Jay Bhattacharya: The Case Against Lockdowns | Lex Fridman Podcast #254
the following is a conversation with jay baracaria professor of medicine health policy and economics at stanford university please allow me to say a few words about lockdowns and the blinding destructive effects of arrogance on leadership especially in the space of policy and politics jay barakaria is the co-author of the now famous great barrington declaration a one-page document that in october 2020 made a case against the effectiveness of lockdowns most of this podcast conversation is about the ideas related to this document and so let me say a few things here about what troubles me those who advocate for lockdowns as a policy often ignore the quiet suffering of millions that it results in which includes economic pain loss of jobs that give meaning and pride in the face of uncertainty the increase in suicide and suicidal ideation and in general the fear and anger that arises from the powerlessness forced onto the populace but the self-proclaimed elites and experts many folks whose job is unaffected by the lockdowns talk down to the masses about which path forward is right and which is wrong what troubles me most is this very lack of empathy among the policymakers for the common man and in general for people unlike themselves the landscape of suffering is vast and must be fully considered in calculating the response to the pandemic with humility and with rigorous open-minded scientific debate jay and i talk about the email from francis collins to anthony fauci that called jay and his two co-authors fringe epidemiologists and also called for a devastating published takedown of their ideas these words from francis broke my heart i understand them i can even steel man them but nevertheless on balance they show to me a failure of leadership leadership in a pandemic is hard which is why great leaders are remembered by history they are rare they stand out and they give me hope also this whole mess inspires me on my small individual level to do the right thing in the face of conformity despite the long odds i talked to francis collins i talked to albert burleigh pfizer ceo i also talked and will continue to talk with people like jay and other dissenting voices that challenge the mainstream narratives and those in the seats of power i hope to highlight both the strengths and weaknesses in their ideas with respect and empathy but also with guts and skill the skill part i hope to improve on over time and i do believe that conversation and an open mind is the way out of this and finally as i've said in the past i value love and integrity far far above money fame and power those latter three are all ephemeral they slip through the fingers of anyone who tries to hold on and leave behind an empty shell of a human being i prefer to die a man who lived by principles that nobody could shake and a man who added a bit of love to the world this is the lex friedman podcast to support it please check out our sponsors in the description and now here's my conversation with jay batakaria to our best understanding today how deadly is coveted do we have a good measure for for this very question so the the best evidence for covet the deadline to covet comes from a whole series of zero prevalent studies sierra preference studies are these studies of antibody prevalence in the population at large i was part of the you know the very first set of sierra problem studies one in santa clara county one in l.a county and one in the with major league baseball around the u.s uh if i may just pause you for a second if people don't know what uh serology is in cerro prevalence it does sound like you say zero prevalence it's not it's cerro and serology's antibodies so it's it's a a survey that counts the number of antibodies specifically people that have antibodies specific to kovaid which perhaps shows an indication that they likely have had cobit and therefore this is a way to study how many people in the population have been exposed to have had exactly yeah exactly so the idea is that uh we don't know exactly the number of people with cove just by counting the people that are there to present themselves with symptoms of covid um covet has it turns out a very wide range of symptoms possible ranging from no symptoms at all to this deadly viral pneumonia that's killed so many people and the problem is like in if you just count the number of cases the people who have very few symptoms so often don't show up for testing we just don't they're outside of the can of of public health and so it's really hard to know that the answer to your question without understanding how many people are infected because you you can probably tell the number of deaths that's even though there's some controversy over that but uh that so that the numerators is possible but the denominator is much harder how much controversy is there about the death we're gonna go on million tangents is that okay we're gonna i have a million questions so one i love data so much but i've like almost tuned out paying attention to cover data because i feel like i'm walking on shaky ground i don't know who to trust um maybe you can comment on different sources of data different kinds of data the death one that seems like a really important one can we trust the reported deaths associated with covid or is it just a giant messy thing that mixed up and then there's this kind of stories about hospitals being incentivized uh to report a death as covert death so uh uh there's some truth in some of that let me just so let me just talk about the incentive so in the united states we passed this cares act that was aimed at making sure hospital assistance didn't go bankrupt in the early days the pandemic the couple things they did one was they provided incentives to treat covet patients tens of thousands of dollars extra per per covered patient um and the other thing they did is they they gave a 20 bump to medicare payments for elderly patients who are treated with covet the idea is that there's more expensive to treat them i guess the early days um so that did provide an incentive to sort of have have a lot of code patients in the hospital because your financial success of the hospital or at least not by the lack of financial ruin depended on having many covered patients the other thing on the death certificates is that reporting of deaths is a separate issue i don't know that there's a financial incentive there but there is this sort of like complicated you know when you fill out a death certificate for a patient with a lot of conditions uh like let's say a patient has diabetes a patient that well that diabetes could lead to heart failure you know you have a heart attack heart failure your lungs fill up then you get covered and what and you die so what do you what do you write on the death certificate was it cause it covered the killed you was it the lungs filling up was it the the heart