Making Sense - Sam Harris - #270 — What Have We Learned from the Pandemic？

00:00:00.000 Welcome to the Making Sense Podcast, this is Sam Harris.

00:00:26.900 Okay, we are well into December here.

00:00:30.840 The end of the year is upon us.

00:00:33.600 I'm sure this has put you all in a reflective mood, as it has me.

00:00:38.560 Where did 2021 go?

00:00:41.340 That really felt like it was six months long, at best.

00:00:46.980 It is amazing.

00:00:49.440 It has also been ten years since Christopher Hitchens died.

00:00:55.600 That anniversary has arrived, the 15th of this month, which, depending on when I release

00:01:04.080 this, is either tomorrow or today.

00:01:07.520 Anyway, and that remains a loss.

00:01:13.300 The truth is, Hitch was really just hitting his stride when I came to know him.

00:01:18.520 I believe his book, God is Not Great, was his first bestseller.

00:01:24.200 He was famous in journalistic circles, but was really just connecting with a wider audience.

00:01:32.640 And then his memoir was the last book that he actually wrote.

00:01:37.380 His amazing short book, Mortality, was a collection of his Vanity Fair essays that came out after

00:01:46.620 he died.

00:01:47.940 Well worth reading.

00:01:49.020 Anyway, he is sorely missed in this post-institutional time, where journalism and media and the ivory

00:01:59.620 tower, or really the whole class of professional commentariat, has heaped shame upon itself with

00:02:09.480 both hands.

00:02:11.060 And that in part will yet again be the topic of today's podcast.

00:02:14.540 It is amazing to think of how good Hitch would have been, aiming his intelligence at the

00:02:22.740 twin horrors of Trumpism and Wokeism.

00:02:28.720 Man, the pyrotechnics we would have seen on both sides of the political spectrum would have

00:02:35.640 been amazing.

00:02:36.940 Hopefully in some universe that is happening.

00:02:39.400 Anyway, I will endeavor to do my best with the tools at hand.

00:02:46.040 However, as you know, one of the things that lures my attention away from matters journalistic

00:02:51.500 and political is what I'm doing over at Waking Up, where there has been a development that has

00:02:58.440 made me very happy of late.

00:03:00.120 On January 1st, 2022, a mere two weeks away, we will be releasing the collected talks of

00:03:09.780 Alan Watts.

00:03:11.880 Watts was an extraordinarily lucid thinker and writer, and one of the most gifted speakers

00:03:18.640 we've ever had.

00:03:20.580 I could be describing Hitch there as well.

00:03:22.900 But, as many of you know, Watts did as much as anyone, and probably more than anyone, to

00:03:31.140 bring Eastern wisdom to the West.

00:03:34.120 And the counterculture of the 1950s and the 1960s would be hard to imagine without him.

00:03:39.880 I never met Watts.

00:03:41.160 He died in 1973 at the age of 58.

00:03:45.900 I believe in his library on the slopes of Mount Tamalpais in Marin County.

00:03:50.020 But in my 20s, I had nearly a hundred cassette tapes of his recorded talks, all of which got

00:03:57.640 lost in transit when I moved back to California.

00:04:01.800 But now all of these hours of good company have been restored to me in the digital archive

00:04:07.700 that has been curated by Alan's son, Mark Watts.

00:04:11.640 And it makes me very happy to present these collected talks on Waking Up.

00:04:16.240 So look for that on January 1st.

00:04:18.840 That'll be a great way to start the new year.

00:04:22.280 And that is it, by way of housekeeping.

00:04:25.540 Today I'm speaking with Nicholas Christakis.

00:04:28.580 Nicholas has been on the podcast a few times before.

00:04:32.660 He probably needs no introduction.

00:04:35.440 He is a physician and sociologist, an expert on network theory, a professor at Yale, and a

00:04:44.300 wonderful guide to the COVID pandemic, about which he has written a book just out in paperback

00:04:50.960 titled, Apollo's Arrow, The Profound and Enduring Impact of Coronavirus on the Way We Live.

00:04:58.740 And in this episode, we discuss the lessons we have learned or struggled to learn or should

00:05:06.100 have learned from the pandemic at this point.

00:05:08.800 We discuss our failures to coordinate an effective response at almost every level, the politics

00:05:16.900 surrounding the rollout of the vaccines, vaccine efficacy, vaccine safety, how to think about

00:05:23.420 scientific controversies, the epidemiology of excess deaths, transmission among the vaccinated,

00:05:29.960 natural immunity, selection pressures, and new variants, the failure of institutions, the

00:05:37.800 lab leak hypothesis, the efficacy of lockdowns, vaccine mandates, boosters, what would happen

00:05:45.220 in a worse pandemic, and other topics.

00:05:48.220 Anyway, the purpose of the conversation is to try to say something reasonable to those

00:05:55.040 who are as yet unvaccinated.

00:05:57.380 As you'll hear, I am quite consciously providing a counter-message to much of what is heard out

00:06:04.100 here in Podcastistan and over there in Substackistan.

00:06:08.480 Again, I'm increasingly worried about the appetite I have detected outside the gates of the mainstream

00:06:19.340 media for contrarian takes on more or less everything.

00:06:25.040 A generic word of caution to everyone with an earshot of this broadcast.

00:06:30.660 The non-standard explanation is not always the correct one.

00:06:35.640 Even when our institutions have repeatedly disappointed us.

00:06:42.420 In fact, the non-standard explanation is still, I would say, generically, rarely the correct one.

00:06:49.680 So keep that in mind as you listen to my fellow podcasters discuss what they think is true

00:06:56.200 or likely to be true in this universe of ours.

00:07:00.240 And as this is yet another PSA on this topic, there will be no paywall.

00:07:05.640 But if you value the work we're doing here, you can support the podcast by going to samharris.org

00:07:11.060 and subscribing.

00:07:13.500 Okay, without further delay, I bring you Nicholas Christakis.

00:07:22.820 I am here with Nicholas Christakis.

00:07:25.160 Nicholas, thanks for joining me again.

00:07:26.420 Nicholas Christakis.

00:07:26.560 Nicholas, thanks for joining me again.

00:07:27.060 Nicholas Christakis.

00:07:27.500 Sam, thanks so much for having me back.

00:07:29.420 So you might be the record holder at this point on the podcast.

00:07:32.620 I've lost count.

00:07:33.860 And I think maybe Paul Bloom might be ahead of you, but it's you and Bloom for most frequent guests.

00:07:39.680 I think it's our third conversation that's being recorded, at least.

00:07:42.600 Right, right.

00:07:43.440 Well, you're in good company.

00:07:45.500 So there's a lot to talk about here.

00:07:49.200 First, your book, Apollo's Arrow,

00:07:51.800 The Profound and Enduring Impact of Coronavirus on the Way We Live,

00:07:56.220 just came out in paperback about six weeks ago or so.

00:07:59.880 We're going to cover some of the themes in that book because,

00:08:02.800 you know, among other things,

00:08:04.760 I want to talk to you about the state of our understanding

00:08:08.200 and the state of our public conversation around all things COVID,

00:08:12.360 vaccines, vaccine hesitancy, lockdowns, school closures,

00:08:17.360 everything that has happened, any missteps that we may think we have made

00:08:22.360 in the last 18 months, coming up on two years.

00:08:26.200 And I want to get some of the public service aspects of this conversation

00:08:31.360 sort of loaded to the front for us here.

00:08:35.240 But before we jump in, briefly remind people who you are.

00:08:38.740 How is it that you know anything about what we're about to talk about?

00:08:42.700 Okay, so yeah, first of all, it's getting really nice to talk to you again.

00:08:46.460 I'm a physician and a sociologist,

00:08:48.440 and I've spent 20 years studying social networks.

00:08:51.700 So I study spreading processes and networks,

00:08:54.180 you know, how ideas spread, how emotions spread,

00:08:56.980 and, of course, how germs spread,

00:08:59.020 which is a very profound metaphor for how other things spread.

00:09:04.420 But it's not just a metaphor, it's germs spread.

00:09:07.180 And so understanding how germs spread is very important.

00:09:10.060 And so I have some training in public health and epidemiology as well.

00:09:14.740 And actually, when the pandemic was coming on about a year and a half ago now,

00:09:20.420 in January of 2020,

00:09:22.300 I became very alarmed about what was coming down the pike

00:09:25.980 and decided to redirect a lot of my efforts to study it.

00:09:29.720 Yeah, yeah.

00:09:30.200 And you've been, you really have been on the short list of people

00:09:33.460 who have been worth listening to

00:09:35.880 below these many months that we have been in this pandemic experience.

00:09:39.820 And I must say, I remain fairly mystified

00:09:45.780 about the sociological problem we face here,

00:09:51.060 just in figuring out how to communicate about these issues

00:09:56.180 in a way that doesn't just obviously fail to solve

00:10:01.860 some basic problems of coordination and cooperation and persuasion.

00:10:07.760 I mean, we just, apart from the speed with which we developed vaccines,

00:10:13.720 we have failed on so many other fronts

00:10:16.360 that it's really, it is fairly bewildering and depressing.

00:10:21.840 I don't know if you share that outlook at this point.

00:10:24.600 It's almost a quintessentially American success on the technological front,

00:10:29.560 you know, that we did the vaccines.

00:10:30.960 And we'll talk about that, I'm sure.

00:10:32.500 But it's also depressingly American in some ways, our failures.

00:10:38.260 I mean, one of the things that I think it's interesting to step back for a moment

00:10:41.220 and understand is that we are a rich and plural society in the 21st century.

00:10:47.580 And we are a capitalist economy and we exchange goods and services of all kinds.

00:10:54.220 And in our society, you can find any expertise that is humanly available.

00:10:58.260 So when you need a cabinet made or your car repaired, or you need surgery,

00:11:02.540 or you need, you know, detectives or military activities,

00:11:08.680 or basically any kind of domain of musicians, artists, you name it.

00:11:13.420 We have people who've devoted their lives to those different sorts of activities.

00:11:17.960 And we pay for those, right?

00:11:20.920 When you have a plumbing problem, you don't know how to fix the problem

00:11:24.920 or you have an amateur understanding.

00:11:27.520 So you hire an expert plumber.

00:11:29.340 And there's a famous saying in sociology that

00:11:32.040 one man's occupation is composed of another man's emergencies.

00:11:35.740 So for you, the plumbing thing happens rarely and is a disaster.

00:11:41.220 You know, your placement is flooding.

00:11:43.040 But for the plumber, this is his or her, you know, usual course of business.

00:11:48.020 And then you gladly give money to that person in a classic, you know,

00:11:52.260 you know, Adam Smith kind of, you know, everyone has their own expertise

00:11:56.040 and we exchange our expertise and we're all better off as a result.

00:11:58.900 But here's my point.

00:12:00.120 In our society, and after hundreds of years since the Enlightenment

00:12:03.800 with, you know, advances in science, we have experts on every scientific topic,

00:12:09.800 including respiratory pandemics.

00:12:12.720 And what is happening to us is not novel.

00:12:17.640 There is an enormous wealth of knowledge about what is happening to us

00:12:21.820 and about how optimally to respond

00:12:23.500 and about the epidemiology of respiratory pathogens

00:12:26.480 and the biology of coronavirus and the development of vaccines

00:12:30.160 and an understanding of the human body, the physiology,

00:12:34.060 and the treatment of people with these conditions

00:12:36.060 and the organization of our hospitals and our public health systems.

00:12:39.400 And we have thousands of people who have devoted their lives

00:12:42.820 to acquiring this expertise.

00:12:44.040 And so it's a mystery to me that we don't happily deploy them

00:12:48.880 like we would with any other activity in our capitalist society.

00:12:52.780 And what's especially odd to me is that different societies have different strengths.

00:12:57.640 So, for example, the Chinese, you know, are an authoritarian country

00:13:01.580 with a collectivist culture.

00:13:03.960 And when coronavirus, the pandemic began,

00:13:07.680 they deployed those attributes and did things that would have been impossible

00:13:12.760 in our society and, frankly, things I wouldn't have wanted either.

00:13:16.040 I think which included welding people into their apartments at various points.

00:13:19.780 Yes. I don't know.

00:13:22.500 I mean, I've heard the same stories.

00:13:24.100 I don't know for sure they're true.

00:13:25.420 But functionally, yes, that's what they did.

00:13:28.100 They ordered 930 million people to stay at home for months.

00:13:33.760 And they enforced this.

00:13:35.800 And they tightly controlled the messaging and so on.

00:13:39.080 Now, we, thankfully, are not like that.

00:13:41.840 We have more freedom.

00:13:44.000 We have a free and open society.

00:13:45.920 We have free press.

00:13:48.580 But we didn't bring our best game.

00:13:50.620 You know, we didn't bring our strengths to the battle.

00:13:52.720 We have world-leading scientists, world-leading epidemiologists.

00:13:56.240 We have a media environment which would have allowed for the, you know,

00:14:00.360 rapid diffusion of information.

00:14:02.300 And we kind of bungled it from the beginning.

00:14:04.860 Now, a lot of that, in my view, is the fault of the previous administration.

00:14:09.160 But it's not just the fault of previous administration.

00:14:11.780 We, the citizenry, also have some responsibility for this fiasco.

00:14:16.360 So, and I think it's worth pausing for your listeners to understand,

00:14:20.120 just to frame what has happened to us.

00:14:21.880 Because I don't think people really get it yet, honestly.

00:14:24.820 It's over 750,000 Americans.

00:14:28.120 Nearly 1 million will probably die from this in the end.

00:14:31.740 When the dust settles, the excess deaths will be a million of our fellow citizens will have died.

00:14:36.440 And probably five times as many, and we should talk about this, won't die,

00:14:41.120 but will be disabled by the infection.

00:14:43.360 In other words, they'll, it's not long or short COVID.

00:14:46.020 They'll have survived the acute infection, but their bodies will be marked.

00:14:49.160 They'll have pulmonary fibrosis or renal insufficiency or neurologic or psychiatric problems or so on.

00:14:55.220 These individuals, our fellow citizens, will need our care.

00:14:58.420 So a million will have died.

00:15:00.100 Five million will probably be disabled.

00:15:01.780 We, Larry Summers, a former treasury secretary, and David Cutler, a health economist at Harvard,

00:15:07.600 have called this the $16 trillion virus.

00:15:10.500 They, they estimate that the, the loss to our society is $16 trillion,

00:15:16.000 $8 trillion due to economic damage and $8 trillion due to loss of life and,

00:15:20.960 and disability and, and illness, death, disability, and illness.

00:15:24.520 This is a catastrophe that far exceeds the, the Great Depression in its economic impact.

00:15:30.620 And, and, and then we have millions of children that have missed school, uh, who will have been

00:15:35.460 harmed by, uh, by the, the, this and, and, and, and millions of, of people who are entering the

00:15:40.560 job market during the pandemic and faced extra difficulties, millions of firms that, uh, went

00:15:45.660 bankrupt.

00:15:46.580 So I don't think people get it yet.

00:15:50.480 Like this is a once in a century event.

00:15:54.180 And part of the reason I think they don't get it is first of all, economically, we are borrowing

00:15:58.840 trillions of dollars from the future to soften the blow right now.

00:16:03.400 And because this virus, while it's bad, it's not, it's not smallpox.

00:16:07.800 It's not bubonic plague.

00:16:09.040 So even though a million Americans will die, probably only 10 million will have known those

00:16:14.680 people intimately.

00:16:16.180 And maybe a hundred million will have known of someone who died, which still means the

00:16:21.280 majority of Americans will get through this pandemic, neither having died, nor having a

00:16:25.640 loved one died, nor having known someone personally who died.

00:16:29.160 So that's why in part, I think we aren't, haven't taken this as seriously as we, as we

00:16:33.840 should.

00:16:34.080 Any other kind of calamity like this, I can't imagine we, you know, if we, if, if, if the,

00:16:39.380 if the Russians had invaded and killed a million Americans and decimated our economy this way,

00:16:44.060 yeah, I think people would be standing up and paying attention.

00:16:46.680 So.

00:16:47.840 Yeah.

00:16:48.200 Yeah.

00:16:48.560 Yeah.

00:16:48.840 Well, I mean, if you had told me that we would more or less be totally sanguine about

00:16:55.360 a million people dying from a disease, a disease that we had very quickly developed vaccines

00:17:01.700 for, and that in that context, nearly half the country would decline to get these vaccines

00:17:08.060 and more or less ignore the fact that nearly a million people had died.

00:17:13.900 And, uh, and even dispute whether anything like that number had actually died and then

00:17:20.360 fall into various conspiracy theories about the number of deaths being exaggerated.

00:17:25.320 I don't think I would have believed that we would have arrived here, but it seems to

00:17:29.160 me that's where we are.

00:17:31.520 And, you know, that there's no.

00:17:33.120 Well, we haven't, just to correct one statistic, I don't think we have 50% refusing vaccines.

00:17:37.480 I think it's closer to 20% or something like that.

00:17:40.500 Well, it's 23% of healthcare workers still refuse to get vaccinated.

00:17:46.440 Last I looked.

00:17:46.720 Is that true still like that?

00:17:48.340 I'm surprised by that, but I believe you.

00:17:49.840 I mean, I, there are a lot, it's approximately, the numbers are high in the general public,

00:17:53.760 higher than we would want, but they're, you know, we should look it up.

00:17:56.580 If that, if the precise number is important, we should look it up.

00:17:59.720 So 60% have been fully vaccinated.

00:18:01.760 40% have not.

00:18:03.120 In that 40% probably also includes children who, for whom the vaccine has not yet been fully

00:18:07.440 indicated.

00:18:07.840 But anyway, regardless of the precise percentages and, you know, a large fraction of our population

00:18:13.940 still has not been vaccinated, which is to someone like me, very surprising.

00:18:18.900 So there's an opinion that has solidified on the right politically, and it's, it appears

00:18:24.700 at other points on the political spectrum, but it's mostly on the right, I would say.

00:18:29.080 And it's also taken hold out in the alternative media wilderness among podcasters and Substack

00:18:36.220 newsletter writers that much of what has been communicated about COVID by the government

00:18:43.720 and by the mainstream media has amounted to really a hoax, right?

00:18:49.460 And then much of what we've done and demanded that others do in response to COVID has been

00:18:55.460 therefore unnecessary and even unethical.

00:18:59.420 And so everything from lockdowns to school closures, to mask mandates, to the vaccination

00:19:05.860 campaign itself, to downplaying the efficacy of ivermectin, right?

00:19:11.560 All of this has been done for sinister political motives and based on corporate greed, right?

00:19:21.500 So what we have now is something, I mean, the tens of millions of people, at least, believe

00:19:27.400 that our entire response to COVID, I mean, basically everything we've done for the last 18 months

00:19:34.780 or so has had the ulterior purpose of increasing social control, right?

00:19:41.840 And basically we've got people, this is the explicit claim, one here is from, from all these

00:19:48.160 quarters now that the whole purpose of this has been to soften us up for some kind of Orwellian

00:19:54.920 acquiescence to state power.

00:19:57.320 And then with respect to the vaccines in particular, it's also being driven by just the sheer profiteering

00:20:04.540 motive of pharmaceutical companies.

00:20:07.100 Now, I mean, there are many specific points.

00:20:10.180 Which is odd because, of course, the vaccines are free to the citizenry, but anyway, go on.

00:20:14.340 Right, right.

00:20:14.760 Oh, yeah.

00:20:15.060 So we should just unpick all of this.

00:20:17.620 But I mean, there are specific policies that one could debate, obviously.

00:20:22.660 I mean, I guess I'm, at the moment, I think I'm currently uncertain about why kids in schools

00:20:28.940 where all the kids have been vaccinated are still wearing masks.

00:20:32.180 I think you could wonder about the wisdom or necessity of that.

00:20:35.640 And, you know, I'd like to talk about that kind of stuff.

00:20:37.600 But it seems to me that this basic idea, which has, again, it's infected, these are not just

00:20:43.620 uneducated rubes who believe this.

00:20:47.520 And I'm not talking about, you know, the QAnon cult, although obviously this includes the QAnon cult.

00:20:52.260 But I'm talking about many people who are quite smart, several friends and colleagues who have prominent podcasts, right,

00:21:01.900 have fallen into this paranoid picture of what's going on.

00:21:07.180 And, you know, there are extreme endpoints of this paranoia.

00:21:10.340 There's the idea that Bill Gates is putting tracking devices into us with the vaccines, right?

00:21:14.940 I mean, so there's the crazy end of crazy.

00:21:17.940 But it seems to me that this basic picture, even without the craziest flourishes on it, is more or less insane.

00:21:28.400 I mean, the idea that we are dealing with something akin to the Chinese Communist Party here

00:21:32.800 and that all COVID-related policies have been implemented merely to abridge our freedom politically,

00:21:39.840 that does strike me as patently insane.

00:21:43.760 And so I'm just wondering, what do you think accounts for this kind of, I mean, it's, you know,

00:21:50.040 it's still a fringe view, but it's a fringe view that I think something like a quarter of the country has been taken in by.

00:21:56.780 What do you think accounts for its popularity?

00:21:59.520 Well, I think part of the answer has to do with the, what happens during times of plague and a typical human response.

00:22:07.760 I mean, one of the things, again, that's helpful is to look at how humans have responded to plagues for thousands of years.

00:22:14.800 And denial and lies have been a constant companion to plagues.

00:22:21.220 If you look at accounts going back a very long time, you find them.

00:22:26.020 One of my favorite stories, I forgot which ancient plague it was.

00:22:28.980 I want to say the plague of Justinian, which was about 1,500 years ago.

00:22:32.500 There was an account by an observer that said that, you know, the plague was decimating the city

00:22:36.880 and you could, there was fear in the streets, of course.

00:22:39.880 And that he observes that a rumor went out amongst housewives that if they threw clay pots

00:22:46.340 from the second stories of their houses onto the streets below, that this would ward off the plague.

