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

Episode Date: December 14, 2021

Sam Harris speaks with Nicholas Christakis about the lessons of the COVID pandemic. They discuss our failures to coordinate an effective response, the politics surrounding vaccination, vaccine efficacy, vaccine safety, how to think about scientific controversies, the epidemiology of excess deaths, transmission among the vaccinated, natural immunity, selection pressures and new variants, the failure of institutions, the lab-leak hypothesis, the efficacy of lockdowns, vaccine mandates, boosters, what would happen in a worse pandemic, and other topics. If the Making Sense podcast logo in your player is BLACK, you can SUBSCRIBE to gain access to all full-length episodes at samharris.org/subscribe.   Learning how to train your mind is the single greatest investment you can make in life. That’s why Sam Harris created the Waking Up app. From rational mindfulness practice to lessons on some of life’s most important topics, join Sam as he demystifies the practice of meditation and explores the theory behind it.

Welcome to the Making Sense Podcast. This is Sam Harris. Okay, we are well into December here. The end of the year is upon us. I'm sure this has put you all in a reflective mood, as it has me. Where did 2021 go? That really felt like it was six months long at best. It is amazing. It has also been 10 years since Christopher Hitchens died. That anniversary has arrived, the 15th of this month, which, depending on when I release this, is either tomorrow or today. And that remains a loss. The truth is, Hitch was really just hitting his stride when I came to know

him. I believe his book, God Is Not Great, was his first bestseller. He was famous in journalistic circles, but was really just connecting with a wider audience. And then his memoir was the last book that he actually wrote. His amazing short book, Mortality, was a collection of his Vanity Fair essays that came out after he died. Well worth reading. Anyway, he is sorely missed in this post-institutional time where journalism and media and the ivory tower, or really the whole class of professional where really the whole class of professional commentariat has heaped shame upon itself with both hands, and that in part will yet again be the topic of today's podcast. It is amazing to think of how good Hitch would have been

aiming his intelligence at the twin horrors of Trumpism and wokeism. Man, the pyrotechnics we would have seen on both sides of the political spectrum would have been amazing. Hopefully in some universe that is happening. Anyway, I will endeavor to do my best with the tools at hand. However, as you know, one of the things that lures my attention away from matters journalistic and political is what I'm doing over at Waking Up, where there has been a development that has made me very happy of late. On January 1st, 2022, a mere two weeks away, we will be releasing the Collected Talks of Alan Watts. Watts was an extraordinarily lucid thinker and writer, and one of the most gifted speakers

we've ever had. I could be describing Hitch there as well. But as many of you know, Watts did as much as anyone, and probably more than anyone, to bring Eastern wisdom to the West. And the counterculture of the 1950s and the 1960s would be hard to imagine without him. I never met Watts. He died in 1973 at the age of 58. I believe in his library on the slopes of Mount Tamalpais in Marin County. But in my 20s, I had nearly 100 cassette tapes of his recorded talks, all of which got lost in transit when I moved back to California. But now all of these hours of good company have been restored to me in the digital archive that has been curated by Alan's son, Mark Watts, and it makes me very happy to

present these collected talks on waking up. So look for that on January 1st. That'll be a great way to start the new year. And that is it by way of housekeeping. Today I'm speaking with Nicholas Christakis. Nicholas has been on the podcast a few times before. He probably needs no introduction. He is a physician and sociologist, an expert on network theory, a professor at Yale, network theory, a professor at Yale, and a wonderful guide to the COVID pandemic, about which he has written a book just out in paperback titled Apollo's Arrow, The Profound and Enduring Impact of Coronavirus on the Way We Live. And in this episode, we discuss the lessons we have learned or struggle to learn or should have learned from the pandemic at this point. We discuss our failures to coordinate an effective response

at almost every level, the politics surrounding the rollout of the vaccines, vaccine efficacy, vaccine safety, how to think about scientific controversies, the epidemiology of excess deaths, transmission among the vaccinated, natural immunity, selection pressures and new variants, the failure of institutions, the lab leak hypothesis, the efficacy of lockdowns, vaccine mandates, boosters, what would happen in a worse pandemic, and other topics. Anyway, the purpose of the conversation is to try to say something reasonable to those who are as yet unvaccinated.

As you'll hear, I am quite consciously providing a counter-message to much of what is heard out here in Podcastistan and over there in Substakistan. I'm increasingly worried about the appetite I have detected outside the gates of the mainstream media for contrarian takes on more or less everything. A generic word of caution to everyone within earshot of this broadcast. The non-standard explanation is not always the correct one, even when our institutions have repeatedly disappointed us. In fact, the non-standard explanation is still, I would say, generically, rarely the correct one.

So keep that in mind as you listen to my fellow podcasters discuss what they think is true or likely to be true in this universe of ours. And as this is yet another PSA on this topic, there will be no paywall, but if you value the work we're doing here, you can support the podcast by going to SamHarris.org and subscribing.

Okay, without further delay, I bring you Nicholas Christakis. I am here with Nicholas Christakis. Nicholas, thanks for joining me again. Sam, thanks so much for having me back. So you might be the record holder at this point on the podcast. I've lost count. I think maybe Paul Bloom might be ahead of you, but it's you and Bloom for most frequent guests.

I think it's our third conversation that's being recorded, at least. Right, right. Well, you're in good company. So there's a lot to talk about here. First, your book, Apollo's Arrow, The Profound and Enduring Impact of Coronavirus on the Way We Live, just came out in paperback about six weeks ago or so. We're going to cover some of the themes in that book because, among other things, I want to talk to you about the state of our understanding and the state of our public conversation around all things COVID. Vaccines, vaccine hesitancy, lockdowns, school closures, everything that has happened, any missteps that we may think we have made in the last 18 months coming up on two years. And I want to get some of the public service aspects of this conversation sort of loaded

to the front for us here. But before we jump in, briefly remind people who you are. How is it that you know anything about what we're about to talk about? Okay, so yeah, first of all, it's getting really nice to talk to you again. I'm a physician and a sociologist, and I've spent 20 years studying social networks. So I study spreading processes in networks, how ideas spread, how emotions spread, and of course, how germs spread, which is a very profound metaphor for how other things spread, but it's not just a metaphor, it's germ spread. And so understanding how germs spread is very important.

And so I have some training in public health and epidemiology as well. And actually, when the pandemic was coming on about a year and a half ago now, in January of 2020, I became very alarmed about what was coming down the pike and decided to redirect a lot of my efforts to study it. Yeah, yeah. And you've been, you really have been on the short list of people who have been worth listening to below these many months that we have been in this pandemic experience. And I must say, I remain fairly mystified about the sociological problem we face here, just in figuring out how to communicate about these issues in a way that doesn't just obviously

fail to solve some basic problems of coordination and cooperation and persuasion. I mean, apart from the speed with which we developed vaccines, we have failed on so many other fronts that it is fairly bewildering and depressing. I don't know if you share that outlook at this point. It's almost a quintessentially American success on the technological front that we did the vaccines, and we'll talk about that, I'm sure, but it's also depressingly American in some ways, our failures. I mean, one of the things that I think it's interesting to step back for a moment and understand is that we are a rich and plural society in the 21st century, and we are a capitalist economy, and we exchange goods and services of all kinds. And in our society, you can find any expertise that is humanly available. So when you need a

cabinet made, or your car repaired, or you need surgery, or you need detectives or military activities, or basically any kind of domain of musicians, artists, you name it. We have people who've devoted their lives to those different sorts of activities, and we pay for those. When you have a plumbing problem, you don't know how to fix the problem or you have an amateur understanding. So you hire an expert plumber. And there's a famous saying in sociology that one man's occupation is composed of another man's emergencies. So for you, the plumbing thing happens rarely and is a disaster. Your placement is flooding. But for the plumber, this is his or her usual course of business. And then you gladly give money to that person in a classic Adam Smith kind of,

everyone has their own expertise and we exchange our expertise and we're all better off as a result. But here's my point. In our society, and after hundreds of years since the Enlightenment with advances in science, we have experts on every scientific topic, including respiratory pandemics. And what is happening to us is not novel. There is an enormous wealth of knowledge about what is happening to us and about how optimally to respond and about the epidemiology of respiratory pathogens and the biology of coronavirus and the development of vaccines and an understanding of the human body, the physiology and the treatment of people with

these conditions and the organization of our hospitals and our public health systems. And we have thousands of people who have devoted their lives to acquiring this expertise. And so it's a mystery to me that we don't happily deploy them like we would with any other activity in our capitalist society. And what's especially odd to me is that different societies have different strengths. So for example, the Chinese are an authoritarian country with a collectivist culture. our authoritarian country with a collectivist culture. And when coronavirus, the pandemic began, they deployed those attributes and did things that would have been impossible in our society, and frankly, things I wouldn't have wanted either. I think which included welding people into their apartments at various points. Yes. I don't know. I mean, I've heard the same stories. I don't know for sure they're true. But functionally, yes, that's what they did. They ordered 930 million people to stay at home for months. And they enforced this. freedom. We have a free and open society. We have

free press. But we didn't bring our best game. You know, we didn't bring our strengths to the battle. We have world-leading scientists, world-leading epidemiologists. We have a media environment which would have allowed for the, you know, rapid diffusion of information. And we kind of bungled it from the beginning. Now, a lot of that, in my view, is the fault of the previous administration. But it's not just the fault of previous administration. We, the citizenry, also have some responsibility for this fiasco. And I think it's worth pausing for your listeners to understand, just to frame what has happened to us, because I don't think people really get it yet, honestly, is over 750,000 Americans, nearly 1 million will probably die from this in the end. When the dust settles, the excess deaths will be a million of our fellow citizens will have died. Probably five

times as many, and we should talk about this, won't die, but will be disabled by the infection. In other words, it's not long or short COVID, they'll have survived the acute infection, but their bodies will be marked. They'll have pulmonary fibrosis or renal insufficiency or neurologic or psychiatric problems or so on. These individuals, our fellow citizens, will need our care. So a million will have died, 5 million will probably be disabled. Larry Summers, a former Treasury Secretary, and David Cutler, a health economist at Harvard, have called this the $16 trillion virus. They estimate that the loss to our society is $16 trillion, $8 trillion due to economic damage, and $8 trillion

due to loss of life and disability and illness, death, disability and illness. This is a catastrophe that far exceeds the Great Depression in its economic impact. And then we have millions of children that have missed school who will have been harmed by this, and millions of people who were entering the job market during the pandemic and faced extra difficulties, millions of firms that went bankrupt. So I don't think people get it yet. This is a once in a century event. And part of the reason I think they don't get it is, first of all, economically, we are borrowing trillions of dollars from the future to soften the blow right now. And because this virus, while it's bad, it's not smallpox, it's not bubonic plague. So even though a million Americans will die, probably only 10 million will have known those people intimately. And maybe 100 million will have known of someone

who died, which still means the majority of Americans will get through this pandemic, neither having died, nor having a loved one die, nor having known someone personally who died. So that's why, in part, I think we haven't taken this as seriously as we should. Any other kind of calamity like this, I can't imagine we... If the Russians had invaded and killed a million Americans and decimated our economy this way, I think people would be standing up and paying attention. Yeah. Well, if you had told me that we would more or less be totally sanguine about a million people dying from a disease, a disease that we had very quickly developed vaccines for, and that in that context, nearly half the country would decline to get these vaccines and more or less ignore the fact that nearly a million people

had died, and even dispute whether anything like that number had actually died, and then fall into various conspiracy theories about the number of deaths being exaggerated. I don't think I would have believed that we would have arrived here, but it seems to me that's where we are. And, you know, there's no- Well, we haven't, just to correct one statistic, I don't think we have 50% refusing vaccines. I think it's closer to 20% or something like that. Well, it's 23% of healthcare workers still refuse to get vaccinated. Last I looked. Is that true still like that? I'm surprised by that, but I believe you. I mean, there are a lot,

it's approximately, the numbers are high in the general public, higher than we would want, but they're, you know, we should look it up. If the precise number is important, we should look it up. So 60% have been fully vaccinated, 40% have not. In that 40%, probably also includes children for whom the vaccine has not yet been fully indicated. But anyway, regardless of the precise percentages, a large fraction of our population still has not been vaccinated, which is, to someone like me, very surprising. So there's an opinion that has solidified on the right politically, and it appears at

other points on the political spectrum, but it's mostly on the right politically. And it appears at other points on the political spectrum, but it's mostly on the right, I would say. And it's also taken hold out in the alternative media wilderness among podcasters and sub-stack newsletter writers, that much of what has been communicated about COVID by the government and by the mainstream media has amounted to really a hoax, right? And much of what we've done and demanded that others do in response to COVID has been, therefore, unnecessary and even unethical. And so everything from lockdowns to school closures to mask mandates to the vaccination campaign itself

to downplaying the efficacy of ivermectin, right? All of this has been done for sinister political motives and based on corporate greed, right? So what we have now is something, I mean, the tens of millions of people, at least, believe that our entire response to COVID, I mean, basically everything we've done for the last 18 months or so, has had the ulterior purpose of increasing social control, right? And basically, we've got people, this is the explicit claim, one here is from all these quarters now, that the whole purpose of this has been to soften us up for some kind of Orwellian acquiescence to state power. And then with respect to the vaccines, in particular, it's also being driven by just the sheer profiteering motive of pharmaceutical companies.

Now, I mean, there are many specific points. Which is odd because, of course, the vaccines are free to the citizenry. But anyway, go on. Right, right. Oh, yeah. So we should just unpick all of this. But I mean, there are specific policies that one could debate, obviously. I mean, I guess I'm at the moment, I think I'm currently

uncertain about why kids in schools where all the kids have been vaccinated are still wearing masks. I think you could wonder about the wisdom or necessity of that, and I'd like to talk about that kind of stuff. But it seems to me that this basic idea, which has, again, it's infected. These are not just uneducated rubes who believe this. I'm not talking about the QAnon cult, although obviously this includes the QAnon cult, but I'm talking about many people who are quite smart, several friends and colleagues who have prominent podcasts, right, have fallen into this paranoid picture of what's going on. And there are extreme endpoints of this paranoia. There's the idea that Bill Gates is putting tracking devices into us with the vaccines. So there's the crazy end of crazy. But it seems to me that this basic

picture, even without the craziest flourishes on it, is more or less insane. I mean, the idea that we are dealing with something akin to the Chinese Communist Party here and that all COVID-related policies have been implemented merely to abridge our freedom politically, that does strike me as patently insane. And so I'm just wondering, what do you think accounts for this kind of, I mean, 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. What do you think accounts for its popularity? Well, I think part of the answer has to do with what happens during times of plague and a typical human response. I mean, one of the things, again, that's helpful is to look at how humans have

responded to plagues for thousands of years. And denial and lies have been a constant companion to plagues. If you look at accounts going back a very long time, you find them. One of my favorite stories, I forgot which ancient plague it was. I want to say the Plague of Justinian, which was about 1,500 years ago. There was an account by an observer that said that the plague was decimating the city and there was fear in the streets, of course. And he observes that a rumor went out amongst housewives that if they threw clay pots from the second stories of their houses onto the streets below, that this would ward off the plague.

And so this observer says, mocking the superstition, he says, it became more dangerous to walk down the street for fear of being hit by pots than for being infected, getting the plague. And I mean, that's exactly what we have now with, you know, people with crazy ideas about bleach or, frankly, ivermectin, for which, in my view, there's not anywhere near enough evidence to support its use, or hydroxychloroquine, which also was the previous ivermectin. Let's not forget that. So we did lots of randomized trials to show it was not useful. So people don't want to believe that a calamity of this kind

has happened, that their ordinary lives have been disrupted. Nobody wants to believe this. It's a little bit like the Jews at the beginning when Hitler was rising to power. Many did not want, there were more and more and more anti-Semitism was rising and more acts of violence. These people, they lived in these communities, they had businesses, they had families, they had connections, they had languages and religious connections, they'd spend their whole lives there. They didn't want to believe it, right? And so it is difficult to accept that your life is changing and that this, and there has been a change, you know change in our environment.

