The Munk Debates Podcast - Dr. Eric Topol Dialogue - Variants And The Future of Covid-19

Starting point is 00:00:01 These statues have to come down. It's always been a pandemic of the unvaccinated. The problem now is it's a pandemic of the willfully unvaccinated. Falling birth rates are good. They're good for our planet. They're good for our societies. We're not responsible for the escalation with Russia. We're not the ones who invaded Ukraine.

Starting point is 00:00:21 I don't think it's fair to portray people of color as victims. It is a very dangerous time in American politics. Hello, Monk debate listeners. Rudyard Griffiths here. and moderator. Well, we're back at it. This is the latest installment of our Monk Dialogue series that we're bringing to you this summer. These are long-form conversations with some of the world's sharpest minds and brightest thinkers on the big issues transforming our society. Today, an in-depth and far-reaching conversation on the state and future of the COVID-19 pandemic with one of

Starting point is 00:01:02 medicines leading global experts. Chinese health authorities are still working to identify the virus behind a pneumonia outbreak in the central city of Wuhan. At least 59 people are believed to have been sickened by the new virus. Tonight, U.S. airports on high alert, screening passengers for symptoms of a deadly new virus. Very concerned. Now that you brought it to my attention, I'll stay away from most people wearing masks. The COVID-19 pandemic has now ravaged the world for over two.

Starting point is 00:01:32 years. The death toll of this modern contemporary plague is 6.4 million and counting. Over a million of those are from the United States. And here in Canada, 40,000 of our fellow citizens have perished as a result of COVID-19. Today, we're asking ourselves, what does the future of this pandemic look like, particularly with the emergence of new, fast-evolving variant? What should be expected this autumn and winter in terms of the behavior of the virus. Do these new highly infectious variants hold more surprises in store for us? Or is there some good news out there? Could current and new vaccines, along with powerful antiviral treatments, lead to a future trajectory of this pandemic that avoids a repeat of the Delta and Omicron surges we experienced in 2021?

Starting point is 00:02:32 and early 2022. Well, to dig into all of this, we are thrilled to welcome onto the Monk Dialogues, renowned physician, scientist, and author Eric Topal. Eric is a American cardiologist, widely published scientific researcher and author. He is the founder and director of the Scripps Research Translational Institute, a professor of genomics at the Scripps Research Institute,

Starting point is 00:03:00 and a senior consultant at the Division of Cardiovascular Diseases. As a primary researcher, Eric has published over 1,200 peer-reviewed articles with more than 300,000 scholarly citations. This makes him one of the top 10. So let's take advantage of the format of these monk dialogues, which are long-form, extended conversations, to have you begin by giving us a sense of, what surprised you about the course, the trajectory of COVID-19 this year so far? What's been new and possibly what's of concern for you in terms of how the virus has evolved over this summer? Let's start there.

Starting point is 00:03:49 Well, it's great to be with you, Rudyard. And I think it's been a series of surprises, the unpredictability that characterize where we've been. you know, a year ago, or at least in June of 2021, things look really quite good. And the thought was if we could just get up our vaccination rates a bit more, we might be on our way to coast out of this. And then Ammocrine hit, and it didn't only just hit with such a ferocious, particularly in the United States, but throughout the world. It ushered in a series of subsequent variants, which have been particularly,

Starting point is 00:04:29 rough, the one that we're just getting through now, this BA5, which became globally dominant. So what we learned is that in this family of Omicron, it just keeps finding new ways to get more immune evasive, that is, our immune system having a harder time to recognize it, despite prior infections or vaccines or both, and it then gets so transmissible. And our vaccines just don't hold up. It's challenged our vaccines to an extent, that I don't think we would have envisioned. And that's why we need to fix that. Well, Eric, let's explore some of the key points of your analysis.