00:22:51.680 And so this observer says, mocking the superstition, he says, it became more dangerous to walk down the street

00:22:58.680 for fear of being hit by pots than for being infected, you know, getting the plague.

00:23:04.580 And I mean, that's exactly what we have now with, you know, people with crazy ideas about bleach or,

00:23:09.380 or frankly, ivermectin for which, in my view, there's not anywhere near enough evidence to support its use.

00:23:14.580 Or hydroxychloroquine, which also was the previous ivermectin, let's not forget that.

00:23:18.720 So we did lots of randomized trials to show it was not useful.

00:23:22.540 So people don't want to believe that this, a calamity of this kind has happened,

00:23:28.480 that their ordinary lives have been disrupted.

00:23:30.720 Nobody wants to believe this.

00:23:32.240 It's a little bit like, it's like the Jews at the beginning, when Hitler was rising to power.

00:23:37.760 Many did not want, there were more and more and more anti-Semitism was rising,

00:23:42.040 and more acts of violence. These people, they lived in these communities, they had businesses,

00:23:46.940 they had families, they had connections, they had languages and religious connections,

00:23:50.280 they'd spend their whole lives there. They didn't want to believe it, right?

00:23:54.240 And so it is, it's difficult to accept that your, your life is changing.

00:24:00.280 And, and that this, this, this, there, and there has been a change, you know, in, in our environment.

00:24:05.540 This, this new deadly germ is introduced into our midst, it's circulating, it's doing its,

00:24:11.440 what it, what germs do, you know? And so, so part of me understands the American response

00:24:19.680 from the great sweep of history. But part of me is also like you, baffled and if not enraged by it,

00:24:27.040 because it is so immature, and it is so unscientific, and it is so unnecessary, we could

00:24:34.160 have had a much better response that would have saved lives, and I think have spared our economy

00:24:41.160 even more. So, so...

00:24:43.540 You mentioned at the top the role that you believe that the previous administration played here.

00:24:49.260 And I must say, even the politics of that seem fairly confounding to me, because there was this

00:24:56.500 moment where Trump seemed desperate to take credit for Operation Warp Speed, right? And to,

00:25:03.620 to have us all think of the vaccines as the, essentially the Trump vaccine.

00:25:08.080 I don't know why he didn't do that. I mean, I have a theory.

00:25:10.500 Why, why did he walk away from that? I mean, I, I think he didn't even acknowledge getting the

00:25:15.800 vaccine himself in the end. I mean, he certainly didn't turn it into a photo op and recommend that

00:25:19.940 others do it.

00:25:20.560 Well, I think he wasn't sure the vaccine would arrive in time to make a difference in the election. So,

00:25:24.960 I think from Trump's point of view, the emergence of the pandemic, he correctly deduced that it would

00:25:30.860 be a threat to his re-election. And I think his strategy, and this man, that Trump is not a very

00:25:36.640 honest individual. And I also don't think he took his duties to the American people sufficiently

00:25:41.300 seriously. I think he was more selfish and more interested in his own, I think, you know,

00:25:45.540 I think he's very narcissistic. So it was a threat. He took it as a personal threat and was

00:25:49.920 interested in what was good for him, not what was good for the country. And what was good for him,

00:25:53.800 he thought, was to pretend like it wasn't there. And the, and, and, and there's detailed account

00:25:59.560 of this that I actually give in the books. I won't necessarily rehearse it here, but, but his,

00:26:03.340 Trump was ignoring and saying, it'll go away. It will go away. It will go away. He said when there

00:26:09.420 were 50 cases in the USA, he said it will go away. When there were 500 cases, it will go away. When

00:26:13.980 there were 5,000 cases, it will go away. When there were 50,000 cases, it will go away. He kept

00:26:18.260 saying it will go away. There was no evidence that was going to go away. And we now know that he was

00:26:22.300 briefed, unsurprisingly, where the United States, for the love of God, we, we have elite, you know,

00:26:28.400 intelligence agencies and scientists working for the government, briefing the president.

00:26:33.780 He was briefed on what was going to happen and he chose to ignore it. And in fact, this is one of the

00:26:38.280 things that got me, not interested, I was interested in this topic, but one of the things that

00:26:41.420 motivated me to direct the attentions of my lab to this pandemic and also to up my public profile a

00:26:47.360 little bit and write the book and so on was that, so my interactions with COVID actually began in

00:26:53.860 January of 2020. So I had this longstanding collaboration with some Chinese scientists and

00:26:59.080 we were studying using phone data, looking at the mobility, the networks of people in China

00:27:05.360 ascertained because of their phone calls and studying things like, well, what happens when

00:27:11.100 you build a high-speed rail line? You know, how does that reshape, if at all, social interactions

00:27:16.040 or economic interactions? Or what happens when there's an earthquake, for example, in China?

00:27:20.380 And so I had, I had been, had this collaboration and we had data on people moving through Wuhan

00:27:27.180 in January of 2020 and my, and my collaborators. And I thought, well, we could use these data to

00:27:33.460 understand this nascent pandemic. And so as a result of this, I was working day and night beginning

00:27:40.600 middle of January to study what might be happening in China. And therefore I was aware on January the

00:27:46.240 24th of 2020 that the Chinese government had basically shut the country down. And, and I was also

00:27:51.740 aware of some of the papers that Chinese scientists were putting online describing the basic

00:27:57.120 properties of this pathogen in January. And by February, let's not forget, we had Italian

00:28:01.940 scientists doing the same thing when Lombardy collapses. And I did some basic calculations that

00:28:07.140 every competent epidemiologist could do, and we can discuss those if you want. And it was clear as

00:28:11.900 day. It was going to be a, a serious respiratory pandemic, like a once in a century event. And

00:28:16.860 you and I spoke, I think our second ever conversation, but our first about the pandemic,

00:28:22.380 I can't remember exactly in March maybe or something.

00:28:24.560 Yeah, probably early.

00:28:25.060 Yeah. Something like that. I can't remember exactly. And I, I think I said,

00:28:29.040 you know, from my desk, this looks bad. And what surprised me was that, that the pronouncements

00:28:35.280 from the White House were so anodyne and they, and they stayed anodyne. And I was getting really,

00:28:41.520 really concerned. And I thought to myself, how is it possible that I, Nicholas Christakis,

00:28:47.580 you know, Yale professor sitting at my desk appeared to know more about this situation than the

00:28:53.140 president of the United States. This is alarming. You know, like, and of course we now know that,

00:28:58.680 that that was not true. In fact, the president was briefed and chose to ignore it. And I think

00:29:03.840 this is a grave dereliction of duty because I think that the central function of the government

00:29:09.400 is to keep the citizenry safe. And, and the fact that there was a super spreading event in the White

00:29:14.460 House itself, which is a national security threat. Let's not forget, like if the whole apparatus had

00:29:20.240 been decimated, that would have been a grave problem, shows the kind of lackadaisical attitude

00:29:26.140 that they had, not only to the safety of the country, but to their own safety. So, you know,

00:29:32.160 I know that other governments also did poorly, and this is an argument that's often used. And,

00:29:37.120 and to be clear, this is not just a, there were, there were democratic governors who were also

00:29:41.460 incompetent. For example, Governor Cuomo in March was saying absurd things about the pandemic. And I was,

00:29:48.240 me and other epidemiologists were writing letters to try to stop the St. Patrick's Day parade and so

00:29:53.620 on, which would have been nuts. Mayor de Blasio was a Democrat and so on. But we're talking here

00:29:58.900 about the White House. We're talking here about the president of the United States. And so, yes,

00:30:03.040 maybe other countries did poorly as well. Maybe governors of various states, Republican and Democrat

00:30:08.920 did poorly. Okay. But that doesn't excuse the utter collapse, insane public policy in the White House,

00:30:16.860 in our sophisticated, I hope, rich nation. So yes, I think a lot of blame can be laid.

00:30:24.460 Now, just to be clear, and I think Trump perceived this, he must have been told, look,

00:30:29.420 hundreds of thousands of Americans are going to die. And that was clear. And you and I talked

00:30:33.460 about that from the beginning. And, and that, you know, nobody, that's not a, that's not a winning

00:30:38.700 electoral position to be in. And he probably thought, well, maybe I can just use smoke and mirrors

00:30:44.960 until the election. And so the vaccine, he probably at that time, remember the vaccines arrived much

00:30:50.040 faster than anyone, including me, expected. They arrived by November, we, of 2020, which is just

00:30:55.980 miraculous. We, we had clues that the vaccines would work and they, people started getting vaccinated

00:31:01.060 by December. So it was after the election and too late for him to frame the politics that way.

00:31:07.580 But I think if he had, I think he might've won the election, honestly.

00:31:11.420 Well, well, well, the politics were awful here because, you know, there was a, I think a valid

00:31:15.980 concern that given Trump's political selfishness, given that everything was being motivated based

00:31:24.760 on what was politically expedient for him. And one didn't really understand how much he could

00:31:31.100 bend the apparatus of the vaccine approval process to his will. There was this period where it seemed

00:31:37.960 like the vaccines were coming soon, perhaps in time for the election. And he was going to try to

00:31:43.260 rush them out in time for the election. And now we have, you know, video of all of these

00:31:48.500 prominent Democrats saying the, you know, that they would be reluctant to take the vaccine. And this

00:31:54.000 includes Joe Biden and Kamala Harris. And, you know, they, you get them on a microphone

00:31:59.320 in 2020 before the election. You have them saying, yeah, I wouldn't take, I'm not sure I would trust

00:32:06.820 a vaccine that came out that fast. Right. Whereas, you know, just-

00:32:10.200 Well, no, what my memory, and you might be right.

00:32:13.040 Yeah, no, I mean, this is not, this has all been spread on social media of late as a, you know,

00:32:17.180 basically a campaign ad for more Trumpism. And I remember thinking about, I mean, I think I may have

00:32:22.600 even talked about it on the podcast. It's just, if you thought that Trump could possibly

00:32:26.820 get vaccines out sooner to surface political ends, and thereby we would be cutting corners

00:32:34.000 with respect to safety above all, that was something that people were openly worrying

00:32:39.080 about at that point.

00:32:40.280 Yes.

00:32:40.740 And then when, you know, then when the vaccines came out after the election, the whole thing

00:32:45.920 flipped and you have Democrats by and large saying, oh, these have been totally well vetted.

00:32:51.940 And then you've got Trump not taking credit for the thing he was desperate to take credit

00:32:55.780 for a few months before.

00:32:57.280 Yeah, but I think that's a bit of a coincidence and a misreading of the sequence of events. So

00:33:01.300 nobody was saying we shouldn't rush to get vaccines into the arms of people. At least I

00:33:07.000 wasn't saying that. But I and others were saying, we don't want to cut corners. And I still agree

00:33:12.480 with that. Now, it turns out these vaccines have been miraculously effective and miraculously safe.

00:33:16.620 But there is a long history of bad things happening when you cut corners with drug approval.

00:33:21.780 And we have a conservative drug approval process in this country. Now, we can debate and there is a

00:33:28.460 rational argument to be had. How, where do you want to set, like how conservative do you want to

00:33:33.540 be when you approve drugs for public circulation? And there's a scientific debate about this and a

00:33:38.280 political debate. You know, you have libertarians will say, what business is it of the government

00:33:42.380 to decide what I can and can't put in my body? And you'll have others that say, no, that's not true,

00:33:47.020 especially with communicable diseases. But anyway.

00:33:49.060 Right. And there's also a way to go faster. I mean, we could have had challenge trials,

00:33:52.600 right? I mean, that's the ethics of that are interesting.

00:33:55.080 Correct. And I discussed that in the book. And people talked about that. And that would have

00:33:59.060 been, I think, a legitimate in the international security kind of strategy. Although it was not,

00:34:04.640 the pace was so fast that those were not deployed, although they could have been deployed. But

00:34:08.140 anyway, my point is, to my memory, and I won't speak for the politicians, the scientists that I know

00:34:13.520 were not saying we shouldn't rush to get a vaccine. They were saying we shouldn't implement a process

00:34:19.240 for speedy development of vaccine that is unsafe. Now, and if we can do it fast and remain safe,

00:34:27.180 then of course we should do that. Now, as it turned out, we did do that. And it happened that

00:34:32.160 the approval happened right after the election. I don't think there was a conspiracy there. It's just

00:34:36.620 that, you know, it actually, it was even sooner than we expected. You know, the trial results,

00:34:42.040 the trials were shut down early because the vaccine was so obviously effective in November,

00:34:46.340 whenever the precise timing was. So that's just the way it happened to come out. But Trump could

00:34:52.660 have, you know, the phase two trials were already out. We had a lot of clues that the vaccines would

00:34:58.300 be good, well, even before the election. And there was a scenario in which it could have been

00:35:04.440 handled that way. But maybe Trump decided that that wouldn't have been enough to mollify the

00:35:08.600 American people, like the promise of a vaccine at some point. And remember, at the time, we didn't

00:35:12.960 know that it would be quite so good and quite so fast, right? It's just now in retrospect, we know

00:35:17.500 that. And this is, you know, an astonishing accomplishment to have these types of vaccines,

00:35:22.460 this safe, this fast. So let's talk about this. Yeah. So, I mean, there's a few questions I just want

00:35:27.420 to dispatch up front here, certainly before a paywall comes crashing down so we can get the PSA

00:35:33.800 component out into the world. So what do we know about the vaccines at this point? Basic question,

00:35:42.080 how much does vaccination reduce a person's risk of hospitalization and death? And maybe we can break

00:35:50.860 this down by age cohort, or maybe we just, we can take the general case. I mean, obviously,

00:35:55.640 it's more important the older you are and less important the younger you are. But what do we know

00:36:00.280 about the efficacy of the vaccines? Let's leave safety aside. That's my next question.

00:36:05.980 Well, there's a huge, we know a huge amount. And I think it's important to distinguish the

00:36:09.520 Pfizer and Moderna so-called mRNA vaccines from some of the others. So the AstraZeneca and the J&J

00:36:15.660 vaccines are based on so-called adenovirus vectors. And we have Novavax, a protein-based vaccine,

00:36:22.060 which is also very good. We have a, and these don't even include the foreign, you know, the Chinese

00:36:27.780 and the Russian vaccines and other vaccines developed around the world. So we have many

00:36:32.060 vaccines right now. But the main ones we have in this country, the Pfizer and the Moderna vaccines

00:36:36.600 are so-called mRNA vaccines. They're based on 30 years of science. And what you have to understand

00:36:43.560 is, is that if the virus infects you, it's the whole virus with some proteins on the surface and

00:36:50.180 30 kilobases of RNA. And the RNA has quite a few genes in it. And one of those genes is for the

00:36:57.440 spike protein that the virus has on its surface. And then the virus inserts all of this RNA into

00:37:04.300 your cells of your body and takes over your cellular machinery. And then you start producing

00:37:09.280 all the constituent elements of another virus. That's how the virus reproduces, which are then

00:37:14.860 assembled in your body and your body tries to fight them off and so on. What the vaccine does

00:37:19.880 is, is it takes just a small part of that process. In other words, instead of being exposed to the

00:37:23.560 whole virus, you're just exposed to the RNA, what the RNA vaccines do, you're exposed to the RNA

00:37:28.820 of just the spike protein, which can't harm you. The spike protein itself alone can't harm you.

00:37:34.760 And so you fool the body into thinking it's been infected with a whole virus when you haven't been,

00:37:39.400 you've only been affected by a small part of it. And then you mount an immune response. Your body says,

00:37:44.520 warning, warning, there's an invader, and you develop antibodies and memory immunity against

00:37:50.840 the spike protein, which is a part of the virus, so that if you then are ever exposed to the real

00:37:55.620 virus, you eradicate the real virus because you're prepared. Now, these vaccines that we have, the mRNA

00:38:01.760 vaccines, are about 95% effective. What does that mean? It's kind of like an airbag in your car.

00:38:07.980 Having an airbag in your car doesn't mean that if you get into a head-on collision, you won't die.

00:38:12.720 But if you get into a head-on collision, the airbag greatly reduces your chances of death.

00:38:19.140 How much? Let's say 95% reduction in your chance of death. That's how you can think about the

00:38:24.120 vaccine. It's like an airbag. If you're exposed to the virus, if you're infected with a virus,

00:38:28.520 it will reduce your chance of serious illness by 95%. Not 100%. You still could die, even if you're

00:38:34.340 vaccinated. But it is a really strong line of defense. It's like a seatbelt or an airbag.

00:38:40.060 And we now know this not only from the original trials, which involved tens of thousands of

00:38:46.620 people. Some got the vaccine, some did not. And then we waited to see how many people in the placebo

00:38:53.780 arm got infected or seriously ill. And we waited to see how many people in the treatment arm who got

00:38:59.820 the vaccine got infected or got seriously ill. And we compared those numbers. And the vaccinated group

00:39:04.200 had a much smaller number by an amount that yields an efficacy of 95%. But now that hundreds of

00:39:10.660 millions of people have been vaccinated, we also have other kinds of quantitative data that confirms

00:39:15.680 those findings, that confirms that the vaccine efficacy is about 95% for the mRNA vaccines, which

00:39:21.260 is amazing. That is a higher efficacy than many, many other vaccines that have been developed that

00:39:26.940 people have been routinely taking for decades, for diphtheria, for tetanus, for mumps, for measles,

00:39:33.000 for all of these other scourges, for which we're blessed that modern science has given us these vaccines

00:39:38.600 and prevent hundreds of millions of deaths. I mean, two or 300 years ago, tens of millions of people died

00:39:45.440 every year from these contagious diseases. And they don't anymore, at least in the rich countries in the world,

00:39:50.480 because we have vaccines. So we have this amazingly effective vaccine in coronavirus.

00:39:56.680 Actually, a historical comparison is kind of interesting to the polio vaccine, because,

00:40:03.140 and I had forgotten this if I ever knew it, but I recently encountered this fact online that-

00:40:09.380 I think you spend a lot of time online.

00:40:10.880 Yes, I'm too online, yes. But I'm not alone there. I know that there are other people there.

00:40:16.140 But something like 95% of polio cases were quite mild, right? Like, we think of polio as just as this,

00:40:25.820 you know, spectacularly awful disease, which it is. But something like 95% of cases were virtually

00:40:32.880 asymptomatic. And the Salk vaccine was around 80 to 90% effective. You know, many people have

00:40:41.480 alleged that, you know, in the time of polio, when the Salk vaccine came out,

00:40:46.140 it would have been unimaginable to meet this kind of politicized vaccine resistance.

00:40:53.260 What explains that? Just the fact that when polio is bad, it's so graphically bad that-

00:40:59.400 I think that's part of it. I think that we have to remember, you're exactly right,

00:41:03.680 that polio looms large in all of our memories as being a complete scourge. And it was a nasty

00:41:08.340 piece of work, but it only killed a few thousand people every year, paralyzed some more, some greater

00:41:14.320 number. But it was nothing like the toll of death that coronavirus is taking, yet the entire nation

00:41:18.700 mobilized. And the people who invented the Sabin and Salk, who invented the two vaccines, were widely

00:41:24.220 hailed as heroes. They were on the cover of magazines. This was seen as a triumph of American science and

00:41:29.940 engineering and technology. And the public lined up to get vaccinated. They were afraid of polio,

00:41:36.060 of course, but they also saw it as a normal civic thing to do. And the entire nation was vaccinated,

00:41:43.260 I don't remember the precise amount of time, someone listening will probably know, but within

00:41:46.660 weeks or months or something. I mean, it was very rapid. There was also some glitches. It was a so-called

00:41:53.280 famous cutter incident, where there was a defective batch of vaccine that was released due to bad factory

00:41:59.400 procedures in one manufacturer that resulted in the vaccine not being sufficiently inactivated such that

00:42:06.540 it actually gave a few people polio. This cannot happen. It's just biologically impossible with the

00:42:11.500 mRNA vaccines, to be completely clear, because you're not being given the virus. But the way the polio

00:42:17.320 vaccine worked is there was inactivated virus. So what we did is we made the virus, weakened it,

00:42:23.580 so that you would mount an immune response. And that way, if you ever encountered the live version of

00:42:28.580 the virus, you would be prepared, but you didn't run any risk from the weakened version. Anyway,

00:42:33.780 and that, of course, that happened too, in fairness, during the polio. But the country tolerated that.

00:42:38.360 I mean, I think about 10 or a few kids died, and they also spread it to a few other people who got

00:42:44.420 sick. But it was in the low tens of people that had this adverse event from that. And the country

00:42:49.080 moved on, and all of us got vaccinated for polio. And we had to be. There are rules. You can't go to

00:42:54.020 school if you're not vaccinated for polio. As well, you shouldn't be able to

00:42:58.580 you need to be vaccinated. That's part of being a 21st century citizen of a country like ours.

00:43:03.740 Okay. So back to this first question about the efficacy of the vaccine. So in recent reading

00:43:10.540 about this, I encounter a range of numbers around this mitigation of risk of hospitalization and

00:43:19.080 death. And again, this is undoubtedly different as you asked the question about each age cohort. But

00:43:26.520 generally speaking, it's something like a tenfold reduction in risk of death for those who get

00:43:36.300 vaccinated versus those who don't get vaccinated. So is that your understanding in terms of what the

00:43:43.180 efficacy is of vaccination?

00:43:47.320 Yeah. And you had asked her a little bit earlier, and we didn't quite nail it in the follow-up

00:43:51.680 conversation we just had now about by age. And the studies that I've seen show that the vaccine

00:43:57.760 is equally effective at young ages and old ages. There have been a couple of papers that the CDC has

00:44:03.160 released looking at cohort studies or studies of cohorts of people that are 12 to 18 versus

00:44:10.720 greater than 65 and so on. And the way to think about it is that, go back to the airbag example.

00:44:16.160 So if you have a 65-year-old that's in an accident and they can either have an airbag or not have an

00:44:21.500 airbag, the airbag is going to reduce their risk of death. And if you can have a 20-year-old that's

00:44:27.380 in an accident and they can have an airbag or not have an airbag, the airbag will reduce their risk

00:44:32.460 of death. Now, it's also the case that a young, fit body of a 20-year-old may be less likely to die

00:44:38.860 if in a collision than in an elderly person. It's true. Young people are better bodies than old people.