This new deadly germ is introduced into our midst. It's circulating. It's doing what germs do. And so part of me understands the American response from the great sweep of history. But part of me is also, like you, baffled and, if not, enraged by it, because it is so immature, and it is so unscientific, and it is so unnecessary. We could have had a much better response that would have saved lives, and I think have spared our economy even more. So... You mentioned at the top the role that you believe the previous administration played here. And I must say, even the politics of that seem fairly confounding to me, because there was this

moment where Trump seemed desperate to take credit for Operation Warp Speed, right? And to have us all think of the vaccines as the, essentially, the Trump vaccine. I don't know why he didn't do that. I mean, I have a theory. Why did he walk away from that? I mean, I think he didn't even acknowledge getting the vaccine himself in the end. I mean, he certainly didn't turn it into a photo op and recommend that others do it. Well, I think he wasn't sure the vaccine would arrive in time to make a difference in the election. So I think from Trump's point of view, the emergence of the pandemic, he correctly deduced that it would be a threat to his reelection. And I think his strategy, and this man, Trump is not a very honest individual. And I also don't think he took his duties to the American

people sufficiently seriously. I think he was more selfish and more interested in his own... I think he's very narcissistic. So it was a threat. He took it as a personal threat and was interested in what was good for him, not what was good for the country. And what was good for him, he thought, was to pretend like it wasn't there. And there's a detailed account of this that I actually give in the book, so I won't necessarily rehearse it here. But Trump was ignoring and saying, it'll go away, it will go away necessarily rehearse it here. But Trump was ignoring and saying, it'll go away, it will go away, it will go away. He said when there were 50 cases in the USA, he said it will go away. When there were 500 cases, it will go away. When there were 5,000 cases, it will go away. When there were 50,000 cases, it will go away. He kept saying it will

go away. There was no evidence it was going to go away. And we now know that he was briefed, unsurprisingly, where the United States, for the love of God, we have elite intelligence agencies and scientists working for the government briefing the president. He was briefed on what was going to happen, and he chose to ignore it. And in fact, this is one of the things that got me not interested, I was interested in this topic, but one of the things that motivated me to direct the attentions of my lab to this pandemic and also to up my public profile a little bit and write the book and so on was that, so my interactions with COVID actually began in January of 2020. So I had this long standing collaboration with some Chinese scientists and we were studying using phone data,

looking at the mobility, the networks of people in China ascertained because of their phone calls, and studying things like, well, what happens when you build a high-speed rail line? How does that reshape, if at all, social interactions or economic interactions? Or what happens when there's an earthquake, for example, in China? And so I had this collaboration, and we had data on people moving through Wuhan in January of 2020, and my collaborators, and I thought, well, we could use these data to understand this nascent pandemic. beginning middle of January to study what might be happening in China. And therefore, I was aware on January the 24th of 2020 that the Chinese government had basically shut the country down. And I was also aware of some of the papers that Chinese scientists were putting online describing the basic properties of this pathogen in January. And by February, let's not forget, we had Italian scientists doing the same thing when Lombardi collapses. And I did some basic calculations that every competent epidemiologist could do,

and we can discuss those if you want. And it was clear as day, it was going to be a serious respiratory pandemic, like a once-in-a-century event. And you and I spoke, I think, our second ever conversation, but our first about the pandemic, I can't remember exactly, in March maybe or something. Yeah, probably early. Yeah, something like that. I can't remember exactly, in March maybe or something. Yeah, probably early. Yeah, something like that. I can't remember exactly. And I think I said, you know, from my desk, this looks bad. And what surprised me was that the pronouncements from the White House were so anodyne, and they stayed anodyne. And I was getting really, really concerned. And I thought to myself, how is it possible that I,

Nicholas Christakis, Yale professor, sitting at my desk, appear to know more about this situation than the president of the United States? This is alarming. And of course, we now know that that was not true. In fact, the president was briefed and chose to ignore it. And I think this is a grave dereliction of duty because I think that the central function of the government is to keep the citizenry safe. And the fact that there was a super spreading event in the White House itself, which is a national security threat, let's not forget, like if the whole apparatus had been decimated, that would have been a grave problem, shows the kind of lackadaisical attitude

that they had, not only to the safety of the country, but to their own safety. So I know that other governments also did poorly, and this is an argument that's often used. And to be clear, there were Democratic governors who were also incompetent. for example, Governor Cuomo in March was saying absurd things about the pandemic. And I was, me and other epidemiologists were writing letters to try to stop the St. Patrick's Day parade and so on, which would have been nuts. Mayor de Blasio was a Democrat and so on. But we're talking here about the White House. We're talking here about the President of the United States. And so, yes, maybe other countries did poorly as well. Maybe governors of various states, Republican and Democrat, did poorly.

Okay, but that doesn't excuse the utter collapse, insane public policy in the White House, in our sophisticated, I hope, rich nation. So yes, I think a lot of blame can be laid. Now, just to be clear, and I think Trump perceived this, he must have been told, look, hundreds of thousands of Americans are going to die. And that was clear. And you and I talked about that from the beginning. And that's not a winning electoral position to be in. And he probably thought, well, maybe I can just use smoke and mirrors until the election. And so the vaccine, he probably thought, well, maybe I can just use smoke and mirrors until the election.

And so the vaccine, he probably at that time, remember the vaccines arrived much faster than anyone, including me, expected. They arrived by November of 2020, which is just miraculous. We had clues that the vaccines would work and people started getting vaccinated by December. So it was after the election and too late for him to frame the politics that way. But I think if he had, I think he might have won the election, honestly. Well, the politics were awful here because there was, I think, a valid concern that given Trump's political selfishness, given that everything was being motivated based on what was politically expedient for him, and one didn't really understand how much he could bend the apparatus of the vaccine

approval process to his will. There was this period where it seemed like the vaccines were coming soon, perhaps in time for the election, and he was going to try to rush them out in time for the election. And now we have, you know, video of all of these prominent Democrats saying, you know, that they would be reluctant to take the vaccine. And this includes Joe Biden and Kamala Harris. And, you know, you get them on a microphone in 2020 before the election, you have them saying, yeah, I wouldn't take, I'm not sure I would trust a vaccine that came out that fast, right? Whereas, you know, just- Well, no, what, my memory, and you might be right, my memory is not-

This has all been spread on social media of late as a, you know, basically a campaign ad for more Trumpism. And I remember thinking about, I mean, I think I may have even talked about it on the podcast. It's just, if you thought that Trump could possibly get vaccines out sooner to serve his political ends, and thereby we would be cutting corners with respect to safety, above all, that was something that people were openly worrying about at that point. And then when, you know, then when the vaccines came out after the election, the whole thing flipped and you have Democrats by and large saying, oh, these have been totally well vetted. And then you've got Trump not taking credit for the thing he was desperate to take credit for a few months before.

Yeah, but I think that's a bit of a coincidence and a misreading of the sequence of events. So nobody was saying we shouldn't rush to get vaccines into the arms of people. At least I wasn't saying that. But I and others were saying we don't want to cut corners. And I still agree with that. Now, it turns out these vaccines have been miraculously effective and miraculously safe. But there is a long history of bad things happening when you cut corners with drug approval. And we have a conservative drug approval process in this country. Now, we can debate, and there is a rational argument to be had, how, where do you want to set, like, how conservative do you want to be when you approve drugs for public circulation?

And there's a scientific debate about this and a political debate. You know, you have libertarians who'll say, what business is it of the government to decide what I can and can't put in my body? And you'll have others that say, no, that's not true, especially with communicable diseases. But anyway- And there's also a way to go faster. I mean, we could have had challenge trials, right? I mean, that's- Yes, and people were- The ethics of that are interesting.

Correct. And I discussed that in the book. And people talked about that. And that would have been, I think, a legitimate in the national security kind of strategy, although it was not, the pace was so fast that those were not deployed, although they could have been deployed. But anyway, my point is, to my memory, and I won't speak for the politicians, the scientists that I know were not saying we shouldn't rush to get a vaccine. They were saying we shouldn't implement a process for speedy development of vaccine that is unsafe. Now, and if we can do it fast and remain safe, then of course we should do that. Now, as it turned out, we did do that. And it happened that the approval happened

right after the election. I don't think there was a conspiracy there, just that, you know, it actually, it was even sooner than we expected. You know, the trial results, the trials were shut down early because the vaccine was so obviously effective in November, whenever the precise timing was. So that's just the way it happened to come out. But Trump could have, the phase two trials were already out. We had a lot of clues that the vaccines would be good, well, even before the election. And there was a scenario in which it could have been handled that way. But maybe Trump decided that that wouldn't have been enough to mollify the American people, like the promise of a vaccine at some point. And remember, at the time, we didn't know that

it would be quite so good and quite so fast, right? It's just now in retrospect, we know that. And this is an astonishing accomplishment to have these types of vaccines, this safe, this fast. So let's talk about this. Yeah. So I mean, there's a few questions I just want to dispatch up front here, certainly before a paywall comes crashing down so we can get the PSA component out into the world. So what do we know about the vaccines at this point? Basic question, how much does vaccination reduce a person's risk of hospitalization and death? And maybe we can break this down by age cohort, or maybe we just, we can take the general case. I mean, obviously, it's more important the older you are and less

important the younger you are, but what do we know about the efficacy of the vaccines? Let's leave safety aside. That's my next question. Well, there's a huge, we know a the efficacy of the vaccines? Let's leave safety aside. That's my next question. Well, there's a huge, we know a huge amount. And I think it's important to distinguish the Pfizer and Moderna so-called mRNA vaccines from some of the others. So the AstraZeneca and the J&J vaccines are based on so-called adenovirus vectors. And we have Novavax, a protein-based vaccine, which is also very good. We have a, and these don't even include the foreign, you know, the Chinese and the Russian vaccines and other vaccines developed around the world. So we have many vaccines right now, but the main ones we have in this country, the Pfizer

and the Moderna vaccines are so-called mRNA vaccines. They're based on 30 years of science. And what you have to understand is that if the virus infects you, it's the whole virus with some proteins on the surface and a 30 kilobases of RNA, and the RNA has quite a few genes in it. And one of those genes is for the spike protein that the virus has on its surface. And then the virus inserts all of this RNA into your cells of your body and takes over your cellular machinery. And then you start producing all the constituent elements of another virus, that's how the virus reproduces, which are then assembled in your body and your body tries to fight them off and so on. What the vaccine does is it takes just a small part of that process.

In other words, instead of being exposed to the whole virus, you're just exposed to the RNA, what the RNA vaccines do, you're exposed to the RNA of just the spike protein, which can't harm you. The spike protein itself alone can't harm you. And so you fool the body into thinking it's been infected with a whole virus when you haven't been,

you've only been affected by a small part of it. And then you mount an immune response. Your body says, warning, warning, there's an invader. And you develop antibodies and memory immunity against the spike protein, which is a part of the virus, so that if you then are ever exposed to the real virus, you eradicate the real virus because you're prepared. Now, these vaccines that we have, the mRNA vaccines, are about 95% effective. What does that mean? It's kind of like an airbag in your car. Having an airbag in your car doesn't mean that if you get into a head-on collision, you won't die. But if you get into a head-on collision, the airbag greatly reduces your chances of death. How much? Let's say 95% reduction in your chance of death.

That's how you can think about the vaccine. It's like an airbag. If you're exposed to the virus, if you're infected with a virus, it will reduce your chance of serious illness by 95%. Not 100%. You still could die, even if you're vaccinated. But it is a really strong line of defense. It's like a seatbelt or an airbag. And we now know this not only from the original trials, which involved tens of thousands of people, some got the vaccine, some did not and then we waited to see how many people in the placebo arm got infected or seriously ill and we waited to see how many people in the treatment arm who got the vaccine got infected or got seriously ill, and we compare those numbers, and the vaccinated group had a much smaller number by an amount that yields an efficacy of 95%. But now that hundreds of millions of people have been vaccinated, we also have other kinds of quantitative data that confirms

those findings, that confirms that the vaccine efficacy is about 95% for the mRNA vaccines, which is amazing. That is a higher efficacy than many, many other vaccines that have been developed that people have been routinely taking for decades, for diphtheria, for tetanus, for mumps, for measles, for all of these other scourges for which we're blessed that modern science has given us these vaccines and prevent hundreds of millions of deaths. I mean, two or 300 years ago, tens of millions of people died every year from these contagious diseases. And they don't anymore, at least in the rich countries in the world, because we have vaccines. So we have this amazingly effective vaccine in coronavirus.

Actually, a historical comparison is kind of interesting to the polio vaccine, because, and I had forgotten this if I ever knew it, but I recently encountered this fact online that- I think you spend a lot of time online. Yes, I'm too online, yes. But I'm not alone there. I know that there are other people there. But something like 95% of polio cases were quite mild, right? Like we think of polio as just this, you know, spectacularly awful disease, which it is, but something like 95% of cases were virtually asymptomatic. And the Salk vaccine was around 80 to 90% effective. You know, many people have alleged that, you know, in the time of polio, when the Salk vaccine came out,

it would have been unimaginable to meet this kind of politicized vaccine resistance. What explains that? Just the fact that when polio is bad, it's so graphically bad that... I think that's part of it. I think that we have to remember, you're exactly right, that polio looms large in all of our memories as being a complete scourge. And it was a nasty piece of work, but it only killed a few thousand people every year, paralyzed some more, some greater number. But it was nothing like the toll of death that coronavirus is taking. The entire nation mobilized. And the people who

invented the Sabin and Salk, who invented the two vaccines, were widely hailed as heroes. They were on the cover of magazines. This was seen as a triumph of American science and engineering and technology. And the public lined up to get vaccinated. They were afraid of polio, of course, but they also saw it as a normal civic thing to do. And the entire nation was vaccinated. I don't remember the precise amount of time.

Someone listening will probably know. But within weeks or months or something. I mean, it was very rapid. There was also some glitches. There was a so-called famous the cutter incident where there was a defective batch of vaccine that was released due to bad factory procedures in one manufacturer that resulted in the vaccine not being sufficiently inactivated such that it actually gave a few people polio. This cannot happen. It's just biologically impossible with the mRNA vaccines, to be completely clear, because you're not being given the virus. But the way the polio vaccine worked is there was inactivated virus. So what we did is we made the virus, weakened it, so that you would mount an immune response.

And that way, if you ever encountered the live version of the virus, you would be prepared, but you didn't run any risk from the weakened version. Anyway, and that, of course, that happened too, in fairness, during the polio. But the country tolerated that. I mean, I think about 10 or a few kids died, and they also spread it to a few other people who got sick. But it was in the low tens of people that had this adverse event from that. And the country moved on, and all of us got vaccinated for polio. And we had to be. There are rules. You can't go to school if you're not

vaccinated for polio. As well, you shouldn't be able to... You need to be vaccinated. That's part of being a 21st century citizen of a country like ours. Okay, so back to this first question about the efficacy of the vaccine. So in recent reading about this, I encounter a range of numbers around this mitigation of risk of hospitalization and death. And again, this is undoubtedly different as you ask the question about each age cohort. But generally speaking, it's something like a tenfold reduction in risk of death for those who get vaccinated versus those who don't get vaccinated. So is that your understanding in terms of what the efficacy is of vaccination? Yeah.

And you had asked her a little bit earlier, and we didn't quite nail it in the follow-up conversation we just had now, about by age. And the studies that I've seen show that the vaccine is equally effective at young ages and old ages. There have been a couple of papers that the CDC has released looking at cohort studies or studies of cohorts of people that are 12 to 18 versus greater than 65 and so on. And the way to think about it is that, go back to the airbag example. So if you have a 65-year-old that's in an accident and they can either have an airbag or not have an airbag, the airbag is going to reduce their risk of death.

