The Munk Debates Podcast - Be it resolved: We should be very worried about the variants

Episode Date: May 20, 2021

B1617, which has plunged India into a catastrophic third wave of COVID-19 and is spreading globally, is the latest “variant of concern” that has emerged since the pandemic began over a year ago. Many leading infectious disease experts are warning that our failure to contain the spread of the virus, with dozens of high population countries nowhere close to acquiring vaccines, has created the ideal conditions for dangerous new variants to emerge threatening the efficacy of vaccines. They say that only a strategy of maximum global suppression using all the public health tools at our disposal in combination with a massive ramp up of vaccination rates in every country will prevent COVID-19 from becoming a serious, endemic illness capable of killing millions annually. Critics of this view say that once again we are over-estimating the severity of COVID as well as our ability to control the virus's spread. They say that the mutations it generates are a normal part of the evolution of all viruses and COVID-19 is no exception: there have already been thousands of new variants over the past year and the majority are not associated with a change in infectiousness or deadliness. Mutations also tend to repeat across variants making it possible for vaccine makers to target the changes that are associated with increased risk of infection and death with booster shots. Herd immunity achieved by vaccination and naturally occurring infections among healthy individuals, will steadily bring COVID-19 to heel making it a manageable disease for humanity. Arguing for the motion is Salim Abdool Karim, Director of the Center for the AIDS Program of Research in South Africa (CAPRISA) and CAPRISA Professor for Global Health at Columbia University. He is a member of the WHO Science Council, the Africa Task Force for Coronavirus, and the Lancet Commission on COVID-19.  Arguing against the motion is Richard Schabas, a former Chief Medical Officer of Health for the province of Ontario, Canada and Chief of Staff of York Central Hospital during the SARS outbreak. Sources: CNA, CNBC, BBC, Tom Woods TV, AFP News Agency, ABC News Australia, Global News The host of the Munk Debates is Rudyard Griffiths - @rudyardg.   Tweet your comments about this episode to @munkdebate or comment on our Facebook page https://www.facebook.com/munkdebates/ To sign up for a weekly email reminder for this podcast, send an email to [e-mail]. To support civil and substantive debate on the big questions of the day, consider becoming a Munk Member at https://munkdebates.com/membership Members receive access to our 10+ year library of great debates in HD video, a free Munk Debates book, newsletter and ticketing privileges at our live events. This podcast is a project of the Munk Debates, a Canadian charitable organization dedicated to fostering civil and substantive public dialogue - https://munkdebates.com/ The Munk Debates podcast is produced by Antica, Canada's largest private audio production company - https://www.anticaproductions.com/   Executive Producer: Stuart Coxe, CEO Antica Productions Senior Producer: Christina Campbell Editor: Kieran Lynch Associate Producer: Abhi RahejaBecome a Munk Donor ($50 annually) to get 72-hour advanced access to the full length editions of Friday Focus and Munk Dialogues. Go to www.munkdebates.com to sign up. Hosted on Acast. See acast.com/privacy for more information.

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Today's debate, be it resolved. We should be very worried about the variants. India has acknowledged for the first time that a double-muted variant may be fueling its COVID-19 crisis. We are classifying this as a variance of concern at the global level. There is some available information to suggest increased transmissibility of B1. 617. The level with you that this new variant could pose a serious disruption to our progress and could make it more difficult to move to step four in June. Hello, I'm your moderator, Rudyard Griffiths.

B1617, which has plunged India into a catastrophic third wave of COVID-19, and is spreading fast globally, is the latest variant of concern that has emerged since the pandemic began over a year ago, many leading infectious disease experts are warning that our failure to contain the spread of the virus, with dozens of high population countries nowhere near to acquiring, let alone administrating vaccines, has created the ideal conditions for new dangerous variants to emerge, threatening the efficacy of vaccines themselves. We also hope this discovery of the variants is a wake-up call to the rest of the virus. of the world that we should not leave any country behind.

These same specialists say that only a strategy of maximum global suppression using all public health tools at our disposal, in combination with a massive ramp-up of vaccination rates in every country, will prevent COVID-19 from becoming a serious, endemic illness capable of killing millions annually. Critics of this view say that once again, and we are overestimating the severity of COVID-19 as a threat to humanity, as well as our ability to control the viruses spread.