00:44:44.760 But both bodies benefit from the airbag roughly equally. In other words, there's a reduction in

00:44:50.340 the risk of death by the airbag for both the young and the old if you're in a head-on collision. And

00:44:56.040 it's the same with the vaccines. It is the case that the intrinsic probability of death is lower

00:45:01.440 if you're young if you get COVID, but it is reduced by a proportionate amount if you get the vaccine.

00:45:06.900 One of the things that's a big misconception about this, and one of the figures that I use in

00:45:11.520 Apollo's arrow is the following. So illness and death are problems of the aged, right? Young people

00:45:18.140 face a low risk of death in the next year. You and I might have a risk of death in the coming year of,

00:45:22.980 uh, I don't know, one out of a hundred, one out of 200. And, uh, a 20-year-old might have a risk of

00:45:28.560 death in the following year of one in 5,000 or one in 10,000. So most 20-year-olds that are alive

00:45:34.540 today, the great majority will be alive a year from now.

00:45:37.160 But the thing about- I'm tempted to use a few 20-year-olds as human shields now.

00:45:41.100 Well, because-

00:45:41.940 Where are the 20-year-olds in my life?

00:45:44.380 Yes, yes. Or I mean, I could use a 20-year-old body. But the point is that, but the coronavirus

00:45:51.020 will increase your risk of death at any age by about 30%. So in other words, you're unlikely to

00:45:58.040 die if you're a young person and you get coronavirus. It's true. But your low probability will be upped by

00:46:03.980 about 30% should you get infected with coronavirus. And that is a nasty thing to happen. It's not

00:46:10.480 necessary for you to needlessly face this increased risk of death in the new year. It is absolutely low,

00:46:16.680 your risk of death, in absolute terms, but whether you get coronavirus or not. But if you get coronavirus,

00:46:22.960 it's relatively higher. So another way to think about this is that if you would be concerned about

00:46:27.460 having a heart attack, if you're 20 or 40 or 60 or 80, and being hospitalized with a heart attack,

00:46:33.380 if you're hospitalized with coronavirus, if you're 20 or 40 or 60 or 80, your risk of death is higher

00:46:38.680 than if you had had a heart attack. In other words, whatever age you are, being hospitalized for

00:46:43.700 coronavirus is significantly more deadly than being hospitalized for a heart attack. So yes, 20 and 40-year-olds

00:46:50.140 are not commonly afflicted with heart attacks. But if it crosses your mind, you would say,

00:46:53.160 gee, you know, God, it would be bad to have a heart attack. It's worse to get coronavirus.

00:46:58.400 So that I think is-

00:46:59.880 And to have an outcome bad enough to hospitalize you.

00:47:02.620 Yes, yes, yes. I'm not talking that's correct, but this is conditional on being hospitalized for

00:47:06.340 that. That's right. So let's be clear about what comparisons we're making here. But it's just a way

00:47:10.500 of benchmarking people's expectations of risk in a way that helps them sort of see it.

00:47:16.600 Yeah. And the stratification by age sets up some equivalents here. We would have to research the

00:47:24.020 details, but it's something like if you're a 75-year-old who gets vaccinated, that gives you

00:47:31.080 the equivalent risk of hospitalization or death of an unvaccinated 45-year-old or something. There's

00:47:39.440 some equivalents there, right?

00:47:41.120 Yeah, I haven't seen that calculated, but it could be calculated pretty trivially. That's correct.

00:47:45.180 Something like that. That's right.

00:47:47.100 So that's on the question of efficacy. Now let's talk about vaccine safety, because this

00:47:51.460 really is the sticking point. I mean, we're living in a world where millions and millions

00:47:57.660 of people, whatever they think about the danger of the coronavirus and whatever they think about

00:48:03.780 the risk of getting COVID not having been vaccinated, some people think that's trivial.

00:48:11.720 Some people think that is perhaps as dangerous as we think it is. But on the other side of the

00:48:18.280 balance, they think the vaccines themselves in particular, the mRNA vaccines are terrifying,

00:48:25.640 right? And therefore, the option to get vaccinated is more or less unthinkable. It's just whatever

00:48:33.040 story you paint about the risks of getting COVID unvaccinated, it's not scary enough to motivate

00:48:40.200 them to get vaccinated, given how they feel about these vaccines. And I must say, I personally know

00:48:46.840 people who have been spreading this fear to, no exaggeration, tens of millions, if not hundreds of

00:48:53.560 millions of people. And it has the predictable result of convincing millions of people that they

00:49:01.500 shouldn't get vaccinated. So what do we know about vaccine safety at this point?

00:49:07.800 Well, first of all, there's a lot going on there. There's some people who are saying vaccines are

00:49:13.560 dangerous, don't get vaccinated, are also preaching a little bit to a willing audience. In other words,

00:49:17.800 people want to think there's a desire that humans have to be the person that... So on the one hand,

00:49:24.180 we follow the crowd. We copy our neighbors. We don't wish to stick out. This is how fashion works.

00:49:31.220 This is how all of our norms work in our society. I mean, people copy their neighbors. And this is

00:49:38.060 something actually which I spent a lot of time studying. And it's actually a little bit odd in a

00:49:43.040 way that we are that way. When we're free to do anything we want, what do we do? We do what our

00:49:47.920 friends are doing. But there's also a strain of people that want to seem smart. They've outsmarted

00:49:53.920 the crowd. Everyone else wanted to do something. But I knew. I pulled my money from the stock market just

00:49:58.540 before it crashed. Look at me. Or everyone else was going left, and I decided to go right. And look,

00:50:05.240 I was right about that. So I think there is a strain of that which telling people... There'll

00:50:11.280 be people who want to have gone against the crowd and been proven right. And that's a kind of an

00:50:15.980 appealing fantasy for many people, no doubt. So some of the people that are pitching that are capturing

00:50:22.680 a little bit of that psychology. And then, of course, there are people, like we said earlier,

00:50:28.340 who want to deny the seriousness of what's happening. But I think that the claim that the

00:50:34.940 vaccine is... And there are some people, and I think these people need to be met head-on, who rightly

00:50:41.580 say, wait a minute, this vaccine was developed very fast. I'm a little worried about that. Or this

00:50:48.460 technology is very new. We haven't used the mRNA vaccines. We haven't used that before.

00:50:53.500 Although, if they say that, you could say, well, why don't you take the Chinese Sinovac vaccine,

00:50:56.980 which uses old technology. It inactivates the coronavirus, and then you're injected with

00:51:02.780 inactivated coronavirus, or live attenuated coronavirus, which is another technique. In other

00:51:07.940 words, you take the live version of the virus, and basically you mutate it until it still elicits an

00:51:12.720 antibody response from you, but it's not sufficiently severe so as to infect you.

00:51:17.860 This is actually analogous to what happened with the invention of vaccines, with the cowpox being

00:51:22.900 used by Jenner instead of smallpox, you know, 200 years ago or more. So if you don't want... If you're

00:51:28.480 really worried about the novel technology, okay, get the Chinese vaccine, which is based on older

00:51:32.920 technology. It's been around a long, long time. That's better than nothing to get the Chinese

00:51:36.300 vaccines. There are several, actually, Chinese vaccines. Anyway, the point is that people who say,

00:51:41.540 hey, I'm a little worried about the speed, or I'm a little worried about the novelty of technology,

00:51:44.480 I understand that on an intellectual level. And that's a topic you can then engage.

00:51:48.840 You can say to such people, well, let's talk about what happened, why this vaccine was developed so

00:51:54.440 swiftly. You know, the billions of dollars that were spent, the mobilization of the nation's doctors

00:52:00.420 and pharmaceutical companies, the tens of thousands of people that rapidly signed up to be in the trial so

00:52:06.840 that we were able to discern it. The good luck that the vaccine candidates actually happened to work

00:52:11.420 all the biology that informed our design of these vaccines. And can I reassure you thereby

00:52:17.720 that the speed is...

00:52:19.020 And also, at this late date, the fact that we have a cohort of literally hundreds of millions of people,

00:52:25.400 globally, billions of people who have received these vaccines.

00:52:29.480 Correct. So now you can even add that to the argument in answering such a person.

00:52:34.280 And then some subset of them, in turn, will say, well, you know, we don't have enough follow-up.

00:52:39.760 You know, what if in 10 years it proves that this vaccine... And then the honest answer to that is

00:52:43.160 we can't know for sure without the passage of time, but there's no reason to believe,

00:52:47.920 no rational reason that anyone can discern, you know, that that would be the case.

00:52:52.780 And so, conversely, we know for a fact that if you get coronavirus, you know, you face a 1% risk of death.

00:52:59.440 Now, it depends by age, but on average, getting infected with a coronavirus, you have a 1% chance

00:53:05.940 of dying, approximately. So, and then there are other people who say, well, it's not the speed,

00:53:11.400 it's the novelty of the technology. To those, you could say, well, we have other vaccines that use

00:53:15.100 older technology. Would you like those instead? And so on. So, I don't think...

00:53:19.440 Also, there's one footnote I'd like to add here, because there is a brilliant piece of

00:53:23.780 incoherence here, because these same people for whom the, you know, the emergency use

00:53:30.580 authorization was a, more or less a declaration of the unfitness for human consumption of these

00:53:38.080 vaccines, these are precisely the people who have no problem with monoclonal antibodies or

00:53:45.040 any of the treatments that one gets after getting COVID. And in, I think, in every case,

00:53:52.680 these treatments have been less validated and less safety tested than the vaccines themselves at this

00:53:58.700 point.

00:53:59.420 Well, I'm not sure I would be prepared to say that they're less validated and less safety tested,

00:54:02.660 but I am prepared to say that they are less safe.

00:54:05.080 Right.

00:54:05.820 Because, you know, most of these, with a few exceptions, so there's the dexamethasone,

00:54:13.280 which is a very safe steroid that early on we knew was the randomized controlled trials that

00:54:17.400 shows effective. A lot of these antiviral drugs, you know, have known toxicities. And now,

00:54:22.140 of course, they're still worth it because your alternative is to run the risk of death from

00:54:26.360 the virus, but they're not benign, these treatments, whereas the vaccines are, you know,

00:54:31.320 truly benign. And you asked me about, like, the safety profile. There was a paper that was published

00:54:37.940 in September of this year in a journal called Vaccines in issue nine. The first author's last name

00:54:46.120 is FAN, F-A-N. It's a meta-analysis of safety trials. And just that was using the safety of the

00:54:55.140 trials themselves. And for example, if you look at 100,000 people that were in the mRNA trials across

00:55:02.520 all the vaccines and trials, about 51,000 were in vaccine group and 51,000 were in the control group,

00:55:10.580 and there was no statistical difference in adverse events occurring in those two groups.

00:55:15.960 In other words, if you want to claim that vaccines are causing strokes or heart attacks or whatever

00:55:20.960 you want to claim, those rates were roughly the same in both the people who got the vaccine and the

00:55:26.160 people who didn't get it. And then if you look across body system by body system in this meta-analysis,

00:55:33.420 the rates of the adverse events are almost, without exception, exceedingly low, you know,

00:55:40.280 less than 0.1. In other words, less than one out of 1,000 people. And now we have follow-up studies

00:55:46.300 that show that, for example, a lot of people are talking about this risk of myocarditis and

00:55:50.980 pericarditis. These are inflammation of either the heart muscle itself, myocarditis, or the casing

00:55:57.500 of the heart muscle, pericarditis. Just to be clear, the viruses can also cause those conditions.

00:56:03.200 The question is, we see some of those in vaccines, but those are also exceedingly rare, let's say on

00:56:09.200 the order of one in a million people who get vaccinated, and also relatively self-limited.

00:56:13.800 Myocarditis and pericarditis are serious conditions, but to date, most of the people who got that as a

00:56:18.360 result of the vaccine have been fine. So the point is, is that the rate of death due to the vaccine

00:56:25.940 or serious events due to the vaccine is exceedingly low, less than a one in a million. And one of the

00:56:31.440 things that we need to understand is that when we're dealing with public health threats, we have

00:56:36.740 to engage in a kind of cold utilitarian calculus, just like when we send men and women to the battlefield,

00:56:43.060 to the battlefront, we decide that the sacrifice of those lives is for the greater good, that it saves

00:56:50.020 more lives than are lost. And the same thing happens here. If you, if you, the way I would think about it

00:56:55.860 is this way. Unless you're a, given the new mutations, the Delta variant, and perhaps the Omicron variant

00:57:02.640 as well, unless you're a hermit that lives on a mountaintop, or unless you're exceedingly lucky, everybody on the

00:57:09.720 planet will either be infected by the virus or will be vaccinated. Those are your choices. If you're

00:57:17.500 infected with a virus, you face a one out of a hundred risk of death from the virus. If you're given

00:57:22.500 the vaccine, you face a one in a million or less chance of death from the vaccine. And this is a

00:57:27.860 no-brainer as far as I'm concerned about which of those two choices to make. And the vaccines, we're

00:57:34.260 lucky, are exceedingly safe and far safer than any, you know, the usual standard that's used for

00:57:40.640 vaccines is that are serious adverse events or death are less than one in a hundred thousand or

00:57:45.860 one in two hundred thousand. In other words, there are vaccines out there which we administer, which

00:57:50.640 we say, okay, one in two hundred thousand people we give this vaccine to will die because we give them

00:57:55.360 the vaccine, but we'll save thousands of lives. And so that's what we're going to do. This,

00:58:00.720 these mRNA vaccines are even safer than that, which is a prior standard we had.

00:58:06.040 Okay. I mean, this is, this point is so important that I think I want to just cycle on it again

00:58:11.480 just so that there can be no question about it. I mean, so with respect to the inevitability of some

00:58:20.060 adverse events and even fatalities for any intervention, I mean, this is how I made this

00:58:26.120 point previously. If peanut butter were the perfect prevention of COVID and we gave peanut butter

00:58:34.940 to hundreds of millions of people, we would have some number of people dying outright from peanut

00:58:40.280 butter, right? We know this, right? Just given the nature of allergies to peanut butter, we would kill

00:58:46.720 many more people with peanut butter than we've killed with these vaccines.

00:58:50.200 Correct. Actually, that's about right.

00:58:51.880 And yet it would be a miracle if we could solve the COVID problem

00:58:55.920 with peanut butter to the tune of 95% with peanut butter.

00:59:00.160 Yes.

00:59:00.640 And we'd count ourselves very lucky in that case. So, and none of this would minimize the tragedy of

00:59:06.760 being the, you know, the parents whose kids were killed by peanut butter, right?

00:59:11.700 Yes.

00:59:12.480 You know, so that's the world we're living in. We're talking about an intervention that rolls out

00:59:17.060 to hundreds of millions and globally billions of people. And then you do these statistics on

00:59:24.740 those population level outcomes. I mean, this is such a simple case to make. I mean, we have this

00:59:31.820 head-to-head comparison. You can, everyone's going to be eventually going to be exposed to COVID.

00:59:38.200 Personally, you have a choice about whether you should be exposed having been vaccinated or not

00:59:42.840 vaccinated. And we know that you're running a 10x or more greater risk of death or serious

00:59:51.500 complication if you're unvaccinated. And yet many people are making this choice and everything,

00:59:59.120 everything they're worried about with respect to vaccines, you know, the, you know, myocarditis

01:00:04.200 or any other very low probability side effect is much worse with COVID when you're unvaccinated,

01:00:13.580 right?

01:00:14.020 Yes.

01:00:14.360 So, I mean, I guess.

01:00:16.640 Yes. And in addition, in addition, not getting, you can also make the argument quite apart from

01:00:21.200 the fact that it's in your self-interest to get vaccinated. It's also civic duty, you know.

01:00:25.820 Well, I want to get to that. Let's, let's table that because that's a, that's a further question I

01:00:29.080 have. I just want the, the choice point here that there's a two branch tree of where our utility

01:00:35.680 function should be pretty damn easy to calculate, right? Down one branch, you've got, you know, a,

01:00:41.640 a 1% probability of death or, you know, worse if you're older and, and less if you're younger.

01:00:47.020 But if you're 50 and above, this is really a no-brainer. You know, it's probably a no-brainer

01:00:53.080 if you're 20 and above. I guess, I mean, I guess we should talk about kids in particular.

01:00:57.780 And so it is true. So here's some, you know, I think it's true to say that when you're talking

01:01:04.880 about mortality, the flu poses a greater risk of hospitalization and death to a three-year-old

01:01:14.020 than COVID does. Does that do, I don't know if that's, if we still believe that.

01:01:18.860 I don't know if that's, I don't know if that's true. I would have to double check that to report

01:01:22.240 that. I know that flu, flu is bad, but flu is also non-trivial for three-year-olds, right?

01:01:27.600 I mean, it's...

01:01:28.600 Yes, that's correct. So, I'm sorry, which way did you say it was that flu was intrinsically

01:01:32.840 deadlier to three-year-olds than coronavirus? Is that what you just said?

01:01:35.140 That was my belief, but that's circa some months ago. I don't know if it's...

01:01:38.500 Yeah, I mean, flu has a so-called U-shaped mortality function.

01:01:42.220 Right.

01:01:42.340 So it kills the very old and the very young and spares middle-aged.

01:01:45.880 Whereas coronavirus is a so-called backward L-shaped mortality function. So it kills the elderly,

01:01:50.680 but spares the middle-aged and the young. Now, I don't know the scale of the Y-axis on those

01:01:55.600 curves offhand. I'd have to double check. But yes, flu is worrisome to young kids. Absolutely,

01:02:01.660 that is the case.

01:02:02.300 So we have people who are saying to themselves, you know, I have not taken these crazy precautions,

01:02:09.460 you know, masking and testing, vaccination and boosting and watching the news in fear,

01:02:17.420 et cetera, for flu for my kids, right? And now we're looking at the complete derangement of our

01:02:22.960 education system and society in order to protect kids from COVID.

01:02:28.040 Yeah, here I see this argument a bit more, honestly.

01:02:31.280 Yeah.

01:02:31.820 So just very narrowly and quickly on the issue of vaccination, I would still,

01:02:35.420 despite anything we might discuss, I still believe it's appropriate and smart to vaccinate

01:02:40.200 your children. Certainly those for whom the results show already older than five,

01:02:44.260 there's a benefit. And my brother, who's a well-known pediatrician, you know,

01:02:49.260 has publicly argued for this position. And I have a 10-year-old at home or 11-year-old and we

01:02:54.960 vaccinated him. They're very relieved and happy to vaccinate him. There are lots of reasons to

01:02:58.940 vaccinate your kid, including the fact that it reduces their probability of spreading the virus

01:03:02.080 to others, including you. By the way, your death as a parent would be really a bad thing for your

01:03:07.400 child. So if your child, if vaccinating your child reduces your own risk of dying, it's good for

01:03:12.460 the child that that happened. So there are lots of reasons. And also, the more we vaccinate children,

01:03:17.920 the less we run the risk of outbreaks at schools that might require us to close schools, which is

01:03:22.260 harmful. So the bottom line for me is that I still believe the benefits of vaccination outweigh any

01:03:27.400 putative risks down to the age of five, for which we have good data so far. The masking is harder for

01:03:33.900 me. And I also think here, when we talk about schools and masking, it's very important to draw

01:03:40.740 distinctions between elementary school and middle school and high school. As the kids get older and

01:03:45.700 more adult-like, and they face more adult-like risks, and it's easier for them to wear masks,

01:03:50.500 and then less harm comes to them from wearing masks, I think we can expect high school kids

01:03:54.480 to wear masks. But when we're talking about four and five and six-year-olds, especially the way the

01:03:59.440 masking is implemented in our country, which is, it's very hard to get these kids to obediently

01:04:03.620 wear masks. They're rarely on their faces. These kids need to see the faces of their teachers and

01:04:10.760 of each other to read their emotions, to learn language, to learn to read, and so on. The benefits

01:04:17.660 of the mask, while there, may not outweigh the educational costs. And for me here, I have no

01:04:23.620 political agenda. I would just like to see some really good cost-effectiveness analyses that, on the

01:04:28.980 benefit side, say, okay, if we have kids wear masks, we reduce a certain number of infections,

01:04:34.160 we reduce the likelihood the kid will have to stay home because they're sick, and that missing school

01:04:38.920 is not good for the kid. We reduce the transmission in the community when we mask our children and save

01:04:45.000 some adult lives, and those are all the benefits. And on the downside, we have some educational loss,

01:04:50.320 we have some financial costs, we have some inconvenience, we have all of these things.

01:04:54.840 Let's just do the calculations and then decide. Like we said earlier, public health is a cold

01:05:00.280 utilitarian calculus. And for me, I'm happy to be led wherever such an analysis would lead. And at

01:05:05.900 the end of it, we might conclude, no, it's inconvenient to wear masks, but it's worth it.

01:05:09.780 Or we might conclude it's beneficial to wear masks, but it's not worth it. And either outcome would be

01:05:14.760 fine with me. It's just a scientific question, as far as I'm concerned.

01:05:18.300 Yeah. I think once you're talking about a school population, you know, for kids above five, where

01:05:24.340 everyone has been vaccinated, then the logic of wearing masks, for me, truly evaporates. Then it

01:05:31.820 just seems like a silly imposition.

01:05:34.360 Yeah, but, well, I mean, I think we could either, like you, I mean, I think that's quite possible that

01:05:40.840 you're exactly right about that. But I guess all I'm saying is, is that I would like us to just do

01:05:45.500 these in a very sober-minded way, to do these calculations and see what happens. And see,

01:05:50.000 here's the thing. The other thing I wanted to communicate at some point is, earlier when we

01:05:53.420 were talking about paranoia and people who hold crazy beliefs, and it makes little sense to us,

01:05:58.800 I think another approach to such individuals is to ask them, what kind of evidence could I bring

01:06:03.600 to the table that would make you change your mind? And invite them to say, okay, if you did this study,

01:06:09.300 or you showed me this thing, then I would change my mind. Then at least we're dealing in the realm

01:06:14.080 of science. But if, you know, the classic kind of Paparian falsifiability issue, in other words,

01:06:20.100 if you cannot think of an experiment that would disprove your hypothesis, then that's theology,

01:06:25.140 it's not science.