And if you can have a 20-year-old that's in an accident and they can have an airbag or not have an airbag, the airbag will reduce their risk of death. Now, it's also the case that a young, fit body of a 20-year-old may be less likely to die if in a collision than in an elderly person. It's true. Young people have better bodies than old people. But both bodies benefit from the airbag roughly equally. In other words, there's a reduction in the risk of death by the airbag for both the young and the old if you're in a head-on collision. And it's the same with the vaccines. It is the case that the intrinsic probability of death is lower if you're young if you get COVID, but it is reduced by a proportionate

amount if you get the vaccine. One of the things that's a big misconception about this, and one of the figures that I use in Apollo's Arrow is the following. So illness and death are problems of the aged, right? Young people face a low risk of death in the next year. You and I might have a risk of death in the coming year of, I don't know, one out of 100, one out of 200. And a 20-year-old might have a risk of death in the following year of one in 5,000 or one in 10,000. So most 20-year-olds that are alive today, the great majority will be alive a year from now. But the thing about- I'm tempted to use a few 20-year-olds as human shields now. Well, because- Where are the 20-year-olds in my life? human shields now. Well, because, yes. We're the 20-year-olds in my life. Yes, yes, yes. Or I mean,

I could use a 20-year-old body. But the point is that the coronavirus will increase your risk of death at any age by about 30%. So in other words, you're unlikely to die if you're a young person and you get coronavirus. It's true. But your low probability will be upped by about 30% should you get infected with coronavirus. And that is a nasty thing to happen. It's not necessary for you to needlessly face this increased risk of death in the new year. It is absolutely low, your risk of death, in absolute terms, but whether you get coronavirus or not. But if you get coronavirus, it's relatively higher. So another way to think about this is that if you would be concerned about having a heart attack, if you're 20 or 40 or 60 or 80 and being hospitalized with a heart attack, if you're hospitalized with coronavirus, if you're 20 or 40 or 60 or 80, your risk of death is higher

than if you had had a heart attack. In other words, whatever age you are, being hospitalized for coronavirus is significantly more deadly than being hospitalized for a heart attack. In other words, whatever age you are, being hospitalized for coronavirus is significantly more deadly than being hospitalized for a heart attack. So yes, 20 and 40-year-olds are not commonly afflicted with heart attacks. But if it crosses your mind, you say, gee, God, it would be bad to have a heart attack. It's worse to get coronavirus. So that I think is- And to have an outcome bad enough to hospitalize you. Yes, yes, yes. I'm not talking, that's correct. But this is conditional on being hospitalized for that. That's right.

So let's be clear about what comparisons we're making here. But it's just a way of benchmarking people's expectations of risk in a way that helps them sort of see it. And the stratification by age sets up some equivalence here. We would have to research the details, but it's something like if you're a 75-year-old who gets vaccinated, that gives you the equivalent risk of hospitalization or death of an unvaccinated 45-year-old. There's some equivalents there, right? I haven't seen that calculated, but it could be calculated pretty trivially. That's correct. Something like that. That's right. So that's on the question of efficacy.

Now let's talk about vaccine safety, because this really is the sticking point. I mean, we're living in a world where millions and millions of people, whatever they think about the danger of the coronavirus and whatever they think about the risk of getting COVID not having been vaccinated. Some people think that's trivial. Some people think that is perhaps as dangerous as we think it is. But on the other side of the balance, they think the vaccines themselves, in particular, the mRNA vaccines, are terrifying, right? And therefore, the option to get vaccinated is more or less unthinkable. It's just whatever story you paint about the risks of getting COVID unvaccinated, it's not scary enough to motivate them to get

vaccinated, given how they feel about these vaccines. And I must say, I personally know people who have been spreading this fear to, no exaggeration, tens of millions, if not hundreds of millions of people. And it has the predictable result of convincing millions of people that they shouldn't get vaccinated. So what do we know about vaccine safety at this point? Well, first of all, there's a lot going on there. There's some people who, people who are saying vaccines are dangerous, don't get vaccinated, are also preaching a little bit to a willing audience. In other words, people want to think, there's a desire that humans have to be the person that, so on the one hand, we follow the crowd. We copy

our neighbors. We don't wish to stick out. This is how fashion works. This is how all of our norms work in our society. I mean, people copy their neighbors. And this is something actually which I spent a lot of time studying. And it's actually a little bit odd in a way that we are that way. Like when we're free to do anything we want, what do we do? We do what our friends are doing. But there's also a strain of people that want to seem like smart, like they've outsmarted the crowd, like everyone else wanted to do something, but I knew. I pulled my money from the stock market just before it crashed. Look at me. Or everyone else was going, and I decided to go right. And look, I was right about that. So I think there is a strain of that, which telling people,

people will, there'll be people who want to have gone against the crowd and been proven right. And that's a kind of an appealing fantasy for many people, no doubt. So some of the people that are pitching that are capturing a little bit of that psychology. And then, of course, there are people, like we said earlier, who want to deny the seriousness of what's happening. But I think that the claim that the vaccine is... And there are some people, and I think these people need to be met head on, who rightly say, wait a minute, this vaccine was developed very fast. I'm a little worried about that. Or this technology is very new. We haven't used the mRNA vaccines. We haven't used that before. Although if they say that, you could say, well, why don't you take the Chinese

Sinovac vaccine, which uses old technology. It inactivates the coronavirus, and then you're injected with inactivated coronavirus or live attenuated coronavirus, which is another technique. In other words, you take the live version of the virus and you basically you mutate it till it still elicits an antibody response from you, but it's not sufficiently severe so as to infect you. This is actually analogous to what happened with the invention of vaccines with the cowpox being used by Jenner instead of smallpox, you know, 200 years ago or more. So if you don't want, if you're really worried about the novel technology, okay, get the Chinese vaccine, which is based on older technology. It's been around a long, long time. That's better than nothing to get the Chinese vaccines. There are several, actually, Chinese vaccines. Anyway, the point is that people who say, I'm a little worried about

the speed or I'm a little worried about the novelty of the technology, I understand that on an intellectual level. And that's a topic you can then engage. You can say to such people, well, let's talk about what happened, why this vaccine was developed so swiftly. You know, the billions of dollars that were spent, the mobilization of the nation's doctors and pharmaceutical companies, the tens of thousands of people that rapidly signed up to be in the trial so that we were able to discern the good luck that the vaccine candidates actually happened to work, all the biology that informed our design of these vaccines. And can I reassure you thereby that the speed is-

And also at this late date, the fact that we have a cohort of literally hundreds of millions of people, globally millions of people, globally billions of people who have received these vaccines. Correct. So now you can even add that to the argument in answering such a person. And then some subset of them in turn will say, well, we don't have enough follow-up. What if in 10 years it proves that this vaccine... And then the honest answer to that is we can't know for sure without the passage of time, but there's no reason to believe, no rational reason that anyone can discern, you know, that that would be the case. And so conversely, we know for a fact

that if you get coronavirus, you know, you face a 1% risk of death. Now it depends by age, but on average, getting infected with a coronavirus, you have a 1% chance of dying, approximately. And then there are other people who say, well, it's not the speed, it's the novelty of the technology. To those, you could say, well, we have other vaccines that use older technology. Would you like those instead? And so on.

So I don't think— Also, there's one footnote I'd like to add here, because there is a brilliant piece of incoherence here, because these same people for whom the emergency use authorization was more or less a declaration of the unfitness for human consumption of these vaccines, these are precisely the people who have no problem with monoclonal antibodies or any of the treatments that one gets after getting COVID. And I think in every case, these treatments have been less validated and less safety tested than the vaccines themselves at this point. Well, I'm not sure I would be prepared to say that they're less validated and less safety tested,

but I am prepared to say that they are less safe because most of these, with a few exceptions. So there's the dexamethasone, which is a very safe steroid that early on we knew was a randomized controlled trial that shows effective. A lot of these antiviral drugs have known toxicities. And now, of course, they're still worth it because your alternative is to run the risk of death from the virus, but they're not benign, these treatments, whereas the vaccines are, you know, truly benign. And you asked me about, like, the safety profile. There was a paper that was published in September of this year in the journal called Vaccines, in issue nine, the first author's last name is Fan, F-A-N. It's a meta-analysis of safety trials. And just that was using the safety of the trials themselves. And for example, if you look at 100,000 people that were in the mRNA trials across all the vaccines and trials, about 51,000 were in vaccine group and

51,000 were in the control group. And there was no statistical difference in adverse events occurring in those two groups. In other words, if you want to claim that vaccines are causing strokes or heart attacks or whatever you want to claim, those rates were roughly the same in both the people who got the vaccine and the people who didn't get it. And then if you look across body system by body system in this meta-analysis, the rates of the adverse events are almost, without exception, exceedingly low, less than 0.1. In other words, less than one out of 1,000 people. And now we have follow-up studies that show that, for example, a lot of people are talking about

this risk of myocarditis and pericarditis. These are inflammation of either the heart muscle itself, myocarditis, or the casing of the heart muscle, pericarditis. Just to be clear, the viruses can also cause those conditions. The question is, we see some of those in vaccines, but those are also exceedingly rare, let's say on the order of one in a million people who get vaccinated, and also relatively self-limited. Myocarditis and pericarditis are serious conditions, but to date, most of the people who got that as a result of the vaccine have been fine. So the point is, is that the rate of death due to the vaccine or serious events due to the vaccine is exceedingly low, less than a one in a million. And one of the things that

we need to understand is that when we're dealing with public health threats, we have to engage in a kind of cold utilitarian calculus, just like when we send men and women to the battlefield, to the battlefront, we decide that the sacrifice of those lives is for the greater good, that it saves more lives than are lost. And the same thing happens here. The way I would think about it is this way. Unless you're a—given the new mutations, the Delta variant and perhaps the Omicron

variant as well, unless you're a hermit that lives on a mountaintop, or unless you're exceedingly lucky, everybody on the planet will either be infected by the virus or will be vaccinated. Those are your choices. If you're infected with a virus, you face a one out of 100 risk of death from the virus. If you're given the vaccine, you face a one in a million or less chance of death from the vaccine. And this is a no-brainer as far as I'm concerned about which of those two choices to make. And the vaccines, we are lucky, are exceedingly safe and far safer than any... The usual standard that's used for vaccines is that serious adverse events or death are less than 100,000 or 1 in 200,000.

In other words, there are vaccines out there which we administer, which we say, okay, 1 in 200,000 people we give this vaccine to will die because we give them the vaccine, but we'll save thousands of lives, and so that's what we're going to do. These mRNA vaccines are even safer than that, which is a prior standard we had. Okay. This point is so important that I think I want to just cycle on it again just so that there can be no question about it. So with respect to the inevitability of some adverse events and even fatalities for any intervention, I mean, this is how I made this point previously. If peanut butter were the perfect prevention of COVID and we gave peanut

butter to hundreds of millions of people, we would have some number of people dying outright from peanut butter, right? We know this, right? Just given the nature of allergies to peanut butter. We would kill many more people with peanut butter than we've We know this, right? Just given the nature of allergies to peanut butter. We would kill many more people with peanut butter than we've killed with these vaccines. Correct. Actually, that's about right. And yet it would be a miracle if we could solve the COVID problem- With peanut butter. To the tune of 95% with peanut butter.

Yes. And we'd count ourselves very lucky in that case. And none of this would minimize the tragedy of being the parents whose kids were killed by peanut butter, right? Yes. So that's the world we're living in. We're talking about an intervention that rolls out to hundreds of millions and globally billions of people. And then you do these statistics on those population-level outcomes. I mean, this is such a simple case to make. We have this head-to-head comparison. Everyone's going to be eventually going to be exposed to COVID. Personally, you have a choice about whether

you should be exposed having been vaccinated or not vaccinated. And we know that you're running a 10x or more greater risk of death or serious complication if you're unvaccinated. And yet many people are making this choice. And everything they're worried about with respect to vaccines, about with respect to vaccines, you know, the myocarditis or any other very low probability side effect is much worse with COVID when you're unvaccinated, right? So, I mean, so let me just... Yes, and in addition, not getting... You can also make the argument quite apart from the fact that it's in your self-interest to get vaccinated.

It's also civic duty. You know, you are... Well, I want to get to that. Let's table that because that's a further question I have. I just want the choice point here that there's a two-branch tree of where our utility function should be pretty damn easy to calculate, right? Down one branch, you've got a 1% probability of death or worse if you're older and less if you're younger. But if you're 50 and above, this is really a no-brainer. It's probably a no-brainer if you're 20 and above. I guess we should talk about kids in particular. Yes, the kids are harder. here's some, you know, I think it's true to say that when you're talking about mortality,

the flu poses a greater risk of hospitalization and death to a three-year-old than COVID does. Does that do, I don't know if that's, if we still believe that. I don't know if that's true. I would have to double check that to report that. I know that flu... Flu is bad, but flu is also non-trivial for three-year-olds, right? I mean, it's... Yes, that's correct. So, I'm sorry, which way did you say it was that flu was intrinsically deadlier to three-year-olds than coronavirus? Is that what you just said? That was my belief, but that's circa some months ago. I don't know if it's... Yeah, I mean, flu has a so-called U-shaped mortality function, so it kills the very old

and the very young and spares middle-aged, whereas coronavirus has a so-called U-shaped mortality function, so it kills the very old and the very young and spares middle-aged, whereas coronavirus has a so-called backward L-shaped mortality function, so it kills the elderly but spares the middle-aged and the young. Now, I don't know the scale of the y-axis on those curves offhand. I'd have to double-check. But yes, flu is worrisome to young kids. Absolutely, that is the case. So we have people who are saying to themselves, you know, I have not taken these crazy precautions, you know, masking and testing,

vaccination and boosting and watching the news in fear, etc., for flu for my kids, right? And now we're looking at the complete derangement of our education system and society in order to protect kids from COVID. Yeah, here I see this argument a bit more, honestly. So just very narrowly and quickly on the issue of vaccination, I would still, despite anything we might discuss, I still believe it's appropriate and smart to vaccinate your children. Certainly those for whom the results show already older than five, there's a benefit. And my brother, who's a well-known pediatrician, has publicly argued for this position. And I have a 10-year-old at home, or 11-year-old, and we vaccinated him. They're very relieved and happy to vaccinate him. There are lots of reasons to vaccinate your kid,

including the fact that it reduces their probability of spreading the virus to others, including you. By the way, your death as a parent would be really a bad thing for your child. So if your child, if vaccinating your child reduces your own risk of dying, it's good for the child that that happened. So there are lots of reasons. And also, the more we vaccinate children, the less we run the risk of outbreaks at schools that might require us to close schools, which is harmful. So the bottom line for me is that I still believe the benefits of vaccination outweigh any putative risks down to the age of five for which we have good data so far. The masking is harder for me. And I also think here when we talk about schools and masking, it's very important to draw distinctions between elementary school and middle school and high school. As the kids get older and more adult-like, and they face more adult-like risks, and it's

easier for them to wear masks, and then less harm comes to them from wearing masks, I think we can expect high school kids to wear masks. But when we're talking about four and five and six-year-olds, especially the way the masking is implemented in our country, which is, it's very hard to get these kids to obediently wear masks. They're,. They're rarely on their faces. These kids need to see the faces of their teachers and of each other to read their emotions, to learn language, to learn to read, and so on. The benefits of the mask, while there, may not outweigh the educational costs. And for me here, I have no political agenda. I would just like to see some really good cost-effectiveness analyses that, on the benefit side, say, okay, if we have

kids wear masks, we reduce a certain number of infections. We reduce the likelihood the kid will have to stay home because they're sick and that missing school is not good for the kid. We reduce the transmission in the community when we mask our children and save some adult lives, and those are all the benefits. And on the downside, we have some educational loss, we have some financial cost, we have some inconvenience, we have all of these things. Let's just do the calculations and then decide. Like we said earlier, public health is a cold utilitarian calculus. And for me, I'm happy to be led wherever such an analysis would lead. And at the end of it, we might conclude, no, it's inconvenient to wear masks, but it's worth it.

Or we might conclude it's beneficial to wear masks, but it's not worth it. And either outcome would be fine with me. It's just a scientific question as far as I'm concerned. Yeah. I think once you're talking about a school population for kids above five where everyone has been vaccinated, then the logic of wearing masks, for me, truly evaporates. Then it just seems like a silly imposition. Yeah, but I think we could either, like you, I mean, I think that's quite possible that you're exactly right about that. But I guess all I'm saying is that I would like us to just do these in a very sober-minded way, to do these calculations and see what happens. And see, here's the thing. The other thing I wanted to communicate at some point is,

earlier when we were talking about paranoia and people who hold crazy beliefs and it makes little sense to us, I think another approach to such individuals is to ask them, what kind of evidence could I bring to the table that would make you change your mind? And invite them to say, okay, if you did this study, or you showed me this thing, then I would change my mind. Then at least we're dealing in the realm of science. But the classic kind of Popperian falsifiability issue, in other words, if you cannot think of an experiment that would disprove your hypothesis, then that's theology, it's not science. Well, part of it is, I can tell you on the vaccine arm, they're saying that we can't possibly know

what the long-term consequences of these novel vaccines are. And I would just say that you need another branch in this decision tree and the other branches, you can't possibly know what the long-term consequences are of catching COVID unvaccinated are. And there's every reason to believe they're worse in this case. That's correct. But many people won't even give you that response. They'll say, well, I don't think we should mask for this or that reason, or I don't think we should engage in lockdowns for this or that reason, or vaccinate for this or that reason. And I think the point I'm trying to make, just a very narrow point, is that if the person says to you, there's nothing you could tell me that would change my mind, then you are dealing with someone who has an ideological or religious

conviction. We're not dealing with the realm of science. So I would ask everyone who has strongly held beliefs about what is or is not the right thing to do in this case, for example, masking children, to say, well, what evidence would make you change your mind? And if you're a person who thinks the kids should be masked, what evidence could I bring to the table that would persuade you, no, actually, they shouldn't? And conversely, if you're the person who thinks that kids should not be masked, well, what evidence could I bring to the table that would persuade you otherwise? Then we're in the realm of science.

