Making Sense - Sam Harris - #425 — Are We Prepared for the Next Pandemic？

00:00:00.000 Welcome to the Making Sense Podcast. This is Sam Harris. Just a note to say that if you're

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00:00:30.180 doing here, please consider becoming one. I am here with Mark Lipsitch. Mark, thanks for

00:00:39.180 joining me. Thanks for having me. I enjoy your podcast and happy to be on it. Oh, nice. Well,

00:00:44.180 I am a big fan of the Center for Communicable Disease Dynamics, which is a mouthful, which

00:00:49.740 you run at Harvard. Before we jump into the topic at hand, can you summarize your scientific

00:00:55.740 background? Sure. I was trained as an evolutionary biologist and mathematical biologist. I'm now an

00:01:01.360 infectious disease epidemiologist and microbiologist, so I've moved sideways a little bit. But the

00:01:07.920 common thread is that I'm very interested in understanding how, when we give people vaccines

00:01:13.820 and antibiotics, how that affects the populations of infectious agents, and then how those changes in

00:01:19.860 the infectious agents affect us and our health. And so I work on how that works, how we measure it,

00:01:27.580 how we measure whether vaccines are doing their job, for example, how we track antibiotic resistance

00:01:33.520 over time, and so forth. And then more recently, I've been involved in two other things. One is the

00:01:41.600 response to the COVID pandemic on a bunch of different fronts. And the other is areas of research policy

00:01:48.020 and research ethics around potentially risky experiments and human challenge trials for COVID

00:01:56.560 vaccines. So I move around a little. Yeah. Well, it's probably been a busy few years for you, I can

00:02:02.500 imagine. This has really been, the entire world came crashing into your wheelhouse somewhere around

00:02:08.860 the beginning of 2020. Yeah. Let's start with COVID. I mean, obviously, I'm very concerned about

00:02:14.860 the Trump administration's apparent assault on American science and scientific institutions. I

00:02:20.940 want to get there, but let's start with COVID. What did we learn from COVID? I guess, what did we

00:02:27.740 learn that we should have learned? What have we imperfectly learned? And what perhaps wrong lessons

00:02:32.660 might we have learned at this point? Yeah. And I think the other pieces, what did we observe and

00:02:39.120 probably won't learn even though we should have? There's a whole history of observing lessons and

00:02:46.940 repeating the same mistakes. I think what we learned was a number of things, but one really big one is

00:02:54.200 the importance of public trust and public solidarity in the response to an emergency like COVID. I think

00:03:01.680 that the fact that different parts of the country and different people had very different levels of

00:03:06.660 trust in what the government was telling them and in the vaccines and before that, the interventions

00:03:14.680 that were put in place to slow the spread meant that it was much more divisive than it was in some

00:03:22.600 other places and that our response was worse. I think we also learned that our public health system

00:03:28.260 needs an upgrade. It was designed in the 19th century at a very hyper-local level with all the data and all

00:03:35.660 the power really in the states and counties. And that makes it very hard to have a unified national

00:03:42.100 response. And I think we also learned that, and this is one of those things that we sort of relearned,

00:03:50.680 had been already noted a few decades ago, that policies need to be revisited on a regular basis

00:03:59.440 with new information. The information is changing very fast in the middle of a pandemic and the

00:04:05.820 policies that seemed like a good idea in the past may have lost their value or we may have more new

00:04:11.880 information that says they weren't actually valuable and we should stop them. And I think an example of

00:04:16.820 that might be, a good example might be school closure, which looked like the right thing to do. I think it was

00:04:22.500 the right thing to do in the absence of good information. But we learned pretty quickly that

00:04:28.220 young children in particular were not very important in transmission. We learned that those

00:04:34.740 schools that stayed open managed to do so pretty safely. And the policy was kind of stuck in place.