They say that the mutations it generates are a normal part of the evolution of all viruses, and COVID-19 is no exception. Hurt immunity, achieved by vaccination and naturally occurring infections among healthy individuals, will steadily bring the virus and its variants to heal, making it a manageable disease for humanity. The virus mutates. It's been mutating since the day it was released under the population. Tens of thousands or more mutations have happened already this virus,

most of which do nothing to the virus. The variants don't change anything fundamental. You don't do a lockdown. You do focus protection. And with the vaccine, we can do pretty close to perfect focus protection. On this installment of the Monk debates, we challenged the essence of these arguments by debating the motion, be it resolved.

we should be very worried about the variance. Arguing for the motion is Salim Abdul-Karim, director of the Center for the AIDS Program of Research in South Africa and Professor for Global Health at Columbia University. He's a member of the WHO's Science Council, the African Task Force for Coronavirus, and the Lancet Commission on COVID-19. Arguing against the motion is Richard Chabas,

a former chief medical officer of health for the province of Ontario and Canada, and chief of staff of a major hospital, York Central Hospital, during the SARS outbreak. Salim, Richard, welcome to the Monk Debates. Thank you very much. Pleasure to be here. Thanks a lot. It's great to be here, too. This is an important conversation that we're going to have today, an important debate, I think one that is on everybody's mind. To what extent are these new variants that are emerging around

the world, these new strains of COVID-19, a threat to an assumption, especially here in the developed West, that we are on the verge of reopening our economies, that life could in the days and weeks to come return to something closer to a pre-COVID normal. So to have the opportunity to speak with both of you from different parts of the world, with different perspectives on this issue, the threat of the variance. and what they pose right now to the global response to COVID-19 is a privilege indeed. Our resolution today, simple to the point, be it resolved, we should be very worried about the variance. Salim, you're arguing in favor of the motion. I'm going to put two minutes on the clock

and turn the program over to you. As we look at the development of variance of SARS-COVID, we're seeing that there are four things we have to be most concerned about. First, is do they spread faster? And indeed, the evidence shown quite clearly now for both the B117 variant from the UK and the B351 variant from South Africa, that they do indeed transmit much faster, as we are seeing in India where the B617 variant is spreading much faster. It's not clear whether these variants are causing more severe disease, but early data from the UK certainly suggests that the variance spreading,

is causing more severe disease. What concerns us most is, are these variants able to escape immunity? Data so far suggests that these variants are able to escape natural antibodies. And what we're seeing is that escape is also present in the form of reinfection. We have seen multiple reinfections occur in South Africa, and we are now are deeply concerned about vaccine efficacy. looking at just one vaccine, the AstraZeneca vaccine, which was 70% effective in the UK, it was not effective, or only 10% effective in South Africa against the variant.

However, other vaccines seem to be doing equally well regardless of variants. And so that's where we stand in terms of what we know about vaccine efficacy. Our concern is that the variants are going to become more and more common. As we get a larger vaccinated community, we're likely to see more variants emerge that may be able to escape vaccine immunity. Thank you, Salame. Okay, Richard, we've got you on deck here for your opening statements. Similarly, two minutes on the clock. Give us your assessment as to why you think we should not be very worried about the variants at this stage in the COVID-19 pandemic.

Our response to the COVID pandemic has been driven by an exaggerated assessment of the threat, unrealistic expectations of the effectiveness of the non-pharmaceutical interventions, and fueled by fear. The result has been a so-called cure that in many ways is worse than this terrible disease itself. We have become obsessed with COVID to the exclusion of the things that matter most in our world, like the education of our children. A year ago, we paddocked, threw away carefully crafted plans, and we've been floundering ever since. The variants are the natural evolution of the virus, and their net impact so far has been a modest increase in transmissibility.

They have not changed the fundamentals of the disease, and we have no control over this process. The virus will do what the virus will do. Fortunately, the real story of the past few months has been the impact of the vaccines. Countries that have immunized their vulnerable populations, including Canada, have already seen a dramatic decline in death rates. The vaccines work, and they work well. What should we worry about? We should worry about getting vaccines out to the world. We should worry about vaccine hesitancy. And we should worry about getting our lives back. Our governments have painted themselves into a corner with COVID because they have no clear idea what they are trying to accomplish. The significance of the

of the variance is that we need to accept that COVID is not going away. Mitigation must be our objective, not elimination, which is unachievable globally and unfeasible nationally. The more transmissible the variance, the less effective, the non-pharmaceutical interventions, lockdown is on a slippery slope leading nowhere. We need to get out of this. We need to get our world back. Our response to the variance doesn't need more fear. Thank you, Richard.

Okay, time now for rebuttal. This is an opportunity for both of you to react to what you've just heard. So, Salim, another two minutes on the clock. Give us your take on what you've just heard from Richard. What do you want to take exception with? I think at a very fundamental level, the evidence we have seen on the efficacy of vaccines has been showing that they are very effective in preventing severe disease.