heart failure was it the diabetes it's really difficult to like disentangle um and i think a lot of a lot of times what's happened is they people have like erred on the side of signing is covet now what's the evidence of this there's been a couple of of audits of death certificates in places like santa clara county where i live in alameda county uh california where they they carefully went through the death certificate said okay is this reasonable to say this was actually covered or is it was covered incidental and they found that about 25 20 25 of the deaths were more likely incidental than directly due to covet i i personally don't get too excited about this i mean it's a philosophical question right like ultimately what kills you it's which is an odd thing to say if you if you're if you're not you're not in medicine but like really it's it's a it's almost always multifactorial it's always always just the bus hits you the bus hits you that you get a brain bleed was the brain bleed that killed you would it burst anyway i mean you know the bus hits you killed you right the way you die is a philosophical question but it's also a sociological and psychological question because it seems like every single person who's passed away over the past couple of years kind of the first question that comes to mind is just was it not not just because you're trying to be political but just in your mind no i think there's a psychological reason for this right so um you know we have we spent uh the better part of a at least a half century in the united states not worried too much about infectious diseases and we the notion was we'd essentially conquered them it was something that happens in faraway places to other people and that's true for much of the developed world life expectancies were going up for you know decades and decades and for the first time in living memory we have a disease that can kill us i mean i think we're effectively evolved to fear that like the the panic centers of our brain the lizard part of our brain takes over and our central focus has been avoiding this one risk um and so it's not surprising that but people when they're filling out death certificates or thinking about what what led to the death this most salient thing that's in the front of everyone's brain would jump to the top and we can't ignore this very deep psychological thing when we consider what people say on the internet what people say to each other what people write in scientific papers what everything it feels like when covid has been um has been brought onto this world everything changed in the way people feel about each other just the way they communicate with each other i think the the level of emotion involved i think it in many people it brought out the worst in them for sometimes short periods of time and sometimes it was always therapeutic like you were waiting to get out like the darkest parts of you just to say if you're angry at something in this world i'm going to say it now and um i think that's probably talking to some deep primal thing that um fear we have for um formalities of all different kinds and then when that fear is aroused and all the deepest emotions it's like a freudian uh psychotherapy session but across the world something that uh psychologists are gonna have a field day with for generation trying to understand um i mean i think that i mean what you say is right but piled on top of that is also this sort of uh this impetus to empathy to empathize compassion toward others essentially militarized right so i'm protecting you by by some actions and uh those actions if i if i don't do them if you don't do them well that months must mean you don't just you you hate me um it's created this like social tension that i've never seen before and we and we start have started we started we looked at each other as if we were just simply sources of of germs rather than people to get to know people to enjoy people to get you know to learn from um it it colored basically almost every human interaction for every every human on the planet yeah the basic common humanity it's like you can wear a mask you can stand far away but the love you have for each other when you look into each other's eyes that was dissipating and by region too i've experienced having traveled quite a bit throughout this time it um it was really sad even people that are really close together just the way they stood the way they looked at each other and i it made me feel for a moment um that the fabric that connects all of us is more fragile than i thought i mean if you walk down the street or if you ever if you did this during covet i'm sure you had this experience where you walk down the street if you're not wearing a mask or even if you are people will jump off the off the sidewalk as you walk past them as if your poison even though the data are that covet spreads you know indifferently outdoors or if at all really at outdoors but it's not simply a biological or infectious disease phenomenon or immunological it's it is a it is a it's a it is a change in the way humans treated each other i hope hope temporary i do want to say on the flip side of that so i was mostly in boston massachusetts when the pandemic broke out i think that's where i was yeah and then i got came here to austin texas to visit my now good friend joe rogan and he was the first person without pause this wasn't a political statement this was anything just walk toward me and give me a big hug and say it's great to see you and i can't tell you how great it felt because i in that moment realized the absence of that connection back in boston over just a couple of over a couple of months and um it's we'll talk about it more but it's tragic to think about that distancing that dissolution of common humanity at scale what what kind of impact it has on society just across the board political division uh and just in the quiet of your own mind in the privacy of your own home the depression the sadness the loneliness that leads to suicide and forget suicide just low key suffering yeah no i think that's that's the suffering that isolation we're not meant to live alone we're not meant to live apart from one another that's of course the ideology of lockdown is to make people live apart alone isolated so that we don't spread diseases to each other right but we're not actually designed as a species to live that way and that uh what you're describing i think if everyone's honest with themselves have felt uh especially in places where that where lockdowns have been sort of very militantly enforced has felt deep into their core well i if i could just return to the question of deaths he said that the data isn't perfect because we need these kind of serial prevalence surveys to understand how many cases there were to determine the rate of deaths and we need to have a strong footing in the number of deaths but if we assume that the the the number of deaths is approximately