Starting point is 00:05:09 And I want to, you know, begin with vaccines. You know, all of us, the vast majority, are double vaccinated, boosted. You name it. We've done it. And we've done it on the basis of hope and expectation that vaccines will protect us, not simply from infection. We get it. These new variants are breaking through, but more importantly, from severe illness and hospitalization. It'd be interesting to hear you go a bit deeper on just what's happening with vaccines right now. We all remember when they were first announced

Starting point is 00:05:54 in the fall of 2020, you know, the 95% plus efficacy. Those numbers seem to be falling in terms of, again, protection from severe illness and hospitalization. What could that mean? And why is this happening? Right. Well, you bring up such a central point because it was just so extraordinary in November of 2020 when we had 95% efficacy in two very large trials, over 70,000 people with Pfizer and Moderna, you know, basically replicating that. And the whole point about that is that lasted right on through Delta, that juncture we talked about just a moment ago of June 2020 because although there was some waning, if you got a third shot, you still had that 95% efficacy against infection,

Starting point is 00:06:51 no less the same or more against hospitalizations and death. So the vaccines work like too good to be true, just momentous. We've never had vaccines like this. And then basically their protection against infection fell apart with Omicron. You know, it became much more brief. And, you know, although there was some protection, there still is. It's really the vaccines became very leaky against infections and, spread. On the other hand, they have held up not perfectly well. There's cracks in this,

Starting point is 00:07:27 but they have held up to at least 80% reduction of death and hospitalization. That's not 95% by any means. But that's what's holding us from, you know, having really had even far worse outcomes. And the reason for this goes back to that concept that the virus changed so much. it acquired so many mutations in critical areas that it just fakes out our immune system. And no matter how well we're primed against it, we just can't mount as good a response, particularly in our upper airway to get infected, much less so in our lungs and other organs, but still, not as what we used to have when this pandemic, you know, is right on through mid-2021. Eric, talk to us more about what you're seeing in terms of these latest variants B5A and its sub-linages,

Starting point is 00:08:27 in terms of declining effectiveness of the vaccine to prevent hospitalization, severe illness, and in some cases death. I think, again, we had hoped that through natural infection and through being double-vaccinated, boosted, that we would enjoy continuing high protection going into the autumn, and maybe more importantly or equally as important, our health care systems could avoid the burden already stressed and strained by over two years of coping with the large-scale death and illness caused by COVID. So I just want to hear a bit more from you about whether we have some false complacency around the extent to which vaccines remain a panacea for our control and management of the COVID-19

Starting point is 00:09:26 pathogen. Yes, absolutely. This is a central point because there's still a lot of happy talk. We saw this a year ago when the boosters, that was the third shot or the first booster, the data came out of Israel and then other countries showing how important it was. And we had the denialist that said, oh, we don't need them, that we have no reduction in our protection from severe disease. Well, now we're seeing that again.

Starting point is 00:09:57 Like I said, it was 95% with a booster. Now we're seeing some reports, you know, in the mid-70s. That's a big drop. I mean, that's a really big drop. It isn't as if we don't have very good protection. Remember, Roger, if we had had a vaccine efficacy of 75% in the beginning, we would have thought that was pretty good. So, yeah, it's still good, but we're having more people wind up in the hospital now who had a third shot and even some with a fourth shot because the vaccines have, we have a combination of two things. predominantly it's the issue of the immune evasiveness and waning with that.

Starting point is 00:10:43 But the other thing, of course, is this so-called imprinting or antigenic sin. That is the first thing that you're exposed to with the virus, whether it's an infection and which variant or vaccine, which is only one so far, which is the original spike protein, you tend to really be really great against that, but not as good as the new things that you get exposed to. And so that's also contributing probably to our inability to mount that 95% protection that we were seeing in the earlier phase of the pandemic. You also have some concerns, Eric, that, you know, the antivirals have been really heralded as a terrific intervention, especially for at-risk, vulnerable.

