make this swimming motion with my arms. So fancy that, I don’t like to brag, but I could swim anytime I feel like it. I just need some water. Okay. That’s our sermon. This is a fun conversation with Laurie Garrett, I want to tell you, we get into it by getting into the science of it. And since I’m not a science person, like I love talking to sciency people who can explain the sciency stuff really well. And we get into a lot of the topics about like, what is this variant all about? And how do we fight against variants? And she’s very, very smart. I really like her, you will too, here it goes.

Andy Slavitt  08:12

Well, hi, Laurie.

Laurie Garrett 

Hi, Andy.

Andy Slavitt 

How are you?

Laurie Garrett 

I’m hanging in there, sometimes by my fingernails.

Andy Slavitt

It’s a, imagine it’s tough being the one that tells the absolute truth. And make sure that that happens no matter what I know that that’s tiring. But I thank you for it. I think so many people find that so invaluable.

Laurie Garrett 

Well, I try to tell the truth. You know, I don’t always know what the truth is. And then I will acknowledge that I’m as confused as everyone else.

Andy Slavitt 

Yeah, I think the best way to start with someone like yourself, is just with like some basic fundamentals to remind people of that are in arguable, in that maybe step back and tell us a little bit about why viral mutations occur? Do they occur a lot? What’s an assign of, what allows them to occur, and then maybe lead that a little bit into when they turn into something troublesome versus when it’s just a part of natural evolution?

Laurie Garrett 

Well, I think the best way to talk about this is to imagine that you have a glass in front of you, and in that glass is a thimble full of ocean water. You’ve just recently pulled it out of the sea. And in that water, you might see some cloudiness and some salt. It’s room temperature. You know, you don’t know a whole lot else about it. But if you were to look under a microscope and with ever greater power, go into electron microscope and then take a look at the DNA and the RNA in this little tiny amount of water in your glass. You would discover that it’s teeming with viruses and they far outnumber anything else in that water. And that the viruses run the gamut from fully structured, well protected viruses like the Coronavirus that we’re all worried about right now or like Influenza, all the way down to what we call phage, which are just little tiny packages of genetic material that drift in and out of bacteria. they infect, you know, larger microorganisms that are still microscopic in size.

Laurie Garrett  10:32

When you really look at that little pile of water, that little few drops of water in your class, you realize that you’re looking at a kind of microbial soup that is constantly changing. If it doesn’t change, and it doesn’t adapt to changing conditions in that glass, then things die, things fall apart. Death for a virus is a very odd thing to think about. Because there’s no heartbeat, there’s no brain, you know, all these things that we think of is life, but its genetic material falls to pieces. And so eventually you realize that survival of the fittest for a virus is about constantly mutating, constantly being able to reach into its environments and pull from this sort of genetic library, that is the suit that it resides in whatever little bits of genetic material might be useful in its next round of reproduction and it’s next round of reproduction and viruses are particularly sneaky, because they don’t carry their own machinery for reproduction. They have to steal.

Laurie Garrett 

So they invade your house, they get inside yourselves, and they steal your machinery to make copies of themselves. Well, that means then that their victim to whatever other counterinsurgency capacity your cell has. And of course, we have mechanisms like CRISPR, all sorts of mechanisms that are in place to try and stop and chop up viruses that have tried to take us over. And the result is that things mutate constantly. There’s sloppiness, there’s mistakes made. Well, some viruses are especially sloppy Influenza is notoriously sloppy. It has RNA that’s packaged in chromosomes, and the chromosomes literally fall apart inside your cells. And then reform and in the process, they kind of grab whatever happens to be around them and reform along with it. And that’s why there’s constantly a different influenza around every year. And we’re constantly trying to find a way to vaccinate people against all influences instead of having to come up with a new one every single year.

Laurie Garrett  12:56

Coronavirus are less mutation prone than influenza; we think. But our experience with them is not very long. We haven’t been as familiar with this whole family of viruses, as we have obviously been with Influenza. What it looks like is happening now, with COVID, you have to ask yourself, well, what conditions are conducive to putting selection pressure on a virus to make it so that the old forms of the virus die out and newer forms takeover. So the sort of alpha form we were looking at six months ago, has all but disappeared in most countries, and being completely overwhelmed by Delta. And there are new other ones, the Mu form, the Gamma, the Lambda, they’re all out there. What makes this happen? And there are several things to think about, first of all, the virus once, once now I don’t want to make that sound like it has a brain. But for its survival, the virus needs to get around your immune system.