Then we just do the science. We just conduct the experiments or do the studies, and then maybe we can... Then you're at least thinking rationally from my point of view. Now, I also need to say something else, which is often misunderstood. It is normal for scientists to disagree. It is normal for scientists to revise their opinions, especially as new data and studies come in. It is normal for studies to be confusing and conflicting. And this is why, you know, if you want to hold a belief, and then you're going to cherry pick the data to go and find, well, which one study, for example, of masking showed that masking didn't work, you'll find a study or more

where masking did not work. And conversely, if you are pro-masking, you know, you could reject the studies that show that masking didn't work. But what you really want to do is to look at the totality of the evidence and judge and weigh the evidence as a scientist who's trying to discern, does masking help or not? What is the scientific evidence in support of this claim? Just like when you're trying to figure out, does the Earth rotate around the sun or not? Which is it? Is it the heliocentric or geocentric theory of our solar system? Well, what is the evidence on either side of this debate as

Galileo's discourse famously engaged? And so I think that's the way I would approach this. And I would not be afraid of the fact that some scientists disagree. And also, just one more thing just to hammer this home. people have said, well, the scientists used to tell us this, now they're telling us that. Well, that's not a bug, that's a feature. That's how science progresses. As we get more knowledge, we change our mind. As the famous British, I forgot who it was, you may know who said this, when the facts change, I change my mind. What do you do, sir? You know, like, why do I stick to my guns? You know, I ignore the facts, the new facts. No. So I think we as a society, one of the things that has happened, and the virus has relentlessly exploited this, it struck us at a particular moment of

vulnerability in our civic discourse. We had century-high levels of economic inequality and therefore sort of suspicion and polarization on that grounds. We have decades-high level of political polarization, and we have lost the capacity for nuance in our civic discourse. People think you're with me or you're against me, you're right or you're wrong, not like that there's shades of gray. We have this kind of anti-elitism where people are very suspicious of larger forces that are governing their lives, because I think we are at a particular historical juncture, looking across the sweep of centuries, where there is a lot of confusion about what forms of governance are optimal and so on, and can we believe our

leaders or not, and are they trustworthy and so on, all of which preceded the pandemic. And this anti-elitism has bled into a kind of anti-science as well, where scientists are seen as just another elite that's telling me how to live my life and what do they know anyway, which is, again, kind of stupid if you think about it because surgeons and expert car mechanics are also elite and have expertise in that regard.

And yet we don't seem to be suspicious of them necessarily as trying to exploit us. So all of these things predated the virus. And the virus, you see, has relentlessly exploited this. And we have a kind of a thinned out intellectual life as a nation right now, where we are not engaging in public policy debates in the most rational and self-protective way. And we're dying as a result of it. I think many hundreds of thousands of Americans will have died needlessly because we politicized it, because we were unable to just approach this in a quintessentially American technocratic way, just like we approached the vaccine. Wasn't it amazing we invented these

vaccines? Why couldn't we have done that with other aspects? On this point, I would add a few more nefarious pieces that have been in play. I mean, one is the fragmentation of our information ecosystem, social media being the prime offender here, but also just alternative media, you know, podcasts like this one and newsletters and the failing business model of mainstream journalism leading to a kind of Wild West effect around just providing information. And this interacts unhelpfully with political polarization and siloing, and people can curate their own echo chamber such that they really never have to deal with information that they don't like,

or they deal with the straw man version of it. But there's also just this fact, which has been true forever, but its nefarious effects are amplified here, is that you can always find a PhD or an MD or half a dozen PhDs or MDs to take any crazy position on any topic within or outside of their wheelhouse for psychodynamic reasons that are as yet not fully understood. You can find PhDs who are willing to testify that cigarette smoking is non-harmful and non-addictive and climate change is not a thing. And in this case, there have been several MDs in particular, some of whom have just five minutes of digging exposed their longstanding anti-vax roots, but in other cases, it's a little more mysterious, who have jumped on the most

popular podcasts in existence and in other forums, said just absolutely crazy things about the vaccines and about ivermectin and just muddied the waters powerfully for millions of people here. And without dealing with the specifics of any of that, it's just, it will always be the case that if you want to, you can find someone who apparently has the right credentials to have a strong opinion, give you a very crazy opinion about more or less anything. There's always that contrarian to be found and to be amplified. I'm not sure what we do with that. It's a very high leverage environment now where you can get the weaponization of that. Yeah. I mean, I think, again, this is a bug, not a feature of... I'm sorry, this is a feature,

not a bug of science. We actually want scientists to be skeptical. We want there to be people who are saying, wait a minute, I don't believe you. There's, of course, a very famous story about ulcers. You know, when I was in medical school, we were taught that ulcers were due to stress. I was taught this. I went to Harvard Medical School in the 1980s, and people were aware of alternative theories, but we were still kind of taught that this was a possibility. And of course, you know, there was this crank guy in Australia that said, no, wait a minute, I think it's caused by a bacterium, Helicobacter

pylori. And he was right, and he won the Nobel Prize and so on. And scientists tell these types of stories to each other all the time. And it's a way of checking our ego and checking our beliefs. This is what we want scientists to do. We want them to be skeptical. We want them to consider alternatives. We want them to consider crazy, far-fetched ideas that were previously rejected by everyone, and so on. Nevertheless, I don't think that when we are going to address a question, let's say as a consumer of information, we should go about seeking the person who has the opinion we want. We should instead try to say, okay, what is the opinion of scientists on this topic in general? In other words, I don't think you should sort of say, well, I don't want to believe about climate change, or I don't want to think humans do it.

Can I find a scientist that holds that belief? Oh, here is one, therefore I'm right. That's not a search for truth. That's a search for confirmation. Right. But this is a very interesting point of scientific epistemology, because yes, in science, the status of scientific authority must remain forever precarious because we just know that significant progress in science entails again and again the usurpation of scientific authority and scientific consensus, right?

Like everyone was wrong yesterday about topic X and the new Einstein has shown us why. So there's that process that is, as you say, it's a feature, not a bug. And yet, scientific consensus on any given topic, if you're just going to reason probabilistically, right, is climate change a thing? Or does the Earth rotate around the sun or not? You know, you are virtually always wise to be guided by, unless we're in some zone of truly perverse incentives and confirmation bias, you're always wise to be guided by scientific consensus as a consumer of information, especially when lives are hanging in the balance. And I mean, we're going to talk about some of the ways in which we have just obviously failed,

you know, and our main institutions have obviously failed to provide an accurate picture of good information during this pandemic. But still, there is this apparent paradox to reconcile because we don't rely on authority in science. I mean, you really only have as much authority as your last sentence in science, right? You can be a Nobel laureate who's completely unhorsed by a freshman, you know, who asks you a pointed question at the end of a lecture, and that's the way scientific debate proceeds. Yes, because, I mean, what we should be committed to is not scientists, but the scientific process. So if you're trying to understand, do vaccines help control epidemics? Well, let's engage in a process to see what the answer to that question is. And that's what we should

be doing, not trying to pick which scientist we want to hear on whatever particular topic. And that means looking at the totality of the evidence, and that means forming our own opinions. Now, the other thing that's important here is that if you're outside your expertise, it's probably not wise to do this yourself. So for example, if it's a question well outside my scientific expertise, a topic in geophysics or quantum mechanics or something like that, I'm not the right person to decide what is or is not the truth. Same, by the way, with more humdrum topics. If I have differing opinion, my car is broken and I take it to three different mechanics and each expert gives me a different opinion, well then,

do I conclude that the car mechanics are all idiots, then none of them know what's going on? Or more likely, I find a friend of mine who I trust, who is a more expert car mechanic, and I have him take my car to these three guys and then decide who to do. So we have to, at some point, repose our confidence in someone else. And so here's where I think something like, if you're the man on the street and you don't know, you believe that there's some conflicting ideas about something, you could or should have some confidence in some authorities. Who would those be? The CDC, Tony Fauci, I don't know. But you should be humble and recognize that you are actually not a fit judge of the scientific consensus on this topic. You might be a fit judge of other topics that you are actually not a fit judge of the scientific consensus on this

topic. You might be a fit judge of other topics that you have expertise in, but not in this regard. Yeah, except in this case, I mean, in this case, the CDC, the FDA, the WHO, certainly Tony Fauci- They've slipped up from time to time, yes. They have slipped up in truly impressive and galling ways. Yes, they have slipped up because they're human also, and because science is not infallible. That's true. But that doesn't mean that if someone

slips up, you then move to astrology. You say, well, what do the scientists know? What do the astronomers know? Let's just go with the astrologers. That's not a rational response. There was a very famous experiment about background radiation and the Big Bang theory called the BICEP2 experiment that was published, I don't know, five or 10 years ago, one of the most elite journals of science, I think it was in the journal Science, actually. And it turns out that the scientists screwed up. They had thought they had detected this, and they had to withdraw their results. They made a mistake. Yes, they made a mistake. But that doesn't mean that because these elite astronomers

screwed up in that occasion, that now the alternative is just to go with the astrologers. No, right? Or just the backyard astronomers, right? Yes. It's like, even if a backyard astronomer occasionally does point out a flaw in a professional astronomer's paper, there's two things there. That is science actually working. The cure for bad science is more science and better science.

But it also doesn't, it shouldn't completely reset our bias for professional astronomers over backyard astronomers. Yes, that's exactly right. And we can listen to that. We should also not close off the backyard astronomers from the discourse. No one is proposing that they be silenced or unable to speak. But, you know, we're also not proposing that they somehow be seen as having special virtue or

special wisdom. You know, there was this famous case recently, a couple of years ago, about this housewife that there's this geometric problem called tessellations, whether you can create with a set of geometric shapes. Can you tile a floor with them? Can you arrange them in a fashion where there are no gaps between them and there's like this repeated pattern, like complex tiling, like hexagons on your bathroom floor? You can tessellate a hexagon, but there are other non-hexagon shapes you can tessellate as well. And there's a lot of interesting mathematics about this. And it was theorized. I think Roger Penrose was in this area. Yes. Yes. And it was theorized. I don't remember the precise details, but it was theorized

that there were like only four ways to tessellate a floor with a quadrilateral or something. And some housewife who had some mathematical training, but had never been a professional mathematician was saying, well, wait a minute, you know, I think I should be able to figure this out. And she started noodling around and developed her own notation. And she found unexpectedly two other ways that no one had known before, disproving the claim that there were only four or whatever it is. I'm garbling the story a little bit. But the point is she was right. And here's the proof. We know she's right because we can evaluate her claims using the scientific method. We can test and see, is she right or is she not? And so here's the thing, when some backyard astronomer says ivermectin works, we're like, okay, let's evaluate this claim. Let's do a randomized controlled trial of ivermectin and see if it works. Oh my goodness,

we've done the trial, it doesn't work. It doesn't work. So, you know, this is, and in fact, we've done so many trials of ivermectin now. Yes, there's some that hint that it may have some effect, et cetera, and there's some biological reasons, suppose, but not at the doses we would give people and so on. The body of the evidence shows that ivermectin is not useful. I'd be delighted if it worked. I have no political agenda here. But it's like hydroxychloroquine. We put that one to bed, and now we have ivermectin rearing. Incidentally, I don't understand why people are so obsessed with believing that ivermectin is useful. What's that to do with? You don't have to take a political stand on this. Either the drug works or it doesn't. Maybe there's some other drug that

works. Maybe there are no drugs that work and you should get vaccinated. I think this may be what people are afraid of. Well, there is this diabolical notion that the profit motives are completely skewed here, where no one stands to make any money off of ivermectin, but people stand to make billions of dollars off of the vaccines, and therefore

a legion of mustache-twirling pharmaceutical executives have rigged the whole conversation to foreclose the compassionate use of a essentially free generic drug and bilk all of us at expense of our lives for vaccines. Well, no, I mean, you take more risk taking ivermectin than you do by getting the vaccine.

No, I mean, you have to ask yourself, why would someone like me, who's, I'm not profiting, I don't own stock in Pfizer or Moderna, why would I recommend the use of this? Or your doctor who says you should get vaccinated, they're not being paid for offering this advice over one thing or another thing. I mean, I understand people's suspicion of the profit motive, just like if my mechanic recommends that I, you know, there's a little knocking sound that- I can't currently see you, but you don't have Pfizer and Moderna merch all over your office there, coffee cups and fleece jackets. No, no, I do not. And the same goes for, you know, but yes, that's right. And so the person, you know, yes, your car mechanic may be lying to you and tell you that a $50 thing is a $1,000 repair and so on. And so, you know,

rapidly such a car mechanic loses credibility or loses business or gets sued or whatever. So I just don't think it's credible theory to imagine that there's some vast conspiracy among your doctor and the expert on TV or someone like me. Some people, I guess I was accused on Twitter somewhere of being a, I forgot what the accusation was, that I was like a, not a COVID whore exactly, but that I was a, that like somehow, some word like whore, I can't remember what it was, where I was like somehow jonesing, I think was the word. Someone said I was jonesing on COVID or something. And I was like, really? You think that I was just, you know, the way I would actually, to be honest, here's what I'll tell you.

For years and years, I've been teaching public health. And there's a very famous graph in public health where on the x-axis is years, since like 1900, and on the y-axis is mortality. And there's this decline in mortality over the last 100 years, which is just a miraculous achievement of modern society. Primarily, and the story goes that this is for three reasons. First of all, we got richer. And as we got richer, we died less. Second, we had public health interventions like clean water and hygiene and cotton underwear and so on, and that's why we died less, and that's about a third

of it. So a third of it is we got richer. A third of the decline in mortality is we got public health interventions, and only about a third is because of medicine, modern medicine. Anyway, I've been teaching this topic for years. And in this graph, however, there's this huge spike, like that just dominates the graph in 1918. And for 30 years, I've been teaching public health, and I teach this graph, and I put it up on the table, up, and I show the students, and I ask the students, who knows what the spike is? Invariably, someone knows. It's the 1918 Spanish influenza pandemic. And I say, isn't it amazing, except for that pandemic, you have this steady decline in mortality decade after decade because of what we as a society are

doing. Isn't that a triumph of human ingenuity? And honestly, Sam, I've been teaching this for all these years. It never occurred to me. I taught this as a historical oddity. Why it didn't occur to me that it could happen again while I was alive, I don't know. It just never occurred to me that I would be alive while there was a major respiratory pandemic. And so when it started bearing down on us, the COVID in 2020, in January 2020, as we were talking about earlier, on the one hand, I was prepared because I know about these things and I had been thinking about this thing. On the other hand, it took me a while to sort of register, oh my goodness, why was I not even more prepared? Like, why was I so surprised

that this thing was happening? You've been teaching about this for decades, Nicholas. So I don't know why I went off on this tangent. Well, honestly, my expectations have been reset here. Now I'm surprised that it's not always happening. Yes. Well, respiratory pandemics come every 10 or 20 years, and serious ones every 50 or 100 years. And there's some evidence that the serious ones are coming more frequently. We can talk about that if you're interested. Well, I just want to put a few more numbers to what you just described here, because there's what we know about COVID deaths directly, but then there's this other analysis of excess death statistics that people have done. and globally they estimate that it's more like 17 million people who have died so far.