But that's in the context or in countries that do not have the significant, variants with immune escape, such as the B-1351, the variant that we see in South Africa. South Africa officially passed one million cases of COVID-19, the highest number in Africa. The rise in infections has been, in part, driven by a new strain of the virus that's believed to be more contagious. When we will start seeing the benefits of vaccines and that they are able to continue to protect against variance, then I would be not concerned. Right now, I would be concerned that variance may cause severe disease if they are able to escape immunity. And the evidence we have is only from countries that do not have these variants. Thank you, Salim. Okay, Richard's same opportunity for you.

You can react to what you've just heard from Salim, from his opening statement. What points do you want to push back on? Yeah, I actually don't take exception to very much of what Salim. Liam said in his opening statement, I think it's a question of perspective and how we view the world. I'm an epidemiologist by training and by instinct, and epidemiology's job is to see the big picture. People who focus on the virus, I think, are only seeing part of the picture because the spread of diseases in human populations is a very complex matter, and it's determined not just by the virus, but by the post and by the environment. The big picture, the proof of the pudding, in this case with variance is at least so far, all we've seen is some modest increase in transmissibility.

That's not nothing. We've seen a significant, a substantial wave, probably the largest wave of infection. In fact, indeed, the largest wave of infection we've seen with COVID in the last couple of months, but it's been accompanied by less mortality, not just over mortality rates, but less mortality overall, largely because of the impact of the vaccines. So the virus is going to change. This is not a process that's going to end, that there's any reason to think is going to end. The virus is going to continue to evolve as all viruses do, as all living things do. But what we have to do is we have to learn to adjust to that. We have to reach the balance that allows us to mitigate the most important impacts of COVID, which of course are the deaths and the serious illnesses. The various things

the vaccines are most effective at, but we need to balance that with a need to get a return to our normal life. Thanks, Richard. Well, my opportunity now to join into this debate and kind of think about some of the questions that are top of mind for our listeners, put those to you and engage in this conversation. So, Salim, I want to start with you and I want to start with what we're seeing in India, because this is really consumed, certainly our attention here in Canada and I think across the world. India up to a matter of a month or so ago, having a surprisingly it's always hard to characterize these things properly. I wouldn't say an easy pandemic, but a pandemic that was in some ways remarkable for the size of the country,

the condition of its health care system, the seeming absence of deaths in India. Now all of a sudden, we are confronted with a wave of death and suffering in India on a scale that we have really hitherto not seen to date. So what's going on there? What are you hearing from your colleagues around the world? about this Indian variant and why, particularly, given your experience in South Africa, why are you worried about the Indian variant? You raise a very critically important question, and that is that each of the three countries

that have described in great detail their first waves, India, South Africa and Brazil, each of them dealt with their first wave and didn't come out of it particularly badly, and particularly in India where there were comments about, oh, we've reached herd immunity because of high levels of seroprevalence. The Prime Minister even declared, we've conquered this virus. And that led to some level of complacency. It led to permissions being given for large gatherings, for religious festivals, for political rallies. And so what we saw in India was a combination.

of three things occur. The first is that there was a sense of complacency and people were letting their guard down. The second is that super-spreading events were enabled a virus to spread. Millions of pilgrims have for weeks flouted COVID safety guidelines. Packed along the Holy Ganga River

for the Hindu festival of Kumb Mela, there's barely a mask in sight. Social distancing is impossible. And the third is that those two behavioral activities, one at a level of the community, was that you had a new variant. And that variant was able to spread rapidly. If they had an existing previous variant, they would have been in a better position to cope. But because this new variant is transmitting faster, people get into hospital quicker, there's a greater demand for oxygen. and so the system starts collapsing.

It isn't able to cope. There are too many people requiring health care, too many people needing oxygen, and the system begins to burst at the seams. And that's what we're seeing in India. Now, the variant is not responsible on its own. It's a major contributor, but it's able to do that because of the complacency and because of the super-splitting events.

So Richard, I want to come to you on this because there are reports now out of the UK government, which seems to have done some initial analysis of this Indian variant, that it could be upwards of 40, 50, possibly 60% more contagious than the already highly contagious Kent strain. And there's a concern there that because of the higher R. not number, the Indian variant will replace the Kent strain. And with its very high rates of infectiousness,

there is a danger here of it finding people who are not immunized or certainly it looks like people are only immunized with one dose have less protection against severe illness and hospitalization. So why aren't you very worried about that? And particularly why aren't you very worried about that in terms of a country like Canada, which has low single digits when it comes to double dose inoculation across our population? Why aren't we in the crosshairs of the Indian variant right now? Okay, there's a lot to unpack there. Let me start by making a few comments about India, because I think our reaction to the COVID outbreak in India is a really great example of how we have totally lost all sense of perspective.