correct like what's your sense what kind of statements can we say about the deadliness of covet against across different demographics maybe not in a political way or in the current way but when history looks back at this moment of time 50 years from now 100 years from now the way we look at the pandemic 100 years ago what will they say about the deadliness of code i mean i think the deadlines of kova depends on not just the virus itself but who who it infects um so the probably the most important thing about it about the deadlines of covet is is this steep age gradient in the mortality rate um so according to these zero prevalence studies that that that have been done now hundreds of them um mostly from before vaccination because vaccination also reduces the mortality risk of covid um the the sierra prevalent studies suggest that the risk of of death if you're say over the age of 70 is very high if you have five percent if you get covered if you're if you're under the age of 70 it's lower 0.05 but there's not a single sharp cut off it's more like i have a rule of thumb that i use um so if you're 50 say the infection fatality rate from covalent is 0.2 according to the zero prevalence data that means 99.8 survival if you're 50 and for every seven years of age above that double it every seven years of age below that have it so 57 year old have a 0.4 mortality a 64 year old would have a point eight percent and so on and uh if you have a severe chronic disease like diabetes or if you're more morbidly obese it's like adding seven seven years to your life and this is uh for unvaccinated folks this is unvaccinated uh in the before delta also are there a lot of people that will be listening to this with phds at the end of their name that would disagree with the 99.8 would you say so i think there's some disagreement over this uh and the disagreement is about the quality of the zero prevalence studies that were conducted so as i said earlier i was the senior investigator in three different sierra problem studies and very early in the epidemic i view them as very high quality studies um we we um in santa clara county what we did is we used a a test kit uh to uh that we obtained from uh someone who was works in major league baseball actually he ordered these test kits very early in march 2020 that measures very accurately measures antibody levels antibodies in the in in the bloodstream uh these test kits were eventually were approved by the the head of eua by the emergency use authorization by the fda sort of shortly after we did this and uh it had a very low false positive rate false plot of means if you if you uh if you don't have these coveted antibodies in your bloodstream the cut kit shows up positive anyways that that turns out to happen about point five percent of the time um and uh based on studies a very large number of studies looking at blood from 2018 you try it against this kit and uh you know point five percent of the time 2018 there shouldn't be any bodies there so for to cover if it turns positive as a false positive 0.5 of the time um and then you know like a false negative rate about 10 12 something like that i don't remember the exact number but the false positive rate is the important thing there right so you have a population in march 2020 or april 2020 with very low fraction of patients having been exposed to code you don't know how much but low even a small false positive rate could end up biasing your study quite a bit but there's a formula to adjust for that you can adjust for the fourth spot rate falls negative rate we did we did that adjustment and those studies found in a community population so leaving aside people in nursing homes who have a higher death rate from covid um the that the death rate was point two percent in santa clara county and in l.a county across all these groups in the community community meaning just like regular yeah so like that that's actually a real important question too so uh the santa clara study we did this facebook sampling scheme um which is i mean not not the ideal thing but just like it was very difficult to get a random sample on and during the you know during lockdown um where we put out uh an ad on facebook soliciting people to volunteer for the study a randomly selected set of people we were hoping to get a random selection of people from santa clara county but it tended to the people who tend to volunteer were from the richer parts of the county like i had stanford professors writing begging to be in the study because they wanted antibody levels so we did some adjustment for that in la county we hired a firm that had a pre-existing representative sample of la county um so but it didn't include nursing homes it didn't include people in jail things like that didn't include the homeless populations so it's it's representative of a community dwelling population both of those and there we found that both in l.a county and santa clara county in april 2020 something like 40 to 50 times more infections than cases in both places so for every case that had been reported to the public health authorities we found that you know you know 40 or 50 other infections people with antibodies in their blood that suggested that they'd had coveted recovered so people were not reporting or severe at least in those days under reporting yeah i mean there was you know there's testing problems there weren't so many tests available people didn't know a lot of a lot of them we asked a set of questions about the symptoms they've faced and most of them said they faced no symptoms or the most uh 30 40 of them said face their no symptoms and i mean even these days how many people report that they get covered when they get covered okay i'll have those numbers that point two percent has that approximately held up over time that is so if professor john ian edis who's a colleague of mine at stanford uh is a world expert in meta analysis probably the most cited scientist on earth i think uh at least living he he did a a meta-analysis of now a hundred or more of these cereal prevalence studies um and uh uh what he found was that that point two percent is roughly the worldwide number in fact i think he cites this lower number 0.15 percent as the median infection fatality rate worldwide so we did these studies and it generated an enormous amount of blowback by people who thought that the infection rate is much higher and there's some controversy over the quality of some of the other studies that that are done and so there are some people who look at this same literature and say well the the lower quality studies tend to have lower ifrs the higher quality studies how far oh infection fatality right i apologize i do this in lectures too and i'm going to rudely interrupt you and ask for uh for the basics sometimes if it's okay no of course so these these higher quality studies they say are tend to produce higher but the problem is that if you want