Starting point is 00:11:32 patients, preventing, again, hospitalization, death. Some sense here possibly, Eric, that the virus in terms of its ability to mutate is being pressured not only by the vaccines, but by the antivirals, and maybe we're a little bit complacent about the longevity of these antivirals into the future and their ability to continue to be as effective as they are right now. Yeah, another vital point, and that is we rely very heavily on Paxilvid in the U.S. 3 million people have taken Paxilvid already. And that is working. I mean, there is a rebound issue, of course, that has to be addressed.

Starting point is 00:12:20 But for the most part, the efficacy of reducing hospitalizations and deaths is important. But we can't count on that because under pressure, sure the virus's mission is to find more hosts. It's all it wants to do is just find more hosts and hijack their cells. And the problem, of course, is the Paxilvid works through this M-Pro, the main protease enzyme. And we've already seen mutations in that occurring naturally in people, whereby it could really knock out the efficacy of Paxil-Ovite. We just haven't seen them, you know, to account for why people aren't responding, or eventually it's likely we'll see that.

Starting point is 00:13:04 And we don't have a backup right now. We don't have another pill that has that potency. There's lots of them that are in the hopper, that in the pipeline, but none of them are getting serious accelerated attention. So, you know, after the vaccines, Paxovid was our biggest jump forward because normally it takes many years to get a pill

Starting point is 00:13:23 with high efficacy and safety. And here it was all done, essentially de novo within a two-year period. But we may not have that to rely on. And the other thing, of course, I think you're alluding to is we've had all these really potent monoclonal antibodies, you know, more than 10 of them. And now we're down to one, only one that works, betamilovab. So this just shows you how tough this virus's evolution has been.

Starting point is 00:13:52 And no reason to think that Paxilvid is going to be as effective in a few months or, or so than as it is now or so then as it is now. So you think this could be a matter of months in terms of seeing real degradation and, sorry, seeing real degradation in the effectiveness of these key antivirals? Well, you know, it's hard to know. Ideally, if you are the optimist that I like to be, there would never be resistance. but with the increasing use of Pax of it around the world, and now that there's a supply of well over 80 million blister packs,

Starting point is 00:14:35 it's pretty likely that this is going to happen at some point. Maybe it will take till mid-20203. It's hard to know. But I think most people looking at these mutations that keep cropping up in the M-Pro, which previously had been a portion of the virus that was not prone to mutations, So this is different, different than the spike protein? Right, right. This is a portion of the virus that's conserved.

Starting point is 00:15:02 That is, it doesn't tend to mutate much. But, of course, what's happening under the pressure, the virus is just so, you know, it wants to be unstoppable. And it will mutate to select out, you know, how it can achieve its goals. And facts of it is potent because when you take it after just, you know, a couple of doses, is it basically stops replication of the virus in its tracks. And so, you know, I think it's not as fast an evolutionary arc as other ways the virus responds to pressure, but it's increasingly likely at some point. Paxovid will lose some of its efficacy, possibly even all of it.

Starting point is 00:15:45 What is your explanation or thoughts on why we're seeing these variants seem to emerge faster and faster. There seems to be a kind of a cadence or a increasing rhythm to this virus. What is that? Is it real? Does it herald something? Can you draw a direction, a trajectory going into the future as to this increasing pace for the emergence of these effective, highly effective, at least from the virus's perspective, of variance? Yes, I think this is something to note in that We meant the whole first year of the pandemic, literally, without any significant evolution that is no new strain that was really spreading around the world. And then, you know, we had alpha that was globally dominant delta and then culminating in amyricon and its family of the variance. The difference between pre-Amocrine and now is that in this Amicron stretch,

Starting point is 00:16:52 where it's just adding more mutations on a hyper-mutated version of the virus, it can do that much more readily, faster. And so the virus adaptability is extraordinary now because it started out with this virus that was just 60 different mutations from the prior delta and the original ancestral strain. So this was such a shakeup that, you know, I think the problem we have to consider is, will there be another family distinct from Ammocrine? The problem we have is, as you know, we have tens of millions of people around the world that are immunocompromise. It only takes one person to have a virus infection that has accelerated evolution, which is where we think Amicron came from.