And it's not just from COVID, but it is because of COVID. I mean, for instance, there are people who didn't get treatment for cancer because they couldn't get into the hospital because the hospital was full of COVID patients, right? So there are knock-on effects of the pandemic. And I think for the economists, there was a 95% confidence interval between 11 million and 20 million for excess deaths globally now. And in North America, they put it at, you know, officially we're around 800,000 deaths. This analysis would adjust that upward by about 20% to something close to a million at this point. Which, by the way, is the range that I had forecast the last time. Actually, on our call, I had thought several hundred thousand,

but in the book that I released in August of 2020, I put the range of deaths in the United States between half a million and a million. I'm not saying this to pat myself on the back and say I'm so smart or something. I'm just saying this is standard epidemiology. You can just do the calculations and look at exponential growth and the intrinsic properties of the pathogen and forecast the impact on our society. So I'm not at all surprised. And I've been long saying, in fact, at the beginning of this conversation, I said that probably in the end, when the dust settles, a million Americans will have died from this condition. That's exactly right. Maybe more. But let's talk about excess

deaths. The technique was invented actually by a demographer called, the founder of epidemiology called William Farr in England in the 19th century, in the middle of the 19th century. He did a lot of very cool things. And the reason they invented this technique was that the state of knowledge about nosology, about diseases and what causes illnesses and deaths, was so weak 200 years ago that it was not often possible to know what someone died of. So what Farr said is, you know, we don't actually need to know what every, you know, some people died without having a doctor, there were no death certificates, they were buried, but we don't know what they died of. Or we said they died of A,

but in fact they died of B, and so we were ignorant. And Farr said, you know, we can dispense with all of that. Let's just count how many people died, and that was a number that was known. And we're going to compare that to the number that we expected to die, and we're going to compute that expected number by looking at the last five years and saying, okay, in England, you know, we had 100,000 people died every year, and during the plague year, 200,000 people died. And so we're going to say that the plague caused 100,000 deaths. This is the method of excess deaths. Now, it turns out that that method is also useful even to scientists today for a number of reasons. One is it's useful when you're looking

at very ancient plagues, and there are no death certificates or records, so you don't know, but you can calculate how many bodies, how many people died in a particular year, looking at graveyard or other evidence, compare that to other years, and conclude that, oh my goodness, this plague killed so many people. Now, it can also be used even not looking historically, looking at the present day, in part for the reasons that you mentioned. During times of plague, some people are killed directly by the germ infecting them. Others are killed indirectly, for example, like you said, in the situation in which a person with cancer dies because they weren't unable to get hospital care, or they're killed indirectly in other ways. For example, the plague forces people to stay at home

and you have domestic violence goes up. So more people are killed by their spouses, for example, during the plague, let's say. But also there are people whose lives are saved by the plague. For example, car accidents might decline because we're not out on the road. So 10,000 Americans who would have died from car accidents didn't die because we were, let's say, locked down at home or something. Not that that's why I would lock us down, but in fairness, you have to put all of those together, all of the direct and indirect deaths caused by the plague and all of the lives saved because of the plague, for whatever reason. For example, in India, because of the lockdowns, the air quality got so much better a year and a half ago, people for the first time could see

the Himalayas at some distance because the air pollution is so bad in India. Ditto in China, by the way. Millions of Indians and Chinese die every year because of bad air quality. And when all the factories stopped and all the people stopped driving their cars, air quality improved. So fewer kids died of asthma, fewer adults died of emphysema and so on, or pneumonias because exacerbated by the air pollution. So you got to put all of that together. And that's how you ultimately, we will ultimately calculate the impact of COVID-19. And when that calculus is done in two or three years, we will see that the impact of this epidemic has been enormous on our society. As you say, probably in excess of a million people, at least a million, I think, will have been judged to have died. And let me just say,

excess of a million people, at least a million, I think, will have been judged to have died. And let me just say, and then I'll shut up in a second, that we're not through this yet, okay? We should not be spiking the football, not only because of the Omicron variant, which we haven't talked about yet, but also because respiratory pandemics, it's in their nature to come in waves, especially in the winter. So we're having a winter wave right now, a thousand Americans are still dying every day of this condition right now. And we will have another winter wave a year from 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, but I would have said, Sam, be aware of the fact that next winter we'll have another wave. And here we are having that wave. And a year from now, we will have another wave. The amplitude of the wave

will be lower. That's what happens. The waves tamp down as time goes by. But these respiratory pandemics typically take four or five years before the mortality that the plague is causing falls into the kind of background welter of general causes of death. So some of the people who think, well, this will be just like influenza are right. It will eventually be like influenza, but that doesn't mean like lemmings, we have to run for the cliff and die needlessly. There are things we can do to reduce the toll of death. Right, right. Okay, so I can see this entire conversation is turning into a PSA because we're still working through my questions that I imagine we would answer in the first 10 minutes of the podcast. So we've hit vaccine efficacy and safety, although I think there's one other point to make about efficacy, because there's a kind of confused notion

traveling around now that the vaccines actually don't work very well because there still is some transmission with respect to vaccinated populations, right? So people are imagining that the goal of the vaccine was to stop transmission entirely. And if you can still get breakthrough cases and you can still pass the virus to others in a vaccinated population, well, then these vaccines don't work. There's a related issue here where people think, well, if you need to get boosted, just how many boosters are we going to have to get? Are we going to have to get one booster a year for the rest of our lives? Oh, these vaccines don't work. So in the anti-vax world,

there's just an endless amount of chatter about how these vaccines really haven't panned out. You really are spending too much time online. haven't panned out, you know, we should... You really are spending too much time online. We should address these concerns. Okay, well, and also you did put on the table this ridiculous statement that natural immunity, I mean, there's, you know, like, not a ridiculous statement, there's some interesting science about natural immunity versus artificial immunity through vaccination, like, which is better, and we can talk about that too. So on the issue of the vaccine, so when we say a vaccine is effective, we have to specify what is the effective against what. Does it prevent you from becoming infected? Does it prevent you from being able to infect others? Does it prevent you from becoming

seriously ill? Or does it prevent you from dying? Those are four different outcomes. And believe it or not, the vaccine doesn't have to be equally effective against all of those outcomes. For example, only some vaccines provide what's known as sterilizing immunity. In other words, it prevents you from even being able to be infected. That's not what the coronavirus vaccine does. Yes, it does reduce your probability of being infected if exposed, but what it really does is it reduces your probability of getting seriously ill if infected. And infectiousness is another topic because even if the vaccine prevents you from becoming seriously ill, if I'm vaccinated and I'm exposed to the virus, as the virus multiplies in

my body and my body starts ramping up because it's been vaccinated to fight off the virus, there is a window of time when I could potentially spread it to others. But that window is greatly narrowed if I have been vaccinated. In fact, the vaccine does benefit, does reduce my infectiousness and does benefit others. We had deferred still the topic of whether it is a civic duty to be vaccinated. I think it is. You should be vaccinated not just to protect yourself, but also to protect others. And there are many, many examples in our society where we have state power that prevents you from being a risk to others. The reason we regulate speeding on the highway is not so much because of our solicitous interest in your well-being, but because you don't have the right to crash

in and kill someone else. Yeah. I would also add here, though, that even if we knew the effect was only born by you directly, you still, you getting sick and dying has a very likely a terrible effect on other people. I mean, there are these cases where, I mean, there literally have been cases where two anti-vax parents get killed by COVID and their kids are, they got, you know, two four-year-old orphans now, right? I mean, it's just unbelievable what is out there when you go looking for details. And I mean, the idea that it was just, you know, an expression of the personal autonomy of these two parents not to get vaccinated because, you know, no one's putting a needle in their bodies, as though there were no implications for anyone else. Now they've got these two orphaned kids that society has to figure out somehow how to raise. And that's really sad. And I also think it's sad for those people that they politicized something which could have been seen...

Look, I like the fact that we live in a plural democracy. We don't live in North Korea or some kind of autocracy. We have people across the political spectrum with different political beliefs. I like this fact. We live in a plural democracy. And we resolve, how do we resolve our disputes? We do not resolve them by force of arms. We vote. And we get to vote repeatedly. So if we don't like the people we vote for, we get another bite at the apple in two years or in four years or in six years. This is fantastic about our society. So when people are wanting to communicate their divergent political beliefs, I think the right way for them to do that is to have a bumper sticker or a lawn sign. It is not by whether they get vaccinated or not. In other words, you do not need to link your political beliefs or your political identity to whether you get a vaccine or not. You can signal where you are in the political spectrum in all kinds of other ways. And so this, the hypothetical case you described of the two anti-vax parents who...

Not hypothetical. I mean, I can... No, no, real case. I know, but exactly. Let's take the generic version of that, yeah. Yeah, yeah, there are real cases. I actually sent out a Twitter thread that assembled some of these cases months and months ago when some of them were hitting the news. They were heartbreaking. But the point is, just as you're suggesting, that those individuals, they could have had their political beliefs and their political ideology about the government or whatever it is they want, but they don't need to signal that by whether they get vaccinated or not. They may have other reasons not to get

vaccinated, they may not want to, but it's a kind of wrongheaded admixture of belief systems. Also, there's just this fact, which I know we almost certainly mentioned last time, there are some people who can't get vaccinated, right? Also true. We have a duty to do whatever we can to mitigate their risk. Yeah. That's correct. So the fact that there's some breakthrough infections, the fact that there's still some transmissions, this is normal. There's nothing surprising. This does not mean the vaccines don't work. It's just, again, going back to the airbag example, the fact that someone was in a

collision and died despite an airbag doesn't mean that airbags don't work. It means they work pretty good, but not 100%. And that's exactly the same thing with the vaccines. And on the natural immunity thing, it's a very complicated and interesting topic. So it is usually the case, not always, but usually the case that people who survive an infection with a natural pathogen have better immunity than those who are vaccinated. And the reason, the intuitive reason for this is that when you're infected with a natural pathogen, you're exposed to all the so-called epitopes, you're exposed to all the antigens, all of the proteins in the pathogen. So your body mounts a very broad attack on the pathogen with antibodies and memory T cells that attack many parts of the pathogen.

Whereas if you're vaccinated, you typically get a reduced set of those. For example, in the mRNA vaccines, you're just exposed to the spike protein, not the other proteins of the coronavirus. I just got to say as an aside here that the name spike protein has done some terrible PR for these vaccines. People find the name so scary. The idea that just mRNA vaccines are proliferating this spike protein throughout your body. It's something that the spike protein certainly sounds like it's going to harm you in all kinds of ways. And there are people who are alleging that it almost certainly will. It's just, it really, I mean, in addition to people's ambient fear of needles, a fear of the spike protein is, I'm convinced, doing at least subliminal work here.

I hadn't thought of that, but I think you're right. If scientists by chance had been calling it the rainbow protein, and we were going to inject you with rainbow protein, I think I'd be the same. If it were called the rainbow protein, and we could deliver these vaccines with a nasal inhaler, or better yet, a pill, we would be living in a different world, I'm convinced. Oh, like on a sugar cube, like the polio vaccine, yes. So yeah, let's have some rainbow protein on a sugar cube and you'll be better. Sorry, I derailed you. So you're talking about natural immunity. Yeah, so no, so natural immunity. So it is generally the case that, but having said that, let me say a couple of other things. This is not always the case.

There are previous examples where the vaccines provide superhuman immunity, for example, with human papillomavirus or tetanus. It is known that those vaccines provide a kind of immunity that's superior to the immunity acquired for natural reasons. And we can discuss a little bit about why that is the case. But in addition to that, in order to acquire the natural immunity, let's not forget you have to survive. You have to run the risk of death. And this is, in my opinion, just stupid. In other words, there's no polite way to put this. It is not a rational strategy to say, even if you believe

that the natural immunity acquired, natural immunity superior to the vaccine immunity, it is not wise to seek to acquire it by natural infection because you have to survive. You run the risk of death in order to be in that state. Incidentally, for any listeners who've had COVID, there are abundant studies right now that show that you should still be vaccinated. And actually, the people who have both been vaccinated and have had COVID in either order, those are the ones that are actually in the best position to endure, even mutants like Omicron and other mutants that are on the horizon, so variants that are on the horizon, because they have a mix of intense immunity, let's say, from the vaccine and broad immunity from the natural infection. So it is not a rational

approach to say we are going to reach herd immunity as a society, or we are going to, as an individual, that's going to be my strategy. It is far superior from an individual and a collective point of view to get vaccinated. Let me ask you here on this point, many people have expressed the grievance that in all this push to get people vaccinated, natural immunity of those, you know, many millions of people at this point who have caught COVID and recovered, their natural immunity is not being dignified as akin to or even better than normal vaccination. And, you know, they should be given credit for... Essentially, they are vaccinated. They were vaccinated by the virus. Yes, I think there's some validity to that point of view. Yeah. I mean, even though as you did, you would just recommend that they also get a dose of the vaccine, it does seem crazy that if... I mean, this comes down to just the colossal failure of our testing regime, but it does seem crazy that we have not figured out a way to credit people for having recovered from COVID so that they then can, you know, in a world where, you know, you can't get into a restaurant unless you prove that you've been vaccinated, you should be able to get into a restaurant proving that you had COVID. Survive the infection. Yes, I think that would be, from an individual's point of view,

that's not crazy. Although, as I just said, if I were such an individual, I would still be vaccinated because you're actually not as protected, and it's a very wise course of action to have that. Well, you're not as protected as you might be, but I still think it's true that we currently believe that natural immunity is superior to a two-dose mRNA course. No, I don't think that's true. That's not true. That's not true. No, no, no, no. No, no, that's not true. That's what I'm saying. You're saying that the mRNA vaccines are analogous to a tetanus vaccine? Yes, yes, yes. They provide superhuman immunity.

That's exactly right. I'm not, well, that's... By sheer coincidence. There's a lot of, so I don't know where we're going to find the ground truth for that information because I've heard it both ways, but more recently I've heard it the way I'm saying it, which is natural immunity is actually better than vaccinated immunity, although the combination of a vaccine and natural immunity is the best. The last thing is true, but it is not true that natural immunity is superior. That's what I was

saying before, that there are cases, and the mRNA vaccines are in that category. I'm quite confident about this, that the immunity conferred by two doses of mRNA vaccine is superior to the immunity conferred by having survived a natural infection. That's what I was saying, that there are two reasons to be vaccinated. Obviously, the audience can fact-check us here, but whatever is the case, there seems to be a current consensus that even if you've recovered from COVID, you're better off getting a boost of the vaccine, and then you are the superhero you want to be. So like we're talking about, the question is, which immunity is superior? If you survive, assuming you survive, and let's again

constantly remind ourselves of this important feature. There is a survivor bias in this data. Yeah, absolutely. So to acquire this natural immunity, you have to run the risk of death. But let's say you acquire it, is it better than having been vaccinated or not? So there was actually a study that was released by the CDC on November the 5th, about a month ago, that looked at this question and concluded, as have several other studies, by the way, that no, in fact, it's superior to be the immunity conferred by vaccination is superior. And here I'm looking at the adjusted odds ratio. It's about five times your odds of being hospitalized with serious illness are five times worse if you have natural

immunity compared to immunity from vaccination. And the last author of this paper is Bozio, B-O-Z-I-O, and it was published in MMWR on November the 5th, 2021. So that's one of many studies that have come to this conclusion. So no, I reject the claim that immunity, as of now, I mean, I reserve the right to change my mind if the facts change or we see more studies. But as of now, my summary of the literature is that in most people, on average, vaccination with two doses of the mRNA vaccine provides superior immunity than having acquired it naturally. Yeah, well, I think I want to spend more time on the sociological problem here just to account for how this got so politicized and so crazy, but I just have one more question here around vaccines and their efficacy.

It's widely claimed now among people not disposed to get the vaccines that vaccines are creating a, because we do not have a sterilizing vaccine here that's 100% effective, vaccines are therefore creating a selection pressure that is spawning new variants that will, you know, perforce evade the vaccines. And so we're basically our own worst enemy here, and we, you know, vaccinating imperfectly. What these people tend not to notice is that also natural immunity would be doing the same thing. It would be exerting a selection pressure that would then cause variants to emerge that escape natural immunity. But among the fans of vaccination, there's this rival claim, which is that it's better to have a vaccinated population than an unvaccinated one,

for all the reasons we've mentioned, but for the additional reason that in an unvaccinated population, when you have a reservoir of tens of millions, hundreds of millions, globally billions of people who have not been vaccinated, you have the condition of greatest spread and greatest virulence and greatest opportunity to manufacture fresh variants that keep this game of chicken with evolution running in the worst possible way. And so I guess my question is, to what degree does vaccination mitigate the problem of variants compared to lack of vaccination? How do you think about this selection pressure that the vaccinated and the unvaccinated together are creating for the arising of new variants? I think people are right to be concerned about that. And let me try

to see if I can provide an analogy. As most people will have an understanding, you know, there's a herd of antelope and there's a lion that's going to predate them. And everyone knows from having watched nature videos that the lion kills the slowest antelope, the weak one, the old one, whatever it is. But if you can run fast, you outrun the lion and you don't get eaten. As the lion kills a few antelope each generation, the antelopes evolve to run faster and faster and escape the lion. Now, of course, the lion also evolves to run faster and faster, and you have predator-prey coevolution. And there are experts in our society

who have studied this in many predator-prey relationships and many relationships between pathogens and the animals they infect, which is a similar kind of thing, or parasite-host interactions, for example. This is a well-understood topic. But you should also have the intuition that if there is no lion, what happens to the speed of the antelope? Does it change? No. There's no selection pressure on speed, and so the average speed of the antelope remains the same. And conversely, if the lion is indifferent to speed, if the lion kills all the antelope, also the antelope don't evolve, right? They're all dead. So you don't get faster and faster antelope.