00:04:41.640 And the U.S. was one of the places that kept schools closed the longest for not very good results

00:04:47.500 and for a lot of damage that that did. And that was pretty clear pretty early. But we, for various

00:04:53.340 reasons, kept policies in place past their useful life. How would you describe the unraveling of

00:05:01.880 institutional trust and actual trustworthiness over the course of the pandemic? I mean, to what degree

00:05:08.920 was the loss of trust warranted? I mean, I think everyone who's on the highly

00:05:17.180 contrarian anti-establishment side at this point has a litany of abuses they can cite, you know,

00:05:24.400 real or imagined abuses, noble lies that were told, you know, masks don't work and masks, you know,

00:05:30.020 don't grab all the PPE because they're desperately needed for first-line responders. But, you know,

00:05:35.900 also masks don't work. You know, try to square those to that logical contradiction. How would you describe

00:05:42.240 the, what happened and the challenge of communicating scientific uncertainty to a public in the middle

00:05:51.300 of a global health emergency that the scope of which is still, you're still struggling to understand

00:05:56.300 and you're messaging into a highly polarized and fragmented information landscape?

00:06:03.300 Yeah. Well, I think we started from a position of very low levels of trust in government among some

00:06:10.140 people and some segments of society and in public health, particularly. Public health has been

00:06:15.500 underfunded for a long time in the United States and particularly in the least advantaged parts of

00:06:22.360 the country. And so we started from a rough position and we also started from a level of enormous

00:06:30.580 inequality. And we know that people who were more disadvantaged had worse COVID outcomes within the

00:06:36.760 U.S. And so there was already grounds for polarization. I do think that the early communication from the

00:06:44.720 U.S. government under the first Trump administration was very confusing and that the promises that it

00:06:53.600 would be over by Easter had no basis in any kind of science and were nonetheless made from the White 1.00

00:07:01.400 House. On the other hand, indeed, as you said, there were comments made by people who were trying to

00:07:08.280 induce the behaviors in the population that they thought would be more desirable. And they did come

00:07:15.560 out with comments that were not scientifically valid. And that, of course, undermined trust when they

00:07:21.480 changed or when people, as you noted, figured out that it actually didn't make logical sense to say,

00:07:27.280 don't use all the PPE, which doesn't work in the first place. So I think there's plenty of blame to

00:07:33.640 go around, but that the system was in bad shape to begin with. And that's something to remember for

00:07:39.880 the future because the people will largely be different the next time, but the system is going

00:07:45.300 to be very much whatever we make it or at the moment, however we're breaking it. And seeing the current

00:07:53.460 threats to good science and good public health is pretty, pretty worrisome as I think about the

00:08:00.120 future. Yeah, we will get to fears of the future because I share them. What is the appropriate

00:08:08.080 posture and just rhetorical algorithm to be running as a communicator of, you know, public health

00:08:16.380 information in the midst of a, an epidemic like that, where, where uncertainty is real and the

00:08:23.220 story is changing. And yet, you know, that you're getting, you know, clipped into social media and

00:08:29.640 you've got six minutes on CNN and you're, you're, it's an environment that's hostile to nuance.

00:08:35.460 It's hostile to uncertainty on the part of the so-called experts. The very role of an expert is being

00:08:42.120 undermined by perceived failures of expertise. And unfortunately, scientific uncertainty, while it

00:08:48.500 is the, often the, the only sane thing to confess in the midst of a conversation about the science,

00:08:55.540 when you're confessing it on the news, you're, at least to many people's ears, you're, you're failing

00:09:02.120 to function in the political role that is also part of the communication of, of science during an

00:09:08.520 emergency, right? So you're, you're giving advice to the public and when the story changes or when the

00:09:14.240 store or when, when the story is always a probabilistic one, like you, you, you think

00:09:18.260 something may be benefit, but you may be it's, but you're not sure. And you're, you're aware that the

00:09:23.440 stories might change. How will you want to walk that tightrope next time? Because clearly during COVID

00:09:30.700 that just the, the communication burden and the failure to meet that burden was just unbearable at a

00:09:38.300 certain point. I mean, we just, we had a society that shattered over the perceived failure of, of

00:09:45.320 expertise in the midst of this pandemic is so much so, I mean, the shattering is a little bit of a