Starting point is 00:17:49 and then that person infects others and then, you know, it just can go into hyper spread mode. So this is why, you know, there's fear about we might see something distinct from the Amherron family completely. But the explanation to your question, I think mainly lies in the fact that once we got this curveball, with this just, you know, incredible Amacron, it wasn't so hard for it to acquire a few more mutations here and there, including the crucial one in L452, which is a delta mutation that drove its disease-causing capability. So governments now are really tasked our pharmacological industry companies, Pfizer, modernity, you name it, to come up with a new vaccine, I guess, targeting what looks like, correct me if I'm wrong, but the BA5,

Starting point is 00:18:46 kind of variant. What do you think about that approach? Because I guess there's a bit of a sense, isn't there, Eric, of a kind of whack-a-mole here that we're always behind. We're always dealing with, we're always fighting the last war as opposed to the next war. So what's going on here? And what do you think about that strategy coming into the fall? You know, there's expectations here on the part of a lot of people that this next iteration of the vaccine will be ready early in the fall with lots of time for turkey, turkey dinners, you know, fully boosted, fully protected against, I guess what people hope is not only BA5, but the sub-linages, 0.2 and 2.12.1, and I guess even whatever comes next. Right. Well, you've really described that so well, Rodger. I think the problem here is,

Starting point is 00:19:40 this variant chasing strategy. It's almost like we're ignoring the potential there to squash this virus once and for all. So why is that, Eric? Is it politics? Is it governments that are just, you know, fed up with the pandemic? They're fed up with spending money on,

Starting point is 00:19:59 in this case, we know hundreds of millions of doses for the original, from the original lineages that will never be used now, that have gone to waste. Exactly. You know, it's a combination of factors. On the one, it's really attitude and cultural because so many people are just denying the pandemic, you know, just trying to will it away. It just doesn't work that way, as you know. The second one is that when you're trying to deny that it's a problem and you're relying on, you know, hope and prayers that it's just going to go away. and the myth that the variants just get less and less severe over time and then just fade away, which is, of course, debunk.

Starting point is 00:20:44 But then there's the issue of, well, we have to put in more funding, and we don't like to do that, especially in the U.S., where it relies on Congress, and there's a portion of Congress, the Republicans, who are not supportive of further pandemic funding. So we have issues where politics are overriding where the science takes us, where it could get us. And also, you know, I think there's the issue, will a pan-coronavirus vaccine work? Will it, will it, you only know that when you go X number of months or a year or two subsequently in the pandemic, that, you know, what you theorize is going to knock out every virus in this, family, it's the uncertainty. Whereas when you look at these companies like a Pfizer and

Starting point is 00:21:36 Moderna and others, making a specific vaccine variant, it's so easy for them. You know, it's like no risk. They would get a lot of reward. They don't have to take any risk because it's very, it's a tunnel vision sort of project, right? I'm going to make a BA5 specific vaccine. I'm going to show to the HPV or the FDA or the EMA that it works against that strain or a variant, whatever. So you have lack of willingness to take risk, lack of priority to put in the resources, but the science is extraordinary. And there's at least 35 of these broad neutralizing antibodies that you could make a vaccine against multiple BNABs, as we call them.

Starting point is 00:22:21 And you could knock this virus on its, you know, flat out. And I'd like to see that happen because I am worried that we can see worse forms of this virus. I hope it doesn't happen. Maybe we'll be, you know, in really good shape in the months ahead. But there's still that uncertainty. So play out a scenario for us where that, where your concern becomes heightened in the autumn. What would you look for to say, okay, wow, something is emerging here. that seems to either have this type of lineage connected to these, you know, previous variants,

Starting point is 00:22:58 or I don't know, it's expressing these kinds of characteristics in terms of infection and illness in usually the countries like South Africa and elsewhere where we're seeing these new variants emerge. Yeah, I mean, I think, you know, we're fortunate because the genomic sequencing of the virus revved up so much during the pandemic. We have now, you know, well over 11 million viruses sequenced throughout the world. So we have at least a form of genomic surveillance, which is formidable. And what the good news is, I'm always looking for good news, we don't see any new version of the virus, anything at the moment that threatens to outcompete BA5 for global dominance. now if we can sit tight like that you know our fall will be good and in fact you know the BA5