But you get a really good Netflix video narrated by David Attenborough. Yes, he killed, it's like a fox in the chicken coop, you know, just killed them all. Okay, but the point is that from this little toy example, that we realize that partial selection pressure is the thing that will be most likely to induce evolution of speed in the antelope. And it's a little, and that's the argument that people are making in terms of partial vaccination. And the crucial thing here is partial. So if you partially vaccinate the population, for example, in South Africa, where they have 24% or something vaccination rate, and they have a lot of immunocompromised individuals, which is another interesting and important detail in the emergence of the Omicron variant, is that what happens is you

create almost the perfect circumstances for vaccine evading strains, right? So what we're talking about here is not new strains that cause us trouble. We're specifically focused on causing us trouble in a particular way, which is that they can evade the vaccines. If we vaccinate some of the population but not the rest, those strains that are circulating that can move despite the partial vaccination come to predominate. And so it's just like the partial predation by the lion example. And so partial vaccination will enhance or pick up the speed of the virus or endow the virus with more of the property that allows it to avoid the predation, or in this case,

the elimination because of vaccination. But the crucial thing there is partial. So basically, what we want is a world in which either no one is vaccinated or everyone is vaccinated. If no one is vaccinated... Just to escape confusion here, there are two forms of partiality here. There's partial vaccination, you know, not everyone has received a vaccine in any given population. But then there's the partial efficacy, the incomplete efficacy of the vaccine itself, right? And it's not sterilizing. Yes, I'm talking about... Yes, correct. And I'm... Both are contributing to this problem. Well, the latter, the fact that the vaccine is

not 100% perfect, I have to think for another moment or two before I can put that into the story. But the part of the story that I'm emphasizing right now is the fact that not everyone is vaccinated. This is, by the way, the reason that I and many others have been arguing that the United States should vaccinate the whole world. It would cost us $50 billion to vaccinate the world, and we should do it. We should do it, first of all, because we profess it's a moral obligation. We profess to have the right morals and be a leading nation, and I think it's something we should do for moral reasons. We should do it for economic reasons.

We're a rich country. Everyone is experiencing supply chain problems now. They have trouble buying Christmas presents or products are missing at the grocery store. And they make orders for furniture and they're told it won't arrive for months. And this is not a typical experience of late American capitalism. But everyone is having this experience now because of supply chain problems. And we need training partners. So we have economic reasons to vaccinate the world, but most importantly, I would argue, we have epidemiological reasons. Because to the extent there are parts of the world that are not vaccinated or partially vaccinated,

those are petri dishes for the emergence of new worrisome strains of the virus. And those strains will inevitably come to our shores, just like we've seen with Omicron. They will come to our shores and they will cause us woe. So we need to vaccinate the whole world, not just our country. Now, you made a second point, which is really important, and I just alluded to it a moment ago, which is to the extent that there are partially vaccinated or unvaccinated. The reason wholly unvaccinated parts of the world are also a problem is a numbers game. Because if you have 100 people who are infected with a virus, or 10 million people who are infected, you should have the intuition that with many more people afflicted with the virus, you have many more opportunities for the virus to have a mutation that makes it worse.

And this is why rip-roaring infection is also not good. In other words, why the so-called, you know, the point you made earlier, which is that large numbers of people who are infected with the virus don't necessarily benefit us because it provides more terrain, more opportunity for the virus to explore what's known as the Darwinian fitness landscape, where the virus by chance, because known as the Darwinian fitness landscape, where the virus by chance, because there's so many millions of people who are infected, by chance it'll stumble on a variant that's really bad for us. It's a little bit like, you know, if you want to roll a heads, are you more likely to roll a heads if you get 10 coin flips or a thousand coin flips? Well, everyone has the understanding that, you know, however unlikely it is,

however likely it is to roll a heads when you flip a coin 10 times, it's a certainty you're gonna get a heads if you flip a coin a thousand times. And it's a little bit like that with the coronavirus. If you have millions of people who are infected, the virus has more opportunities to have a worrisome strains mutate and emerge.

So for both of these reasons, the wisest strategy is if you have three options, no immunization, partial immunization, or complete immunization, from the point of view of us combating the virus, the wisest strategy is complete immunization. Yeah. You mentioned in passing the implications of having a large population of immunocompromised people in Africa. What is that? I assume you're talking about the spread of HIV there. Yes. Well, there's a lot of theories. For example, let's take the Omicron variant.

The Omicron variant, its most recent relative in the virus family tree is about a year ago. So it's not a descendant of Delta, for example, the Omicron variant. It seems to be a descendant from some other ancestral strain about a year ago. This is work that Trevor Bedford and others have done. And so the question is, well, what happened? Well, one possibility is that the Omicron variant was spreading in parts of the world where we had low genetic surveillance, and therefore we just didn't detect it earlier. We just finally stumbled on it when it got to South Africa. Let's say it was in Botswana or somewhere else nearby,

and there wasn't a lot of genetic surveillance, but in South Africa, they have decent genetic surveillance. Then it comes to South Africa, up, we detect it. And so it seems like it hadn't been around for a year, but actually it had been. That's one possibility for the emergence of such a strain, a sudden emergence of a new strain. Another possibility is that it wasn't circulating in a population, rather it was enduring in a specific individual. So for example, imagine you're an immunocompromised individual, you're infected with a virus, you can't fight it off, and that virus lives in your body and keeps mutating and mutating and mutating. Viruses,

chance mutations occur. I forgot the rate of mutation in this virus. I think it's once a week or every two weeks or so. And so over a year in your body, the virus accumulates a lot of mutations. So one theory is that the Omicron variant kind of was incubated in an immunocompromised individual, where finally enough mutations occurred in the virus, and then it leapt from this person to others and then began spreading. That's a second theory. And therefore, in a place where there are a lot of immunocompromised people, and I think in South Africa, something like 20% of the population is HIV positive. I don't know the precise number,

but I think that's about right. You have a lot of people there that we really should be vaccinating because they can, those poor individuals can serve as incubators for new worrisome strains of the virus. A third possibility, and this is one of the reasons we will never eradicate coronavirus, is that unlike smallpox, which can only infect humans, coronavirus can infect animals. And everyone has been reading about this. There's the gorillas in the zoo. There's no leopard in the zoo, yeah. Yeah, and the tigers in the zoo, and deer, something like some studies show that a significant fraction of North American deer are infected. They got it from humans, apparently feeding deer is a

thing, and then the deer spread it among themselves. And mink, there was an outbreak in, I think in Denmark, where they had to slaughter thousands of mink, and outbreaks in China in fur farms. And we know our pets, our dogs and cats can get it. So the point is that the coronavirus can, even if we vaccinated everybody, we'll never eradicate this virus because it can live in animals who we live with. So there are animal reservoirs possible. So a third possibility is that Omicron was incubated in some kind of animal reservoir and then returned to humans. It wasn't humans, it went to animals. It started first in bats. It came to humans. And then from humans, it went to some other animals. And now it's coming back to us. The

coronavirus is a feature of the natural world. Our world has changed. There's a new pathogen in our midst that was not there before. And so we have to accept this reality. That's the third possibility. And then, of course, there's some, since you're in the dark reaches of the internet, Sam, there's some people who speculate that this is still a Chinese plot. First, they softened us up with the original strain, and now they're releasing another strain suddenly, which I think we can exclude that possibility. I think the most likely thing of the three I've just mentioned is the second possibility, that it was in an immunocompromised human, and that's where Omicron was incubated and now has leapt to us. Interesting, interesting. Okay, well, let's pivot to the topic of why this all became so confusing and so difficult to talk about. I mean, we've touched on it some here, but I want to at least acknowledge, just try to put yourself in the position of someone who has listened to us now for two hours and is still unconvinced because they still can't

shake the feeling that the incentives are such, the corruption of our institutions is such that we just can't trust the information we've gotten. We've got a whole segment of our society that is declaring epistemological bankruptcy on some level, and then turning to non-standard sources of information for their facts. And as I said, I think the alternative media wilderness is especially culpable for giving energy to this. But the truth is our institutions have failed to a remarkable degree. I mean, they have proven hypocritical and capturable by crazy ideology to a degree that I would not have thought possible. And I'll just give you a couple of examples here to react to. I would imagine these are in your memory, but there was at one point

during the pandemic where we had something like a thousand public health professionals who signed an open letter attesting to the necessity of demonstrating for Black Lives Matter protests, necessity of demonstrating for Black Lives Matter protests and how that was epidemiologically a fine thing to do because racism is such a problem in our society. But of course, it was a terrible thing to demonstrate against lockdowns or any other sort of mass gathering on the right side of the political spectrum. That was totally irresponsible and dangerous and guaranteed to get people killed. But lo and behold, it's safe to get out there after the killing of George Floyd and demonstrate en masse for the right political cause. I mean, that was such a distortion of public health messaging that I think, I mean, anyone right of center politically took one look

at that and said, all right, we're done here. I don't need to hear from the Anthony Fauci's of the world. This is how they bend their scientific advice in response to woke identity politics. Well, I don't know if Anthony Fauci himself was saying it was fine. I don't think he was. I don't know if he signed that letter or not, but Fauci-like people were signatories to that. Well, yeah, but I was publicly opposed, just to be very clear. So in real time, I was saying, this is insanity. The virus does not care about the justice or non-justice of your cause. Or whether you have pink hair.

Yes, it doesn't care. And therefore, I could not see how we had denied people the right to visit loved ones who were dying in the hospital or funerals. Let's not forget funerals were deemed too risky at that time, but somehow turn on a dime and say, well, we're going to sort of give a pass to... Or at that time in New York, I think the governor of New York City was cracking down on Jewish weddings amongst the Orthodox Jews, but turned around in the very same week or something. I may have bungled these facts a little bit, but was saying, oh, well, BLM protests are okay. This is not rational. And I was strongly opposed.

Now, we can talk about what is the actual risk from outdoor interactions. And now we have a lot more evidence now a year later about the extent to which it is or is not risky to be outside. And we now know a lot more about the aerosol dynamics of this pathogen. But at the time, it was inconsistent and I think deeply injurious to credibility. But this is why I would tell listeners who are skeptical, try to find a voice that you trust. Try to find someone who you trust about these matters. And try also to ask yourself, again, I repeat what I said earlier, what evidence would disprove my beliefs? If I believe that ivermectin works or that masks are useless, what evidence could I find from perhaps ideally someone you trust that would make you change your

mind? Again, I think that's a crucial heuristic. But on your point on the crisis in institutions, I mean, you and I have talked about in some of our past conversations, for example, But on your point on the crisis in institutions, I mean, you and I have talked about in some of our past conversations, for example, the collapse of institutions of higher learning in our society. I think we're at an interesting moment in the history of our nation where the pendulum swings back and forth. And I think you're right to talk about a crisis of our institutions. I think the media, people are worried about the legacy publishers. There was a time when you could have confidence in the New York Times and CBS and the Evening News with Dan Rather or Walter Cronkite or whatever. And you had a kind of notion about the Supreme Court. Yes, maybe they didn't rule your way, but you didn't think of them as venal or as somehow being driven

by their politics, perhaps. And our universities. You thought of them as perhaps as institutions that were devoted to free expression and scientific inquiry, and no idea was, you know, nothing was unsayable, no idea was unthinkable, and so on, and to our public health institutions and so on. And I think there is a moment right now, again, the virus has struck us when we're vulnerable in this regard, because I think there is a crisis for other reasons. There's a crisis of institutions in our society. Just to give you another example here, I think this is more recent, but the American Medical Association has changed its guidance for doctors about how to talk to patients. And at one point, they recommend instead of referring to low-income people, they recommend that you say, and this is a quote, people underpaid and forced into poverty as a result of banking policies, real estate developers, gentrifying neighborhoods, and corporations weakening the power of labor movements, among others, have the highest level of heart disease, right? Yeah. So I'm saying poor people have high levels of heart disease. We're supposed to say all that. Well, I mean, you could even do a little, like you said, an onion headline or not. Yeah, this is an SNL sketch, yeah.

Exactly. Maybe SNL will do it. Who knows? Yes, that's ridiculous. I mean, that's like shooting fish in a barrel. There are other examples. By the way, just to be clear, I have studied the influence of those forces for decades, like how it is that poverty kills you and the mechanisms by which being poor is harmful to your health. And many of those things that were identified, I have looked at. For example, how for-profit hospices, I did a lot of work in the 1990s on how for-profit hospices had different incentives to care for the dying than not-for-profit hospices.

So I'm completely sympathetic to the workings of such forces and their relevance, but to manipulate our language in that fashion and to politicize it, to ex-anti-politicize it, to like prejudge the outcome through the manipulation of language, I think is nuts. Yeah, yeah. And then there was the example of, this included Fauci in the beginning, when so many people in the medical establishment told what was really, I think, considered a noble lie, but was in fact, you know, That was a fiasco. They basically claim that masks don't work because they were worried about all the run on PPE and that there would be no N95 masks left for doctors and healthcare workers. But, you know, if masks don't work, why do you care that there's going to be a run on the masks? It made no sense. And it's, I mean, just that alone was so damaging that it was, I mean, some people just never recovered their

caring about what's a valid source of information coming from the government or from CDC. That was absolutely awful. And in early April, and I was, again, not in that category. I was talking about the utility of masks and making homemade masks and using N95 masks. I released a paper with some colleagues at Yale in April of 2020. So again, I was thankfully not in that category either. And I think that was a slip up by Fauci. And I don't know the reasons they did that. It may have been, as you suggest, this sort of noble lie idea. But for those individuals who are pissed about that, I would encourage those individuals, especially if they have a political reason for being pissed, to ask themselves, why our wealthy great nation didn't have PPE? Why did the President of the United States, when warned, you know,

actually back in November of 2019, certainly by January, certainly by February when Italy was collapsing, why were we not manufacturing PPE? Why did hundreds of doctors and nurses and EMTs and others die from infection that they acquired in hospitals caring for the rest of us because they did not have adequate PPE? This boils my blood. When I was early, I'm a hospice doctor. I was. I don't see patients anymore. But in the 1990s, I used to take care of people who had HIV. And about a third of our patients in hospice had HIV. And of course, in the hospitals, many had HIV. These were typically young gay men who were dying awful deaths until the invention of highly active antiretroviral therapy in the late 90s. We had to take risks to care for these

people. We were worried that if we were drawing blood from them, we would have a needle stick injury. Some of my colleagues did have needle stick injuries, and we were worried that you would get HIV. If they vomited on you, these patients, or urine or spit, body fluids got on you, you would get a deadly disease, and you would be infected with HIV. But it was our duty to care for these patients, and we did, and we took some risk in so doing, as was expected of us, just like a soldier going into battle, but we had equipment. We had masks, we had gloves, we had gowns, we had special rooms, we had special ways of disposing for the needles to minimize needle stick risk, and so on. So we were expected by the society to take a risk, but we were equipped by the society to minimize that risk. This was not what happened as coronavirus crashed into our society in March of 2020. We expected our doctors and nurses to take risks, but did not provide them with equipment. And this was

an enormous dereliction of duty by the federal government. And so people who are saying, why was Fauci lying? They should then ask the next question, why was Trump lying? Why did Trump not order or otherwise engineer this wealthy nation to produce the PPE that we needed? In fact, I'll tell you an anecdote, because as I said earlier, I was worried about this pandemic back in January and February of 2020, I can't remember precisely when, but roughly in February, I decided that I should buy some equipment. And I went, I live in Vermont, and I went to the Home Depot in West Lebanon, New Hampshire, across the border, to buy some N95 masks, which are often available in such places to minimize when you're dusting or sanding stuff,

which are often available in such places to minimize when you're dusting or sanding stuff, you need this type of mask. And I went there to buy it, and I got one of these guys in one of these orange aprons, and I asked him where the masks were. And he looked at me and said, we don't have any more. And I said, what do you mean we don't have any more? And he said, in this West Lebanon Home Depot, that many Chinese people that live in this area had purchased the masks and sent them back to China. So why? Why was our country not able, why were other people aware of the need for this equipment and acquiring it, and yet our country was not on the ball and manufacturing adequate amounts. By the way, I'm saying this not to demonize those particular individuals or to demonize the Chinese. That's not my point of my story. The point of my story is that other people in

other countries were aware of the utility of this equipment, but we seemingly were not. And so this was a major collapse of the federal government, in my opinion, that we expected healthcare workers to run these enormous risks and did not properly equip them. Incidentally, one more point, many loved ones, as a hospice doctor, we would struggle mightily so that people would not die alone. Having a patient die alone was considered a really bad outcome. And I have held the hand of countless people who otherwise would have died alone when they died, just as a doctor, sitting in their room, watching and helping this person transition to death.