Laurie Garrett  14:07

And that best way for a virus to dodge your immune system is to change its outer coating so that what your antibodies see is not the same as what they were programmed to see. So the virus isn’t the same thing that the end of your whole antibody mechanism recognizes, or your T cells or all the other components of your immune system. So this COVID selection pressure is very strong. And there’s a couple of things that work in favor of mutating to escape the immune system. One is having large numbers of human beings who are immunocompromised, meaning they don’t have healthy, strong immune systems. So a virus can get into those people and sort of you know, model around make millions and billions of copies of itself until something pushes through that’s a better form.

Andy Slavitt 

Because it just has more time, it just has more time in there before the immune system stops it.

Laurie Garrett 

Yeah, because the pressures are there, the selection pressure is there, but it’s not effective. And it’s not as overwhelming as it would be in a healthy, strong immune system environment. So for example, if you had a country where 25% of the adult population was HIV positive, and now if they are appropriately treated, so that they don’t have a lowered CD4 levels, which is a key component of your immune system, then they may not really be a good safe haven for the virus. But if they’ve either gone untreated, or their treatment has been interrupted, because the pandemic is making a lot of other health functions fall apart in, especially in poor countries, then they may have a permissive environment, if you will, for the virus. Another would be cancer patients that are undergoing radiation therapy or chemotherapy, both of which are devastating temporarily to your immune system. And then, of course, there are other reasons that people can have a compromised immune response, including aging, which is why we’re always more worried about people, you know, over 75, then we would be about, say, people 35. So that all of that is in place.

Laurie Garrett  16:37

And then the second thing is if you have an intervention that’s meant to stop the virus by promoting your own immune response against the virus, but you don’t use it right. If you don’t use it fully and you don’t use it properly, then you actually may end up having a situation that backfires on you, because you’ve done is sort of on select for viruses that would escape from this inadequate response. So I’m worried, for example, that Florida under Governor DeSantis has put huge emphasis on monoclonal antibody therapy as a way to somehow deal with this disease, and set up all these clinics all over Florida that people are supposed to walk into and get regeneron, which is what President Trump had, or some other monoclonal antibody treatment in lieu of vaccination, in lieu of wearing masks, in lieu of preventing getting infected in the first place. And they hope in lieu of going to hospital. But of course, this is all you know about staging and immune response towards the virus. And I fear that widespread inappropriate, monoclonal antibody use might actually render all these monoclonal antibodies eventually useless, because the viruses, populations will emerge that will escape and be, you know, mutated around them.

Andy Slavitt  18:05

So you’re saying, first of all, that Ron DeSantis is not good at science, and that this approach does not make sense, well, I’m shocked. Now, as COVID itself mutates, we’ve seen different variants, some of which have been more immune evasive, and such as Beta, Delta+, Ioda, Mu. But we’ve been we’ve seen other ones, like Alpha and like Delta, that have been more contagious. And it appears so far, that because the more contagious virus outcompetes, the ones that are less contagious, that so long as we’ve had a virus that has been contagious, but manageable by a vaccine, it’s been defeating on our behalf. The other variants that the vaccine would have had trouble with. So admittedly, in other words, Delta is not our friend, but it’s at least the enemy of our enemy.

Laurie Garrett 

Well, that’s one way to look at it. I mean, if you look at HIV, you see no evidence of one type of HIV dominating over another type based on those sorts of that kind of algorithm. You know, it’s just never happening. But again, that’s the extreme case. If you look at influenza, it’s almost like it’s about chance in the homosapien population, what trend will dominate in the swarms of influenza in a given year? It seems to be more about escaping the immune system than anything else. So, you know, when 1918 happened, the best guess is that there weren’t a lot of human beings except very, very old folks who had previously had their immune system recognize and see that particular constellation of Influenza before. And the biggest death toll was actually in young adults who were otherwise very healthy, very fit.