00:09:50.300 cartoon, but it's not too far from what, what's true. We had half of our society that was absolutely

00:09:56.200 terrified of COVID and desperate to get vaccinated at the first opportunity. I mean, I, you know, I,

00:10:00.900 I waited in the dark at four in the morning to get, you know, overflow, possible overflow vaccines

00:10:06.080 in a ghetto in Maya city. And yet the other half of the country thought COVID was more or less a

00:10:12.660 non-issue. It was the flu, but they were terrified to get vaccinated. And that division remained for,

00:10:19.940 in some sense, it still remains, right? Still remains. Yeah. Again, how would, how would you, as someone

00:10:24.900 who's trying to give an honest account of the best information in so far as you have it, you know,

00:10:30.960 hour by hour during a pandemic meet this challenge of communicating nuance and uncertainty in the

00:10:38.880 current environment? Because I just think we, we obviously failed somehow last time. And there has

00:10:45.080 to be some rhetorical device that authorities can arm themselves with so as to inoculate people against

00:10:52.340 their conspiracy thinking and their, and their waiting of when the story changes, that's how science

00:10:58.920 is done, right? It's not, there's nothing nefarious about the story changing in principle. And yet

00:11:04.340 every time the story changed, it was perceived to be to the absolute discredit, that really the

00:11:11.560 everlasting discredit of scientific institutions. Yeah. I think it's a great set of questions you ask,

00:11:17.040 and it's not hypothetical. At the Center for Communicable Disease Dynamics at the Harvard Chan School,

00:11:22.060 we ran 150 plus Zoom-based press conferences during the course of the pandemic to try to

00:11:28.900 do exactly what you're saying, to try to lay out what was known and what was not known. But I think

00:11:33.500 from the perspective of government spokespeople and, and experts, this is something that really

00:11:39.140 has to start between, during peacetime, during a period when people are hearing about, you know, beach

00:11:45.520 safety and avoiding heat stroke and sort of more routine things. And it has to be, come clear that

00:11:54.180 science evolves. Most science doesn't evolve as fast as pandemic science. And so it is a special time

00:12:00.080 during a pandemic. But when there's a new outbreak of something that's not understood, experts can say,

00:12:06.700 look, this is what we think it is. These are the precautions we're taking because we think it may

00:12:10.960 be these things. And we're going to keep updating and we're going to keep refining what we know and then

00:12:16.480 changing our recommendations as we understand it better, or as the situation changes or both.

00:12:22.040 And I think people, people do that in their normal lives all the time. You know, weather forecasts

00:12:28.080 are use, use science and, and people are perfectly capable of, uh, understanding that as you track a

00:12:34.820 storm, you update what you think about it. They don't say that the weather forecasters are, are

00:12:40.760 wafflers or, or incompetent. Uh, we sometimes do think they wish they were more on the ball, but we know

00:12:47.460 that it's a probabilistic game. I think people are actually smarter and more able to deal with these

00:12:52.780 kinds of things than, uh, they're often given credit for, but they have to be treated as adults

00:12:59.620 and, and be used to it during peacetime and during, during periods when, when they aren't also under

00:13:05.800 incredible stress from the pandemic itself. Uh, the leader of Singapore actually set an extraordinary

00:13:12.000 example. He did a Facebook live post or session in February of 2020 as the pandemic was starting

00:13:19.420 and, uh, had come to Singapore already. And he got on, on Facebook live and said, this is what we know.

00:13:25.640 We went through SARS one, uh, in the past and, and we have learned some lessons from that because they

00:13:32.140 were very hard hit by the original SARS in 2003. He said, this is what we know. This is what we're doing.

00:13:37.240 We're going to change what we do and what we know as, as the situation changes. And it was very

00:13:43.380 straightforward, all in very clear language. And, you know, I think we have a lot to learn from that

00:13:49.740 performance and it's not something that a lot of public health officials are comfortable doing.

00:13:55.980 I think there are also ways to build it into the system. Up until the end of last month, I was part of

00:14:01.840 setting up a new center within the CDC called the Center for Forecasting and Outbreak Analytics.