a global eye infection fatality rate you need to get sierra problem studies from everywhere even places that don't necessarily have the infrastructure set up to produce very very high quality studies and in poor places in the world this the the st that uh like places like africa the infection fatality rate is incredibly low uh and in some richer places like new york city the infection fatality rate is is much higher it's there's a range of ifrs not a single number this sometimes surprises people because they think well it's a it's a virus it should have the same properties no matter where it goes but the virus kills or infects or hurts in interaction with the host and the properties of both the host and the virus combine to produce the the outcome but you also mentioned the environment too well it's i'm thinking mainly just about the the person like if i'm gonna think about it like the most simplest way to think about it is age age is the single most important risk factor so older places are going to have a higher ifr than younger places africa three percent of africa is over 65. so in some sense it's not surprising that they have a low infection fatality rate so that's one way you would explain the difference between africa and new york city in terms of the fatality rate is the age the average age yeah and especially in the early days of the epidemic in new york city the uh older populations living in nursing homes were differentially infected based on because of policies that were adopted right to send coveted infected patients back to nursing homes to keep hospitals empty what do you mean by differentially infected the policy that you adopt determines who is most exposed right that okay so that's what the policy it's the person that matters i mean it's not like the virus just kind of it doesn't care i mean the policy determines the nature of the interaction and there's also i mean there is some contribution from the environment different regions have different proximity maybe of people interacting or the dynamics of the way they interact like if you have a if you have situations where there's lots of intergenerational uh interactions yeah then you have a very different risk profile than if than if you have societies that are where generations are more separate from one another um okay so let me just finish real fast about this so you you have in new york you have a population that was infected in the early days that was very likely going to die but had a much higher likelihood of dying if infected and so new york city had a higher ifr especially in the early days than um than um then like africa has had um the other thing is treatment right so the treatments that we adopted in the early days the epidemic i think actually may have exacerbated the risk of death which do so like using ventilators like the the over reliance on ventilators is what i'm primarily thinking of but i can think of other things um but that that uh also we've learned over time how better to manage patients with the disease so you have those you have all those things combined so that's that's where the controversy over this over this number is i mean new york city also it has a is a central hub for those who tweet and uh those who write powerful stories and narratives in article form and i remember those quite dramatic stories about sort of doctors in the hospitals and these kinds of things i mean there's very serious very dramatic very tragic deaths going on always in hospitals those stories um a lot of loved ones losing each other on a deathbed that's always tragic and you can always write a hell of a good story about that and you should about the loss of loved ones but they were doing it pretty pretty well i would say um over this kind of dramatic deaths and so in response to that it's very unpleasant to hear even to consider the possibility that the death rate is not as high as you might otherwise as you might feel yeah i was surprised by the reaction both by regular people and also the scientific community in response to those studies those early studies in april of 2020 um uh to me they uh they were there were studies i mean they're they're the kinds of not exactly the kinds of work i've worked on all my life but it's kind of kind of like the kind of you know like you you write a paper and you get response responses from your fellow scientists and you you know change the paper to improve it uh you have hopefully learned something from it well but to push back it's just a study but there's some studies and this is kind of interesting because i've received similar pushback on other topics there's some studies that if wrong might have a wide ranging uh detrimental effects on society so that's that that's the way they would perceive the studies if you say the death rate is lower and you end up as you often do in science realizing that nope that that was there was a flaw in the way the study was conducted or were just not representative of a broader population and then you realize the death rate is much higher that might be very damaging in in people's view uh so so that's probably where the scientific community sort of just steal man the kind of response is that's where they felt like you know there's some findings where you better be damn sure before you kind of report them yeah i mean we were pretty sure we were right and it turns out we were right so like when we so um we released the the santa clara study via this open open science process and this uh server called med med archive it's it's designed for releasing studies have not yet been pre-reviewed in order to garner comment from the from scientists before peer review the the la county study we went through the traditional peer review process and got it published in the journal of american medical association sometime in like uh july i think forget the date of 2020. the santa clara study released in april of 2020 in this you know sort of working paper archive the the reason was that we felt we had an obligation we had a result that was we thought was quite important and we wanted to tell the scientific community about it and also tell the world about it and it wasn't we wanted to get feedback i mean that's part of the purpose of sending it to these kinds of places i think a lot of the problem is that uh when people think about published science they think of it as automatically true and if it goes through peer review it's automatically true if it hasn't gone through peer review it's not automatically true and especially in medicine when we're not used to having this at this access to pre-peer-reviewed work i mean in economics actually that's quite normal you it takes years to get something published so there's a very active debate over or discussion about papers before they're peer-reviewed in this in this sort of working paper way um much less normal or much much newer in in medicine and so i think part of that the perception about