As you said, India is a huge country. India has a population of more than 1.3 billion people. That's more than all of North America and South America combined. and it's a country with huge health challenges. There are more than 10 million deaths every year in India and 27,000 deaths a day. And most of those deaths are by our Western standards preventable. They're caused by the effects of poverty. They're caused by malnutrition, by poor sanitation, by lack of access to basic medical care. There are a thousand children under the age of five years. Infants and babies who die every day in India, overwhelmingly preventable. deaths caused, and the leading cause of that is diarrhea. So if we want some perspective on what's going on in India, yes, the COVID outbreak there is tragic. It started about six weeks ago. It has, by the way, piqued. The numbers are coming down very rapidly in India, but by the time the dust settles, there will be about 200,000 reported deaths from COVID, and undoubtedly that's an

underestimate. However, compared to the 500,000 deaths every month in India, preventable deaths, it's a sense of perspective. So yeah, India needs oxygen all right, but they need safe drinking water much, much more. The issue about the increased transmissibility of the variance, it's not surprising. This is exactly what's going to happen. The virus is going to continue to try to escape reproductive pressures. And one of the ways that viruses do that is that they become more transmissible. But the bottom line on COVID, what caused all of the concern a year ago, was not the number of infections because the vast majority of infections with COVID, in fact, are asymptomatic or mild disease. The number of infections doesn't matter. What matters is the

number of serious illnesses and deaths. And that's exactly where the vaccines are so effective. So sure, Canada is rushing to immunize, and yes, there's a possibility. that we will get the Indian variant and we'll get another outbreak. But we also have another ace up our sleeve. And that's what's driving case rates down dramatically in Canada right now. And it's called spring because this is a seasonal virus. So the probability is the reason I'm not consumed with worry about the variance is I think even countries like Canada, in fact, will be in pretty good shape by the time next September

comes around. But it's not going to go away. We're going to have more disease. We're going to have to learn to accept the fact. that COVID is going to join the list of maybe a thousand other diseases that we simply have to coexist with. Fortunately, we have the tools, the tools with the vaccines, to mitigate the worst effects of this disease. Hi, I'm a monk podcast listeners. I wanted to let you know about our spring 2021 monk dialogue series

on the fate and future of our democracy. These are in-depth, online, and interactive video conversations with some of the world's brightest thinkers. We'll feature over the next number of weeks, everyone from Jonathan Haidt, to Scott Galloway to Douglas Murray, to Nazarene Malik, to Timothy Snyder, and Irshad Manji, all reflecting on how has COVID-19 reshaped our democracy. How are we dealing with the forces and stresses of this pandemic on our institutions and on our shared values? You can find out more about the monk dialogues on our website. www.w monkdebates.com forward slash dialogues. Now back to our program.

So, Salim, do you share Richards, I wouldn't characterize it as confidence, but Richard's, let's say, willingness here to see this disease in the context of a larger epidemiological pattern of human illness, that this will become endemic, it's seasonal, you know, variations are just going to be a feature of COVID going forward. All of this is manageable. And it's manageable

largely because, again, of highly effective vaccines. I want to hear a little bit more for you and Salim, maybe the South African experience, because it's a fairly acute one. Why you don't share that same optimism? I just want to touch on one key issue that has been raised. And that is that in many of the poor countries in the world, we have. have a large amount of excess debts from ostensibly preventable causes, diarrhea and pneumonia and so on. That's not a reason why we should accept another few thousand deaths from COVID. I think that those are diseases we do need to tackle, and indeed many of these countries are attempting to do that. Many of my colleagues in India spend their lives focusing on that.

So now that we are dealing with an issue of COVID, we can't say that. a disease that has caused 161 million infections, 3.3 million deaths, and that's just the reported ones. Excess debts suggest that the current analysis puts it more at around 10 million deaths. That's well above the other pandemics we've dealt with. I spent 30 years focusing on HIV, and we've never had that many deaths from HIV in any one year. So this is not something we can just look the other way and say, oh, it's another disease, just like every other. This is a serious, acute problem. It's killing people.

Now, we've got to deal with it. And we can deal with it in a range of different prevention tools that we have, vaccines, prevention measures, and so on. But we've got to put the political will to it. And we can't just be accepting that we'll just vaccinate our country, and that's the end of the story. That's not going to solve this problem. We have to look at dealing with a pandemic as a global problem that needs a global solution. And a global solution is that we've got to make vaccines available everywhere.