Laurie Garrett  20:45

That was a particularly dangerous virus because it was both highly transmissible very, very contagious, and very deadly. It had both attributes at once. With COVID, you know, we can hope we can pray that with time, high transmissibility, went out over virulence. And it’ll be something like a common cold. And of course, since it’s roughly about half of all common colds are in fact coronaviruses. Then maybe what, you know, some hypothesizes that we’re just seeing the birth of a new Coronavirus, but its ultimate destiny is to be a common cold. That would be the most optimistic forecast. And there are some putting that out right now. But I think it’s way too early to make that call.

Andy Slavitt 

Okay, that’s one possibility. But it feels like one possibility among several at least. So maybe we return to that. But in the meantime, if there is a variant that is more contagious than Delta, and it gives the vaccine more problems. That’s the one that we would be worried about. If it’s, if Delta defeats it, that ultimately, it’s a more limited problem. But if it becomes more dominant, you know, if it says, if it’s as contagious as, say, the measles, tougher for this particular vaccine. That’s the scenario we worry about. Is there any way to probabilistically think about the likelihood of that scenario? Is it likely that given that the Delta is so contagious, that it may be approaching some sort of limit? Or would you say no, it’s really impossible to tell it’s really random. Or would you say, you know what, as long as we keep going like it, it’s actually likely that it will evolve to be even more troublesome?

Laurie Garrett  22:40

You know, I think, I think this whole notion of focusing on the virus itself, to ask what the future of the pandemic is, is wrongheaded. The issue is what’s human behavior, because we’re aiding and abetting the virus. So you know, there’s the whole transmission thing stops being such an issue if everybody’s wearing appropriate math.

Andy Slavitt 

But I think we already know the answer to that absent really significant change.

Laurie Garrett 

Well, then we’re in real trouble. We are in real, real trouble if we can’t get more people to understand why they need to take protective measures, not only for themselves, but more importantly, for those around them. Then we’re stuck with this virus in one form, or another mutating and changing over time, for well, probably the rest of my lifetime.

Andy Slavitt 

Yep. Well, look, I think we both we have this really ambivalent place where we both are completely counting on a scientific Arsenal, to save us from ourselves, a Tamiflu pill, a vaccine, and a great number of us don’t want to trust science, or if it is, in some way presented as a thing we all should do. Or a government or some forces behind it, there’s enough people that rebel against it. Now, this is true in many countries, it seems more true in the US than almost everywhere. You know this Laurie, but I’ll say this for the audience. You know, we were one of the first countries to get mass vaccinations going, and now today, 45 countries have vaccinated more of their population than the US and that 45 will become 75 of 90. And eventually, we’ll be very close to the bottom of the list. And our likelihood, and, you know, we have seen countries that are at 90%. And then and now and then relative to masks, and so forth. You know, I think we have countries around the world that when there are, when there are high levels of contagion. We’ll organically wear masks. There are others that I think we just can’t count on. That that’s going to change with enough of the population, so that may or may not be the right outlook for humans. But if it is, and the virus has enough chances to mutate, is it your sense that we stand strong odds of Delta being defeated? Or is there something that in looking at the virus would tell you think? No, it’s not the case.

Laurie Garrett 

Well, there’s a lot of work going on right now to try and come up with a universal Coronavirus vaccine. And for a variety of reasons, it looks easier than then this long sought holy grail of influenza fighting a universal you know, all of all flus vaccine, and obviously, if we can come up with something along those lines, then everybody is protected except the idiots that won’t get vaccinated. And, you know, in countries where the idiot level is high, there will continue to be virus circulating, but it would protect those who were vaccinated. We don’t we’re not there yet. So where we are now is we’re still reactive.

Andy Slavitt  26:06

How far do you think we might be from a science standpoint, from a kind of pan Coronavirus type of vaccine?

Laurie Garrett 

Yeah, well, there’s a lot of work going on in that area. Several companies and research laboratories and academic centers are working on it. I don’t think anybody really knows for sure, you know, how close is it, but recognizing that it’s more than the stock. So all in all the vaccines we have right now target what are called the stock proteins, which are, if you, you know, look at the classic cartoon of the Coronavirus. It’s like a sphere with a whole bunch of little points sticking out and then they have a little ball on the top of the points. And those points sticking out are the stock, the protein stocks, and they have very specific what are called epitopes, meaning things that your antibodies would recognize and respond to. And then they have a receptor mechanism that latches on to a particular kind of receptor on the outside of human cells, or mammalian cells called the ACE2 receptor.