Starting point is 00:23:53 specific vaccines may you know be a reasonable uh strategy the chance of that holding over time though gets diminished because you know we just because we don't see anything now um you know it's certainly possible that there will be some other uh either either amocron derived uh or new family the latter would be a far worse scenario. Eventually, you know, out-competees where we are right now. So the good news is, you know, we're seeing the fading of BA5, the descent of its outcomes. We already saw that in Europe.

Starting point is 00:24:33 We're starting to see that in North America. Eventually, we'll see the same in Asia, which has been hit hard, Australia, and New Zealand. But fortunately, there's nothing that we can see in the works yet. And does that mean the pandemic? epidemics over, no. You know, we could go a stretch where things look really good for a few months, you know, including the fall and early winter. And then, you know, the surveillance shows us that, uh-oh, we got a whole bunch of new mutations. You know, the number of, there's 30,000 letters

Starting point is 00:25:07 in this virus. The number of combinations and mutations is almost infinite. And so, you know, we've seen some really novel mutations. You know, there's a virus that's low level right now in the U.S. called B.A.4.6. It doesn't look like a threat, but it's got new mutations that we've never seen before in the whole pandemic. That just kind of shows you what can happen. We also, as you know, have these big animal reservoirs, whether it's the white-tailed deer or the hamsters or the cats or the mink. And they can, like the, the, immunocompromise people. They can harbor the virus, have it evolve, and then spill it over to humans.

Starting point is 00:25:51 And so we have a lot of liabilities out there dangling about why we might see another worse form of the virus. To use an imprecise analogy, just to try to understand this, is there any way of thinking of the virus like a computer, like a supercomputer? Like you reach certain processing speeds and you just can't go any faster unless you use quantum physics. You know, so are these viruses like that? I mean, I mean, they're becoming, in the case of the infectiousness of the BA strains, I mean, significant jumps, multiples of the previous strain. I mean, is there a certain natural upper bound, I don't know, just realities that the virus

Starting point is 00:26:37 confronts in terms of its own evolution and maybe more importantly how it behaves in hosts and it interacts in the world? Is it possible that we reach a plateau of infectiousness, which the virus can't go beyond, and therefore that strain remains dominant? Yeah, this is a critical point you're getting at. So for one thing, we keep building an immunity wall of our populations, right? Because they're getting infections, they're getting vaccines and boosters and combinations of these.

Starting point is 00:27:10 And so on the one hand, you know, our defenses are increasing. You know, every time we go through another surge, we get more protection with that. So there's a tension between that and then the virus's evolution to a more potent version. The problem we have is that every time we think the virus could have maxed out, we get a head fake. You know, there it is again. Oh, my God. How could it be possibly more transmissible? When I saw Omicron, I said, oh, my God, this is incredibly.

Starting point is 00:27:43 These vertical spikes, like, you know, you never saw before. We have the same thing now with BA5, like in Japan, where it actually is over twice the spread of BA1. So the difference for Japan, like many countries in Asia, they controlled the virus, they had not a zero COVID policy there, but they did a great job of containment. So they don't have that natural infection build up to help scaffold their, vaccines. So remember, when you try to interpret the vaccine, excuse me, the virus is evolution to a more potent form, you have to remember that you may not see it where the population immunity wall is

Starting point is 00:28:26 very high. So we tend to make these stupid judgments, oh, well, this mild or more mild, less severe. Well, no, it's not that. It's because of these immunity walls. critical points and really helpful to understand, but also to understand one of the reasons that you're hopeful is that this virus is different than the flu, than influenza, which really is a super mutator that has a capacity to completely change itself from year to year. You know, we've heard so much of this pandemic comparisons of the flu and COVID for usually for worse in terms of arguments that people are making. I wonder if you could just paint that picture for us of how we should understand. these two different pathogens and what they say about each other. Yeah, I mean, I think it's clear that at least in the beginning of the pandemic and for quite a stretch, there was a much higher fatality rate of COVID than flu.