We've got to vaccinate the entire world. It's not going to solve the problem that Israel, Bhutan, the U.S. can vaccinate and reach close to herd immunity, while most of Africa haven't even vaccinated their healthcare workers yet. So, we're not going to solve this problem by really. which countries vaccinating their populations and hoping that that's going to solve the problem while the virus is spreading rampantly in the rest of the world. So we've got to find a pandemic solution that's global level, and we've got to treat it as a disease that needs priority and focus to bring it under control.

And until we get that to that point, it's got to be high priority to vaccinate the whole world. So Richard, come back on Slim's first point there that, you know, we can't be sanguine about this. It's not enough just to say, well, the illness will become endemic, and we can live with it like the other, you know, a couple thousand endemic chronic diseases that humanity deals with. Why do you feel differently? Well, it's not my choice. There's no pro-COVID lobby here. It's facing the reality of a natural world where people die. I mean, there are 60 million people die every year in this world. We'd like to stop all of those deaths. All of those deaths are tragic.

However, with our obsession, and I don't use that word lightly, with COVID, we have, in fact, adopted so-called control measures that are going to cause deaths on their own, that are already causing deaths on their own. Unifesth, this was six months ago, projected that the lockdown was going to kill 300,000 children through malnutrition because of disruption of food distribution. So what we're doing in our efforts to control it with these lockdown measures, in fact, have a death toll. But I want to push back on something that Salim said.

I think we've been a little too glib with numbers with COVID. And people throw out very large and very scary numbers. And the one that he used was 10 million deaths from COVID, which is three times what's been reported. And I wonder where that number comes from. There was, for example, a paper, an article published in The Economist two days ago, which made those sorts of claims about excess deaths. And frankly, it's a piece of scientific judgment. junk. There are so many speculative assumptions in that they assume that these excess deaths occurred in the developing world because they occurred in the developed world, and they assume that if

these people died, which we don't know that they did, that they must have died of COVID. So it's speculation built on speculation. Three, three and a half million deaths is a terrible tragedy from COVID. It's much worse than I thought it would be and that many people thought it would be, and no, we shouldn't be sanguine about it. We should be very concerned. We should be very sad. But we have to be careful that we don't exaggerate the problem. We have to be careful that we don't, therefore, adopt measures, which in the long run are going to do more harm to ourselves than good. Thanks, Richard. Sleam, another question I wanted to ask you was about your thoughts on the future of the vaccines. One of the worries that we here expressed out there

is that the next phase of this virus will be to have a test, a trial of the virus against the vaccines, including the very effective vaccines, like the Pfizer and Moderna vaccines. To what extent should I be worried that these vaccines, as the virus continues through natural evolution, to iterate itself over and over again, that even these super effective vaccines could see reduced efficacy,

efficacy that might not be easily solved simply by tweaking the vaccines through boosters or new iterations. Is that a worry that I should have? Yes, it is a worry you should have. Not because of any projections, but let's look at some facts. There's reported 3.3 million debts. Fact. It's underestimated. Fact.

What the true number is, is you've got. can take whatever data you want and come up with some number. But 3.3 million by itself is a seriously problematic number. That's a large number of debts. Can we prevent those debts? Yes, we can. How? Because a vaccine, as we're seeing now, can effectively avoid and prevent severe disease and in many cases even mild and asymptomatic disease. What is the data that we have? So let me just take South Africa. And we have done in South Africa four vaccine trials. So let me give you the facts.

Vaccine trial one, Astazeneca vaccine. That vaccine was shown to be 70% efficacious in the UK, but only 10% efficacious in South Africa, basically ineffective. Let's take the Novolvax vaccine, 89% effective in the UK, 43% effective in South Africa. We're deeply concerning. Vaccines that lose half the efficacy against the 351 variant. I'm concerned. However, we have two vaccines that show that they're not impacted by the variants.

The Johnson & Johnson vaccine was 72% efficacious in the US, 64% efficacious in South Africa, within the margin of area. So we're in a better position with the Johnson and Johnson vaccine. And then finally, the Pfizer vaccine, which included South Africa, the original trial done in the US and South Africa. It was shown to be 91 to 95% effective in the US in South Africa. To date, we haven't had anyone infected who's received the Pfizer vaccine, even though the controls have been infected with the 351 variant. So at this point, we have 100% efficacy from Pfizer. Small trials, because they are part of a multi-centred trial, but they certainly indicate

that there are some vaccines that are impacted by variants and others that are not. It is a question right now that are all our vaccines going to continue to be as efficacious going forward? The answer to that question is not known, but let's look at what we might predict or speculate. And among those, as populations become vaccinated, the virus will be put under immune pressure to escape vaccine immunity. And so there is a reasonable likelihood that we will see. such escape variants. As Dr. Shabas has pointed out, that's part of how vital evolution works. So that means we need to make a new set of vaccines.