what those that what process happens in open science when you release a study that that got people confused and you're right it was a very important result because we had just locked the world down in middle of march with i think catastrophic results and if the if that study was right if our study was right that meant we'd made a mistake and not because the death rate was low that's actually not the key thing there the key thing is that we had adopted these policies these test and trace policies these policies these lockdown policies aimed at suppressing the virus level to close to zero that was essentially the idea if we can just get the virus to go away we won't have to ever worry about it again the main problem with our result as far as that strategy was concerned wasn't the death rate it was the 40 to 50 times more infections than cases it was the two and a half percent or uh three percent or four percent prevalence rate that we identified of the antibodies in the population if that number is right it's too late the virus is not going to go to zero and no matter how much we test and trace and isolate we're not going to get the viral level down to zero so we're going to have to let the virus go through the entire population in some way or something normal well that we can talk about that in a bit that's the great barrington declaration you don't have to let the virus go through the population you can shield preferentially the policy we chose was to shield preferentially the the laptop class the set of people who could work from home without losing their job yeah and we did a very good job at protecting them well let me um take a small tangent we're gonna jump around in time which i think will be the best way to tell the story so that was the beginning yeah okay actually can i kind of go back one more thing for that because that's really important and i should have i should have started with this um what led me to do those studies was a a paper that i had remembered seeing from the h1n1 flu epidemic in 2009 this is this is where i've been much less active in writing about that i had written up like a paper or two about that when in 2009 there there was actually this same debate over the mortality rate except it unfolded over the course of three years two or three years the early studies of the mortality rate in h1n1 counted the number of cases in the denominator count the number of deaths in the numerator cases meaning people identified as having h1n1 showing up the doctor you know tested to have it um and the early estimates of the h1n1 mortality were like four percent three percent really really high over the course of a couple of more years a whole bunch of zero prevalence studies zero prevalence studies of h1n1 flu came out and it turned out that there were a hundred or more times of people infected per case and so the mortality rate was actually something like 0.02 for h1n1 not the three three like a hundredfold difference so this made you think okay it took us a couple of two to three years to discover the truth behind the actual infections uh for a h1n1 and then what's the truth here and can we get there faster yeah and and there was it spreads in a similar way as the as the h1n1 fluid did i mean it's it's spreads very solidization via you know so person-to-person breathing kind of kind of contact up um and maybe maybe some by by foam eyes but it seems like that's less likely now in any case it seemed really important to me to speed up the process of having those zero prevalence studies so that we can better understand who was at risk and what the right strategy ought to be this might be a good place to kind of compare influenza the flu and covid in the context of the discussion we just had which is how deadly is coved so you mentioned covet is a very particular kind of steepness where the x-axis is age so in that context could you maybe compare influenza and kovid because a lot of people outside the folks who suggest that the the lizards who run the world have completely fabricated invented kovid outside of those folks kind of the natural process by which you dismiss the threat of covait to say well it's just like the flu the flu is a very serious thing actually um so in that comparison where does kovitz stand yeah the flu is a very serious thing it kills you know 50 60 000 people a year something i found that order depending on the the particular strain that goes around uh that's in the united states the primary difference to me are the there's lots of differences but one of the most salient differences is the age gradient and mortality risk for the flu so the flu is more deadly for two children than covet is there's no controversy about that children thank god have much less uh severe reactions to covet infection to than that due to flu infections and rate of fatalities fatality all of that i think you mentioned um i mean it's interesting to maybe also comment on i think in another conversation mentioned there's a u shape to the to the flu curve so meaning like there's actually quite a large number of kids that die from flu yeah i mean the 1918 flu the h1n1 flew that the spanish flu in the us killed millions of of of uh of younger people and um that is not the case with covid more than um i'm going to get the number wrong but something like 70 80 percent of the deaths are people over the age of 60. well we've talked about the fear the whole time really but my interaction with folks now i want to have a family i want to have kids but i don't have that real firsthand experience but my interaction with folks is at the core of fear that folks had is for their children like that somehow you know i don't want to get infected because of the kids like because god forbid something happens to the kids and i think that obviously that makes a lot of sense this kind of the kids come first no matter what that's number one priority but in for this particular virus that reasoning was um not grounded in data it seems like or that emotion and feeling yeah it was not grounded it wasn't at the same time this is way more deadly than the flu just overall and especially to older people yes right so the numbers when when the story is all said and done the covet would take many more lives yeah so i mean 0.2 is sounds like a small number but it's not a small number worldwide what do you think that number will be by the you know that's not that's not like but would we cross i think it's in the united states it's uh the way the desk currently reports like 800 000 something like that do you think we'll cross a million seems likely yeah do you think it's something that might continue with different variants what well i i think um so we can talk about the end state of cover the end state of covet is it's here forever i think that there is good evidence of immunity after infection such that you're protected both against reinfection and also against severe disease upon reinfection