Laurie Garrett 

It turns out, there are other components of the outside of the virus, that are also important to the ability of the virus to both latch onto the outside of your cell and then punch its way in and take over the cell. And what’s going on now is an attempt to target all the whole sequence of events. So all the proteins that are used by the virus to gain entry into human cells and take them over. And with that kind of an all-out assault, it might be possible that virtually every Coronavirus out there, including MERS and the original SARS and common cold viruses would have similar or same mechanisms in at least one or two stages of this process so that you would end up making a universal vaccine.

Andy Slavitt 

That’s a really interesting look at kind of our scientific opportunity. And as we think about the pursuit of the scientific opportunity, one of the things that I find you do so wonderfully is you take those of us that have never been inside a laboratory. And if we did, we would know what we were looking at. It would all look the same to us. Oh is a test tube? Oh, there’s a white coat. Looks like lab work. Can you help us really understand what’s going on? And there’s something about this Coronavirus that has made the development of vaccines, mRNA vaccines and other types effective, at least so far, relative to, as you said, other things that have been trickier. Is that because there is something about our own antibody response when it recognizes SARS-CoV-2 that is it more easy to replicate or why is that? Why is it that companies seem to be so confident that even as a virus mutates, they will be able to create and adapt vaccines to it?

Laurie Garrett 

Well, I think first of all we have to understand there was really only one other successful innovation in mRNA vaccines before now, and that was the Ebola vaccine. And it worked. And it became proof of principle, our National Institutes of Health, particularly the agency that’s run by Tony Fauci invested very heavily in mRNA vaccine research going back a good 15-16 years. And the beauty of the mRNA approach is that you can really swap out genes. So you can swap out finite sets of nucleotides to create a different targeted vaccine relatively easily. Whereas our old-fashioned vaccines were either whole viruses that we killed, or kept alive but crippled, so they couldn’t cause disease, or they were, you know, giant protein complexes of some kind, all of which is harder to manufacture and harder to change. year by year, you know, in response to changes in nature with the viral population. So, I mean, you take something like measles, for example, which it’s easy for Americans to not know today that measles is both the most contagious virus on Earth, you know, it is at least, at least three times more contagious than the Delta of viruses.

Laurie Garrett  31:32

But it’s also tremendously lethal. A true killer of children in the absence of immunization. And it adapts within families. So that, for example is studies in West Africa done back before widespread vaccination showed a measles could hit a household. And the swarms as I was saying of viruses, would as they went from through one child after another after another get more lethal, as if they were adapting to this specific gene pool. measles is a terrible disease. And if unless you’ve seen as I have a child die of measles, you just don’t understand how deadly the enemy can be. But the good news is, the vaccine still works, you know, developed in 1960s. And it still works today, it works beautifully, really, truly protects. We don’t have mass Carnage to measles around the world except where people don’t vaccinate. So when we look down the road and think about this virus, I think there’s uncharted territory, we really don’t know as much about coronaviruses, as we should to be able to answer the kinds of questions you’re putting out. And we can only hope that the pharmaceutical industry and basic biotech researchers can come up with the answers rapidly to create a kind of universal protection, a shield of protection for all of humanity. The one thing I would say to be callous about it works in favor of success is that, unlike, let’s say the HIV vaccine, the profit potential was successful. COVID vaccines is very high.

Andy Slavitt  33:23

Well, and also, I mean, to go back to Fauci, who you referenced is the mRNA platform that he described it to me, because the body’s immune system doesn’t know how to react HIV, it really makes it much a whole different ballgame to try to create a vaccine. Because there’s really no response in the human body that they’re trying to replicate. At least that’s how he described it.

Laurie Garrett 

Well, that the virus actually infects the immune system cells, and then kills, so it’s not just that it infects your genetic code. It’s infecting genetic code inside of your T cells, and turning your T-cells against you and destroying you. So, it’s a really, really tough, we’ve never faced an enemy like this one. This is I mean, if in ancient times humanity experience something like HIV, I think our species would be in real trouble.

Andy Slavitt  34:23

And yet, we, it took a long time, but we have now highly effective treatments for HIV.