01:06:25.820 Well, part of it is, I can tell you on the vaccine arm, they're saying that we can't possibly know

01:06:31.680 what the long-term consequences of these novel vaccines are. And I would just say that you need

01:06:37.700 another branch in this decision tree, and the other branch is you can't possibly know what the

01:06:41.920 long-term consequences are of catching COVID unvaccinated. And there's every reason to believe

01:06:47.400 they're worse in this case.

01:06:49.420 That's correct. But many people won't even give you that response. They'll say, well, I don't think

01:06:55.400 we should mask for this or that reason, or I don't think we should engage in lockdowns for this or that

01:07:00.360 reason, or vaccinate for this or that reason. And I think the point I'm trying to make, just a very

01:07:04.340 narrow point, is that if the person says to you, there's nothing you could tell me that would

01:07:08.880 change my mind, then you are dealing with someone who has an ideological or religious conviction.

01:07:13.520 We're not dealing with the realm of science. So I would ask everyone who has strongly held

01:07:17.900 beliefs about what is or is not the right thing to do in this case, for example, masking children,

01:07:22.740 to say, well, what evidence would make you change your mind? And if you're a person who thinks the

01:07:26.660 kids should be masked, what evidence could I bring to the table that would persuade you,

01:07:30.400 no, actually they shouldn't? And conversely, if you're the person who thinks that kids should not

01:07:34.800 be masked, well, what evidence could I bring to the table that would persuade you otherwise?

01:07:37.640 Then we're in the realm of science. Then we just do the science. We just conduct the experiments or do

01:07:42.540 the studies, and then maybe we can, then you're at least thinking rationally from my point of view.

01:07:46.840 Now, I also need to say something else, which is often misunderstood. It is normal for scientists

01:07:51.840 to disagree. It is normal for scientists to revise their opinions, especially as new data and studies

01:07:57.920 come in. It is normal for studies to be confusing and conflicting. And this is why, you know,

01:08:05.560 if you want to hold a belief and then you're going to cherry pick the data to go and find,

01:08:11.860 well, which one study, for example, of masking showed that masking didn't work, you'll find a

01:08:16.240 study or more where masking did not work. And conversely, if you are pro-masking, you know,

01:08:22.080 you could reject the studies that show that masking didn't work. But what you really want to do is to

01:08:27.020 look at the totality of the evidence and judge and weigh the evidence as a scientist who's trying to

01:08:32.620 discern, does masking help or not? What is the scientific evidence in support of this claim?

01:08:38.260 Just like when you're trying to figure out, you know, does the earth rotate around the sun

01:08:42.220 or not? Which is it? Is it the heliocentric or geocentric theory of our solar system? Well,

01:08:47.900 what is the evidence on either side of this debate as, you know, Galileo's discourse,

01:08:52.880 you know, famously engaged? And so I think that's the way I would approach this. And I would not be

01:09:00.000 afraid of the fact that some scientists disagree. And also, just one more thing, just to hammer this

01:09:04.200 home, people have said, well, the scientists used to tell us this, now they're telling us that. Well,

01:09:08.120 that's not a bug, that's a feature. That's how science progresses. As we get more knowledge,

01:09:14.780 we change our mind. As the famous British, I forgot who it was, you may know who said this,

01:09:19.000 you know, when the facts change, I change my mind. What do you do, sir? You know, like,

01:09:23.700 why do I stick to my guns? You know, I ignore the facts, the new facts. No. So I think we,

01:09:29.140 as a society, one of the things that has happened, and the virus has relentlessly exploited this,

01:09:36.640 it struck us at a particular moment of vulnerability in our civic discourse. We had

01:09:42.320 century high levels of economic inequality and therefore sort of suspicion and polarization on

01:09:48.220 that grounds. We have decades high level of political polarization, and we have lost the capacity

01:09:54.740 for nuance in our civic discourse. People think you're with me or you're against me, you're right

01:09:59.980 or you're wrong. Not like that there's shades of gray. We have this kind of anti-elitism where people

01:10:06.060 are very suspicious of larger forces that are governing their lives, because I think we are at a

01:10:11.320 particular historical juncture, looking across the sweep of centuries, where there is a lot of

01:10:16.060 confusion about what forms of governance are optimal and so on, and can we believe our leaders are

01:10:22.220 not, and are they trustworthy, and so on, all of which preceded the pandemic. And this anti-elitism

01:10:26.820 has bled into a kind of anti-science as well, where scientists are seen as just another elite that's

01:10:32.440 telling me how to live my life and what do they know anyway, which is, again, kind of stupid if

01:10:36.740 you think about it, because, you know, surgeons and expert car mechanics are also elite and have

01:10:41.700 expertise in that regard, and yet we don't seem to be suspicious of them necessarily as trying to

01:10:46.720 exploit us. So all of these things predated the virus, and the virus, you see, has relentlessly

01:10:51.720 exploited this. And we have a kind of a thinned-out intellectual life as a nation right now, where we

01:10:57.740 are not engaging in public policy debates in the most rational and self-protective way, and we're

01:11:05.660 dying as a result of it. I think many hundreds of thousands of Americans will have died needlessly

01:11:11.100 because we politicized it, because we were unable to just approach this in a quintessentially American

01:11:18.200 technocratic way, just like we approached the vaccine. Wasn't it amazing we invented these

01:11:22.140 vaccines? Yeah. Why couldn't we have done that with other aspects? On this point, I would add a few more

01:11:26.980 nefarious pieces that have been in play. I mean, one is the fragmentation of our information

01:11:33.080 ecosystem, social media being the prime offender here, but also just alternative media, you know,

01:11:39.080 podcasts like this one, and newsletters, and the failing business model of mainstream journalism

01:11:46.500 leading to a kind of Wild West effect around just providing information. And this interacts

01:11:54.520 unhelpfully with political polarization and, you know, siloing, and people can curate their own

01:12:00.040 echo chamber such that they really never have to deal with information that they don't like,

01:12:06.220 or they deal with the sort of the straw man version of it. But there's also just this fact,

01:12:10.660 which has been true forever, but its nefarious effects are amplified here, is that you can always find

01:12:17.200 a PhD or an MD or half a dozen PhDs or MDs to take any crazy position on any topic within or

01:12:29.560 outside of their wheelhouse, you know, for psychodynamic reasons that are as yet not fully

01:12:37.060 understood. I mean, you can find PhDs who are willing to testify that, you know, cigarette smoking

01:12:43.720 is non-harmful and non-addictive and climate change is not a thing. And in this case, we have, there have

01:12:50.860 been several MDs in particular, some of whom have just five minutes of digging, exposed their

01:12:58.500 long-standing anti-vax roots, but in other cases, it's a little more mysterious, who have jumped on,

01:13:06.020 you know, the most popular podcasts in existence and in other forums, said just absolutely crazy things

01:13:13.580 about the vaccines and about, you know, ivermectin and about, you know, just muddy the waters

01:13:19.180 powerfully for millions of people here. And, you know, without dealing with the specifics of any of that,

01:13:26.120 it's just, it will always be the case that if you want to, you can find someone who apparently has the

01:13:32.860 right credentials to have a strong opinion, give you a very crazy opinion about more or less anything. I mean,

01:13:40.640 there's always that contrarian to be found and to be amplified. I'm not sure what we do with that.

01:13:47.020 It's a very high leverage environment now where you can, you can get, you know, the weaponization

01:13:51.080 of that. Yeah. I mean, I think, again, this is a, this is a bug, not a feature of, I'm sorry,

01:13:56.160 this is a feature, not a bug of science. We actually want scientists to be skeptical. We want

01:14:00.580 there to be people who are saying, wait a minute, I don't believe you. There's, of course, a very famous

01:14:05.040 story about ulcers. You know, when I was in medical school, we were taught that ulcers were due to

01:14:10.280 stress. I was taught this. I went to Harvard Medical School in the 1980s and people were aware

01:14:15.060 of alternative theories, but we were still kind of taught that this was a possibility. And of course,

01:14:19.180 you know, there was this crank guy in Australia that said, wait a minute, I think it's caused by

01:14:24.120 bacterium, Helicobacter pylori. And he was right and he won the Nobel Prize and so on. And scientists

01:14:29.280 tell these types of stories to each other all the time. And it's a way of checking our ego and checking

01:14:34.940 our beliefs. This is what we want scientists to do. We want them to be skeptical. We want them to

01:14:39.620 consider alternatives. We want them to consider crazy, far-fetched ideas that were previously

01:14:43.760 rejected by everyone and so on. Nevertheless, nevertheless, I don't think that when we are

01:14:49.660 going to address a question, let's say, as a consumer of information, we should go about seeking

01:14:55.080 the person who has the opinion we want. We should instead try to say, okay, what is the opinion of

01:15:01.060 scientists on this topic in general? You know, in other words, I don't think you should sort of say,

01:15:05.260 well, I don't want to believe about climate change or I don't want to think humans do it.

01:15:08.680 Can I find a scientist that holds that belief? Oh, here is one. Therefore, I'm right. That's not a

01:15:13.540 search for truth. That's a search for confirmation.

01:15:16.580 Right. But this is a very interesting point of scientific epistemology because, yes,

01:15:20.620 in science, the status of scientific authority must remain forever precarious because we want,

01:15:29.940 we just know that significant progress in science entails again and again, the usurpation of

01:15:37.300 scientific authority and scientific consensus, right? Everyone was wrong yesterday about topic

01:15:44.420 X and, you know, the new Einstein has shown us why. So there's that process that is, as you say,

01:15:51.480 it's a feature, not a bug. And yet scientific consensus on any given topic, if you're just going

01:15:57.760 to reason probabilistically, right? You know, is climate change a thing? Or does the earth rotate

01:16:03.920 around the sun or not? You know, you are virtually always wise to be guided by, unless we're in some

01:16:12.300 zone of truly perverse incentives and confirmation bias, you're always wise to be guided by scientific

01:16:21.000 consensus as a consumer of information, especially when lives are hanging in the balance. And I mean,

01:16:26.840 we're going to talk about some of the ways in which we have just obviously failed, you know,

01:16:32.360 and our main institutions have obviously failed to provide an accurate picture of good information

01:16:38.160 during this pandemic. But still, there is this apparent paradox to reconcile because we don't rely

01:16:45.340 on authority in science. I mean, you really only have as much authority as your last sentence in

01:16:53.000 science, right? You can be a Nobel laureate who's completely unhorsed by a freshman, you know, who asks

01:16:59.160 you a pointed question at the end of a lecture, and that's the way scientific debate proceeds.

01:17:04.640 Well, that's because, yes, because, I mean, what we should be committed to is not scientists, but the

01:17:08.360 scientific process. So if you're trying to understand, you know, do vaccines help control

01:17:16.020 epidemics? Well, let's engage in a process to see what the answer to that question is. And that's

01:17:21.220 what we should be doing, not trying to pick which scientists, you know, we want to hear on whatever

01:17:26.640 particular topic. And that means looking at the totality of the evidence, and that means forming our

01:17:31.880 own opinions. Now, the other thing that's important here is that if you're outside your expertise,

01:17:36.660 it's probably not wise to do this yourself. So, for example, if I'm, you know, if it's a question

01:17:42.720 well outside my scientific expertise, a topic in geophysics or quantum, you know, mechanics or

01:17:48.800 something like that, I'm not the right person to decide what is or is not the truth. Same, by the way,

01:17:53.900 with more humdrum topics. You know, if I have differing opinion, my car is broken, and I take it to three

01:17:59.280 different mechanics, and each expert gives me a different opinion, well, then do I conclude that the car

01:18:04.460 mechanics are all idiots, then none of them know what's going on? Or more likely, I find a friend

01:18:08.820 of mine who I trust, who is a more expert car mechanic, and I have him take my car to these

01:18:14.880 three guys and then decide who to do. So, we have to, at some point, you know, repose our confidence

01:18:20.400 in someone else. And so, here's where I think something like, if you're the man on the street,

01:18:25.000 and you don't know, you believe that there's some conflicting ideas about something,

01:18:29.140 you could or should have some confidence in some authorities. Who would those be? The CDC,

01:18:35.740 Tony Fauci, I don't know. But, you know, you must, you should be humble and recognize that you are

01:18:40.680 actually not a fit judge of the scientific consensus on this topic. You might be a fit judge

01:18:46.460 of other topics that you have expertise in, but not in this regard.

01:18:49.840 Yeah, except in this case, I mean, in this case, the CDC, the FDA, the WHO,

01:18:55.040 the WHO, certainly Tony Fauci. They've slipped up from time to time, yes.

01:18:57.960 They have slipped up in truly impressive and galling ways.

01:19:02.760 They have slipped up because they're human also, and because science is not infallible. That's true.

01:19:08.680 But that doesn't mean that if someone slips up, you then move to astrology, you know? You say,

01:19:12.920 well, what do the scientists know? What do the astronomers know? Let's just go with the

01:19:16.540 astrologers. That's not a rational response. There was a very famous experiment about background

01:19:22.180 radiation and the Big Bang theory called the BICEP2 experiment that was published, I don't know,

01:19:27.520 five or 10 years ago, one of the most elite journals of science. I think it was in the

01:19:31.020 journal of science, actually. And it turns out that the scientists screwed up. They had thought

01:19:36.740 they had detected this, and they had to withdraw their results. They made a mistake. Yes, they made

01:19:40.700 a mistake. But that doesn't mean that because these elite astronomers screwed up in that occasion,

01:19:46.720 that now the alternative is just to go with the astrologers. No, right?

01:19:50.780 Or just the backyard astronomers, right? It's like, even if a backyard astronomer

01:19:57.260 occasionally does point out a flaw in a professional astronomer's paper, there's two

01:20:03.220 things there. That is science actually working. The cure for bad science is more science and better

01:20:08.800 science. But it also doesn't, it shouldn't completely reset our bias for professional astronomers

01:20:17.020 over backyard astronomers. Yes, that's exactly right. And we can listen to the, we should also

01:20:22.340 not close off the backyard astronomers from the discourse. No one is proposing that they be silenced

01:20:26.940 or unable to speak. But, you know, we're also not proposing that they somehow be seen as having

01:20:30.900 special virtue or special wisdom. You know, there was this famous case recently a couple years ago

01:20:35.600 about this housewife that there's this geometric problem called tessellations, whether you can

01:20:40.260 create overlap with a set of geometric shapes. Can you tile a floor with them? Can you arrange

01:20:48.020 them in a fashion where there are no gaps between them? And there's like this repeated pattern,

01:20:52.120 like complex tiling, like hexagons on your bathroom floor. You can tessellate a hexagon,

01:20:57.080 but there are other non-hexagon shapes you can tessellate as well. And there's a lot of

01:21:00.260 interesting mathematics about this. I think Roger Penrose was in this area. Yes. Yes. And it was

01:21:05.620 theorized, I don't remember the precise details, but it was theorized that there were like only four

01:21:09.260 ways to tessellate a floor with a quadrilateral or something. And some housewife who had some

01:21:14.940 mathematical training, but had never been a professional mathematician was saying, well,

01:21:17.720 wait a minute, you know, I think I should be able to figure this out. And she started noodling around

01:21:22.060 and developed her own notation. And she found unexpectedly two other ways that no one had known before,

01:21:28.780 disproving the claim that there were only four or whatever it is. I'm garbling the story a little

01:21:33.060 bit. But the point is she was right. And here's the proof. We know she's right because we can

01:21:37.920 evaluate her claims using the scientific method. We can test and see, is she right or is she not?

01:21:43.740 And so here's the thing. When some backyard astronomer says ivermectin works, we're like,

01:21:48.520 okay, let's evaluate this claim. Let's do a randomized controlled trial of ivermectin and see if it

01:21:53.300 works. Oh my goodness. We've done the trial. It doesn't work. It doesn't work.

01:21:57.300 So, you know, this is, and in fact, we've done so many trials of ivermectin now. Yes,

01:22:01.960 there's some that hint that it may have some effect, et cetera. And there's some biological

01:22:05.780 reasons, suppose, but not at the doses we would give people and so on. The body of the evidence

01:22:11.020 shows that ivermectin is not useful. I'd be delighted if it worked. I have no political agenda

01:22:15.120 here, but it's like hydroxychloroquine. You know, we put that one to bed and now we have ivermectin

01:22:19.880 rearing. Incidentally, I don't understand why people are so obsessed with believing that ivermectin

01:22:23.880 is useful. Like, what's that to do with? Like, you know, you don't have to take a political stand

01:22:28.680 on this. Like, either the drug works or it doesn't. Maybe there's some other drug that

01:22:31.720 works. Maybe there are no drugs that work and you should get vaccinated. I think this may be what

01:22:35.780 people are afraid of. Well, there is this diabolical notion that the profit motives are completely skewed

01:22:45.900 here, where no one stands to make any money off of ivermectin, but people stand to make billions of

01:22:52.660 dollars off of the vaccines. And therefore, a legion of mustache-twirling pharmaceutical

01:22:58.240 executives have rigged the whole conversation to foreclose the compassionate use of a essentially

01:23:06.840 free generic drug and bilk all of us at expense of our lives for vaccines.

01:23:13.820 Well, no. I mean, you're more, you take more risk taking ivermectin than you do by getting the

01:23:17.800 vaccine. No, I mean, you have to ask yourself, why would someone like me, who's, I'm not profiting,

01:23:21.980 I don't own stock in Pfizer or Moderna, why would I recommend the use of this? Or your doctor who

01:23:26.880 says you should get vaccinated. They're not being paid for offering this advice over one thing or

01:23:31.900 another thing. I mean, I understand people's suspicion of the profit motive, just like if my mechanic

01:23:37.580 recommends that I, you know, there's a little knocking sound that is actually a fit.

01:23:41.220 I can't currently see you, but you don't have Pfizer and Moderna merch all over your office

01:23:45.460 there, coffee cups and fleece jackets. No, no, I do not. And the same goes for,

01:23:54.640 you know, but yes, that's right. And so the person, you know, yes, your car mechanic may

01:23:58.720 be lying to you and tell you that a $50 thing is a $1,000 repair and so on. And so, you know,

01:24:03.100 rapidly such a car mechanic loses credibility or loses business or whatever, gets sued or whatever.

01:24:07.840 So I just don't think it's credible theory to imagine that there's some vast conspiracy

01:24:12.540 among your doctor and the expert on TV or someone like me, you know, like what's in it.

01:24:18.900 Some people, I guess I was accused on Twitter somewhere of being a, forgot what the accusation

01:24:22.680 was that I was like a, not a COVID whore exactly, but that I was a, that like somehow there was some

01:24:27.400 word like whore. I can't remember what it was where, where I was like somehow jonesing, I think was

01:24:32.100 the word. Someone said I was jonesing on COVID or something. And I was like, really? You think

01:24:37.940 that I was just, you know, the way I would actually, to be honest, here's what I'll tell

01:24:41.320 you. For years and years, I've been teaching public health and I, there's a very famous graph

01:24:47.120 in public health where on the X axis is years since like 1900 and on the Y axis is mortality.

01:24:53.600 And there's this decline in mortality over the last hundred years, which is just a miraculous

01:24:58.000 achievement of modern society. Primarily, and the story goes that this is for three reasons. First

01:25:03.760 of all, we got richer. And as we got richer, we died less. Second, we had public health interventions

01:25:08.800 like clean water and, and hygiene and, you know, cotton underwear and so on. And that's why we died

01:25:15.780 less. And that's about a third of it. So a third of it is we got richer. A third of the decline in

01:25:19.680 mortality is we got public health interventions. And only about a third is because of medicine,

01:25:24.120 you know, modern medicine. Anyway, I've been teaching this topic for years. And in this graph,

01:25:27.660 however, there's this huge spike like that just dominates the graph in 1918. And for 30 years,

01:25:34.700 I've been teaching public health and I teach this, this graph and I put it up on the table

01:25:39.320 up and I show the students and I ask the students who knows what the spike is. Invariably, someone

01:25:43.220 knows it's the 1918 Spanish influenza pandemic. And I say, isn't it amazing? Except for that pandemic,

01:25:48.620 you have this steady decline in mortality decade after decade because of what we as a society are doing.

01:25:54.780 And, you know, isn't that it's a triumph of human ingenuity. And honestly, Sam, I've been teaching

01:25:59.440 this for all these years. It never occurred to me, this was like, I taught this as like as a historical

01:26:03.960 oddity. Why it didn't occur to me that it could happen again while I was alive, I don't know.

01:26:09.340 You know, I, it just never occurred to me that I would be alive while there was a major respiratory

01:26:13.940 pandemic. And so when it started bearing down on us, the COVID in 2020, in January 2020,

01:26:20.440 as you were talking about earlier, on the one hand, I was prepared because I know about these

01:26:25.620 things and I had been thinking about this thing. On the other hand, it took me a while to sort of

01:26:29.900 register, oh my goodness, why was I not even more prepared? Like, why was I so surprised that this

01:26:36.100 thing was happening? You've been teaching about this for decades, Nicholas. So I don't know why I

01:26:40.960 went off on this tangent.

01:26:41.900 Well, honestly, my expectations have been reset here. Now I'm surprised that it's not always happening.

01:26:47.780 Yes. Well, respiratory pandemics come every 10 or 20 years and serious ones every 50 or 100 years.