Starting point is 00:29:24 No question. But what we've also know and learn more about the biology, that if you want to come up with drugs or vaccines, you definitely want to pick COVID or SARS-CoV2 over. influenza. The reason being is, even though it's mutated and we've talked a lot about that here, it's nothing compared to influenza. So influenza, we have never had a vaccine that was 95% affected. I mean, we're lucky to have 30%. So our vaccines don't do well. Drugs, Tamiflu, which is a drug we have against influenza, it's a weak hitter compared to Paxilvig. So this virus can be taken down. It doesn't mutate as much.

Starting point is 00:30:07 We have had success stories against it that are far beyond what we've ever had for influenza. So that's why we should be optimistic. And that's why I think we have to invest in nasal vaccines, which there is a nasal vaccine. It's the only one commercially available, flumist for flu. It doesn't work great, but it's about the same as a shot in the people that, you know, are approved to take it. But again, we have a much more favorable path of intervention here. So I remain very upbeat about our ability to work against this virus. And the critical thing about those nasal vaccines is that they actually,

Starting point is 00:30:47 they're blocking the infection, right? They're not dealing with it once it gets into the body. They're stopping it kind of on the beach before the troops have landed and stormed up to the pillbox of your immune system. just to finish out because these are really helpful points for me and I think our listeners too in terms of differences between the flu and COVID correct that COVID is much more infectious as a higher are not number than influenza is it significantly higher could it increase even more I mean it isn't it true now that these latest variants of COVID are are really pushing

Starting point is 00:31:52 into the upper band, the upper cohorts of some of the most, you know, infectious viruses that we know and hate. Yeah, there's been a lot of, I guess, controversy about that, you know, did this virus, SARS-Co-2, get to the level of measles? And it hasn't. And the only reason, again, is because of the immunity walls. So the fact is you can't even assess it now, because there's so many infections around the world and vaccinations and boosters and hybrid immunity. So, no, it isn't anything like measles. But if we didn't have all those infections and vaccinations, it might be, it might be the most transmissible virus in history if we hadn't, you know, over the past two and a half years

Starting point is 00:32:42 had all these things that we've built up. So, no, it's definitely been a tough path. but we're not seeing levels of infectiousness that would rival measles at this point, although they have been scary high in terms of the number of people infected. And with doing less central testing and PCR testing, we're grossly underestimating the numbers of people who get infected. And a lot of people, of course, don't even bother testing. So we get some false reads about the level of infectiousness.

Starting point is 00:33:21 this as well. Okay. Remaining moments, just a couple final things I want to focus with you on. What is your recommendation to people right now? There's a lot of,

Starting point is 00:33:32 a lot happening in terms of public information campaigns saying, you know, get a booster, get not simply your second, but if you've had it, your third or even contemplate a fourth booster

Starting point is 00:33:42 based, as we know, on the original wild strains, some people saying, well, I don't know. I mean, I've been, I've had natural. infection, I've been boosted multiple times. Isn't it better for me to try to wait until I've, until possibly I can get the new iteration of this vaccine? I realize each case is different.

Starting point is 00:34:07 You know, obviously older people, people who are immunocompromise should probably take one course or path of advice and treatment. Others may be different. I'm just wondering if you have any thought. or suggestions or ideas on that as people kind of grapple what to do going into the autumn. Right. You know, I think the data for age 50 and older to get a four shot, that whole data set of four different studies, survival improvement, is pretty extraordinary. And so that's why I say if you're 50 plus, get a four shot now if you're well, four months, six months past the third shot.