Laurie Garrett 

Takes me to another point. Way back when this whole adventure started with COVID. I took meetings with leadership of the United Nations and the Secretary General and this would be early 2020. And I said you have a choice. You have only two options going forward with this new disease. Option one, you say, our target is eradication. And you go all out. And what that means is you from the beginning set the bar at the right place, it’s not enough to have a vaccine, it would have to be oral, or inhaled vaccine, no needles, it would have to be capable of surviving the cold chain, so that it could be carried in a backpack up a cliff, into a village and the top of the Himalayas to administer to everybody, there would have to be an infrastructure put in place, tapping into the existing polio vaccination infrastructure, and other major United Nations episodes and efforts in order to get vaccine as fast as possible everywhere in the entire world.

Laurie Garrett 

And that would have to be the target, that would have to be the price point, that would have to be the intent. And if that is not the intent, than the option two, behind the red curtain over there is welcome to the world of the COVID equivalent of PEPFAR, you will have to for who knows how long, years, years, years, if not decades, decades, be in an endless cycle of rich world providing resources to the poor world, to keep people alive and slow epidemics down, constantly adapting to the changes that the viral population swarms go through. And it would be an endless cycle of, you know, hat in hand with the World Bank and the IMF and all the bilateral donors, the G20, all these mechanisms in a giant global exercise to try and create some facsimile of equity out there of whatever tools we come up with. So clearly, what’s happened is, we decided to reject both options, we decided to say, nah we’re going to give lip service to creating a global mechanism. But there never will be enough money or enough vaccine in it.

Laurie Garrett  37:07

We’re clearly not going to do eradication, because it’s too late, our opportunity to have done that has been eclipsed, we now have animal populations carrying this virus. And unless we’re going to go out and vaccinate wild animals, you know, we’re stuck with it in our landscape. But we’re not also going to go for creating, you know, a well-funded, well-oiled mechanism for equity. We’re not going to play the game right. So, so far, the way countries have chosen to deal with this virus is entirely nationalistic. And I don’t care whether you’re, you know, a sweetheart nationalist, say, Iceland, you know, or you’re a big pointy elbowed nationalists like Brazil or China or the United States. Wherever you look, the answer is, we’re focused inside our borders. And we’re coming up with strategies and policies that are good for our people, if they happen to help others. Well, that’s just well.

Andy Slavitt  38:08

Yeah. So I think what you describe, first of all, that’s an incredible conversation that you had with those two choices. And I should make sure for those who don’t know what PEPFAR is, you can go back and listen to a couple of earlier episodes, one with Mark McClellan, where he detailed the work two decades ago, to try to take on HIV in Africa. But the thing that I haven’t spent, I’ve spent Laurie a bunch of time with the PEPFAR people recently, in advance of this upcoming UN meeting, and I’m sure you’re following all this stuff closely as well, for the for the sake of our listeners, you know, the good news is that now maybe belatedly, so there is an effort that is somewhat weaker. But and I think it very much you describe it? Well, it’s the me before the we for sure. But now that the me is getting taken care of meaning my national interest, you know, the IMF has stepped up. There are multinational organizations that are in place under the Act now kind of team. And, indeed, we’re seeing about a billion vaccines a month finally, now, what we haven’t seen is the hard stuff yet.

Andy Slavitt

So when I look at things, Laurie, please correct me if you see it differently. I see North America, most of South America, East Asia, Europe, Oceana, rapidly getting their populations vaccinated. And then I see, you know, about 80 to 100 countries, maybe fewer than that, in Africa, in South Asia, in Latin America and South America that are well behind because they’re poor countries. And then I see you know, the point you made just now which I think is really smart that even in well, Africa trees where you’ve got remote and rural populations, you know, those are still very likely, untouched. So in other words, India, Brazil, have made a lot of progress. But if you’re in rural Brazil or rural India, I suspect it hasn’t gotten to yet.

Laurie Garrett  40:17

Yeah. So the real problem now is can we, let’s imagine where Seth Berkley, so Seth Berkeley runs the Global Alliance of Vaccinators, here GAVI, which is the mechanism internationally that distributes all kinds of vaccines all over the world, to countries that can’t afford to buy them on the open market without subsidies and assistance, and encourages drug companies to make high volumes of vaccines so that they’re affordable and available for the whole world. If you are Seth Berkley, the CEO of GAVI, you look across the landscape right now. And there’s just a lot to be upset about. First of all, he already was having last mile challenges, just with vaccines that go back to the 1950s. And getting them, you know, to all the children in the world that need them. Now add to it, the first tiers of adult vaccines that came on board, hepatitis vaccines, HPV vaccines, pneumococcus vaccines, and you see that the mechanisms really start falling apart fast when you go to adults. Because, you know, parents bring their kids in for routine checkups.