01:26:54.140 And there's some evidence that the serious ones are coming more frequently. We can talk about that

01:26:58.220 if you're interested. Well, I just want to put a few more numbers to what you just described here

01:27:03.400 because there's what we know about COVID deaths directly, but then there's this other analysis of

01:27:12.360 excess death statistics that people have done. And actually, The Economist just did an analysis

01:27:18.000 that was published a few days ago. And globally, they estimate that it's more like 17 million people

01:27:26.180 who have died so far. And it's not just from COVID, but it is because of COVID. I mean, for instance,

01:27:31.860 you know, there are people who didn't get treatment for cancer because they couldn't get into the

01:27:35.680 hospital because the hospital was full of COVID patients, right? So there are knock-on effects of

01:27:40.080 the pandemic. And I think for The Economist, there was a 95% confidence interval between

01:27:46.540 11 million and 20 million for excess deaths globally now. And in North America, they put it,

01:27:53.120 you know, officially we're around 800,000 deaths. This analysis would adjust that upward by about 20%

01:27:59.440 to something close to a million at this point. Which, by the way, is the range that I had forecast

01:28:05.300 the last time. Actually, on our call, I had thought several hundred thousand. But in the book that I

01:28:11.440 released in August of 2020, I put the range of deaths in the United States between half a million

01:28:14.960 and a million. And I'm not saying this to pat myself on the back and say I'm so smart or something.

01:28:18.880 I'm just saying this is standard epidemiology. You can just do the calculations and look at

01:28:25.080 exponential growth and the intrinsic properties of the pathogen and forecast the impact on our society.

01:28:29.760 So I'm not at all surprised. And I've been long saying, in fact, at the beginning of this

01:28:33.140 conversation, I said that probably in the end, when the dust settles, a million Americans will

01:28:37.180 have died from this condition. That's exactly right. Maybe more. But let's talk about excess

01:28:41.760 deaths. The technique was invented actually by a demographer called, the founder of epidemiology

01:28:46.520 called William Farr in England in the 19th century, in the middle of the 19th century.

01:28:49.880 He did a lot of very cool things. And the reason they invented this technique was that the state of

01:28:56.920 knowledge about nosology, about diseases and what causes illnesses and deaths, was so weak 200 years

01:29:04.680 ago that it was not often possible to know what someone died of. So what Farr said is, you know,

01:29:10.220 we don't actually need to know what every, you know, some people died without having a doctor,

01:29:14.980 there were no death certificates, they were buried, but we don't know what they died of.

01:29:18.540 Or we said they died of A, but in fact they died of B, and so we were ignorant. And Farr said,

01:29:23.200 you know, we can dispense with all of that. Let's just count how many people died. And that was a

01:29:27.780 number that was known. And we're going to compare that to the number that we expected to die. And

01:29:32.280 we're going to compute that expected number by looking at the last five years and saying, okay,

01:29:36.260 in England, you know, we had 100,000 people died every year, and during the plague year,

01:29:42.040 200,000 people died. And so we're going to say that the plague caused 100,000 deaths. This is the

01:29:47.000 method of excess deaths. Now it turns out that that method is also useful even to scientists today

01:29:51.980 for a number of reasons. One is it's useful when you're looking at very ancient plagues,

01:29:56.800 and there are no death certificates or records, so you don't know, but you can calculate like,

01:30:02.620 you know, how many bodies, how many people died in a particular year, looking at graveyard or other

01:30:07.700 evidence, compare that to other years, and conclude that, oh my goodness, this plague killed so many

01:30:14.260 people. Now it can also be used even not looking historically, looking at the present day,

01:30:19.300 in part for the reasons that you mentioned. During times of plague, some people are killed

01:30:23.840 directly by the germ infecting them. Others are killed indirectly, for example, like you said,

01:30:29.760 in the situation in which a person with cancer dies because they weren't unable to get hospital

01:30:34.000 care, or they're killed indirectly in other ways. For example, the plague forces people to stay at

01:30:39.120 home, and you have domestic violence goes up. So more people are killed by their spouses,

01:30:43.500 for example, during the plague, let's say. But also there are people whose lives are saved by

01:30:49.120 the plague. For example, car accidents might decline because we're not out on the road. So

01:30:53.380 10,000 Americans who would have died from car accidents didn't die because, you know, we were,

01:30:58.300 let's say, locked down at home or something. Not that that's why I would lock us down, but in

01:31:03.000 fairness, you have to put all of those together, all of the direct and indirect deaths caused by the

01:31:08.760 plague and all of the lives saved because of the plague, for whatever reason. For example, in India,

01:31:14.460 because of the lockdowns, the air quality got so much better a year and a half ago,

01:31:19.820 people for the first time could see the Himalayas at some distance. And because the air pollution is

01:31:25.260 so bad in India, ditto in China, by the way, millions of Indians and Chinese die every year because

01:31:30.260 of bad air quality. And when all the factories stopped and all the people stopped driving their cars,

01:31:34.800 air quality improved. So fewer kids died of asthma, fewer adults died of emphysema and so on,

01:31:40.840 or pneumonias because exacerbated by the air pollution. So you got to put all of that together.

01:31:45.260 And that's how you ultimately, we will ultimately calculate the impact of COVID-19. And when that

01:31:51.520 calculus is done in two or three years, we will see that the impact of this epidemic has been

01:31:56.880 enormous on our society. As you say, probably in excess of a million people, at least a million,

01:32:01.860 I think, will have been judged to have died. And let me just say, and then I'll shut up in a second,

01:32:06.320 that we're not through this yet, okay? We should not be spiking the football,

01:32:11.020 not only because of the Omicron variant, which we haven't talked about yet,

01:32:14.320 but also because respiratory pandemics, it's in their nature to come in waves,

01:32:18.820 especially in the winter. So we're having a winter wave right now. A thousand Americans are

01:32:23.300 still dying every day of this condition right now. And we will have another winter wave a year from

01:32:28.180 now. By the way, when you and I spoke over a year ago, I'm pretty sure I said, I don't know for sure,

01:32:32.820 but I would have said, Sam, be aware of the fact that next winter we'll have another wave. And here

01:32:37.900 we are having that wave. And a year from now, we will have another wave. The amplitude of the wave

01:32:42.760 will be lower. That's what happens. The waves tamp down as time goes by. But these respiratory

01:32:48.280 pandemics typically take four or five years before the mortality that the plague is causing

01:32:53.660 falls into the kind of background welter of general causes of death. So some of the people

01:32:59.780 who think, well, this will be just like influenza are right. It will eventually be like influenza,

01:33:03.400 but that doesn't mean like lemmings, we have to run for the cliff and die needlessly. There are

01:33:09.100 things we can do to reduce the toll of death. Right, right. Okay. So I can see this entire

01:33:15.180 conversation is turning into a PSA because we're still working through my questions that I imagined we

01:33:19.520 would answer in the first 10 minutes of the podcast. So we've hit, you know, vaccine efficacy

01:33:26.460 and safety. Although I think there's one other point to make about efficacy because there's a kind

01:33:32.060 of confused notion traveling around now that the vaccines actually don't work very well because there

01:33:40.180 still is some transmission with respect to in vaccinated populations, right? So people are imagining

01:33:46.720 that the goal of the vaccine was to stop transmission entirely. And if you're, if you can still get

01:33:54.120 breakthrough cases and you can still pass the virus to others in a vaccinated population, well, then

01:33:59.880 these vaccines don't work. There's a related issue here where people think, well, if you need to get

01:34:05.040 boosted, how many, just, just how many boosters are we going to have to get? We're going to get one

01:34:08.920 booster a year for the rest of our lives. Oh, these vaccines don't work. So there's the, in the,

01:34:14.400 in the anti-vax world, there's just an endless amount of chatter about how these vaccines really

01:34:19.860 haven't panned out. Well, you know, we, we should, you really are spending too much time online.

01:34:24.980 We should, we should address, we should address these concerns.

01:34:29.640 Okay. Well, and also you did put on the table, this ridiculous statement that natural immunity,

01:34:33.900 I mean, there's, you know, like why don't you, not a ridiculous statement. There's, there's,

01:34:38.260 there's some interesting science about natural immunity versus artificial immunity through

01:34:41.380 vaccination, like which is better. And we can talk about that too. So on the issue of the vaccine.

01:34:47.380 So when, when we say a vaccine is effective, we have to specify what is the effective against what?

01:34:53.300 Does it prevent you from becoming infected? Does it prevent you from being able to infect others?

01:34:58.600 Does it prevent you from becoming seriously ill? Or does it prevent you from dying? Those are four

01:35:02.720 different outcomes. And believe it or not, the vaccine doesn't have to be equally effective against

01:35:06.760 all of those outcomes. For example, only some vaccines provide what's known as sterilizing

01:35:11.480 immunity. In other words, it prevents you from even being able to be infected. That's not what

01:35:16.160 the coronavirus vaccine does. Yes, it does reduce your probability of being infected if exposed. But

01:35:20.700 what it really does is it reduces your probability of getting seriously ill if infected. And infectiousness

01:35:27.720 is another topic because even if the vaccine prevents you from becoming seriously ill, if I'm vaccinated

01:35:33.900 and I'm exposed to the virus, as the virus multiplies in my body and my body starts ramping up because

01:35:40.220 it's been vaccinated to fight off the virus, there is a window of time when I could potentially spread

01:35:44.580 it to others. But that window is greatly narrowed if I have been vaccinated. In fact, the vaccine does

01:35:51.160 benefit, does reduce my infectiousness and does benefit others. We, we had deferred still the topic of

01:35:57.860 whether it is a civic duty to be vaccinated. I think it is. You should be vaccinated not just to

01:36:02.980 protect yourself, but also to protect others. And there are many, many examples in our society where

01:36:07.840 we, we have state power that prevents you from being a risk to others. The reason we regulate

01:36:12.880 speeding on the highway is not so much because of our solicitous interest in your wellbeing, but because

01:36:17.920 you don't have the right to crash in and kill someone else. Yeah. I would also add here though,

01:36:22.140 that even if we knew the effect was only borne by you directly, you still, you getting sick and

01:36:30.220 dying has a very likely a terrible effect on other people. I mean, there are these cases where,

01:36:37.300 I mean, there literally have been cases where two anti-vax parents get killed by COVID and their

01:36:44.920 kids are, they got, you know, two four-year-old orphans now, right? I mean, it's just unbelievable

01:36:50.220 what is, what is out there if you, when you go looking for details. And I mean, the idea that it was

01:36:57.100 just the, you know, a, an expression of the personal autonomy of these two parents not to get

01:37:01.860 vaccinated because, you know, no one's putting a needle in their bodies as though there were no

01:37:06.940 implications for anyone else. You know, now they've got these two orphaned kids that society has to

01:37:11.640 figure out somehow how to raise. And, and, and, and that's, and that's really sad. And I also think

01:37:17.240 it's sad for those people, you know, that they became, that they politicized something which could

01:37:21.500 have been seen. Look, I, I like the fact that we live in a plural democracy. You know, we don't live

01:37:26.420 in, in North Korea, you know, or some kind of autocracy. We, we have people with, across the

01:37:31.700 political spectrum with different political beliefs. We, I like this fact. We live in a plural

01:37:36.460 democracy and we resolve, how do we resolve our disputes? We do not resolve them by force of arms.

01:37:41.340 We vote and we get to vote repeatedly. So we, if we don't like the people we vote for, we get another

01:37:46.280 bite at the apple in two years or in four years or in six years. This is fantastic about our society.

01:37:50.540 So when people are wanting to communicate their divergent political beliefs, I think the right

01:37:56.700 way for them to do that is to have a bumper sticker or a lawn sign. It is not by whether

01:38:02.940 they get vaccinated or not. In other words, you do not need to link your political beliefs or your

01:38:07.940 political identity to whether you get a vaccine or not. You can signal where you are in the political

01:38:13.340 spectrum in all kinds of other ways. And so this, the hypothetical case you described of the two

01:38:18.100 anti-vax parents who- Not hypothetical. I mean, I can-

01:38:22.340 No, no, real case. I know, but exactly.

01:38:24.860 Let's take the generic version of that. Yeah.

01:38:26.840 Yeah, yeah. There are real cases. I actually sent out a Twitter thread that assembled some of these

01:38:30.520 cases months and months ago when some of them were hitting the news. They were heartbreaking.

01:38:34.840 But the point is, just as you're suggesting, that those individuals, they could have had their

01:38:39.460 political beliefs and their political ideology about the government or whatever it is they want,

01:38:42.900 but they don't need to signal that by whether they get vaccinated or not. They may have other

01:38:48.240 reasons not to get vaccinated. They may not want to, but it's a kind of wrongheaded admixture of

01:38:54.720 belief systems. So anyway-

01:38:56.820 Also, there's just this fact, which I know we almost certainly mentioned last time,

01:39:01.720 there are some people who can't get vaccinated, right?

01:39:04.420 Yeah, also true.

01:39:05.040 We have a duty to do whatever we can to mitigate their risk. Yeah.

01:39:08.960 That's correct. So the fact that there's some breakthrough infections, the fact that there's

01:39:13.320 still some transmissions, this is normal. There's nothing surprising. This does not mean the vaccines

01:39:17.260 don't work. It's just, again, going back to the airbag example. The fact that someone was in a

01:39:21.740 collision and died despite an airbag doesn't mean that airbags don't work. It means they work pretty

01:39:25.800 good, but not 100%. And that's exactly the same thing with the vaccines. And on the natural

01:39:31.580 immunity thing, it's a very complicated and interesting topic. So it is usually the case,

01:39:37.880 not always, but usually the case that people who survive an infection with a natural pathogen

01:39:43.920 have better immunity than those who are vaccinated. And the reason, the intuitive reason for this is

01:39:48.780 that when you're infected with a natural pathogen, you're exposed to all the so-called epitopes.

01:39:53.620 You're exposed to all the antigens, all of the proteins in the pathogen. So your body

01:39:57.940 amounts, a very broad attack on the pathogen with antibodies and memory T cells that attack

01:40:04.780 many parts of the pathogen. Whereas if you're vaccinated, you typically get a reduced set of

01:40:09.240 those. For example, in the mRNA vaccines, you're just exposed to the spike protein, not the other

01:40:13.560 proteins of the coronavirus. I just got to say as an aside here that the name spike protein has done

01:40:20.260 some terrible PR for these vaccines. People find the name so scary. The idea that just mRNA vaccines are

01:40:27.120 proliferating this spike protein throughout your body. It's something that the spike protein

01:40:31.420 certainly sounds like it's going to harm you in all kinds of ways. And there are people who are

01:40:35.480 alleging that it almost certainly will. It's just, it really, I mean, in addition to people's,

01:40:41.200 you know, ambient fear of needles, a fear of the spike protein is, I'm convinced, doing some

01:40:47.580 at least subliminal work here.

01:40:49.880 I hadn't thought of that, but I think you're right. If scientists by chance have been calling

01:40:53.560 it the rainbow protein and we were going to inject you with rainbow protein, I think I'd be the same.

01:40:58.400 If it were called the rainbow protein and we could deliver these vaccines with a nasal inhaler

01:41:02.900 or better yet a pill, we would be living in a different world. I'm convinced.

01:41:07.720 Or like on a sugar cube, like the polio vaccine. Yes. So yeah, let's have some rainbow protein on a

01:41:13.660 sugar cube and you'll be better.

01:41:15.260 Sorry, I derailed you. So you're talking about natural immunity.

01:41:17.960 Yeah. So no, so natural immunity. So, so it is generally the case that it, but, but having said

01:41:23.720 that, let me say a couple of other things. This is not always the case. There are previous examples

01:41:28.500 where the vaccines provide superhuman immunity, for example, with human papillomavirus or tetanus.

01:41:34.900 It is known that those vaccines provide a kind of immunity that's superior to the immunity acquired

01:41:40.400 for natural reasons. And we can discuss a little bit about why that is the case. But in addition to that,

01:41:45.000 in order to acquire the natural immunity, let's not forget you have to survive. You have to run

01:41:49.900 the risk of death. And this is, in my opinion, just stupid. In other words, there's no polite

01:41:55.040 way to put this. It is not a rational strategy to say, even if you believe that the natural immunity

01:42:00.120 acquired, natural immunity is superior to the vaccine immunity, it is not wise to seek to acquire it by

01:42:07.180 natural infection because you have to survive. You, you run the risk of death in order to be in that

01:42:11.960 state. Incidentally, for any listeners who've had COVID, the, there are abundant studies right now

01:42:17.360 that show that you should still be vaccinated. And actually the people who have both been vaccinated

01:42:21.580 and have had COVID in either order, those are the ones that are actually in the best position

01:42:26.940 to endure, even mutants like Omicron and other mutants that are on the horizon.

01:42:31.860 So, variants that are on the horizon, because they have a mix of intense immunity,

01:42:37.160 let's say from the vaccine and broad immunity from the natural infection. So, it is, it is, it is not,

01:42:42.680 it is not a rational approach to say we are going to reach herd immunity as a society,

01:42:47.040 or we are going to, as an individual, that's going to be my strategy. It is far superior from an

01:42:53.900 individual and a collective point of view to get vaccinated.

01:42:57.240 Let me ask you here on this point, many people have expressed the grievance that in all this push

01:43:04.140 to get people vaccinated, natural immunity of those, you know, many, you know, millions of people at

01:43:09.880 this point who have caught COVID and recovered, their natural immunity is not being dignified as

01:43:17.060 akin to, or even better than normal vaccination. And, you know, they, they should be given credit

01:43:23.740 for, and essentially, essentially they are vaccinated, you know, they were vaccinated by the virus.

01:43:29.080 Yes, I think there's some validity to that point of view.

01:43:31.040 Yeah. I mean, even though, as you did, you would just recommend that they also get a dose of the

01:43:37.480 vaccine. It does seem crazy that if we're, I mean, this comes down to just the colossal failure of our

01:43:44.520 testing regime, but it does seem crazy that we have not figured out a way to credit people for having

01:43:51.620 recovered from COVID so that they then can, you know, in a world where, you know, you can't get into

01:43:58.040 a restaurant unless you prove that you've been vaccinated. You should be able to get it into a

01:44:02.400 restaurant proving that you, you had COVID.

01:44:05.720 Survived the infection. Yes. I think that would be, from an individual's point of view, that's not

01:44:09.460 crazy. Although, as I just said, if I were such an individual, I would still be vaccinated because

01:44:13.820 you're actually not as protected. And it's, it's a very wise course of action to have that.

01:44:19.100 Well, you're, you're not as protected as you might be, but you're. Correct. But I still think it's,

01:44:23.100 I still think it's true or that we currently believe that natural immunity is superior to a,

01:44:30.980 a two dose mRNA course. No, I don't think that's true. That's not true.

01:44:35.460 That's not true. No, no, no, no, no, no, no, no, no, no, no, no, no, that's not true. That's what I'm

01:44:37.740 saying. The, the, in fact. You're, you're saying that the code, the mRNA vaccines are analogous to a

01:44:43.460 tetanus vaccine. Yes, yes, yes. They provide superhuman immunity. That's exactly right. I'm not, well,

01:44:47.920 by sheer, by sheer coincidence. There's a lot of, so I don't know where, I don't know where we're

01:44:54.300 going to find the ground truth for that information because I've heard, I've heard it both ways,

01:44:58.060 but more recently I've heard it the way I'm saying it, which is natural immunity is actually better

01:45:03.540 than vaccinated immunity. No. Although, although the combination of a vaccine and natural immunity

01:45:09.040 is the best. That's, the last thing is true, but it is not true that, that natural immunity is

01:45:14.720 superior. That's what I was saying before, that there are cases and the mRNA vaccines are in that

01:45:19.120 category. I'm quite confident about this, that the immunity conferred by two doses of mRNA vaccine

01:45:26.000 is superior to the immunity conferred by having survived a natural infection. That's what I was

01:45:30.240 saying, that there are two reasons to be vaccinated. Obviously, the, the audience can fact

01:45:35.500 check us here, but whatever is the case there, there seems to be a current consensus that even if

01:45:42.280 you've recovered from COVID, you're better off getting a, a boost of the vaccine and then you,

01:45:47.340 then you are the, the superhero you want to be. So like we're talking about, the question is,

01:45:51.980 which immunity is superior? Is it, is it the, if you survive, assuming you survive, let's again,

01:45:58.400 constantly remind ourselves of this important feature. There is a survivor bias in this, in this data.

01:46:04.640 Yeah, absolutely. So to acquire this natural immunity, you have to run the risk of death,

01:46:08.440 but let's say you acquire it. Is it better than having been vaccinated or not? So there was actually

01:46:12.320 a study that was released by the CDC on November the 5th, about a month ago that looked at this

01:46:17.860 question and concluded as have several other studies, by the way, that no, in fact, it's superior

01:46:24.440 to be the immunity conferred by vaccination is superior. And here I'm looking at the adjusted odds

01:46:30.560 ratio. It's about, it's about five times your odds of being hospitalized with serious illness are five

01:46:38.140 times worse if you have natural immunity compared to immunity from vaccination. And this, the last

01:46:44.000 author of this paper is Bozio, B-O-Z-I-O, and it was published in MMWR on November the 5th, 2021.

01:46:50.760 So that's one of many studies that have come to this conclusion. So no, I reject the claim that

01:46:56.600 immunity, as of now, I mean, I may, I reserve the right to change my mind if the facts change or we

01:47:02.420 see more studies. But as of now, my summary of the literature is that in most people, on average,

01:47:08.860 vaccination with two doses of the mRNA vaccine provides superior immunity than having acquired

01:47:14.720 it naturally. Yeah, well, there's a, I think I want to spend more time on the sociological problem

01:47:21.500 here just to account for how this got so politicized and so crazy. But I just have one more question

01:47:27.700 here around vaccines and their efficacy. It's widely claimed now among people not disposed to get the

01:47:39.060 vaccines that vaccines are creating a, because we do not have a sterilizing vaccine here that's 100%

01:47:47.880 effective. Vaccines are therefore creating a selection pressure that is spawning new variants

01:47:54.640 that will, you know, perforce, evade the vaccines. And so we're basically our own worst enemy here and

01:48:00.340 we, you know, vaccinating imperfectly. What these peoples tend not to notice is that also natural

01:48:07.320 immunity would be doing the same thing. It would be exerting a selection pressure that would then

01:48:11.000 cause variants to emerge that escape natural immunity. But, you know, among the fans of

01:48:18.500 vaccination, there's this rival claim, which is that it's better to have a vaccinated population

01:48:24.720 than an unvaccinated one for all the reasons we've mentioned. But for the additional reason that

01:48:29.660 in an unvaccinated population, when you have a reservoir of tens of millions, hundreds of millions,

01:48:35.200 globally, billions of people who have not been vaccinated, you have the condition of greatest

01:48:40.380 spread and greatest virulence and greatest opportunity to manufacture fresh variants that

01:48:48.460 keep this game of chicken with evolution running in the worst possible way. And so I guess my question

01:48:56.700 is, to what degree does vaccination mitigate the problem of variants compared to lack of vaccination?