But the reason we've got to focus on that is because we've got to give this disease high priority. We've got to make sure we put the resources into vaccinating population. We've got to make sure we put the resources into making new vaccines as in when they become needed. And that's why we need to be concerned about these variants and we need to prepare for these variants and not to be caught unawares because we were, oh, it's just another virus. No, we've got to deal with this with the seriousness it requires. Thank you. Richard, similar question about the MRNA vaccines.

These are the Pfizer-Moderno vaccines, really kind of pretty revolutionary technology here. What's your view about the extent to which it might be possible to create a universal vaccine that could work against all future variants of COVID? There's some suggestion here that the ability of these vaccines, these MRNA vaccines, to model the surfaces of the spike protein on the virus that's used to infect the human cells could reach a level of kind of mastery that stops the virus from having the ability to adapt and evolve in any way that would cause infection. Do you hold some optimism that we might be potentially through this technology?

on the verge of a universal vaccine? Well, I'm fundamentally an optimist, so I'll share any optimistic ideas with gladly. But in a sense, it's above my pay grade. I'm not a vaccinologist. I'm not a virologist. But I also get a little nervous when we start to speculate. And that's basically what we're doing now. I was very involved in the SARS outbreak in Toronto, almost 20 years ago now.

And I think my key observation coming away from that outbreak from SARS, which we, by the way, profoundly misjudged. There was a profound misjudgment of what SARS was all about. And SARS very quickly died out, notwithstanding the models that predicted we were going to have, I think it was 120 million deaths in the world. We ended up with about, I think it was 8,000 cases, 800 deaths. And the concern I had at the time was we spent far too much time worrying about what SARS might do. and it distracted us from looking at what SARS was actually doing. And I think we're making fundamentally the same error here with COVID, is that these are immensely complex natural processes,

and we can speculate till the cows come home about what might happen, but it's just speculation. So, of course, you know, Saleem knows I'm not preaching complacency. I'm not saying we shouldn't watch the variants. I'm not saying we shouldn't be working to develop new vaccines. but on the other hand, in terms of our public policy, because my grandchildren in Toronto, are not in school. And by the time the dust settles on this next, if they get back next September, they will have missed a whole year of school.

That's a huge price that they have paid for these lockdowns around COVID. And a lot of that, a lot of the rationale has been our concerns about what might happen, not about what is happening. So yes, I've got an eye to the few. future, but my gaze is firmly fixed on the here and now because that's the world we have to deal with, and that's the world we should be dealing with. Thank you, Richard. So, Sleem, on that point, because it's a good topic for us to dig into before we go to closing

statements, have we calibrated properly for risk when it comes to this virus and the public health responses to it? I mean, Richard's just mentioned. I mean, we have a pretty remarkable situation here in some. Central Canada with really a third wave of lockdowns, surging numbers of deaths of despair, suicide, drug abuse, a mental health crisis. And all the while, you know, we're experienced on a per capita basis as many deaths in Ontario on a daily basis as they are in Florida, whereas the state of Florida is completely open and we're largely closed. So what's your view, Selim, going forward as we

think about the variance. I mean, there's a, how do we calibrate the risk properly and how do we understand the tradeoffs that a lot of these social controls, public health controls, have imposed on the rest of society? So I think it's not accurate to simply equate that we have variance and therefore equals lockdown and that it equals these kinds of restrictions where children shouldn't go to school. I think in each setting, epidemiologists like Dr. Shavas and myself, we make assessments. And back in April of last year, after schools had been closed, we assessed the risk and we recommended that students go back under certain conditions. So we make those assessments all the time. we calibrate our response in relation to what we anticipate are going to be the risks and what the risks are at the time.

We have to do both because we have to understand what are the likely best case and worst case scenarios. They don't always do that. But the issue is that we must very carefully assess based on the evidence that's available what the correct actions are. They're not easy decisions. They're not always made correctly. They are often political considerations that appear and get mingled in all of the science. From my point of view, what are the three key things we need to do? The first is, if we ignore variants, we'll stop looking for them.