And we had tens of thousands, if not hundreds of thousands of Americans during this pandemic, just like in times of bubonic plague. I mean, literally 1,000 years ago, we seemingly had not progressed in 1,000 years, people dying alone because the hospitals could not spare the PPE for their family. So it's not just that the healthcare workers are dying. The decedent died alone. What an awful thing to happen. The loved ones weren't present. These are all derelictions of duty that can be traced back, in my view, to the lack of our preparedness, which again can be traced back to our politicians and others. Yeah, it actually reminds me of another strike against Fauci that is also not said to

disparage the Chinese people. Just to be clear, I don't think Fauci was responsible at all for the lack of PPE. No, no, no. I was coming back to... I'm just trying to get into the heads of the people who haven't believed a word of what we just said for two hours. I mean, there are those people if they're still listening, they have a long list of things. Why are we so concerned? Why are we so concerned with those people, Sam?

Some of these people have bigger podcasts than I do. I mean, it's incredible. Wow, I didn't know that. It's incredible what's happened in podcasts, in the podcast landscape. I mean, it's... Okay. And some of these people have smaller podcasts than I do, but still large podcasts that reach

millions of people. And they have a list of things we have neglected. They have these articles from the preprints from some journal that we haven't heard of that has something that we have scandalously neglected in this conversation. Or there's just so many details that either look nefarious or within their purview are nefarious, but that don't actually have the implications that people would want to draw from them. I mean, what was going on a few weeks ago when it was disclosed that, I think it was Pfizer, when it was disclosed that, I think it was Pfizer, wanted their data on the kids' trials kept out of public view for the next 50 years or something?

I mean, what... So you tell me if you know anything about that, but all I can tell you is that in the minds of tens of millions of Americans, that factoid detonates like a 20 megaton bomb, right? Yes. That is just, that's all you need to hear to know which end is up. Yes, I understand that. And I'm actually sympathetic to that. I am very, you and I have talked about some of these topics before, I'm very high on the

open expression and full transparency. Like I think, I really believe that the cure for ignorance is light, and you need to throw bright light into dark recesses, and that includes releasing pertinent data of this kind. What I read was that a conglomerate, or not a conglomerate, a large group of interested parties had filed Freedom of Information Act requests with the FDA for some of these data, and the FDA said, look, we only have 10 employees to provide all the data that's being requested and clear it in the way that has been asked would take us 50 years, so we can't do it. I hadn't heard that Pfizer itself had said no. To me, that strikes me as bad business in addition to being bad public health practice.

Right. Maybe I have that wrong. Maybe it was the FDA basically saying at this rate, we're not going to get to this for 50 years. Yes. But then I think then Pfizer could step up and say, no, we'll release it ourselves. Why wouldn't they? I think it's in their interest for people to be vaccinated. And I can see why people would say we want... Now, I also think this can be a kind of turtles all the way down, an infinite regress. Like as soon as this data are released, then the conspiracy theorists... There's no satisfying conspiracy theorists. So let's say Pfizer released the data they requested. They would say, well, actually, now we want to see the original Xerox copies of the original clinical charts of the 20,000 people. We want their names

and addresses. If you don't believe their names and addresses, we think you made them up. Like that guy that was hawking the Sandy Hook conspiracy that no chance. What an awful human being. I mean, what a disgusting, a disgusting human being profiting off the murder of other people's children. I mean, this is ridiculous. But even if you showed this guy video and you showed him death certificates, he said, no, I still don't believe it. I mean, at some point you say, well, excuse my language, but fuck off. There's no way to satisfy such individuals. But I do agree that some accommodation for people's curiosity and inquisitiveness and suspicion needs to be made in a society such as ours.

So but in this vein, again, back to Fauci's besmirched reputation. I hold Fauci in high regard, I have to say. I mean, Tony, I don't know him personally. I've never met him. I've read a lot of his papers. I actually had read his papers before COVID. He was, Fauci was writing about respiratory pandemics when I was in high school. And I followed some of his work on HIV, I would say as a politician, as the leader of the National Institute of Allergy and Infectious Diseases, I was aware of some of his work with HIV in the

1990s. And there's a lot of history that's been written about his response to the HIV, the AIDS activists, and how they came to be friends and so on. And I think he was a little slow in responding to them, but ultimately did the right thing. And I generally think highly of him. But I recognize some of the slip-ups, non-trivial slip-ups that you're discussing that you bring to the table. So the other, I think the biggest mark against him at the moment is the lab leak hypothesis and the sort of stonewalling he did around that. Yeah, but those senators are...

No, I don't agree with that. That I think is unfair. I think that from what I've seen, these far-right senators that are trying to suggest that Fauci wanted to give American dollars to Chinese scientists to deliberately weaponize coronavirus, that's ridiculous. Well, I'm not sure that's the shape of the claim, but it was just the claim that we had given money to the Wuhan lab that was used for gain-of-function research. And then he was, in that exchange with Rand Paul, he was lawyering the language.

I mean, he had a very Clintonian, you know, it depends what the meaning of is is, approach to the language around gain-of-function, which drove a lot of people crazy. I mean, the whole left-of-center commentariat ruled Rand Paul to be just an embarrassing ignoramus there. But in most of America, or certainly much of America, it seemed obvious that Fauci was just not acknowledging the plain meaning of gain of function. Well, okay, so first of all, I followed this a little, but I mean, I've not seen every video clip. I've not seen every statement. I have seen some of Ron

Johnson, and I have seen some of Rand Paul. I've seen some every statement. I have seen some of Ron Johnson, and I have seen some of Rand Paul. I've seen some clips. And I honestly don't think those guys are, I think they're being completely disingenuous. And it's also implausible on its face that an American in his 80s, the leader of the National Institute of Allergy and Infectious Diseases, is happily providing money to the Chinese to do gain-of-function research. That's the wrong framing of what— No, but I think the real allegation would be that it was done, however, advertently or inadvertently, and he's just covering for this ineptitude. We had partnerships with Chinese laboratories, which, by the way, if we hadn't blown those up, we'd be in a better position right now to know where the virus came from. Now, I don't know all these facts exactly right,

but my understanding is that the federal government gave some grants to the EcoHealth Alliance, this entity in New York, which had been partnering with Chinese scientists to collect coronaviruses in caves in China. I think roughly that's what was happening. But it's to our advantage. Imagine if we had had a big archive of bat coronaviruses somewhere in the United States right now. And the way Trump defunded that, looking for some kind of a whipping boy, actually was injurious, as I understand the fact pattern, was injurious to our country because we pulled the rug out from a partnership with Chinese scientists at the precise moment when that partnership would have

been most useful to us to actually lay our hands on virus that would have allowed us to figure out where this COVID-19, where SARS-CoV-2 came from. So it is to our nation's credit that we have a commitment to science and scientific inquiry, and that we think that science can be apolitical, and that we have partnerships with scientists around the world who are... Even during our competition with Russia during the nuclear arms race, the American government and the Russian government encouraged physicists to talk to each other so that there would be these back-channeled communications that were apolitical between scientists. So to suddenly take this and make it into something nefarious is, I think, just looking for...

Well, I mean, so I think with respect to the lab leak hypothesis, I mean, my view of it has always been it was always plausible just because of the nature of the case. I mean, you've got the coronavirus lab right next to the epicenter of this outbreak. But it never seemed important to figure out at the beginning because we had the genome sequence of the virus. We know what we have to vaccinate against. But obviously, we need to figure this out eventually because we don't want any more lab leaks. So the thing that seemed truly crazy-making and obnoxious, at a minimum, was the political pressure coming from the other side to say that to rule out the lab leak hypothesis as a racist thought crime against the Chinese. Yeah, that's also BS.

I think if I had to guess, of the two possibilities we're discussing here, the so-called zoonotic leap, that it was a natural move from animals to humans, or the accidental lab leak theory, I still think the zoonotic leap is more likely, but I absolutely do not exclude the lab leak theory. And the Chinese have done themselves no credit by their secrecy and their lack of

transparency. Now, again, however, in fairness to the Chinese, if the Chinese government was demanding that they come to Fort Detrick to inspect our labs, we also would be quite unhappy with that possibility. I think if it was a lab leak, the Chinese have a lot to answer for, not only for the incompetence that resulted in the leak, but also the cover-up, which is not ideally the way our nation would function. There was another famous example of this, I think in the 70s, of an anthrax leak in Russia, which actually was a lab leak. And it was covered up, actually, think, by American scientists as well. And then I don't know the story exactly. There's a couple of books written about this, but I'm used to know the story. I just don't remember it right now at the level of accuracy. I want to

be heard by however many hundreds of thousands of people are hearing us right now. They're this far into our conversation. But I want to say- And they're all very angry. They're all, I hope, yeah, the ones who are, exactly. But on the lab leak, I do want to say a couple of things. My lab has done, my own lab has done a little work on this topic. Earlier, I talked to you about how we had this phone data about movement of people, 11 million people transiting through Wuhan in January. And we published a paper in the journal Nature in April of 2020, very quickly into the pandemic, that showed that we could forecast the timing, intensity, and location of the epidemic in China simply based on human

mobility patterns alone. And a few months ago, it occurred to me, and actually I have this in the paperback version of my book, I put in this analysis in the afterward, it occurred to me that we could use these data to reason backwards, not just forwards, and trace back when would be the likeliest time that the first patient that was infected with coronavirus could have left Wuhan. And I date, we call this, I call this patient zero prime. So this is not the first person to be infected. This is the first person who left Wuhan. And that date is November 1st. So already by November 1st, the virus was circulating. And then if you make some further assumptions based on what's known about the epidemiology of the virus, it suggests that patient zero,

the first person to be infected, probably occurred closer to October 1st. So this, you know, I am interested in the origins of the virus. My own laboratory has done some work on this. I think, if I had to guess, eventually we may know. You know, there's increasing evidence, very good scientists on both sides of this. I don't want to say both sides because that makes it like a political debate. It's not a debate. There's evidence accruing in support of both hypotheses, the lab leak hypothesis and the zoonotic leap.

And eventually, I think we will have a corpus of evidence that allows us to make an educated guess as to the most likely thing. I should say, one thing we left hanging from part of our conversation maybe an hour ago now is this issue of the inter-pandemic interval. Earlier, we talked about how serious pandemics may be coming more frequently. What's the evidence for that? Well, most listeners will be aware of the fact that even in our own lifetimes, there have been many zoonotic diseases. Zoonotic means a disease circulating in animals that comes to humans. HIV was a simian immunodeficiency virus, was in monkeys, came to us. Ebola, we hear about Ebola outbreaks. Zika virus, hanta virus, SARS-1 in 2003. These happened. And there is evidence that

there was a nice paper published in Nature about 10 years ago now, approximately, or approximately, that showed that if you look at zoonotic diseases by decade, we're getting more and more and more of them as each decade goes by. And part of the reason for that actually, believe it or not, connects this global threat of pandemics to the other great global threat of our time, which is climate change, that with climate change, we're seeing increasing motion of people encroaching on the territory of animals, and also animals, their territories being destroyed by climate change, they come in contact with us. So we have more and more contact between humans and wild animals, and therefore more and more of these zoonotic, you know, leaps that are happening. First point. Second point, if you look at the inter-pandemic

interval, the time interval, and this is stochastic, I mean, there's no, it's not like these new respiratory pandemics occur like clockwork. They just occur roughly every 10 or 20 years, but it could be every year, could be every 30 years, there's some variation. The serious ones used to occur every 50 to 100 years, but there's some evidence that that's narrowing. So it's possible that we could have another pandemic, not in 50 or 100 years, but in, let's say, 5 or 10 or 20 years. And here's the thing that I think people need to understand. Bad as coronavirus is, it's actually pandemic light. It only kills about 1% of the people it infects. Just imagine, just imagine if this virus, and the lethality of the virus is an intrinsic

property of the virus. It kills 1% of the people it infects. But imagine if this virus had killed 10 or 30%. There are other coronaviruses like MERS, Middle Eastern Respiratory Syndrome, that kills 30% of the people that are infected. If that had happened, we would have been facing a bubonic plague, like Black Death type situation in the 21st century in the richest nation the world has ever known. And it would be like in the movie Contagion, for example, which is a fantastic movie, one out of three people dying. And I don't think people fully understand how we've kind of almost, bad as it has been, we've kind of dodged a bullet. And this is why Republican and Democratic

administrations for decades have rightly seen respiratory pandemics as a national security threat, and why we need to take them seriously, why we should have taken this one even more seriously than we did, and why we need to continue to take this seriously and prepare for the future, so as not to have to suffer like this again. Yeah, well, that brings up a point that I want to talk about. We are in this wormhole of time dilation where what I thought was going to take 15 minutes has taken two and a half hours. So now we're on to the topic I wanted to address with you at minute 16, which is to the point you just raised. This is a dress rehearsal for a worse pandemic, which is more or less inevitable at some point. some of the wrong lessons here. And I think one lesson we learned, at least in the United States, about which there seems to be almost a consensus, is that lockdowns don't work. No, I don't agree with that.

But I mean, you'd be amazed if you ever turn on your computer and get on the internet. Well, I do. I just don't appear to spend... I don't appear to be in the dark reaches as much as you. I mean, sometimes the dark reaches find me, Sam, as I know they find you, but I don't go looking for it. I am surrounded by people who think lockdowns don't work. And I mean, so there are two ways to make this claim. That's not true. There's a huge amount of scientific evidence of this. Well, so yeah, that's what I want to get to. But there's two things that could be claimed here. You could be claiming that for some truly mysterious

and magical reason, lockdowns don't work. Like you successfully locked down and still the virus spreads. Well, if it spread through the water or if it rained down from the heavens, that could be the case. Or it was spread by an insect vector, for example, that flew from household to household. But in this case, a respiratory virus, we know that could be the case, or it was spread by an insect vector, for example, that flew from household to household. But in this case, in a respiratory virus,

we know that's not the case. If people actually are not commingling, if you actually managed to lock down for a month or six weeks at the outside for a virus like this, yes, you can quash it. But so the second claim, which is apparently true in the United States... No, I don't think that's true either. If you're saying that there are people who argue that if we had just all gone home for six weeks at the beginning, we would have killed this thing, I don't think that's true. I think the virus would have escaped our dragnet and we'd still be, look what's happening in China or even in New Zealand. So here's the second claim, which I think is the more accurate one, which is given just the nature of people and the imperfect nature of any lockdown,

no matter how draconian, you can't fully lock down and people are just not going to comply. And in the United States, we seem to have 300 million people who really were not going to comply. And therefore, what you're calling a lockdown is never really a lockdown. But the counterpoint to that is when you look at Australia and when you look at New Zealand, their level of excess mortality during COVID is nothing like our own. They simply didn't have excess mortality during COVID. Correct. That's right. That is right. And if they now vaccinate their entire population, 50 years from now, those countries will be seen as models. Now, in fairness, New Zealand is a rich island. And Iceland and the United Kingdom, they weren't as able to implement this strategy. But yes, that's right. It would be seen as an incredible victory. They kept their

population secure. They waited till the vaccine was available. They vaccinated everyone and they had a minimal loss of life. And they are having minimal loss of life. And that is admirable. But another point of confusion on this lockdown thing is people, the word is used very sloppily. For me, lockdown is stay-at-home orders or business closure orders. But there are many other steps short of that that are effective. For example, closing schools or banning gatherings or minimizing the size of gatherings or curfews where we say, okay, you can only be out from 9 a.m. to 10 p.m. or whatever. There are all kinds of procedures the government can implement to reduce social mixing. By the way, sometimes those procedures have paradoxical effects, which make things worse. Like curfews, for example, that I just mentioned,

can actually sometimes make things worse by increasing the density in stores. So these are all complicated things that need to be thought through and worked out and modeled and experimented with and so on. And also, you don't do idiotic things like close the beaches when you're talking about a virus that we know where outdoor transmission is greatly reduced. You force people into their boxes and you tell them they can't go to beaches or parks. Yes. Yes, that was dumb. And in fact, we had a paper on that that we published, I forgot where. I think on The Atlantic, we just had a little kind of cute little study we did about why every time they were talking about lockdowns or mass gatherings, they showed photographs of beaches, which was just stupid.