01:49:06.680 How do you think about this selection pressure that the vaccinated and the unvaccinated together are

01:49:13.960 creating for the arising of new variants?

01:49:17.600 I think people are right to be concerned about that. And let me try to see if I can provide an

01:49:21.520 analogy. As most people will have an understanding, you know, there's a herd of antelope and there's

01:49:28.400 a lion that's going to predate them. And everyone knows from having watched nature videos that the lion

01:49:32.900 kills the slowest antelope, the weak one, the old one, whatever it is. But if you can run fast,

01:49:38.820 you outrun the lion and you don't get eaten. As the lion kills a few antelope each generation,

01:49:44.680 the antelopes evolve to run faster and faster and escape the lion. Now, of course, the lion also

01:49:49.160 evolves to run faster and faster. And you have predator-prey co-evolution. And there are experts

01:49:55.140 in our society who have studied this in many predator-prey relationships and many relationships

01:50:00.780 between pathogens and the animals they infect, which is a similar kind of thing, or parasite-host

01:50:05.640 interactions, for example. This is a well-understood topic. But you should also have the intuition

01:50:10.980 that if there is no lion, what happens to the speed of the antelope? Does it change? No. There's no

01:50:18.320 selection pressure on speed. And so the average speed of the antelope remains the same. And conversely,

01:50:23.840 if the lion is indifferent to speed, if the lion kills all the antelope, also the antelope don't

01:50:30.880 evolve, right? They're all dead. So you don't get faster and faster antelope.

01:50:35.260 But you get a really good Netflix video narrated by David Attenborough.

01:50:40.300 Yes, you kill them. It's like a fox in the chicken coop. You know, just kill them all.

01:50:44.840 Okay, but the point is that from this little toy example, that we realize that partial selection

01:50:50.360 pressure is the thing that will be most likely to induce evolution of speed in the antelope.

01:50:56.140 And that's the argument that people are making in terms of partial vaccination.

01:51:00.480 And the crucial thing here is partial. So if you partially vaccinate the population,

01:51:05.360 for example, in South Africa, where they have 24% or something vaccination rate,

01:51:09.380 and they have a lot of immunocompromised individuals, which is another interesting and

01:51:12.720 important detail in the emergence of the Omicron variant, is that what happens is you create almost

01:51:19.000 the perfect circumstances for vaccine-evading strains, right? So what we're talking about here

01:51:24.660 is not new strains that cause us trouble. We're specifically focused on causing us trouble in a

01:51:29.740 particular way, which is that they can evade the vaccines. If we vaccinate some of the population but

01:51:34.760 not the rest, those strains that are circulating that can move despite the partial vaccination come

01:51:40.860 to predominate. And so it's just like the partial predation by the lion example. And so partial

01:51:47.680 vaccination will enhance or pick up the speed of the virus or endow the virus with more of the

01:51:54.460 property that allows it to avoid the predation, or in this case, the elimination because of

01:52:00.120 vaccination. But the crucial thing there is partial. So basically what we want is a world in which either

01:52:06.060 no one is vaccinated or everyone is vaccinated. If no one is vaccinated...

01:52:10.260 Well, just to escape confusion here, there are two forms of partiality here. There's partial

01:52:16.360 vaccination. You know, not everyone has received a vaccine in any given population. But then there's

01:52:21.660 the partial efficacy, the incomplete efficacy of the vaccine itself, right? And it's not sterilizing.

01:52:30.660 Yes. Correct.

01:52:31.900 I mean, both are contributing to this problem.

01:52:34.740 Well, the latter, the fact that the vaccine is not 100% perfect, I have to think for another moment or two

01:52:39.140 before I can put that into the story. But the part of the story that I'm emphasizing right now is the

01:52:44.100 fact that not everyone is vaccinated. This is, by the way, the reason that I and many others have

01:52:48.700 been arguing that the United States should vaccinate the whole world. It would cost us $50 billion to

01:52:54.820 vaccinate the world, and we should do it. We should do it, first of all, because we profess,

01:52:58.280 it's a moral obligation. We profess to have the right morals and be a leading nation. And I think it's

01:53:03.380 something we should do for moral reasons. We should do it for economic reasons. We're a rich country.

01:53:07.880 Everyone is experiencing supply chain problems now. They have trouble buying Christmas presents

01:53:13.040 or products are missing at the grocery store, and they make orders for furniture, and they're told

01:53:18.520 it won't arrive for months. And this is not a typical experience of late American capitalism,

01:53:22.920 but everyone is having this experience now because of supply chain problems. And we need

01:53:26.860 trading partners. So we have economic reasons to vaccinate the world, but most importantly,

01:53:30.940 I would argue, we have epidemiological reasons. Because to the extent there are parts of the world

01:53:35.040 that are not vaccinated or partially vaccinated, those are petri dishes for the emergence of new

01:53:40.820 worrisome strains of the virus. And those strains will inevitably come to our shores, just like we've

01:53:45.860 seen with Omicron. They will come to our shores, and they will cause us woe. So we need to vaccinate

01:53:50.860 the whole world, not just our country. Now, you made a second point, which is really important,

01:53:55.160 and I just alluded to it a moment ago, which is to the extent that there are partially vaccinated

01:53:59.820 or unvaccinated. The reason wholly unvaccinated parts of the world are also a problem is a numbers

01:54:05.900 game. Because if you have 100 people who are infected with a virus, or 10 million people who are

01:54:13.160 infected, you should have the intuition that with many more people afflicted with a virus, you have many

01:54:18.700 more opportunities for the virus to have a mutation that makes it worse. And this is why rip-roaring

01:54:25.980 infection is also not good. In other words, why the so-called, you know, the point you made earlier,

01:54:32.040 which is that large numbers of people who are infected with a virus don't necessarily benefit

01:54:37.440 us because it provides more terrain, more opportunity for the virus to explore what's known as the

01:54:43.280 Darwinian fitness landscape, where the virus by chance, because there's so many millions of people

01:54:48.420 who are infected, by chance it'll stumble on a variant that's really bad for us. It's like,

01:54:52.900 it's a little bit like, you know, if you want to roll a heads, are you more likely to roll a heads

01:54:57.920 if you get 10 coin flips or 1,000 coin flips? Well, everyone has the understanding that,

01:55:02.820 you know, however unlikely it is, however likely it is to roll a heads when you flip a coin 10 times,

01:55:09.280 it's a certainty you're going to get a heads if you flip a coin 1,000 times. And it's a little bit

01:55:14.040 like that with the coronavirus. If you have millions of people who are infected, the virus has more

01:55:19.400 opportunities to have a worrisome strains mutate and emerge. So for both of these reasons,

01:55:24.100 the wisest strategy is if you have three options, no immunization, partial immunization, or complete

01:55:30.180 immunization, from the point of view of us combating the virus, the wisest strategy is complete

01:55:35.620 immunization. Yeah. You mentioned in passing the implications of having a large population of

01:55:42.640 immunocompromised people in Africa. What is that? What's it called? I assume you're talking about

01:55:49.360 the spread of HIV there. Yes. Well, there's a lot of theories. For example, let's take the Omicron

01:55:55.020 variant. The Omicron variant, its most recent relative in the virus family tree is about a year

01:56:03.020 ago. So it's not a descendant of Delta, for example, the Omicron variant. It seems to be a descendant

01:56:08.740 from some other ancestral strain about a year ago. This is work that Trevor Bedford and others have

01:56:14.220 done. And so the question is, well, what happened? Well, one possibility is that the Omicron variant

01:56:21.040 was spreading in parts of the world where we had low genetic surveillance, and therefore we just

01:56:26.840 didn't detect it earlier. We just finally stumbled on it when it got to South Africa. Let's say it was

01:56:32.020 in Botswana or somewhere else nearby, and there wasn't a lot of genetic surveillance, but in South Africa,

01:56:36.540 they have decent genetic surveillance. Then it comes to South Africa, up, we detect it. And so it

01:56:41.060 seems like it hadn't been around for a year, but actually it had been. That's one possibility for

01:56:47.940 the emergence of such a strain, a sudden emergence of a new strain. Another possibility is that it

01:56:54.600 wasn't circulating in a population. Rather, it was enduring in a specific individual. So for example,

01:57:00.160 imagine you're an immunocompromised individual, you're infected with a virus, you can't fight it off,

01:57:05.460 and that virus lives in your body and keeps mutating and mutating and mutating. Viruses,

01:57:10.700 chance mutations occur. I forgot the rate of mutation in this virus. I think it's once a

01:57:15.240 week or every two weeks or so. And so over a year in your body, the virus accumulates a lot of

01:57:23.560 mutations. So one theory is that the Omicron variant kind of was incubated in an immunocompromised

01:57:30.360 individual, where finally enough mutations occurred in the virus, and then it leapt from this person

01:57:36.080 to others and then began spreading. That's the second theory. And therefore, in a place where

01:57:43.340 there are a lot of immunocompromised people, and I think in South Africa, something like 20% of the

01:57:47.540 population is HIV positive. I don't know the precise number, but I think that's about right.

01:57:51.640 You have a lot of people there that we really should be vaccinating because those poor individuals

01:57:57.400 can serve as incubators for new worrisome strains of the virus. A third possibility,

01:58:03.600 and this is one of the reasons we will never eradicate coronavirus, is that unlike smallpox,

01:58:09.460 which can only infect humans, coronavirus can infect animals. And everyone has been reading about this.

01:58:17.620 You know, there are the gorillas in the zoo.

01:58:18.400 Yeah, the snow leopard at the zoo, yeah.

01:58:19.560 Yeah, and the tigers in the zoo, and deer, like something like, some studies show that a

01:58:24.900 significant fraction of North American deer are infected. They got it from humans, apparently

01:58:28.980 feeding deer is a thing, and then the deer spread it among themselves. And mink, there was an outbreak

01:58:34.080 in, I think in Denmark, where they had to slaughter thousands of mink, and outbreaks in China,

01:58:39.360 in fur farms. And we know our pets, our dogs and cats can get it. So the point is that the coronavirus

01:58:46.660 can, even if we vaccinated everybody, we'll never eradicate this virus because it can live in animals

01:58:51.660 who we live with. So there are animal reservoirs possible. So a third possibility is that Omicron

01:58:57.200 was incubated in some kind of animal reservoir and then returned to humans. It wasn't humans,

01:59:01.260 it went to animals. It started first in bats, it came to humans, and then from humans it went to some

01:59:06.600 other animals, and now it's coming back to us. The coronavirus is a feature of the natural world.

01:59:12.200 Our world has changed. There's a new pathogen in our midst that was not there before, and so we have

01:59:17.220 to accept this reality. That's the third possibility. And then, of course, there's some, since you're in

01:59:21.920 the dark reaches of the internet, Sam, there's some people who speculate that this is still a Chinese

01:59:26.660 plot. Like, first they softened us up with the original strain, and now they're releasing, you know,

01:59:30.920 another strain suddenly, which I think we can exclude that possibility. I think the most likely

01:59:37.160 thing of the three I've just mentioned is the second possibility, that it was in an immunocompromised

01:59:43.500 human, and that's where Omicron was incubated and now has leapt us.

01:59:47.840 Interesting, interesting. Okay, well, let's pivot to the topic of why this all became so confusing and so

01:59:56.180 difficult to talk about. I mean, we've touched on it some here, but I want to at least acknowledge,

02:00:02.040 just try to put yourself in the position of someone who has listened to us now for two hours and

02:00:10.160 is still unconvinced because they still can't shake the feeling that the incentives are such,

02:00:17.480 the corruption of our institutions is such that we just can't trust the information we've gotten.

02:00:26.180 We've got a whole segment of our society that is declaring epistemological bankruptcy on some

02:00:31.480 level, and then turning to non-standard sources of information for their facts. You know, and as I

02:00:41.500 said, I think the alternative media wilderness is especially culpable for giving energy to this,

02:00:49.020 but the truth is our institutions have failed to a remarkable degree. I mean, they have proven

02:00:55.520 hypocritical and capturable by crazy ideology to a degree that I would not have thought possible.

02:01:03.440 And I'll just give you a couple of examples here to react to. I would imagine these are in your

02:01:07.900 memory, but there's at one point during the pandemic where we had something like a thousand public health

02:01:15.720 professionals who signed an open letter attesting to the necessity of demonstrating for Black Lives

02:01:23.720 Matter protests and how that was epidemiologically a fine thing to do because racism is such a problem

02:01:30.700 in our society. But of course, it was a terrible thing to demonstrate against lockdowns or any other

02:01:37.360 sort of mass gathering on the right side of the political spectrum. That was totally irresponsible and

02:01:42.860 dangerous and guaranteed to get people killed. But lo and behold, it's safe to get out there after

02:01:48.620 the killing of George Floyd and demonstrate en masse for the right political cause. I mean, that was such

02:01:55.760 a distortion of public health messaging that I think, I mean, anyone right of center politically took one

02:02:03.380 look at that and said, all right, we're done here. I don't need to hear from the Anthony Fauci's of the

02:02:08.500 world. This is how they bend their scientific advice in response to woke identity politics.

02:02:15.740 Well, I don't know if Anthony Fauci himself was saying it was fine. I don't think he was.

02:02:19.120 I don't know if he signed that letter or not, but Fauci-like people were signatories to that.

02:02:25.740 Well, yeah, but I was publicly opposed, just to be very clear. So in real time, I was saying,

02:02:30.220 this is insanity. The virus does not care about the justness or non-justness of your cause.

02:02:36.320 Or whether you have pink hair.

02:02:38.960 Yes, it doesn't care. And therefore, I could not see how we had denied people the right to visit

02:02:45.560 loved ones who were dying in the hospital or funerals. Let's not forget, funerals were deemed

02:02:50.440 too risky at that time. But somehow turn on a dime and say, well, we're going to sort of give a pass to...

02:02:57.180 Or at that time in New York, I think the governor of New York City was cracking down on Jewish weddings

02:03:03.520 amongst the Orthodox Jews, but turned around in the very same week or something. I may have bungled

02:03:08.500 these facts a little bit, but was saying, oh, well, BLM protests are okay. This is not

02:03:12.280 rational. And I was strongly opposed. Now, we can talk about whether what is the actual risk from

02:03:17.940 outdoor interactions. And now we have a lot more evidence now, a year later, about the extent to

02:03:23.000 which it is or is not risky to be outside. And we now know a lot more about the aerosol dynamics of

02:03:27.660 this pathogen. But at the time, it was inconsistent and I think deeply injurious to credibility. But

02:03:33.220 this is why I would tell listeners who are skeptical, try to find a voice that you trust.

02:03:37.560 Try to find someone who you trust about these matters. And try also to ask yourself, again,

02:03:43.360 I repeat what I said earlier, what evidence would disprove my beliefs? If I believe that

02:03:47.900 ivermectin works or that masks are useless, what evidence could I find from perhaps ideally someone

02:03:54.640 you trust? That would make you change your mind. Again, I think that's a crucial heuristic.

02:04:00.080 But on your point on the crisis in institutions, I mean, you and I have talked about in some of our

02:04:03.680 past conversations, for example, the collapse of higher institutions of higher learning in our

02:04:08.940 society. I think we're at an interesting moment in the history of our nation where the pendulum

02:04:14.900 swings back and forth. And I think you're right to talk about a crisis of our institutions. I think

02:04:20.660 the media, people are worried about the legacy publishers. There was a time when you could

02:04:26.060 have confidence in the New York Times and CBS and the Evening News with Dan Rather or Walter Cronkite

02:04:32.720 or whatever. And you had a kind of notion about the Supreme Court. Yes, maybe they didn't rule your

02:04:37.700 way, but you didn't think of them as venal or as somehow being driven by their politics perhaps.

02:04:42.400 And our universities, you thought of them perhaps as institutions that were devoted to free expression

02:04:49.300 and scientific inquiry and nothing was unsayable, no idea was unthinkable, and so on. And to our

02:04:57.960 public health institutions and so on. And I think there is a moment right now, again, the virus has

02:05:02.560 struck us when we're vulnerable in this regard, because I think there is a crisis for other reasons.

02:05:07.260 There's a crisis of institutions in our society.

02:05:09.380 Just to give you another example here, I think this is more recent, but the American Medical

02:05:14.720 Association has changed its guidance for doctors about how to talk to patients. And at one point,

02:05:22.160 they recommend instead of referring to low-income people, they recommend that you say, and this

02:05:28.840 is a quote, people underpaid and forced into poverty as a result of banking policies, real estate

02:05:34.740 developers, gentrifying neighborhoods, and corporations weakening the power of labor movements.

02:05:39.380 Among others, have the highest level of heart disease, right?

02:05:43.040 Yeah. And so I'm saying poor people have high levels of heart disease. We're supposed to say

02:05:45.760 all that. Well, I mean, you could even do a little, like, is that an onion headline or not?

02:05:51.720 Yeah, this is an SNL sketch, yeah.

02:05:54.380 Exactly. Maybe SNL will do it. Who knows? Yes, that's ridiculous. I mean, that's like shooting

02:05:58.880 fish in a barrel.

02:05:59.800 And there are other examples.

02:06:01.120 I understand, by the way, just to be clear, I have studied the influence of those forces for decades,

02:06:06.360 like how it is that poverty kills you and the mechanisms by which being poor is harmful to

02:06:11.240 your health. And many of those things that were identified, I have looked at, for example,

02:06:15.600 how for-profit hospices, I did a lot of work in the 1990s on how for-profit hospices had different

02:06:21.660 incentives to care for the dying than not-for-profit hospices. So I'm completely sympathetic to the

02:06:26.720 workings of such forces and their relevance. But to manipulate our language in that fashion is,

02:06:31.880 and to politicize it, to ex-ante-politicize it, to, like, prejudge the outcome through the

02:06:37.720 manipulation of language, I think is nuts.

02:06:40.280 Yeah, yeah. And then there was the example of, this included Fauci in the beginning when so many

02:06:46.200 people in the medical establishment told what was really, I think, considered a noble lie,

02:06:53.300 but was, in fact, you know...

02:06:54.820 Yeah, that was a fiasco.

02:06:56.400 Yeah, I mean, just, you know, it was so transparent. It was so illogical. I mean,

02:06:59.980 they basically claimed that masks don't work because they were worried about all the run on

02:07:05.800 PPE and that there would be no N95 masks left for doctors and healthcare workers. But, you know,

02:07:12.360 if masks don't work, why do you care that there's going to be a run on the masks? It made no sense.

02:07:18.540 And it's, I mean, just that alone was so damaging that it was, I mean, some people just never

02:07:25.880 recovered their caring about, you know, what's a valid source of information coming from the

02:07:32.120 government or from CDC.

02:07:33.760 That was absolutely awful. And in early April, and I was, again, not in that category. I was

02:07:38.900 talking about the utility of masks and making homemade masks and using N95 masks. I released a

02:07:44.800 paper with some colleagues at Yale in April of 2020. So again, I was thankfully not in that

02:07:50.260 category either. And I think that was a slip up by Fauci. And I don't know the reasons they did

02:07:56.400 that. It may have been, as you suggest, this sort of noble lie idea. But for those individuals who

02:08:00.620 are pissed about that, I would encourage those individuals, especially if they have a political

02:08:05.160 reason for being pissed, to ask themselves, why our wealthy, great nation didn't have PPE?

02:08:11.780 Why did the president of the United States, when warned, you know, actually back in November of

02:08:16.880 2019, certainly by January, certainly by February when Italy was collapsing, why were we not

02:08:22.300 manufacturing PPE? Why were we, why did hundreds of doctors and nurses and EMTs and others die

02:08:28.340 from infection that they acquired in hospitals caring for the rest of us because they did not

02:08:33.600 have adequate PPE? This boils my blood. When I was early, I was, I'm a hospice doctor. I was,

02:08:40.500 I don't see patients anymore. But in the 1990s, I used to take care of people who had HIV. And about

02:08:45.880 a third of our patients in hospice had HIV. And of course, in the hospitals, many had HIV. These

02:08:50.020 were typically young gay men who were dying awful deaths until the invention of highly active

02:08:54.800 antiretroviral therapy in the late 90s. We had to take risks to care for these people. We were worried

02:09:01.100 that if we were drawing blood from them, we would have a needle stick injury. Some of my colleagues did

02:09:05.740 have needle stick injuries. And we were worried that you would get HIV. If they vomited on you,

02:09:09.580 these patients, or urine or spit, body fluids got on you, you would get a deadly disease and you would

02:09:15.820 be infected with HIV. But we, it was our duty to care for these patients. And we did. And we took

02:09:21.460 some risk in so doing, as was expected of us, just like a soldier going into battle. But we had

02:09:27.460 equipment. We had masks. We had gloves. We had gowns. We had special rooms. We had special ways

02:09:35.400 of disposing for the needles to minimize needle stick risk and so on. So we were expected by the

02:09:40.640 society to take a risk, but we were equipped by the society to minimize that risk. This was not what

02:09:45.680 happened as coronavirus crashed into our society in March of 2020. We expected our doctors and nurses

02:09:53.180 to take risks, but did not provide them with equipment. And this was an enormous dereliction

02:09:57.980 of duty by the federal government. And so people who are saying, why was Fauci lying? They should

02:10:05.000 then ask the next question, why was Trump lying? Why did Trump not order or otherwise engineer

02:10:10.600 this wealthy nation to produce the PPE that we needed? In fact, I'll tell you an anecdote,

02:10:16.780 because as I said earlier, I was worried about this pandemic back in February, January and February of

02:10:22.520 2020. I can't remember precisely when, but roughly in February, I decided that I should buy some

02:10:27.520 equipment. And I went, I live in Vermont, and I went to the Home Depot in West Lebanon, New Hampshire,

02:10:36.880 across the border, to buy some N95 masks, which are often available in such places to minimize

02:10:43.060 when you're dusting or sanding stuff. You need this type of mask. And I went there to buy it,

02:10:48.220 and I got one of these guys in one of these orange aprons, and I asked him where the masks were.