We need to have the genomic surveillance that ensures that the whole world is continually monitoring the evolution of the virus and how the virus is changing. and particularly how it is changing in settings that we currently don't have enough information on. The second is as new variants emerge, we need to have a research program that ensures we assess them. If they are not a concern, and if Dr. Shabas is right,

that they're just part of natural evolution, they're not going to be a big deal, I'd be very happy that we've gone down this road, down the future, and these variants actually don't matter. But we can't take that approach only. we can't adopt a cavalier approach. We have to prepare for a worst-case situation.

I hope it doesn't occur, but that's what we have to prepare for. And so that preparation needs evidence. It needs the science to assess the new variants. And thirdly, we need to have the vaccine companies on their toes. We've got to feed them with the new genetic information so they can make us new vaccines that will be effective against the new strains that are able to escape the current set. of vaccines. So those are three key things that we need to do. So Richard, what's your view on the

kind of risk, the worry versus, let's say, optimism calibration? And maybe just give us your perspective of where Canada is at right now and whether you think we have that right. Okay, just one comment. I didn't say because they're part of natural evolution that the variance are no big deal. I don't know what's going to happen with the variance. I don't have a crystal ball. What I said is so far the impact has not been large, but of course we need to keep our eyes and ears open because that could change. What's going on in Canada, I think, is really comes back to something I said in my opening remarks. I don't think we have a clear idea of what our objectives are with COVID. What exactly are we trying to accomplish? When all of this started, 18 months ago,

15 months ago, the concern was the high level of death and serious illness. And we've made great strides in dealing with that. And the vaccine is going to continue to make great strides because although indeed we've seen far more infections with COVID in Canada in the last two months, we've seen far fewer deaths than we saw even in the wave in January. So we're making great progress there. And if our objective is to reduce the level of death and serious illness from COVID, to I don't want to say an acceptable level because no death is acceptable, but to a level that's comparable to what we get from influenza and a host of other infectious diseases.

Well, I think we're just about there. But what I hear in Canada, and particularly in the province of Ontario, is that we're morphing into an approach that seems to be aimed at getting rid of the COVID virus entirely. Instead of tolerating low levels, a group of health experts is pushing for an aggressive new strategy. It's called COVID-Zero, and it calls for a full-scale lockdown,

stricter restrictions for a longer period of time, until the cases are completely gone. And I see their influence profoundly. We're talking about closing the borders to keep the variance out, as if anyone believes that that's actually going to work, or that it's really worth the price that we would have to pay. I think we need a national discussion very quickly about what it is that we're trying to accomplish.

How do we reach the balance between COVID as it now is with its much lower rate of serious illness and death and our right to go to school, to go to work, to see our families? And we need to have a national discussion where we agree on what it is we're trying to accomplish because if you don't know where you're going, then you won't know when you get there. Final question for you, Sling, before we go to closing statements, which is, do you think that the eradication of COVID is a reasonable public health goal for us to have?

Or is this really a question of kind of disease management? Where do you come down on that? We cannot eliminate or we cannot eradicate SARS-CoV-2. It naturally infects animals. It affects dogs, cats, minks, all kinds of animals. So it can always come back into humans from animals. So its eradication is not a feasible prospect. I think what we need to aim for is a situation where we can get it under sufficient control that it does not pose itself as a major public health threat. It's exactly the same. same goal we set for HIV. That means it gets to a point where we can get back into much of our

lives, live alongside it. There will still be infections occurring. There may be a few deaths, but that at most we are in a situation of endemic transmission that is at low levels, like we see with measles. Every now and then we see a case of measles. I see it in my hospital. You know, we know that vaccines keep measles at bay. Most children are vaccinated now, and so it doesn't really pose a major threat. So our goal needs to head in that direction. But we need to understand that there will be threats to that goal. And one of the threats to that goal will be the possibility of a new variant that escapes

our vaccine immunity. So I am of the opinion that, we need to remain vigilant because this is a threat to the very kind of future, the very kind of endgame we would like to see where we coexist with this virus and where it no longer presents itself as a major public health threat. Thank you, Salaim. Well, let's go to closing statements. This has been a terrific debate. Timely indeed. Our resolution today, be it resolved, we should be very worried about the variance. Richard, you've been speaking against the motion. Let's put a couple minutes on the clock and have you sum up this debate for us. Health is more than just the absence of

disease. It's a positive state of physical, mental, and social well-being. We have completely lost sight of this whole list of concept in the last year when we've equated health, not just with merely the absence of disease, but actually just to the absence of one disease. which is COVID. We spent years crafting pandemic influenza plans, which would have made an excellent blueprint for our response to COVID. And yet, when the COVID emerged, we abandoned those plans in a twinkling, but they had two overarching goals that we would do well to remember. The first was to minimize illness and death, not just from the pandemic illness, but from all illness. and the second was to not interfere with normal life or to minimize the interference with normal life.