00:14:07.240 And one of the things that we really tried to do there when designing our public communications was to

00:14:15.560 have a regular update. Uh, when there was a, when there was a crisis going on, we would set a regular

00:14:20.040 pattern of updating what we said so that people would expect that and wouldn't be, wouldn't think there

00:14:26.120 was some kind of emergency if there was a new statement because there was a new statement on some

00:14:31.260 regular schedule. And also it would be expected that those updates would come. And so

00:14:37.020 if for some reason it didn't come, there would be a demand for it. And that would, uh, insulate

00:14:41.960 against potentially political interference. So I think there are ways to do that. That's something

00:14:48.320 the UK, uh, really has pioneered, uh, in their public health communications and do very well.

00:14:53.760 And so I think building in regular updates of data, building in expiration dates for policy decisions

00:15:00.880 and public health guidance, uh, where you say, this is our guide, our interim decision or guidance until,

00:15:07.800 uh, say 30 days or 90 days. And then we're going to revisit it helps to unstick the process and

00:15:14.460 avoid the kind of policy stickiness that, that really caught us, uh, made our policies worse,

00:15:21.940 uh, during COVID. And that's an old lesson. There's a great book by Harvey Feinberg and Richard

00:15:27.340 Neustadt on the swine flu affair, uh, when we vaccinated millions of Americans against,

00:15:32.400 uh, swine flu in 1976 after three cases. Uh, and then that never became a thing. And we,

00:15:40.680 we had a number of adverse effects and their number one recommendation was to make sure that

00:15:47.080 policies have off ramps. And that's an example of one of those lessons that we should have

00:15:51.380 already had in our back pocket, but we didn't quite. Why do you think vaccines are so uniquely

00:15:57.680 terrifying and polarizing? I mean, it seems that people who are, you know, highly, um, uh,

00:16:05.980 it are radicalized by vaccines and their use and their mandates and their, et cetera, et cetera,

00:16:11.520 aren't radicalized by similarly or even more, you know, even riskier medical interventions,

00:16:19.820 right? I mean, you had the spectacle of people who wouldn't take the COVID vaccine under any

00:16:24.280 circumstances and would have gone to their deathbeds, praising themselves for not having taken

00:16:28.100 it. And yet they'll sign up for something that is the safety of which is far less demonstrated.

00:16:33.800 And I mean, even something that's like a therapeutic for COVID. I mean, there, I know people who wouldn't

00:16:38.880 get vaccinated for COVID, but the moment they got COVID, they got, you know, monoclonal antibodies

00:16:43.780 pumped into them and a bunch of other cocktails just on the, on the chance that it would

00:16:49.180 mitigate the illness. This was early on when it was still an illness that people reasonably feared.

00:16:55.400 What is it about vaccines in your view? Yeah. I think monoclonal antibodies are also quite safe,

00:17:01.060 but yeah, but putting that aside, but I mean, tens of millions of people hadn't taken them at that

00:17:05.760 for COVID at this point. Yeah. So I think one part of the answer is that there is a

00:17:12.340 sophisticated and widespread campaign to try to make people scared of vaccines,

00:17:17.240 vaccines, which has been led in the past by the man who's now our secretary of health and human

00:17:22.380 services. And we shouldn't put that aside that some, some people have an interest in making

00:17:27.560 radicalization about vaccines. Uh, and why that is we could speculate about, I don't actually

00:17:32.980 understand, but it is, it is a fact.

00:17:35.320 I do think that, I think that is just also my question, right? It's like, well, so they're doing

00:17:41.680 it for vaccines in a way that they're not doing it for other medical interventions. And I, so this

00:17:48.060 gets at, it's just another way of stating the question, like, what is so scary about vaccines?

00:17:52.720 Is it, I mean, I, to give you just a, um, a shade of an answer that I have rattling around my brain,

00:17:58.480 it might have something to do with the fact that we give them to healthy children, right? Like,

00:18:03.300 it's not like your child is sick and you have to do something to get him or her well. It's your

00:18:08.980 child's healthy. And now you're, you're sticking a needle into, uh, you know, in many cases, an

00:18:14.700 infant who can't even understand what's happening. That's disturbing. And the idea that there's some

00:18:19.940 risk of a bad effect, which is real, that's somehow intolerable, right?