so the second time you get it it's not true for everyone but for many people the second time you get it will be milder much milder than the first time you get it with the long tail like uh that lasts for a long time yeah so just there's studies that uh that follow of course people who are infected for a year and the reinfection rate is something like somewhere between point three and one percent yeah um and like a pretty fantastic study italy's found that there's there was one in sweden i think there's a few studies that found there's some similar things um and the reinfections tend to produce much mild disease much less likely end up in the hospital much less likely to die um so what the end state of covid is it's circulating the population forever and you get it multiple times yeah and and then there's i think studies and discussions like the the best protection would be to get it and then also to get vaccinated and then a lot of people push back against that for the obvious reasons from both sides because somehow this the discourse has become less scientific and more political well i think you wanna like the first time you meet it is going to be the most deadly for you and so the first time you meet it is wise to be vaccinated the vaccine reduces severe disease yeah well we'll talk about the vaccine because i want to make sure i address it carefully and properly in full context um but yes sort of uh to add to the context a lot of the fascinating discussions we're having is um in the early days of covid and now for people who are unvaccinated that's where the interesting story is the policy story the sociology sociological story and so on but let me go to something really fascinating just because of the people involved the human beings evolved and because of how deeply i care about science and also kindness respect and love and human things francis collins wrote a letter in october 2020 to anthony fauci anything somebody else i have um the letter oh it's not a letter email i apologize uh hi tony and cliff c gb declaration.org this proposal this is the great barrington declaration that you're a co-author on this proposal from the three fringe epidemiologists who met with the secretary seem to be getting a lot of attention and even a co-signature from nobel prize winner mike levitt at stanford there needs to be a quick and devastating published takedown of its premises i don't see anything like that online yet is it underway question mark francis francis collins director of the nih somebody i talked to on this podcast recently okay a million questions i want to ask but first how did that make you feel when you first saw this uh email come to uh uh too light which when when when did it come to light uh this week actually i think or last week okay so this is because of freedom of information yeah which by the way sort of um maybe because i do want to add positive stuff on the on the side of francis here um boy when i see stuff like that i wonder if all my emails leaked how much embarrassing stuff like i think i'm a good person but i don't i haven't read my old emails maybe i'm pretty sure sometimes later i could be an asshole well i mean look he's a christian and i'm a christian i'm supposed to forgive right i mean i think he was looking at this great barrington declaration as a political problem to be solved as opposed to a serious alternative approach to the epidemic so maybe we'll talk about in more detail but just for in case people are not familiar great barrington declaration was was was the document that you co-authored that basically argues against this idea of lock down as a solution to covid and you propose another solution that we'll talk about but the point is it's not that dramatic of a document it is just a document that criticizes one policy solution that was but it was the policy solution that had been put forward by dr collins and by tony fauci and a few other few other science not i mean i think a relatively small number of scientists and epidemiologists in charge of the advice given to governments worldwide and it was a challenge to that policy that said that look there there is an alternate path that that the path we've chosen this path of lock down with an aim to suppress the virus to zero effectively i mean that was unstated um cannot work and is causing catastrophic harm to large numbers of poor and vulnerable people worldwide we put this out in october 4th i think of 2020 and it went viral i mean i've never actually been involved with anything like like this where i just put the document on the web and tens of thousands of doctors signed on hundreds of thousands of regular people signed on it it really struck a accord of uh people because i think even by october of 2020 people had this sense that there was something really wrong with the coveted policy that we've been following and they were looking for reasonable people to give an alternative i mean we're not arguing that covet doesn't isn't a serious thing i mean it is a very serious thing this is why we we had a policy that aimed at addressing it um we were but we were saying that the policy we're following is not the right one so how does a democratic uh government deal with that challenge uh so to me that you asked me how i felt i was actually frankly just i was i i suspected there had been some email exchanges like that not necessarily from francis collins around the government around this time i mean i felt the full brunt of a propaganda campaign almost immediately after we published it where newspapers mischaracterized it in all in the same the same way over and over and over again and sought to characterize me as sort of of a as a sort of a marginal fringe figure or whatnot and me and sinatra grouped uh martin culdor for the tens of thousands of other people that signed it i felt the brunt of that all year long so to see this in black and white in you know with the handwriting essentially if i mean the the metaphorical handwriting of francis collins was actually frankly a disappointment because i i've looked up to him for years yeah i've looked up them as well i um i mean i look for the the best in people and i still look up to him what troubles me is several things the reason i said about the the asshole emails that i send late at night is um i can understand this email it's fear it's panic not being sure the fringe three fringe epidemiologists plus mike levitt who won a nobel prize i mean but using fringe maybe in my private thoughts i have said things like that about others like a little bit too unkind like you don't really mean it now add to that he recently this week whatever uh double down on the fringe this is really troubling to me that like i can excuse this email but to see the arrogance there i that francis honestly i mean broke my heart a little bit there this was an opportunity to like especially at this stage to say just like i told him um to say i was wrong to use those