Starting point is 00:34:47 the other people, you know, in terms of younger, who don't have much in the way of major health issues, probably can wait. Also, then there's this issue about what about health care workers, essential workers? You know, there's a big study from Israel just this week that suggested that people who are health care workers really benefited from a foreshot too. So it's one of these things where there's an uncertainty about when a BA5 vaccine is going to be ready. September, I think, is pretty darn optimistic, how well it will work, how the variant will change in that time versus the certainty if you can get a four-shot now. And so for the people at risk, I'd go with the certainty.

Starting point is 00:35:38 You know, it's like the bird in the hand and two in the bush. It's the shot in the arm is worth, you know, overriding what's, going to happen in October, November. Remember, it took seven months to get a BA1 specific vaccine and then not even being used, whereas now they're saying two months they're going to get a B. That's pretty optimistic. I'm not sure if it's going to happen. I'm thinking it's more October, November, and that gives more time for the virus to evolve. So we'll have to see how it all plays out. hindsight is 2020 but we know this is not going to be humanity's last pandemic so what are some of the key things that we should take away from this in terms of how we think as a society about future

Starting point is 00:36:26 proofing ourselves against you know the next pathogen that will come at a certain point at a certain time we will be faced with this crisis again what are some of the the top lessons that you think we should learn from this. And maybe, Eric, the ones that we're not learning right now, the ones where instead of internalizing some type of understanding, we're still banging our heads against the proverbial wall. Yeah, so crucial to face the music that pandemics are going to be much more common in the future because of climate change, because of what we've done to the environment.

Starting point is 00:37:08 And that's why we have, you know, twin pandemics now with monkeypox and COVID. Who knows, we may have a triple in the next year. The issue is that we haven't learned because, you know, monkeypox was on the radar screen as a potential virus family that could hurt us. In the U.S., we had 20 million monkeypox vaccines, and we let them all expire, right? and now there's a drastic shortage. We never made a coronavirus vaccine, you know, for even though we'd had SARS and MERS. So if we really want to be smart, we'd have stockpiled and not let expire the vaccines of the top five, six, seven families that would be pan family, you know, universal vaccines against those families.

Starting point is 00:38:00 That's our best surefire way because look how long, even 10 months, which is hyper, compressed to get the COVID vaccines. Now they're talking about, well, we make them in 100 days. Well, a lot of bad stuff can happen in 100 days. And we know how long it is to get people to take vaccines. You know, countries, obviously much better in Canada than the U.S. in accepting vaccines. But, you know, I think having the preparedness, it isn't just having tests ready, having the genomics and surveillance systems ready, but having the darn vaccines ready, we can do this. But not, you know, that whole idea of, you know, when you look back at how you let 20 million shots that would have been fantastic to have right now to just let them fall through, it's the same thing

Starting point is 00:38:51 as how we have now tens of millions of COVID vaccines that we're wasting. It's sad. It's quite the juxtaposition, isn't it, Eric? thank you so much for this conversation. I've learned so much. I've had these questions top of mind. I feel a little bit better going into the autumn. You know, it's the known unknowns are a little more known right now than at the start of this conversation. Right. The longer we go without seeing a serious variant threat, the better. Although we certainly can't roll out. We'll see one, you know, at some point. But it's really been a pleasure. Your questions, what do you focus? I've been just, you know, terrific. And I'm so glad to have had this discussion with you. Well, on behalf of the Muck Debates community, all 100,000 members strong, Eric, thank you so much for coming on the program today. Well, that wraps up today's dialogue.

Starting point is 00:39:44 I want to thank our guest, Dr. Eric Topal. He certainly gave us a lot to think about. We'd love to get your feedback in reflections on what you've just heard. So please send us an email to podcast at Munk Debates. That's MUNK Debates with an S. com and a friendly reminder that if you enjoyed this podcast, please sign up for our complimentary monk members-only podcast. This is a weekly look at the big issues and ideas transforming the news each and every Friday delivered to your inbox or your favorite app store. You can register

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The Munk Debates Podcast - Dr. Eric Topol Dialogue - Variants And The Future of Covid-19

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