02:10:53.900 And he looked at me and said, you know, we don't have any more. And I said, what do you mean we don't

02:10:57.000 have any more? And he said, in this West Lebanon Home Depot, that many Chinese people that live in

02:11:05.620 in this area had purchased the masks and sent them back to China. So why? You know, why was our country

02:11:14.240 not able, why were other people aware of the need for this equipment and acquiring it, and yet our

02:11:22.100 country was not, you know, on the ball and manufacturing adequate amounts? By the way, I'm

02:11:26.380 saying this not to demonize those particular individuals or to demonize the Chinese. That's

02:11:30.800 not my point of my story. The point of my story is that other people in other countries were aware

02:11:35.760 of the utility of this equipment, but we seemingly were not. And so this was a major collapse of the

02:11:41.560 federal government, in my opinion, that we expected healthcare workers to run these enormous risks

02:11:46.320 and did not properly equip them. Incidentally, one more point, many loved ones, as a hospice doctor,

02:11:52.960 we would struggle mightily so that people would not die alone. Having a patient die alone was

02:11:57.120 considered a really bad outcome. And I have held the hand of countless people who otherwise would

02:12:02.640 have died alone when they died, you know, just as a doctor, like sitting in their room, you know,

02:12:07.140 watching and helping this person transition to death. And we had tens of thousands, if not hundreds

02:12:13.520 of thousands of Americans during this pandemic, just like in times of bubonic plague. I mean, literally

02:12:18.420 a thousand years ago, we seemingly had not progressed in a thousand years. People dying alone because

02:12:24.700 the hospitals could not spare the PPE for their family. So it's not just that the healthcare

02:12:30.180 workers are dying. The decedent died alone. What an awful thing to happen. The loved ones weren't

02:12:35.400 present. These are all derelictions of duty that can be traced back, in my view, to the lack of our

02:12:40.260 preparedness, which again can be traced back to our politicians and others.

02:12:45.140 Yeah, this actually reminds me of another strike against Fauci that is also not said to disparage

02:12:54.300 the Chinese people. No, I don't think Fauci, just to be clear, I don't think Fauci was responsible at

02:12:58.040 all for the lack of PPE. No, no, no. I just, I was coming back to, I'm just trying to get into the

02:13:03.080 heads of the people who haven't believed a word of what we just said, right, for two hours. I mean,

02:13:07.460 there are those people, if they're still listening, they have a long list of things.

02:13:11.000 Why are we so concerned? Why are we so concerned with those people?

02:13:13.600 Because some of these people have bigger podcasts than I do. I mean, it's incredible.

02:13:19.060 Wow, I didn't know that. Okay.

02:13:20.360 It's incredible what's happened in podcasts, in the podcast landscape. I mean, it's...

02:13:25.060 Okay.

02:13:25.600 And some of these people have smaller podcasts than I do, but still large podcasts that reach

02:13:30.200 millions of people. And they have a list of things we have neglected. They have these,

02:13:34.160 you know, articles from the preprints from some journal that we haven't heard of that has

02:13:40.580 something that we have, you know, scandalously neglected in this conversation. Or, I mean,

02:13:46.780 there's just so many details that either look nefarious or within their purview are nefarious,

02:13:53.080 but that don't actually have the implications that people would want to draw from them. I mean,

02:13:57.640 what was going on a few weeks ago when it was disclosed that, I think it was Pfizer wanted their

02:14:04.640 data on the kids' trials kept out of public view for the next 50 years or something.

02:14:12.840 I mean, what... So you tell me if you know anything about that, but all I can tell you is that in the

02:14:18.980 minds of tens of millions of Americans, that factoid detonates like a 20 megaton bomb, right?

02:14:27.640 Yes.

02:14:27.880 That is just, that's all you need to hear to know which end is up.

02:14:32.100 Yes, I understand that. And I'm actually sympathetic to that. And I'm very, you and I

02:14:37.280 have talked about some of these topics before. I'm very high on the open expression and full

02:14:41.300 transparency. Like I think, I really believe that the cure for ignorance is light. And you need to

02:14:47.140 throw bright light into dark recesses. And that includes releasing pertinent data of this kind.

02:14:51.720 What I read was that a conglomerate or not a conglomerate, a large group of interested parties

02:14:58.260 had filed Freedom of Information Act requests with the FDA for some of these data. And the FDA said,

02:15:03.560 look, we only have 10 employees to provide all the data that's being requested and clear it in the

02:15:07.800 way that has been asked would take us 50 years, so we can't do it. I hadn't heard that Pfizer itself

02:15:12.540 had said no. To me, that strikes me as bad business in addition to being bad public health practice.

02:15:18.140 Maybe I have that wrong. Maybe it was the FDA basically saying at this rate,

02:15:21.500 we're not going to get to this for 50 years.

02:15:23.720 Yes. But then I think then Pfizer could step up and say, no, we'll release it ourselves. Why

02:15:27.460 wouldn't they? I think it's in their interest for people to be vaccinated. And I can see why

02:15:32.540 people would say we want... Now, I also think this can be a kind of turtles all the way down,

02:15:37.400 an infinite regress. Like as soon as these data are released, then the conspiracy theorists...

02:15:41.920 There's no satisfying conspiracy theorists. So let's say Pfizer released the data they requested.

02:15:46.160 They would say, well, actually, now we want to see the original Xerox copies of the original

02:15:49.800 clinical charts of the 20,000 people in the... We want their names and addresses. If you don't

02:15:54.040 leave their names and addresses, we think you made them up. Like that guy that was hawking

02:15:57.160 the Sandy Hook conspiracy that noted. What an awful human being. I mean, what a disgusting human being

02:16:05.120 profiting off the murder of other people's children. I mean, this is ridiculous. But even if you showed

02:16:11.380 this guy video and you showed him death certificates, you said, no, I still don't believe it. I mean,

02:16:15.100 at some point you say, well, excuse my language, but fuck off. There's no way to satisfy such

02:16:22.780 individuals. But I do agree that some accommodation for people's curiosity and inquisitiveness and

02:16:27.400 suspicion needs to be made in a society such as ours. Yes.

02:16:30.340 Yeah. So, but in this vein, again, back to Fauci's besmirched reputation...

02:16:36.600 I hold Fauci in high regard, I have to say. I mean, Tony, I don't know him personally. I've never met

02:16:40.940 him. I've read a lot of his papers. I actually had read his papers before COVID. He was... Fauci

02:16:46.020 was writing about respiratory pandemics when I was in high school. And I followed some of his work

02:16:51.720 on HIV, you know, I would say as a politician, as a leader of... As the leader of the National

02:16:57.180 Institute of Allergy and Infectious Diseases, I was aware of some of his work with HIV, you know,

02:17:01.500 in the 1990s. And there's a lot of history that's been written about his response to the HIV,

02:17:06.700 the AIDS activists, and how they came to be friends and so on. And I think he was a little

02:17:11.940 slow in responding to them, but ultimately did the right thing. And, you know, I generally think

02:17:18.700 highly of him. But I recognize some of the slip-ups, non-trivial slip-ups that you're

02:17:24.700 discussing that you bring to the table. Yeah.

02:17:26.420 So the other... I think the biggest mark against him at the moment is the lab leak hypothesis and

02:17:34.000 the sort of stonewalling he did around that. Yeah, but those senators are... No, I don't agree

02:17:38.800 with that. That, I think, is unfair. I think that from what I've seen, these far-right senators that

02:17:43.600 are trying to suggest that Fauci wanted to give American dollars to Chinese scientists to deliberately

02:17:50.780 weaponize coronavirus, that's ridiculous. Well, yeah. Well, I'm not sure that's the

02:17:56.500 shape of the claim, but it was just the claim that we had given money to the Wuhan lab that was used

02:18:03.540 for gain-of-function research. And then he was, in that exchange with Rand Paul, he was lawyering

02:18:08.780 the language. I mean, he had a very Clintonian, you know, it depends what the meaning of his is,

02:18:14.060 approach to the language around gain-of-function, which drove a lot of people crazy. I mean,

02:18:18.380 the whole left-of-center commentariat ruled Rand Paul to be just an embarrassing ignoramus there.

02:18:26.120 But in most of America, or certainly much of America, it seemed obvious that Fauci was just

02:18:32.700 not acknowledging the plain meaning of gain-of-function. Well, okay. So first of all,

02:18:37.940 I followed this a little, but I mean, I've not seen every video clip. I've not seen every statement.

02:18:42.680 I have seen some of Ron Johnson, and I have seen some of Rand Paul. I've seen some clips.

02:18:47.640 And I honestly don't think those guys are, I think they're being completely disingenuous. And it's

02:18:52.140 also implausible on its face that an American in his 80s, the leader of the National Institute of

02:18:58.300 Allergy and Infectious Diseases, is happily providing money to the Chinese to do gain-of-function

02:19:03.840 research. That's the wrong framing of what- No, but I think that the real allegation would be

02:19:09.820 that it was done, however, inadvertently or inadvertently, and he's just covering for this

02:19:17.380 ineptitude. We had partnerships with Chinese laboratories, which by the way, if we hadn't

02:19:22.740 blown those up, we'd be in a better position right now to know where the virus came from.

02:19:27.460 Now, I don't know all these facts exactly right, but my understanding is that the federal government

02:19:32.480 gave some grants to the EcoHealth Alliance, this entity in New York, which had been partnering with

02:19:38.420 Chinese scientists to collect coronaviruses in caves in China. I think roughly that's what was

02:19:44.220 happening. But it's to our advantage. Imagine if we had had a big archive of bat coronaviruses

02:19:49.840 somewhere in the United States right now. And the way Trump defunded that, looking for some kind of

02:19:56.500 a whipping boy, actually was injurious, as I understand the fact pattern, was injurious to our

02:20:02.540 country because we pulled the rug out from a partnership with Chinese scientists at the precise

02:20:08.360 moment when that partnership would have been most useful to us to actually lay our hands on virus that

02:20:13.640 would have allowed us to figure out where this COVID-19, where SARS-CoV-2 came from. So it is to

02:20:19.540 our nation's credit that we have a commitment to science and scientific inquiry, and that we think that

02:20:26.440 science can be apolitical, and that we have partnerships with scientists around the world

02:20:31.760 who are, you know, even during our competition with Russia during the nuclear arms race,

02:20:37.960 the American government and the Russian government encouraged physicists to talk to each other

02:20:42.240 so that there would be these back-channeled communications that were apolitical between

02:20:46.020 scientists. So to suddenly take this and make it into something nefarious is, I think, just looking for...

02:20:53.280 I mean, I think, so I think that with respect to the lab leak hypothesis, I mean, my view of it has

02:20:59.360 always been, it was always plausible just because of the nature of the case. I mean, you've got the

02:21:04.760 back coronavirus lab right next to the epicenter of this outbreak, but it was, it never seemed

02:21:14.180 important to figure out at the beginning because we had the genome sequence of the virus. We know what

02:21:20.600 we have to vaccinate against, but we obviously we need to figure this out eventually because we don't

02:21:25.580 want any more lab leaks. So the thing that seemed truly crazy-making and obnoxious at a minimum was

02:21:33.760 the political pressure coming from the other side to say that to rule out the lab leak hypothesis as a

02:21:41.140 racist thought crime against the Chinese. Yeah, that's also BS. I think, I think, if I had to guess,

02:21:48.340 I, of the, of the, of the two possibilities we're discussing here, the so-called zoonotic leap, that

02:21:53.380 it was a natural move from, uh, from animals to, uh, humans or the accidental lab leak theory. Uh, I still

02:22:01.480 think the zoonotic leap is more likely, but I absolutely do not exclude the lab leak theory. And the

02:22:07.200 Chinese have done themselves no credit by their secrecy and their lack of transparency. Now, again,

02:22:13.260 however, in fairness to the Chinese, if the Chinese government was demanding that they come to Fort

02:22:16.880 Dietrich to inspect our labs, we also would be quite unhappy with that possibility. Yeah. I think if it

02:22:23.080 was a lab leak, the Chinese have a lot to answer for, not only for the incompetence of that resulted

02:22:28.380 in the leak, but also the coverup, which, you know, is not ideally the way our nation would function.

02:22:33.240 There was a, another famous example of this, I think in the seventies of an anthrax leak

02:22:37.180 in Russia, which actually was a lab leak. And, um, it was covered up actually, I think by American

02:22:43.400 scientists as well. And then I don't know the story exactly. There's a couple of books written

02:22:47.940 about this, but I'm used to know the story. I just don't remember it right now at the level of

02:22:51.760 accuracy. I want to be heard by however many hundreds of thousands of people are hearing us

02:22:56.120 right now. They're this far into our conversation, but I, but I want to say-

02:22:59.680 They're all very angry. They're all, I hope, yeah, exactly. But I, but I, but I, uh, but on

02:23:06.480 the, on the lab leak, I do want to say a couple of things. My lab has done, my own lab has done a

02:23:10.020 little work on this topic. Earlier, I talked to you about how we had this phone data about movement

02:23:15.820 of people, 11 million people transiting through Wuhan in January. And we published a paper in the

02:23:20.160 journal Nature in April of 2020, uh, very quickly into the pandemic that showed that we could forecast

02:23:26.780 the timing, intensity, and location of the epidemic in China simply based on human mobility patterns

02:23:33.080 alone. And a few months ago, it occurred to me, and I actually, I have this in the, uh, in the

02:23:37.420 paperback version of my book. I put in this analysis in the afterward. It occurred to me that we could

02:23:41.780 use these data to reason backwards, not just forwards, and trace back when would be the likeliest time

02:23:49.080 that the first patient that was infected with coronavirus could have left Wuhan. And I date,

02:23:55.820 we call this, I call this patient, uh, zero prime. So this is not the first person to be infected.

02:24:00.640 This is the first person who left Wuhan. And that date is, uh, November 1st. So already by November 1st,

02:24:08.080 the virus was, had certain, was circulating. And then if you make some further assumptions based on

02:24:12.580 what's known about the epidemiology of the virus, it suggests that patient zero, the first person to be

02:24:17.460 infected probably occurred closer to October 1st. So this, you know, I am interested in the origins

02:24:22.980 of the virus. And my own laboratory has done some work on this. I think if I had to guess, eventually

02:24:29.080 we will, we, we may know, you know, there's increasing evidence, very good scientists on both

02:24:33.820 sides of this. I don't want to say it both sides, because that makes it like a political debate.

02:24:37.080 It's not a debate. There's evidence accruing in support of both hypotheses, the lab leak hypothesis

02:24:41.840 and the zoonotic leap. And eventually I think we will have a corpus of evidence that allows us to,

02:24:46.860 you know, make an educated guess as to the most likely thing. I should say one thing we left

02:24:51.840 hanging from part of our conversation maybe an hour ago now is this issue of the inter-pandemic

02:24:57.720 interval. Earlier we talked about how serious pandemics may be coming more frequently. What's

02:25:02.360 the evidence for that? Well, most listeners will be aware of the fact that even in our own lifetimes,

02:25:08.260 there have been many zoonotic diseases. Zoonotic means a disease circulating in animals that comes

02:25:12.720 to humans. HIV is a, was a simian immunodeficiency virus, was in monkeys, came to us. Ebola, we hear

02:25:19.280 about Ebola outbreaks. Zika virus, Hanta virus, SARS-1 in 2003. These happen. And there is evidence

02:25:27.120 that there was a nice paper published in Nature about 10 years ago now, approximately, or approximately,

02:25:32.280 that, that showed that if you look at zoonotic diseases by decade, we're getting more and more

02:25:37.820 of them as each decade goes by. And part of the reason for that actually, believe it or not,

02:25:42.520 connects this global threat of pandemics to the other great global threat of our time, which is

02:25:47.180 climate change. That with climate change, we're seeing increasing motion of people encroaching on

02:25:52.560 the territory of animals and also animals. Their territory is being destroyed by climate change.

02:25:57.100 They come in contact with us. So we have more and more contact between humans and wild animals,

02:26:02.320 and therefore more and more of these zoonotic, you know, leaps that are happening. First point.

02:26:08.260 Second point, if you look at the inter-pandemic interval, the time interval, and this is stochastic,

02:26:13.520 I mean, there's no, it's not like these new respiratory pandemics occur like clockwork. They

02:26:18.660 just occur roughly every 10 or 20 years, but it could be every year, could be every 30 years,

02:26:22.680 there's some variation. The serious ones used to occur every 50 to 100 years, but there's some

02:26:27.380 evidence that that's narrowing. So it's possible that we could have another pandemic, not in 50

02:26:34.100 or 100 years, but in, let's say, 5 or 10 or 20 years. And here's the thing that I think people

02:26:38.660 need to understand. Bad as coronavirus is, it's actually pandemic light. It only kills about 1%

02:26:46.040 of the people it infects. Just imagine, just imagine if this virus, and the lethality of the virus

02:26:51.860 is an intrinsic property of the virus. It kills 1% of the people it infects. But imagine if this

02:26:57.420 virus had killed 10 or 30%. There are other coronaviruses like MERS, Middle Eastern Respiratory

02:27:03.600 Syndrome, that kills 30% of the people it infected. If that had happened, we would have been facing a

02:27:09.100 bubonic plague, like Black Death-type situation in the 21st century in the richest nation the world has

02:27:14.540 ever known. And it would be like in the movie Contagion, for example, which is a fantastic movie,

02:27:19.600 one out of three people dying. And so, and I don't think people fully understand how we've kind of

02:27:26.940 almost, bad as it has been, we've kind of dodged a bullet. And this is why Republican and Democratic

02:27:31.680 administrations for decades have rightly seen respiratory pandemics as a national security

02:27:37.340 threat, and why we need to take them seriously, why we should have taken this one even more seriously

02:27:41.280 than we did, and why we need to continue to take this seriously and prepare for the future,

02:27:46.280 so as not to have to suffer like this again. Yeah, well, that brings up a point that I want

02:27:50.540 to talk about. We are in this wormhole of time dilation where what I thought was going to take

02:27:58.320 15 minutes has taken two and a half hours. So now we're on to the topic I wanted to address with you

02:28:04.280 at minute 16, which is, and it's to the point you just raised, if this were a, you know, this is a

02:28:11.180 dress rehearsal for a worse pandemic, which is, you know, more or less inevitable at some point.

02:28:16.720 I'm very worried that we have learned some of the wrong lessons here. And I think one lesson

02:28:22.740 we learned, at least in the United States, about which there seems to be, you know, almost a consensus

02:28:28.960 is that lockdowns don't work. No, I don't agree with that. But I mean, that's it, like,

02:28:34.380 you'd be amazed if you ever turn on your computer and get on the internet.

02:28:41.300 Well, I do. I just don't appear to spend, I don't appear to be in the dark reaches as much as you.

02:28:46.920 I mean, sometimes the dark reaches find me, Sam, as I know they find you, but I don't go looking for

02:28:52.060 it. I am surrounded by people who think lockdowns don't work. And I mean, so there are two ways to

02:28:58.100 make this claim. That's not true. There's huge amount of scientific evidence of this.

02:29:01.320 Well, so yeah, that's what I want to get to. But there's two things that could be claimed here.

02:29:05.660 You could be claiming that for some truly mysterious and magical reason, lockdowns don't

02:29:12.160 work. Like you successfully lock down and still the virus spreads.

02:29:17.180 Well, if it's spread through the water, if it's rained down from the heavens, that could be the

02:29:21.480 case. Or it was spread by an insect vector, for example, that flew from household to household.

02:29:25.920 But in this case, a respiratory virus, we know that's not the case. If people actually are not,

02:29:31.320 it's commingling. If you actually manage to lock down for a month or six weeks at the outside for

02:29:37.740 a virus like this, yes, you can quash it. But so the second claim, which is apparently true in the

02:29:44.420 United States... No, I don't think that's true either. If you're saying that there are people

02:29:48.300 who argue that if we had just all gone home for six weeks at the beginning, we would have killed

02:29:52.860 this thing. I don't think that's true. I think the virus would have escaped our dragnet and we'd

02:29:58.260 still be, look what's happening in China or even in New Zealand.

02:30:01.680 So here's the second claim, which I think is the more accurate one, which is given just the nature

02:30:07.760 of people and the imperfect nature of any lockdown, no matter how draconian, you can't fully lock down

02:30:16.420 and people are just not going to comply. In the United States, we seem to have 300 million people

02:30:24.280 who really were not going to comply. And therefore, what you're calling a lockdown

02:30:29.660 is never really a lockdown. But the counterpoint to that is when you look at Australia and when you

02:30:35.360 look at New Zealand, their level of excess mortality during COVID is nothing like our own.

02:30:41.580 It's trivial.

02:30:41.980 They simply didn't have excess mortality during COVID.

02:30:44.600 That's right. That is right. And if they now vaccinate their entire population,

02:30:49.820 50 years from now, those countries will be seen as models. Now, in fairness, New Zealand is a rich

02:30:54.220 island. And Iceland and the United Kingdom, they weren't as able to implement this strategy.

02:31:01.000 But yes, that's right. It would be seen as an incredible victory. They kept their population

02:31:06.320 secure. They waited till the vaccine was available. They vaccinated everyone and they had a minimal loss

02:31:11.100 of life and they are having minimal loss of life. And that is admirable. But another point of confusion

02:31:15.300 on this lockdown thing is people, the word is used very sloppily. For me, lockdown is stay-at-home

02:31:21.860 orders or business closure orders. But there are many other steps short of that that are effective.