History will judge whether our lockdowns were necessary or effective or, as I believe, neither. Now's the time to move on. We have to remember what's really important to health. COVID was never quite the monster that we were led to believe. And although the variants show it's evolving in various ways, there's certainly no evidence currently. that that's changing. And that regardless, the vaccines are clipping the cause of COVID. Let's get kids back to school. Let's get people back to work. Let's get families back together. COVID is going to be around for the foreseeable future. I agree with Saleem that eradication is a futile, is a futile strategy.

The variants have made sure of that. The virus can evolve if that's made sure of that. But we can handle it without the fear and without the self-harm that has characterized our response so far. It's time to move on. Thank you, Richard, for those closing remarks. Salim, we're going to give you the last word in our debate today. Be it resolved. We should be very worried about the variance. Let's have your closing statement, please.

As I look at the situation in India, I am touched by the enormity of the challenge. I'm touched by the devastation that's being caused. And as I watch this situation and think to myself that we should have been better prepared, not just in India, but in every country to deal with this problem. Just like that, we need to be better prepared for the next set of variants. Will they occur? There's a very high chance that they will. Will they be able to bypass immunity?

We can't answer that question right now because we can't, don't have a crystal ball, but there's a good chance that that's going to happen. We cannot two years from now look back and say, oh, we should have been better prepared. We've got to make sure right now that we take variance seriously. And to do that, we've got to accept that that is a part and parcel of how we look to the future of this pandemic and how we will not put ourselves in a situation of denial, but in a situation of acceptance that this is a disease we are living with. This is a disease that is causing death.

It has over 3.3 million deaths already. That we want to avoid this kind of situation going forward. We want to protect the benefits that we get from our vaccines. And most of all, that we fully appreciate that this is not a disease that each of us can do and deal with on our own. We are fundamentally interdependent. No one is safe until everyone is safe. I'm not safe until you are safe.

Every person I interact with, I put that person at risk. I need to ensure that I protect myself and the person I deal with protects himself. So it is that interdependence. In South Africa, we have a word for it. It's called Ubuntu. I am because you are. I take responsibility within a society to protect our society, as should all of us, that together we can defeat this virus.

Thank you, Salim. And thank you, Richard. Civil, substantive, on point. This has been a terrific debate. and behalf of the Monk's Debate community, I want to thank you both for lending us your expertise, your analysis, your insights. This is exactly the conversation I was hoping for.

So thank you gentlemen, both, for coming on the Monk debates today. My pleasure. Thank you for hosting us. Thank you very much. Dr. Chavez, lovely to meet you. Wonderful to hear your views. Likewise.

While that wraps up today's debate, I want to thank our participants, Salim and Richard, for a terrific debate and for sharing their knowledge and experience from the front lines of epidemiology. If you have feedback or reflections on what you've just heard, please send us an email to podcast at monkdebates.com. Here's some feedback that we received on our most recent debate. Lots of passionate response to the resolution, be it resolved, Beethoven, not Mozart, is the world's greatest composer.

Alec writes, a great concept with two passionate and knowledgeable participants. However, I vote for J.S. Bach. Thanks, Alec. Howard, the artistic director of the Notte-Bene players and singers series, feels quite differently about the debate. He wrote to us saying the monk debates tend to be stimulating events featuring people of obvious expertise in their field of endeavor. Such was not the case in the recent Mozart-Batoven debate. We were subjected to a display of ill-formed opinionating and the musical selections did little to buttress either side of the debate. Mike finally weighing in on our Beethoven versus Mozart debate says,

Brilliant plan to expand the debate dialogue format beyond the geopolitical. I'm a fan of geopolitics, but I also very much appreciate moving us listeners into a wider field of contemplation and the exchange of views. Let's hear it for the arts too. Hey, thanks, Mike. We appreciate all the feedback that we get on our podcast. It's really important to us to know what you like, what you don't like.

please keep sharing, keep listening, and send us your thoughts to podcast at monkdebates.com. Also, a reminder that our members-only podcast comes out every Friday, a half-hour look at current events, is yours to listen to you any time as a free perk of our basic membership. You can access that at www.munkdebates.com forward slash membership. Thank you for helping us bring back the art of public debate. one conversation at a time. I'm your host and moderator, Rudyard Griffith. The Monk Debates are produced by Antica Productions and supported by the Monk Foundation.

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