words in that email i was i was wrong to not be open to ideas i still believe that this is not like say like actually argue with the with the proposed with the policy of the proposed uh solution also the devastating publish take devastating takedown devastating takedown as you say somebody who's sitting on billions of dollars that they're giving to scientists some of whom are often not their best human beings because they're fighting with each other over money not being cognizant of the fact that you're challenging the integrity you're corrupting the integrity of scientists by allocating the money you're now playing with that by saying devastating takedown where do you think the published takedown will come from it will come from those scientists to whom you're giving money what kind of example would they give to the academic community that thrives on freedom like this this is i believe francis collins is a great man one of the things i was troubled by is the negative response to him from people that don't understand the positive impact that nih has had on society how many people has helped but this is exactly the so he's not just a scientist he's not just a bureaucrat who distributes money he's also a scientific leader that in the time in difficult times we live in is supposed to inspire us with trust with love with the freedom of thought he's supposed to you know those fringe epidemiologists those are the heroes of science when you look at the long arc of history we love those people we love ideas even when they get proven wrong that's what always that attracted me to science like some somebody like the the lone voice saying oh no the the the moon of jupiter does move yeah i mean you know but the funny thing is you know galileo is saying something truly revolutionary we were saying that what we proposed in the great britain declaration was actually just the old pandemic plan it wasn't anything really fundamentally novel in fact there were plans like this that lockdown scientists had written in late february early march of 2020. so we were not saying anything radical we were just calling for a debate effectively over the existing lockdown policy um and this is a disappointment a really truly a big disappointment because by doing this you were absolutely right lex he sent a signal to so many other scientists to just stay silent even if you had reservations yeah devastating takedown the people you know how many people wrote to me privately like stanford mit how amazing the conversation with francis collins was there's a kind of admiration because okay how do i put it um a lot of people get into science because they want to help the world they get excited by the ideas and they and they they really are working hard to help in whatever the discipline is and then there is sources of funding which help you do help at a larger scale so you admire those the people that uh um are distributing the money because they're often at least on the surface are really also good people oftentimes they're great scientists so like it's amazing i that's why i'm sort of um like sometimes people from outside think academia is broken some kind of way no it's it's a beautiful thing it's a it's really is a beautiful thing and that's why it's so deeply heartbreaking where this person um is um i don't think this is malevolence i think he's just incompetence of communication twice i think there's there's also arrogance at the bottom of it too so like but you know all of us have arrogance yeah there's a particular kind of arrogance right so here it's it's of the same kind of arrogance that you see when tony fauci gets on tv and says that uh that if you criticize me you're not simply criticizing a man you're criticizing science itself right right that is at the heart also of this email this so the certainty that the policies that they were recommending collins and fauci were recommending to the president of the united states were right not just right but right so so far right that any challenge whatsoever to it is dangerous um and i think that that is really the heart of that email it's it's um it's this idea that my position is unchallengeable not to be to be complete to be as charitable as i can be to this you know i believe they thought that i believe they some of them still think that that that there was only one true policy possible in response to copenhagen every other policy was immoral and if you if you come from that position then you write an email like that you go on tv you say effectively right i mean that that is that is what happens when you have this sort of unchallengeable arrogance that the policy you're following is correct um i mean when we wrote the great bank declaration what i was hoping for was a discussion about how to protect the vulnerable i mean that was the key idea to me in the whole thing was better protection of the older population who really at really serious risk if infected with covid and we had been doing a very poor job i thought to date in many places in protecting the vulnerable and what i wanted was a discussion by local public health about better methods better policies to protect the vulnerable so when when i was when we were met with instead a series of essentially propagandist lies about it so they for instance i kept hearing from reporters in in those days why do you want to let the virus rip let it rip let it rip the words let it rip does not appear in the great barrington declaration the goal isn't to let the virus rip um the goal is to protect the vulnerable to let society go as you know open schools and do other things that it functions as best it can in the midst of a terrible pandemic yes but not let the virus rip where no the most vulnerable are protected the goal was to protect the vulnerable so why let it rip because it was a propaganda term to hit the fear centers of people's brains oh these people are immoral they just want to let the virus go through society and hurt everybody that was that was that was the idea this it was a way to preclude a discussion and preclude a debate about the existing policy so i've uh this is an app called clubhouse um i've gone back on it recently uh to practice russian unrelated for for a few big russian conversations coming up anyway it's a great way to talk to regular people in russian but i also there was a i was i was nervous i was preparing for a pfizer ceo conversation and there was a vaccine room and so i joined it and there's a there's a pro science room as they they these are like scientists that were calling each other pro science it the whole thing was like theater to me i mean i haven't thoroughly researched but looking at the resume they were like pretty solid um researchers and doctors and they were mocking everybody who was at all i mean it doesn't matter what they stood for but they were just mocking people and the arrogance was overwhelming i had to shut off because i couldn't handle that human