Laurie Garrett 

And they’re highly motivated to keep their children alive and get them to doctors on whatever schedule, even in the most remote parts of the world. A clinic says, you know, you bring this child back in six months, they need another round of shots, it’s very hard to get adults to take themselves in for shots for anything. And then again, if you’re Seth Berkley, you not only have to combat all of that, but you’re arguing with the drug companies to let loose of their patents so that generic manufacturers can make up giant batches over here and move a factory over there, and so on and so forth and break contractual agreements with rich countries or loosen up on them so that the poor countries have a chance to get even if they have money have a chance to actually buy product in competition against the richest countries in the world. So, I mean, I think we’re still looking at a really tough balancing act, led by a relatively small number of idealists who believe very strongly in what they’re doing. And we can only hope will break down more and more barriers and be more and more successful. But all along, there are saboteurs every step of the way.

Andy Slavitt

For sure. I mean, the fact that it seems like, you know, this virus has found a way to take some of the things that are our biggest weak points, and exploit them, Ed Yong use this phrase, the Goldilocks of the anti-Goldilocks virus, where it’s just bad enough to do lots of damage, but not so bad, that it would cause the average citizen to want to change their life for it. Because it happens in part my view, because it happens to other people and happens to older people, sicker people, poor people, people who work by the hour, people who are, you know, people would consider to be not them, disproportionately not white, younger people. So in some ways that the virus is almost designed to, like take advantage of our social features and our behavior towards one another, and exploit them the same way. It exploits a weakened immune system.

Laurie Garrett 

I would argue that that’s true with all viruses, all viruses, all viruses exploit. And I don’t want that to sound conscious by the virus. But exploit human antipathy towards other humans, our ability to say, you know, they don’t matter as much as my colleagues, my peers matter. If me and my peers are okay, then who cares about them? You know, I mean, I’ve had any number of people say to me, well, I don’t know anybody who’s had COVID. As if maybe it’s not really a real problem, or maybe it’s been exaggerated. The lack of empathy, the lack of the ability. I mean, I would say without a doubt, the Supreme example of this was HIV. Yeah. You know, for those of us that were dealing with HIV before it had a name, and we’re on the front lines way back in the early 80s. The hatred that entire populations exhibited towards those who were at risk and those who got infected was like nothing I’ve ever seen, and I hope never to see again.

Laurie Garrett

And that aided and abetted the virus, because it drove the at-risk population underground, it drove them away from health providers away from government into a kind of hiding that allowed the virus to spread, whether they were IV drug users, whether they were sex workers in Puna, or they were gay activists in the Castro district, it drove the spread of virus. I’m here with COVID. You know, I live in New York City, if you were a white, middle-class person with a job that could be executed from your home last year at the peak of our nightmare. Last March and April. Yes. We heard the sirens constantly. Yes, we saw the city shut down. Yes, we were all frightened. Anybody that was it was simply not a sentient human being. But the risks were being taken by the guys who delivered our food to us, the risks were being taken by them out there, the guys on their motorized bicycles, loaded down with sacks of goods to come to our front door.

Andy Slavitt  46:34

You know, you are a problem solver. You’re you document things. You’re a scientist in the way you think and operate, then you, of course, have won a Pulitzer Prize for being able to explain this to people in ways that, quite frankly, others haven’t. And so these are real challenges. And it feels like we don’t know what the solutions are, as you said earlier. But we certainly don’t get there without acknowledging them and trying to understand them. Because we’ve spent a lot of time when we’ve just allowed things to get worse, because the danger didn’t feel here and precedent now to us, us enough to reduce our carbon use, us enough to look out for each other and make sure that the kid that doesn’t have access to the internet, or a school lunch, gets it enough to realize that all those things add up. And they do create a baseline, they create a baseline not just a fear, but a baseline of what we’re willing to accept, in the way people are treated and the way people live.