00:18:26.520 I think that's true. But, uh, and I think, yeah, I think that is part of the story. On the other hand,

00:18:31.980 as you said, there are a lot of things that are more dangerous, much more dangerous in reality

00:18:35.940 than vaccines are. And yes, I think, I think as a, as a matter of human psychology, it is

00:18:41.500 more natural to people to intervene when there is a, an immediate problem. So an illness to treat

00:18:48.340 rather than to prevent. It's just part of human nature as best I understand human nature.

00:18:54.160 But I also think we shouldn't discount the fact that people have chosen to make this

00:18:59.120 a toxic issue to use a, perhaps the wrong word, um, a, an issue that is polarizing and that

00:19:07.020 where fear is being instilled for no good reason. I think the susceptibility to that fear might have

00:19:12.860 something to do with what you said, but, but we shouldn't overlook the fact that this is a big

00:19:17.000 industry. So what should we believe about COVID and COVID vaccines at this point? Maybe we can do

00:19:24.800 this kind of rapid fire. I'll tell, I'll tell you what's in my head and you, and you can debunk my,

00:19:30.780 my, the myths and, and half truths that have gotten there perhaps. I imagine that I know that

00:19:37.060 something like 1.1 million Americans died from COVID and probably, I think this is due to still

00:19:45.240 mathematical modeling, but something like 300,000 people died who didn't need to die based,

00:19:52.200 as a result of vaccine hesitancy. Is it, does that sound right to you?

00:19:56.340 Yeah. I think the numbers are a little bigger on the number who died, but that's the right order 1.00

00:20:00.060 of magnitude. Is there any reason to be more concerned about the risks associated with mRNA vaccines

00:20:08.380 as a class of vaccines than ordinary vaccines? And are, is there something riskier about COVID vaccines

00:20:16.140 than the other vaccines that people routinely take? On COVID? No, it's, I mean, it's a new virus. So

00:20:23.100 we are learning about the safety as hundreds of millions of people get it, but we've learned a lot

00:20:29.680 because hundreds of millions, billions of people have now gotten these vaccines. mRNA is a new

00:20:34.700 technology. It's understandable that people find it unfamiliar and have questions about it, but the data

00:20:41.300 showed that these mRNA vaccines against COVID are extremely safe. They are not 100% without side

00:20:47.780 effects. There are side effects. Those have been documented. It's also clear that in the presence of

00:20:53.060 COVID circulating SARS-CoV-2 or COVID virus, it is a good trade-off to take the risk of side effects

00:21:02.000 for most people compared to the risk of, that it protects you from, from getting COVID and its complications.

00:21:09.140 How do you think about the risks for specific groups like teenage boys? I mean, I think that was the,

00:21:15.140 the one cohort where it seemed like there, there was real signal of myocarditis risk that was

00:21:22.100 looking like, um, in that group, maybe it was a toss-up as to whether or not they should get

00:21:27.260 vaccinated given the risks on, on both sides. I don't, I don't know what the current thinking is

00:21:31.580 there, but it seemed like it was, you were not completely irrational to think maybe my teenage son

00:21:37.700 does not need the COVID vaccine given how benign the disease tends to be in kids that age and the,

00:21:44.580 the elevated risk for boys for whatever reason. Yeah. I think that's not irrational. And I think

00:21:50.020 people who make that decision or whose kids make that decision with them when they're teenagers are,

00:21:56.700 are, are, are making a, an understandable decision. We had our, well, we have girls, but we had,

00:22:04.000 we would have, uh, had our teenagers vaccinated had that been who we had as children because,

00:22:10.540 uh, had we had boys because the myocarditis while real was not very severe in most cases,

00:22:18.720 uh, it went away and the small risk of, of really severe COVID and long COVID, uh, which there's

00:22:27.360 growing evidence that vaccines help with as well was enough, would have been enough in our minds.