That's the least risky place. But anyway, so the thing is, when people talk about lockdowns, what they don't understand is they say, some people say lockdowns are ineffective. But what they mean by that is that the studies show that after you have closed the schools and closed the stores then ordering people to stay home is no longer additionally effective but but basically you've you functionally implemented a lockdown anyway you you know you've thinned out the movement of people dramatically short of ordering everyone home and also those same people who decry lockdowns are also the people who say, well, they don't want to wear masks.

And this is not sensible. Like if you really want to avoid lockdowns, okay, then do your part. You know, wear your mask, get vaccinated. Well, these are the people who don't want vaccinations either. So well, they don't want anything, but that's immature. I mean, that is that is like saying, you know, I wish it is. I wish, you know, it's like that scene in Lord of the Rings when Gandalf is talking to, I forgot if it's Frodo or somebody, he says, you know, we all wish that we didn't

live in such awful times, but what can we do? Yes, I wish I wasn't having to cope with a respiratory pandemic that's a once-in-a-century event. I imagine the young men that fought on the beaches of Normandy wished that the World War hadn't taken place when they were young men either. But that's when they happened to be alive. And so it's just immature to pretend like nothing is happening. No, the world has changed.

There's a new pathogen in our midst. It's like radioactive fallout. It's just there. And so we have to take some action to respond to it. We can debate how to take the least injurious action. We can debate which actions do or do not work, which are effective. Are they worth the cost? All of those are legitimate questions. But to somehow want to pretend like we don't have to do anything, we can have our cake and eat it

too, is not, in my view, befitting a great nation. It's not befitting an educated citizenry or the kind of civilization that I think we have. All right. So on that point, in terms of what we should be doing or not doing at the moment, where do you come out on vaccine mandates of various flavors? I think it's totally fine to have vaccine mandates. In fact, I think I would say I'm in favor of them. Now, I also recognize that we live in a plural democracy, and there are people who will disagree with me. And, you know, for example, I don't think there should, if I could, I would ban the private ownership of weapons. But I realize that I'm in a minority here, and that many Americans want to bear arms, and they use those arms responsibly, and that

we have at least some kind of constitutional right to bear arms and that I live in a plural democracy and I live with other fellow citizens who have different beliefs about different things. And so we kind of have to compromise and tolerate each other. So on the one hand, I would be in favor of mandates. On the other hand, I realize that there are people who will refuse to get vaccinated. I do not think such people should be put in prison. I don't think that we should send the army to their door and say, well, there's a law that

you have to be vaccinated and now we're going to arrest you. That's not what I'm saying. But I do think we can say your non-vaccination is in fact posing a risk to the rest of us, just like we can conscript you in time of war, which the state reserves the right to do that. The state reserves the right to commandeer factories, to manufacture stuff in time of war, which the state reserves the right to do that. The state reserves the right to commandeer factories to manufacture stuff in time of war. We reserve a lot of rights as a collective. We are going to mandate vaccination. And if you refuse, well, it'll be harder for you. You know, maybe you can't fly, or maybe you can't go to restaurants or whatever. You know, it's more difficult for you. But again, so I would say that I think that requiring people to be vaccinated, as we have,

by the way, for decades, for all kinds of childhood immunizations, we provide for some exceptions for people, of course, who have medical exceptions we provide for, and we should with coronavirus. We have some religious exceptions. If there was, I haven't seen a legitimate religious objection to coronavirus vaccination, but maybe there is one, and maybe we should tolerate such individuals, but there'll be very few in number. I would not get personal belief exemptions for vaccine mandates. I don't think that's a credible way to run a society. That's like saying, I have a personal belief exemption to pay my taxes. I mean, that's not how we run

a society. Would you give an exemption for natural immunity if someone can prove that they had COVID? Yes, I would. There, I think I would. Now, we touched on it earlier. I think from an individual perspective, yes, but from a public health perspective, we might not wish to do that for at least two reasons. First of all, we've already established that being vaccinated in addition to being naturally exposed is superior for transmission and for the person being infected. And second, the difficulty in ascertaining whether someone truly had had the infection may mean that it's easier for us to just mandate vaccination for everyone. Just like we have other public policies where we say, you know, we can't sort out who is or is not supposed to do such a thing. Some teenagers

may be able to drink responsibly and some not, but we don't implement a policy of saying, okay, if you're a straight-A student, you can buy alcohol, and if you're not, you can't buy alcohol. No, we just say if you're a teenager, you can't buy alcohol. So we may not want to have complex public policies. So while I would certainly talk about it, and it's not unreasonable to imagine that people who've survived the infection should not have to get vaccinated, I think that would not be a crazy thing to discuss or even to implement. Generally speaking, I would be in favor of mandated vaccination. And again, with the idea not being we will arrest people or something, but for example, I don't think healthcare workers

should be able to perform their duties without being vaccinated. When you go to the doctor, you don't expect the doctor to infect you with his disease. That's the opposite of what you expect when you go to a doctor. I think that hospital systems that mandate that their employees be vaccinated are well within their rights, and they should do that. Yeah, yeah. I have not understood how we can't have hospitals and other places where healthcare is dispensed. Just the idea that we have 23% of healthcare workers currently not vaccinated. I have to look up that. I've seen a lot of cases recently where

there was some resistance in various hospital systems, but in the end, only 100 or 200 people simply refused to get vaccinated and were let go. Most of the time, what I've seen is that when those things have been implemented, they have been effective. The same with the military, by the way. I never understood the argument in the military because if you can order people to battle and they run the risk of being shot and dying, why you can't order them to be vaccinated? And in fact, the military, now that the vaccines have been approved, the army just said, you're in the army now, you're getting vaccinated. It's not battle ready. You can't have outbreaks on ships or on airfields or in the front lines of disease when you're trying to fight a war.

So no, we vaccinate you. That's what we do. to all of the controversy here, the fact that people think it's an extreme imposition to mandate a vaccine in this case, is the belief that there's something extraordinarily concerning about these vaccines, right? Like you really are imposing... Is that really the objection? Is that really what people are saying? They're saying, you are trying to give me something dangerous? Or they're saying, you are trying to give me something against my will? Well, there's that. I mean, there's this bodily autonomy argument, but it does seem anchored to a belief. I mean, here's what you get in this, again, this Wild West space of crazy

and dangerous bloviation, that you'll get people saying, listen, I am not anti-vax. I have had all of my standard vaccines and my kids got vaccinated. I'm not one of these yoga pant wearing wackos who is against vaccines. Yeah, because anti-vaxxers used to be primarily on the left, right? This right-wing anti-vaxxer is kind of a new phenomenon, but... Yeah, because anti-vaxxers used to be primarily on the left, right? This right-wing anti-vaxxer is kind of a new phenomenon, but go on. Yeah. But for these vaccines, in particular, the mRNA vaccines, that's where I draw the line. All right. Well, then get the Chinese, get the Sinovac or Sinopharm vaccine, which are inactivated virus vaccines, old technology, like many other vaccines you got, get that one. Or even Johnson & Johnson, right?

old technology, like many other vaccines you got, get that one. Or even Johnson & Johnson, right? Well, Johnson & Johnson is a new adenovirus vector. What they do is they took the AstraZeneca, I think, took a chimpanzee cold virus, which sounds really weird, but actually smart. That doesn't sound good, yeah. It doesn't sound good, but it's actually smart because we're not really affected by chimpanzee viruses. It's like your dog can be sick in your house, but you don't get the sickness that your dog has because that virus is optimized to infect dogs, not humans. So giving you a chimpanzee virus is just a way of transmitting that has been genetically

modified to express the spike protein on its surface. You mount an immune response against the spike protein, and you just use the so-called adenovirus vector. Or the Johnson & Johnson uses a mild human cold virus that's been weakened even more, and then they add the spike protein to it, and then that's how they deliver it. Those are relatively new technologies, the Johnson & Johnson and AstraZeneca adenovirus, although we have more precedent for those than we did for the mRNA vaccines. But like I said, the Sputnik vaccine, the Russian vaccine, the Chinese vaccines, those are based on older technology. If you want those, get those, right? What's your answer to

that if you're opposed to this new technology? Well, I can only imagine that would be hard to do if one were willing, but I'm sure in this case, they're not willing. So to bring this home, because now we're hitting the three-hour mark, and we're now talking to five people who already agree with us. But it's whized by, Sam. Three hours of whiz by. At least for me. I won't say for you or the listeners.

No, it's been great. So given all that we've said and given just the experience we've had over the last, now coming up to two years almost, what would you expect in the case of a much more dangerous and lethal virus? Let's say we had the 10X or worse version hit us two years from now. We have demonstrated that we can produce vaccines very quickly. I've come to think that we're sort of in the uncanny valley here with respect to pandemics, where it's just not, as you said, it's not dangerous enough to really nullify all political

controversy. I got to think that if 10% of people or 20% of people were dying from COVID, we wouldn't be having this conversation. I think that's right. People would just be getting vaccinated. Yes, I think that's exactly right. And I think, like I said, this virus was deadly enough to cause us harm, but not deadly enough for us to take it sufficiently seriously. I think that if the next respiratory pandemic happens within our lifetimes or within 30 or 40 or 50 years, we will do better.

But if it happens more than that, it'll be like people will forget. And this is why, by the way, plagues have been a part of the human experience. And our ancestors tried to warn us. Plagues are in the Bible. They're in Shakespeare. They're in the Iliad. The beginning of the Iliad, the oldest work of Western literature, begins with a plague. It's Apollo's arrow brings down the plague upon the Greeks laying siege to Troy. So our ancestors tried to warn us about this human experience, this awful thing known as a plague. They put it in our religious traditions, they put it in our literary traditions, and yet we didn't heed the warning of

our ancestors. And partly this is the, and I contrast this with an example with hurricanes. So the residents of districts of parts of the United States that are afflicted by hurricanes, when the meteorologists forecast a hurricane, the people get, watch the TV, they see the radar images, they know what to do and they take it seriously. Because hurricanes come every year or two or three years, bad ones every 10 or 20 years, people remember and they take it seriously. But something that happens at a time interval of every 50 to 100 years out of human memory tends to be forgotten. This is part of the whole denial problem we

discussed earlier. So if the next pandemic occurs within the next 10 or 20 or 30 years, I think we will do better. We'll take it more seriously. There'll be a lot of people that remember this COVID-19 and pay attention. And furthermore, as you mentioned, the world has changed in another way. I rarely am triumphalist about medicine. I can count on one or two hands the number of medical advances I think have radically improved human well-being. Penicillin is in that category. Insulin is in that category. CAT scans are in that category. Aspirin is in that category. But also in this category are mRNA vaccines. I think this is a radical new technology that our descendants, when faced with plagues,

will have at their disposal a tool such that they can effectively and in real time build a defense. So I think a future president of the United States might say, we have detected a new pathogen. It's serious. We're going to lock down for four months while our pharmaceutical companies make a vaccine and make hundreds of millions of doses. And then we're going to efficiently distribute it to you all. And we're going to have minimal loss of life. That is a realistic potential future.

And I think people might be more willing to tolerate such a response and such a common civic purpose, given this new technology that's available. And finally, what are you expecting over the next year or two or three? I mean, when do we get out of pandemic mode with respect to COVID and get into the new normal of endemic illness? Because I got to assume the possibility of getting rid of COVID is in exactly no one's mind. No, we're not going to get rid of COVID for the reasons we discussed earlier. I discussed this a little in the book, like the phases of a respiratory pandemic, the immediate phase, the intermediate phase, and the post-pandemic phase.

We're going to enter the intermediate phase, as I had forecast, in 2022, when we're going to reach herd immunity. Pretty much everyone in our country will either be vaccinated or infected, and we'll have acquired immunity that way. And then coronavirus will become endemic. It will circulate. It won't be eradicated. It'll still kill people, but the numbers will drop and it'll sort of become like another flu. It'll be bad, but it'll be kind of in the background. And this is what happens with respiratory pandemics. And then we're going to have a period of time in which we're coping with the aftershocks where all the kids that miss school, all the workers that lost their jobs, kind of the great resignation, all the rejiggering of our economy, the debts that we're going to have

to start to figure out how to repay our debts. There may be inflation because of the money the government borrowed and so on, those aftershocks. And then I think that'll last for a couple of years until in 2024 or so. And then I think we'll enter a kind of post-pandemic period, a kind of roaring 20s of the 21st century, similar to the roaring 20s of the 20th century, where finally we will put the plague behind us, where people will feel like we survived, let's party. So I think that's sort of what's going to happen. We're going to have, as I said earlier, another wave next winter, and eventually this will tamp down. The clinical impact will tamp down soon, within a year, and the epidemiological impact will tamp down. But then we're going to have to deal with the psychological and social and economic

aftershocks, and then those will eventually recede. And we'll see the other side of this, as our ancestors did, who also confronted serious plagues. Are you expecting to need a booster every year indefinitely, or do you think we're going to get a whole class of coronavirus nullifying vaccines? Yeah. So I think that the forecast I just made depends sensitively on whether we see the emergence of new vaccine evading strains of the virus. The worst thing that could happen to us now would be that we would have mutants of the virus, which were much more deadly, let's say killed 10% of the people instead of 1%, or fully evaded the vaccine. If that were to

happen, we would be back at square one. I think the probability of that happening, a kind of tail risk event is between one and 10%. I think it's unlikely to happen, but it's possible. And that would be awful, really calamitous if that were to happen, where if we had a fully vaccine-evading strain, which Omicron does not appear to be, or if we had a much more lethal strain of the virus, which Omicron is not. So now deaths will rise from Omicron, not because each person, if infected with Omicron, is more likely to die than if infected with Delta. No, deaths will rise because the number of people infected is going to be much larger because Omicron is so much more spreadable and has some capacity for immune escape. So we are going to see a bump.

The United States is going to lag Europe by about three or four or five weeks. So we should watch what's happening in Europe in terms of deaths and their response because that's going to come to this country. So the general overarching forecast I gave, I think, is going to be what happens unless we have the emergence of something that's not Omicron, something that's fully vaccine evading, which I don't think Omicron is, but we don't know for sure yet, or much deadlier, which I don't think Omicron is, but we don't know for sure yet. If that happens, then we're back at square one and so on. On the boosters, I think if you've had two shots, you should get a booster.

I got my booster. I think that's quite sensible. There's evidence that it will be helpful, including against Omicron. And I think that there's a good possibility that we will have to get coronavirus shots in some time interval between every year like we do for flu and every 10 years that we do for tetanus. interval between every year like we do for flu and every 10 years that we do for tetanus. So I can imagine a future in which every three to five years, you go to your doctor and you get a coronavirus shot that is updated for the latest strains of the virus.

Right, right. Well, I can't help but notice that with a last name like Christakis, you're well-positioned to pronounce the name of each new variant. Omicron. Yes. I joked, when they first said they were using the Greek alphabet, which only has 24 letters, I was like, this is not enough. We should have used the Cambodian alphabet or the Khmer alphabet, I think it has 74 letters, because we're going to run out of letters. And then there was also this whole political thing where they skipped the Greek letter Xi. Yeah, Xi, X-I, which looks like the Chinese letter. Yeah, what a stupid thing. We're going to offend the Chinese leader because we happen to use a Greek letter. Oh, and they also skipped N and you, because it would be the new strain.

It would sound like people would confuse it with any W. I think they should have just stuck with, and then it wouldn't be called Omicron, it'd be called something else. Anyway, thank you, Sam. It's been great talking to you. Likewise. Thanks again for all your time.

And again, your book is Apollo's Arrow, which is out in paperback and audio, et cetera. Always great to talk to you, Nicholas. Until next time. It's great, Sam. Yeah, exactly. Thanks, man. I'll talk to you later. you