Andy Slavitt 

You know, once it becomes acceptable, and we learn to live with it, then we seem to be it seems to be a slippery slope over what we’re willing to accept it. And in a world where there are so many creature comforts for people who have all of the wealth. The people who make all the decisions, the chance to shut all that stuff out, is really powerful. And it does some extent it does rely on some sort of enlightenment that’s going to be very imperfect, at best of some of the people with the power.

Laurie Garrett  48:18

Well think about it. How many of you listeners have gotten to the point where you’ve kind of, you know, regretfully shrug and say, yeah, it’s fire season again in the West. So that what might have been really shocking orange skies, people’s homes burnt to the ground that you saw five years ago, you’re starting to already accept as some kind of a new normal, you know, how many of you have thought, yeah, bad hurricanes, really big ones are going to hit in the Gulf of Mexico. And whether they bounce on Texas, or Louisiana, or Florida, or the Carolinas first, they’re gonna be devastating. And they’re bigger, and they’re faster and all of that. And that’s just how it is.

Andy Slavitt 

Yeah. And I have that feeling with, another school where someone walked in and shot 15 kids. And where are you the words are shock, if you read the climate report from the UN, whereas that’s good as it’s going to get. I mean, the smoke we see this season is baseline for at least the next three decades. And so the human condition will have to accept it in order to move on. That kind of built-in ability to eliminate shock is real challenge.

Laurie Garrett 

If there’s anything that should come out of this podcast, and that these listeners should be thinking about it is how do we get the global community to think like a community. Because we’re not going to conquer COVID, we’re not going to conquer the climate crisis, we’re not going to save a huge list of doomed species on Earth. And we’re certainly not going to save the oceans if we can’t have community. And if there’s one thing that is so upsetting to see, with the response to COVID, it is that for a substantial percentage of the American people and people in other countries as well, not just our society, the notion of taking a step because it’s good for the community, is viewed as antithetical to personal freedom. So, wearing a mask, because it’s good for the community, well, how dare you my personal freedom says, I don’t want to wear a mask. Somehow, we have to come back to that notion, which is really a very post-World War 2 way of viewing the world, that the community matters. And the community in all so many cases has to Trump the needs of the what, and that trumping the needs of the one is not the same thing as violating your personal liberty.

Andy Slavitt 

Right. Well, Laurie, we’re gonna have domain over less than less, if we don’t do that. So freedom to fight with sticks and stones perhaps. Liberty to die, liberty to watch other people die, liberty to be alone, Laurie, you’re just brilliant. I’m just so grateful to even get to know you over the last year and a half, there are good things that come out of this podcast, getting to know someone like you is one of them. And maybe the symbol there that we should all think about is the good things happen locally, personally, they happen when we connect people together, they happen when we listen to other people and their ideas. They happen when we’re willing to say, wait a minute, I just learned something. And if we can replicate those moments, you know, which happened even in the context of a crisis. And in fact, I bet you buried in this crisis. There are lots of solutions. But listening to you and getting to know you certainly, for me, at least personally, feels like it’s part of that path. I want to thank you. And I want to thank you for coming on and sharing all your knowledge with people listening to this.

Laurie Garrett  52:31

Well, I want to thank you for all the work you did in the administration, building up to this vaccine campaign, and your service. So right back at you

Andy Slavitt 

Thank you for listening to that intense and fun conversation. I want to tell you, before you get off, you have to hear the next three episodes are. You’re going to be so impressed that we can put episodes up like this every day. I am because I’m not the one booking the guests and doing all that work. I’m impressed with the team. First is a toolkit on boosters, the boosters are coming and we’re going to try to answer your questions and I want to have someone on the distribution and shot giving side and someone on the science sides with interest questions. You had JJ you’ve had Moderna, you’ve Pfizer what should you do all those kinds of things around boosters. Second, the head of the FDA herself Janet Woodcock, now that’s a good get because nobody is getting Janet Woodcock, and we’re in the middle of all this controversy about is it getting approved what’s getting approved for what ages? What about kids? All these things? She’s in charge. So we’re gonna ask her. She’s awesome. She’s not done this before. So all you other podcasts out there. Ha. Okay. And then finally, Sanjay Gupta, America’s doctor. What a bedside manner. What a great guy. I love Sanjay Gupta. We have a lot to talk about. So, talk to you next Monday. Have a great rest of the week.


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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