00:22:32.940 But I, I think people, that's part of treating people like adults is there are ways to reasonably

00:22:40.180 disagree. And I don't begrudge anybody who makes the opposite decision of that for that group of people.

00:22:47.040 I think as you get to age groups, uh, or groups of people like pregnant women who are at very high 1.00

00:22:53.100 risk or comparatively high risk of complications, that decision becomes harder to justify based on

00:23:01.740 numbers and really a matter of being opposed to vaccination more generally. And that, that I think

00:23:08.740 is very hard to, to understand, but it's, it's certainly something that some people, uh, view that some

00:23:14.940 people hold and the needs to be discussed with them, with their doctors and, and figured out.

00:23:20.680 What about now, now that the disease has evolved to be more benign, uh, how do you view the risk

00:23:29.180 reward of vaccination? I mean, so speaking personally, I told you that I was waiting in the dark at four in

00:23:34.960 the morning, hoping to get an early vaccine. Now for the last, I think at least two years,

00:23:41.000 I don't think I've been vaccinated because I I've gotten COVID more or less on schedule once a year.

00:23:47.300 And that in my mind has served as my vaccination for that year. How, how, uh, preposterous is that

00:23:54.900 road to personal health? The value of vaccination as opposed to becoming infected to build immunity

00:24:02.560 is that the risk of long COVID is not there. The risk of, although low of severe illness is not

00:24:09.340 there from the vaccine and it is from COVID even, uh, even though the probabilities are low.

00:24:15.440 So it's an understandable decision. I think you could improve your odds a little bit of

00:24:20.600 certainty of staying healthy by, by periodic COVID vaccination, but it is not the same kind of

00:24:27.840 public health emergency that it was in years past. And so I think, you know, people will,

00:24:34.540 will have different views. And that's certainly true in the numbers that the numbers of people

00:24:39.420 getting vaccinated is, has gone down. Part of the, the main reason why it appears to be a more mild

00:24:45.480 illness is that we have a lot of immunity in the population, both from previous infections and from

00:24:51.400 multiple rounds of vaccination. So some of it is the evolution of the virus, but yeah, there aren't

00:24:57.160 very many people around to test this hypothesis on. But my prediction would be that if you, uh,

00:25:02.240 magically made the entire population susceptible again and removed their immunity, uh, there would

00:25:07.080 be a lot of severe COVID around. It's just that we, the combination of host immunity and a little

00:25:14.340 bit of the evolutionary changes, uh, has combined to make it rarer that people get severe illness.

00:25:21.540 So again, just taking my personal case and people can draw whatever lesson, uh, they can draw from it.

00:25:26.860 So if I get the flu vaccine every year, because that's what I do and it's a new flu every year

00:25:32.720 and I'm not getting the COVID vaccine, do you, uh, detect any cognitive dissonance there? I mean,

00:25:40.300 it's in my own mind, the rationale is I remember every time I got the COVID vaccine, it actually

00:25:46.380 seemed like I had fairly significant side effects and I felt crappy for at least 24 hours. So it seemed

00:25:53.140 like more of a vaccine than a flu vaccine, which I never perceive an effect from. Uh, and that's

00:25:58.000 really just my, the source of my bias. If you were me, would you be getting a COVID vaccine every

00:26:02.900 year and a flu vaccine every year? And that, that would be the rational way to, to have a sane

00:26:07.760 approach. I think so. I mean, these are not the same kinds of truly life and death decisions that

00:26:13.800 they were when the vaccines first came out and when COVID was a bigger threat. So, you know,

00:26:18.860 I'm not going to spend a lot of time trying to convince you one way or the other, but the COVID

00:26:23.940 vaccines are also probably more effective than the flu vaccines on the whole. And so, yeah, you,

00:26:29.660 you pay a bigger price and you get somewhat more protection. So on balance, are we any better prepared

00:26:37.480 for the next pandemic or do you think we're worse off for, for the stress reversal we experienced?

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Making Sense - Sam Harris - July 21, 2025

#425 — Are We Prepared for the Next Pandemic？

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