02:31:28.400 For example, closing schools or banning gatherings or minimizing the size of gatherings or curfews where

02:31:36.820 we say, okay, you can only be out from 9 to a.m. to 10 p.m. or whatever. There are all kinds of

02:31:42.180 procedures the government can implement to reduce social mixing. By the way, sometimes those

02:31:47.040 procedures have paradoxical effects, which make things worse. Like curfews, for example, that I

02:31:53.120 just mentioned, can actually sometimes make things worse by increasing the density in stores.

02:31:59.300 So these are all complicated things that need to be thought through and worked out and modeled and

02:32:03.300 experimented with and so on. And also, you don't do idiotic things like close the beaches when you're

02:32:09.280 talking about a virus that we know where outdoor transmission is greatly reduced. You force people

02:32:15.400 into their boxes and you tell them they can't go to beaches or parks. Yes, that was dumb. And in fact,

02:32:20.420 we had a paper on that that we published. I forgot where. I think on The Atlantic, we just had a little

02:32:25.700 kind of cute little study we did about why every time they were talking about lockdowns or mass

02:32:32.500 gatherings, they showed photographs of beaches, which was just stupid. That's the least risky

02:32:36.320 place. But anyway, so the thing is, when people talk about lockdowns, what they don't understand

02:32:41.320 is they say, some people say lockdowns are ineffective. But what they mean by that is that

02:32:45.180 the studies show that after you have closed the schools and closed the stores, then ordering people

02:32:50.320 to stay home is no longer additionally effective. But basically, you've functionally implemented a

02:32:56.200 lockdown anyway. You've thinned out the movement of people dramatically, short of ordering

02:33:01.700 everyone home. And also, those same people who decry lockdowns are also the people who say,

02:33:06.220 well, they don't want to wear masks. And this is not sensible. Like, if you really want to avoid

02:33:10.360 lockdowns, okay, then do your part. You know, wear your mask, get vaccinated.

02:33:13.640 Well, these people don't want vaccinations either, so.

02:33:16.300 Well, they don't want anything, but that's immature. I mean, that is like saying, you know,

02:33:19.800 I wish, I wish, you know, it's like that scene in Lord of the Rings when Gandalf is talking to,

02:33:26.800 I forgot if it's Frodo or somebody. He says, you know, we all wish that we didn't live in such

02:33:31.180 awful times, but what can we do? Yes, I wish I wasn't having to cope with a respiratory pandemic

02:33:36.600 that's a once-in-a-century event. I imagine the young men that fought on the beaches of Normandy

02:33:40.980 wished that the World War hadn't taken place when they were young men either. But that's when they

02:33:45.640 happened to be alive. And so it's just immature to pretend like nothing is happening. No, the world

02:33:50.360 has changed. There's a new pathogen in our midst. It's like radioactive fallout. It's just there.

02:33:55.420 And so we have to take some action to respond to it. We can debate how to take the least injurious

02:34:02.420 action. We can debate which actions do or do not work, which are effective. Are they worth the cost?

02:34:07.100 All of those are legitimate questions. But to somehow want to pretend like we don't have to

02:34:11.920 do anything, you know, we can have our cake and eat it too, is not, in my view, befitting a great

02:34:16.660 nation. It's not befitting an educated citizenry or the kind of civilization that I think we have.

02:34:22.960 All right. So on that point, in terms of what we should be doing or not doing at the moment,

02:34:29.920 where do you come out on vaccine mandates of various flavors?

02:34:34.920 I think, I mean, I think it's totally fine to have vaccine mandates. In fact, I think I would say I'm in

02:34:40.260 favor of them. Now, I also recognize that we live in a plural democracy, and there are people who will

02:34:46.160 disagree with me. And, you know, for example, I don't think there should, I, if I could, I would

02:34:52.580 ban the private ownership of weapons. But I realize that I'm in a minority here, and that many Americans

02:34:58.400 want to bear arms, and they use those arms responsibly, and that we have at least some

02:35:05.120 kind of constitutional right to bear arms. And, you know, that I live in a plural democracy, and I live

02:35:09.860 with other fellow citizens who have different beliefs about different things. And so we kind of have

02:35:14.000 to compromise and tolerate each other. So on the one hand, I would be in favor of mandates. On the

02:35:18.620 other hand, I realize that there are people who will refuse to get vaccinated. I do not think such

02:35:22.480 people should be put in prison, okay? I don't think that we should send the army to their door

02:35:26.920 and say, well, there's a law that you have to be vaccinated, and now we're going to arrest you,

02:35:30.680 okay? That's not what I'm saying. But I do think we can say, you know, your non-vaccination is,

02:35:36.340 in fact, posing a risk to the rest of us, just like we can conscript you in time of war,

02:35:40.500 which we, the state reserves the right to do that. The state reserves the right to commandeer

02:35:46.040 factories, to manufacture stuff in time of war. We reserve a lot of rights as a collective.

02:35:51.160 We are going to mandate vaccination. And if you refuse, well, it'll be harder for you. You know,

02:35:55.220 maybe you can't fly, or maybe you can't go to restaurants or whatever. You know, it's more

02:36:00.440 difficult for you. But again, so I would say that I think that requiring people to be vaccinated,

02:36:05.600 as we have, by the way, for decades, for all kinds of childhood immunizations. We provide for

02:36:11.080 some exceptions for people, of course, who have medical exceptions we provide for, and we should

02:36:15.220 with coronavirus. We have some religious exceptions. If there was, I haven't seen a legitimate religious

02:36:20.520 objection to coronavirus vaccination, but maybe there is one, and maybe we should tolerate such

02:36:25.400 individuals. But there'll be very few in number. I would not get personal belief exemptions for

02:36:30.360 vaccine mandates. I don't think that's a credible way to run a society. That's like saying,

02:36:34.180 would you give an exemption? I have a personal belief exemption to paying my taxes. I mean,

02:36:38.760 that's not how we run a society. Would you give an exemption for natural immunity if someone can

02:36:43.940 prove that they had COVID? Yes, I would. There, I think I would. Now, we touched on it earlier. I

02:36:48.380 think from an individual perspective, yes. But from a public health perspective, we might not wish to do

02:36:53.580 that for at least two reasons. First of all, we've already established that being vaccinated,

02:36:58.180 in addition to being naturally exposed, is superior for transmission and for the person being

02:37:03.960 infected. And second, the difficulty in ascertaining whether someone truly had had the infection

02:37:08.680 may mean that it's easier for us to just mandate vaccination for everyone. Just like we have other

02:37:14.720 public policies that where we say, you know, we can't sort out who is or is not supposed to do such

02:37:19.860 a thing. You know, some teenagers may be able to drink responsibly and some not, but we don't

02:37:24.880 implement a policy of saying, okay, if you're a straight-A student, you can buy alcohol. And if you're

02:37:29.660 not, you can't buy alcohol. No, we just say if you're a teenager, you can't buy alcohol. So, you

02:37:35.180 know, we may not want to have complex public policies. So while I would certainly talk about

02:37:40.620 it, and it's not unreasonable to imagine that people who've survived the infection should not

02:37:44.220 have to get vaccinated, I think that would not be a crazy thing to discuss or even to implement.

02:37:49.240 Generally speaking, I would be in favor of mandated vaccination. And again, with the idea not being

02:37:54.580 we will arrest people or something, but for example, I don't think healthcare workers should

02:37:58.160 be able to perform their duties without being vaccinated. When you go to the doctor,

02:38:01.640 you don't expect the doctor to infect you with his disease. That's the opposite of what you expect

02:38:06.420 when you go to a doctor. I think that hospital systems that mandate that their employees be

02:38:11.300 vaccinated are well within their rights, and they should do that.

02:38:14.680 Yeah, yeah. I have not understood how we can't have hospitals and other places where healthcare

02:38:22.380 is dispensed. Just the idea that we have 23% of healthcare workers currently not vaccinated.

02:38:29.080 I have to look up that. I've seen a lot of cases recently where there was some resistance in various

02:38:33.720 hospital systems, but in the end, only 100 or 200 people simply refused to get vaccinated and,

02:38:39.020 you know, were let go. Most of the time, what I've seen is that when those things have been

02:38:43.860 implemented, they have been effective. The same with the military, by the way. I never understood

02:38:48.180 the argument in the military because, you know, if you can order people to battle and they run the

02:38:53.140 risk of being shot and dying, why you can't order them to be vaccinated? And-

02:38:59.320 Well, the subtext, you know, the-

02:39:01.500 And in fact, the military, now that the vaccines have been approved, the army just said,

02:39:05.140 you're in the army now, you're getting vaccinated. You know, it's not battle ready. You can't have

02:39:10.020 outbreaks on ships or on airfields or in the front lines of disease when you're trying to fight a war.

02:39:17.060 So no, we vaccinate you. That's what we do. Sorry, Glenn.

02:39:19.300 But the subtext to all of the controversy here, the fact that people think it's an extreme

02:39:25.620 imposition to mandate a vaccine in this case, is the belief that there's something extraordinarily

02:39:34.740 concerning about these vaccines, right? Like you really are imposing-

02:39:39.220 Is that really the objection? Is that really what people are saying? They're saying,

02:39:42.100 you are trying to give me something dangerous or they're saying, you are trying to give me

02:39:47.060 something against my will?

02:39:48.580 Well, there's that. I mean, there's this bodily autonomy argument, but it does seem anchored to

02:39:54.580 a belief. I mean, here's what you get in this, again, this Wild West space of crazy and dangerous

02:40:04.100 bloviation that you'll get people saying, listen, I am not anti-vax. I have had all of my standard

02:40:12.180 vaccines and my kids got vaccinated. I'm not one of these yoga pant wearing wackos who is against

02:40:19.940 vaccines, but-

02:40:21.540 Yeah, because anti-vaxxers used to be primarily on the left, right? This right-wing anti-vaxxer

02:40:25.620 is kind of a new phenomenon, but go on.

02:40:27.140 Yeah. But for these vaccines, in particular, the mRNA vaccines, that's where I draw the line.

02:40:33.620 All right. Well, then get the Chinese, get the Sinovac or Sinopharm vaccine, which are

02:40:37.700 inactivated virus vaccines. Old technology, like many other vaccines you got, get that one.

02:40:42.420 Or even Johnson & Johnson, right?

02:40:44.020 Well, Johnson & Johnson is a new adenovirus vector. What they do is they took

02:40:48.500 the AstraZeneca, I think, took a chimpanzee cold virus, which sounds really weird, but actually-

02:40:54.340 That doesn't sound good, yeah.

02:40:55.620 It doesn't sound good, but it's actually smart because we're not really affected by

02:40:58.740 chimpanzee viruses. It's like your dog can be sick in your house, but you don't get the

02:41:03.220 sickness that your dog has because that virus is optimized to infect dogs, not humans. So giving

02:41:08.900 you a chimpanzee virus is just a way of transmitting that has been genetically modified to express the

02:41:14.020 spike protein on its surface. You mount an immune response against the spike protein,

02:41:18.740 and you just use the so-called adenovirus vector. Or the Johnson & Johnson uses a human,

02:41:23.220 a mild human cold virus that's been weakened even more, and then they add the spike protein

02:41:28.820 to it, and then that's how they deliver it. Those are relatively new technologies, the Johnson & Johnson

02:41:33.940 and AstraZeneca adenovirus, although we have more precedent for those than we did for the mRNA vaccines.

02:41:40.340 But like I said, the Sputnik vaccine, the Russian vaccine, the Chinese vaccines,

02:41:44.500 those are based on older technology. If you want those, get those, right? What's your answer to that,

02:41:49.780 if you're opposed to this new technology?

02:41:50.740 Well, I can only imagine that would be hard to do if one were willing, but I'm sure in this case,

02:41:54.580 they're not willing. Yes.

02:41:56.420 So to bring this home, because now we're hitting the three-hour mark, and we're now talking to

02:42:03.540 five people who already agree with us. But it's whizzed by, Sam. Three hours of whizzed by. At

02:42:10.180 least for me. I won't say for you or the listeners. No, it's been great. So given all that we've said,

02:42:16.420 and given just the experience we've had over the last, now coming up to two years almost,

02:42:24.020 what would you expect in the case of a much more dangerous and lethal virus? Let's say we had the

02:42:31.380 10X or worse version hit us two years from now. We have demonstrated that we can produce vaccines

02:42:38.260 very quickly. I mean, I've come to think that we're sort of in the uncanny valley here with respect to

02:42:44.260 pandemics, where it's just not, as you said, it's not dangerous enough to really nullify all

02:42:50.820 political controversy. I got to think that if 10% of people or 20% of people were dying from COVID,

02:42:59.540 we wouldn't be having this conversation. I think that's right.

02:43:02.900 People would just be getting vaccinated. Yes, I think that's exactly right. And I think,

02:43:07.620 like I said, this virus was deadly enough to cause us harm, but not deadly enough for

02:43:11.780 us to take it sufficiently seriously. I think that if the next respiratory pandemic happens within our

02:43:17.060 lifetimes or within 30 or 40 or 50 years, we will do better. But if it happens more than that,

02:43:23.620 it'll be like people will forget. And this is why, by the way, plagues have been a part of the human

02:43:29.860 experience. And our ancestors tried to warn us. The plagues are in the Bible. They're in Shakespeare.

02:43:37.060 They're in the Iliad. The beginning of the Iliad, the oldest work of Western literature,

02:43:42.980 begins with a plague. It's Apollo. Apollo's arrow brings down the plague upon the Greeks,

02:43:47.860 laying siege to Troy. So our ancestors tried to warn us about this human experience, this

02:43:53.380 awful thing known as a plague. They put it in our religious traditions. They put it in our

02:43:57.220 literary traditions. And yet we didn't heed the warning of our ancestors. And partly this is the,

02:44:02.020 and I contrast this with an example with hurricanes. So the residents of districts of parts of the United

02:44:07.540 States that are afflicted by hurricanes, when the meteorologists forecast a hurricane,

02:44:10.900 that people get, watch the TV, they see the radar images, they know what to do when they take it

02:44:14.820 seriously. Because hurricanes come every year, two or three years, bad ones every 10 or 20 years,

02:44:19.220 people remember, and they take it seriously. But something that happens at a time interval

02:44:24.260 of every 50 to 100 years, out of human memory, tends to be forgotten. This is part of the whole

02:44:29.300 denial problem we discussed earlier. So if the next pandemic occurs within the next 10 or 20 or 30 years,

02:44:35.220 I think we will do better. We'll take it more seriously. There'll be a lot of people that

02:44:38.500 remember this COVID-19 and pay attention. And furthermore, as you mentioned, the world has

02:44:44.500 changed in another way. I rarely am triumphalist about medicine. I can count on one or two hands,

02:44:51.700 the number of medical advances I think have radically improved human wellbeing. You know,

02:44:55.460 penicillin is in that category. Insulin is in that category. CAT scans are in that category.

02:45:01.140 Aspirin is in that category. But also in this category are mRNA vaccines. I think this is a

02:45:07.460 radical new technology that our descendants, when faced with plagues, will have at their disposal a

02:45:13.460 tool such that they can effectively and in real time build a defense. So I think a future president

02:45:21.220 of the United States might say, we have detected a new pathogen. It's serious. We're going to lock

02:45:26.500 down for four months while our pharmaceutical companies make a vaccine and mint and make

02:45:31.540 hundreds of millions of doses. And then we're going to efficiently distribute it to you all.

02:45:34.580 And we're going to have minimal loss of life. That is a realistic potential future. And I think people

02:45:41.220 might be more willing to tolerate such a response and such a civic, a common civic purpose,

02:45:47.940 given this new technology that's available.

02:45:49.940 And finally, what are you expecting over the next year or two or three? I mean, when do we

02:45:57.540 get out of pandemic mode with respect to COVID and get into the new normal of endemic illness? Because

02:46:05.780 I got to assume the possibility of getting rid of COVID is in exactly no one's mind at the moment.

02:46:12.660 No, we're not going to get rid of COVID for the reasons we discussed earlier. I, you know,

02:46:16.740 I discussed this a little in the book, like the phases of a respiratory pandemic, the immediate

02:46:20.260 phase, the intermediate phase, and the post-pandemic phase. We're going to enter the

02:46:23.860 intermediate phase, as I had forecast in 2022, when we're going to reach herd immunity. Pretty

02:46:30.420 much everyone in our country will either be vaccinated or infected and will have acquired

02:46:34.900 immunity that way. And then, then coronavirus will become endemic. It will circulate. It won't

02:46:39.620 be eradicated. It'll still kill people, but the numbers will drop and it'll sort of become like

02:46:44.980 another flu. It'll be bad, but it'll be kind of in the background. And this is what happens

02:46:50.180 with respiratory pandemics. And then we're going to have a period of time in which we're coping with

02:46:54.180 the aftershocks where all the kids that miss school, all the workers that lost their jobs,

02:46:59.220 kind of the great resignation, all the rejiggering of our economy, the debts that we're going to have

02:47:03.540 to start to figure out how to repay our debts. There may be inflation because of the money the

02:47:07.300 government borrowed and so on, those aftershocks. And then I think that'll last for a couple of years,

02:47:12.580 until 2024 or so. And then I think we'll enter a kind of post-pandemic period, a kind of roaring

02:47:17.780 20s of the 21st century, similar to the roaring 20s of the 20th century, where finally we will put

02:47:23.540 the plague behind us, where people will feel like we survived, let's party. So I think that's sort of

02:47:33.940 what's going to happen. We're going to have, as I said earlier, another wave next winter. And

02:47:38.260 eventually, this will tamp down. The clinical impact will tamp down soon, within a year,

02:47:44.340 and the epidemiological impact will tamp down. But then we're going to have to deal with the

02:47:48.260 psychological and social and economic aftershocks. And then those will eventually recede. And we'll

02:47:52.660 see the other side of this, as our ancestors did, who also confronted serious plagues.

02:47:58.660 And are you expecting to need a booster every year indefinitely? Or do you think we're going to get

02:48:04.420 a whole class of coronavirus nullifying vaccines?

02:48:08.020 Yeah. So I think that the forecast I just made depends sensitively on whether we see the emergence

02:48:16.100 of new vaccine-evading strains of the virus. The worst thing that could happen to us now would be

02:48:21.300 that the virus, we would have mutants of the virus which were much more deadly, let's say killed 10% of

02:48:25.460 the people, instead of 1%, or fully evaded the vaccine. If that were to happen, we would be back

02:48:30.980 at square one. I think the probability of that happening, a kind of tail risk event, is between

02:48:36.100 one and 10%. I think it's unlikely to happen, but it's possible. And that would be awful, really

02:48:42.500 calamitous if that were to happen, where if we had a fully vaccine-evading strain, which Omicron does not

02:48:46.500 appear to be, or if we had a much more lethal strain of the virus, which Omicron is not.

02:48:51.140 Yeah.

02:48:52.100 So now, deaths will rise from Omicron, not because each person, if infected with Omicron,

02:48:57.780 is more likely to die than if infected with Delta. No, deaths will rise because the number of people

02:49:02.900 infected is going to be much larger, because Omicron is so much more spreadable and has some

02:49:08.340 capacity for immune escape. So we are going to see a bump. The United States is going to lag Europe by

02:49:13.780 about three or four or five weeks. So we should watch what's happening in Europe in terms of deaths and

02:49:18.980 their response, because that's going to come to this country. So the general overarching forecast

02:49:24.900 I gave, I think, is going to be what happens unless we have the emergence of something that's

02:49:30.180 not Omicron, something that's fully vaccine-evading, which I don't think Omicron is, but we don't know

02:49:35.300 for sure yet, or much deadlier, which I don't think Omicron is, but we don't know for sure yet.

02:49:39.860 If that happens, then we're back at square one and so on. On the boosters, I think if you've had two

02:49:45.780 shots, you should get a booster. I got my booster. I think that's quite sensible. There's evidence that

02:49:50.100 it will be helpful, including against Omicron. And I think that there's a good possibility that

02:49:56.100 we will have to get coronavirus shots in some time interval between every year, like we do for flu,

02:50:02.660 and every 10 years that we do for tetanus. So I can imagine a future in which every three to five years,

02:50:07.780 others, you go to your doctor and you get a coronavirus shot that is updated for the latest

02:50:14.820 strains of the virus. Right, right. Well, I can't help but notice that with a last name like Christakis,

02:50:21.780 you're well-positioned to pronounce the name of each new variant.

02:50:24.740 Omicron. Yes. I joked, when they first said they were using the Greek alphabet, which only has 24

02:50:32.340 letters, I was like, this is not enough. We should have used the Cambodian alphabet, or the Khmer

02:50:37.620 alphabet, I think it has 74 letters, because we're going to run out of letters. And then there was also

02:50:42.900 this whole political thing where they skipped the Greek letter Xi. Yeah, right.

02:50:50.020 Because Xi, Xi, which looks like the Chinese leader. Don't be racist, yeah.

02:50:55.140 Yeah, what a stupid thing. We're going to offend the Chinese leader because we happen to use a Greek

02:51:01.140 letter, you know? I mean, just, oh, and they also skipped new and U because it would be the new

02:51:05.700 strain. It would sound like people would confuse it with any W. I think they should have just stuck

02:51:10.580 with, and then it wouldn't be called Omicron, it'd be called something else. Anyway, thank you,

02:51:14.820 Sam. It's been great talking to you. Likewise. Thanks again for all your time. And again,

02:51:20.340 your book is Apollo's Arrow, which is out in paperback and audio, etc. Always great to talk to

02:51:25.620 you, Nicholas. Until next time. It's great, Sam. Yeah, exactly. Thanks, man. I'll talk to you later.

02:51:31.140 I'll talk to you later.

Making Sense - Sam Harris - December 14, 2021

#270 — What Have We Learned from the Pandemic？

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