beings can be like this to each other and then i i went back to just a double check is this really how many people are here is this theater and then i uh asked to come on stage on clubhouse to make a couple comments and then as i open my mouth and say thank you so much you know this is this is a great room sort of the usual civil politeness all that kind of stuff and i said i'm worried that the kind of arrogance with which things are being discussed here will further divide us not unite us and and before i said even the united further divide us i was thrown off stage now this isn't why i mentioned platform but like i am like uh lex friedman mit uh also which is something those people seem to sometimes care about the followers and stuff like that like did you just do that and then they said enough of that nonsense enough of that nonsense they said to me enough of that nonsense somebody who is obviously interviewed francis collins is uh uh the pfizer ceo uh you're bringing a potential epidemiologist also so just yeah exactly but this broke my heart the arrogance and this is echoes of that arrogance is something you see in this email and i really would love to have a million things to talk about to try to figure out how can we find a path forward i think a lot of a lot of the problems we've seen in the the discussion over cove especially in the scientific community you know there's there's two ways to look at science i think uh that that have been competing with each other for a while now one way and this is the way that i view science and why i've always found it so attractive is an invitation to a structured discussion where the the discussion is tempered by by evidence by data by by reasoning and logic right so it's a dialectical process where if i believe a and you believe b well uh we talk about it we come up with an experiment that distinguishes between the two and while you know b turns out to be right i'm i'm all frustrated but i buy you dinner and i say no no no c and then we go on from there right that's that's what science is at its best it's this process of using data in discussion it's a human activity right uh to to to learn to let have the truth unfold itself before us on the other hand there are there's another way that people have used science or thought about science as a as truth in and of itself right this like if it's if it's science therefore it's true automatically and they're you know what does the science say to do well the science never says to do anything the science says here's what's true and then we have to apply our human values to say okay well if we do this well then this is likely to happen that's what the science says if we do that then that is likely to happen well we'd rather have this than that right and but it doesn't science doesn't tell us that we'd rather have this than that is there human values that tell us that we'd rather this and that science plays a role but it's not the only thing uh it's not the only role it's like it helps us understand the constraints we face but it doesn't tell us what to do in face of those constraints but underneath it at the individual level at the institutional level it seems like um arrogance is really destructive so the flip side of that the productive thing is humility so sort of um always not being sure that you're right this is actually kind of uh stuart russell talks about this for ai research how do you make sure that ai super intelligent ai doesn't destroy us you built in um a sort of module within it that it always doubts its actions like it's not sure like i know it says i'm supposed to destroy all humans but maybe i'm wrong and that maybe i'm wrong is essential for progress for actually doing in the long arc of history better not the perfect thing but better and better and better and better i mean the the question i have here for you is this this email so clearly captures some maybe echo but maybe a core to the problem do you put responsibility of this email of the shortcomings and failures on individuals or institutions no this is an institutional failure right so um the nih i so i've had two decades of nih funding i've sat on nih review panels the purpose of the nih is what you said earlier lex the purpose of nih is to support the work of scientists to some extent it's also how to help scientists to direct scientists to work on things that are very important for public health or for the health of the public um so and the way you do that is you say okay we're gonna put you know 50 million dollars on uh the research in alzheimer's disease this year or 70 million dollars on hiv or whatever it is right some and uh that pot of money then uh scientists compete with each other for the best ideas to to use it to address that that problem so it's essentially an endeavor to support the work of scientists it is not in and of itself a policy organ it doesn't say what public health policy should be for that you have the cdc and what happened during the pandemic is that people in the nih were called upon to contribute to public health making and that created the conflict of interest you see in that email right so now you have the head of the nih in effect saying to all scientists you must agree with me in the policies that i've recommended or else you're fringe that is a deep conflict of interest it's deep because first he he's conflicted he has this dual role as as as the head of the nih supporter of scientific funding and then also inappropriately called to set or help set pandemic policy that should never have happened there should be a bright line between those two roles let me ask you about just francis collins i don't know if you i i had a chance to talk to him on a podcast i don't know if you maybe by chance gotten a chance to hear a few words of it um well i have a kind of a question uh to that because a lot of people wrote to me quite negative things about francis collins and like i said i still believe he's a great man a great scientist um one of the things when i talked to him off mike about the vaccine the excitement he had about when we were recollecting when they first got an inkling that it's actually going to be possible to get a vaccine just he wasn't messaging just in the private or of our own conversation he was really excited and why was he excited because he gets to help a lot of people this is a man that really wants to help people and there could be some institutional self-delusion the arrogance all those kinds of things that lead to this kind of email but ultimately the the goal is this is what i don't think people quite realize this the reason you call your fringe epidemiologist the reason there needs to be a devastating uh published takedown he i believe really believes that this it could be very dangerous yeah and it's a lot of burden to carry on his shoulders because like you said in his role where he defines some of the public policy like you know depending on how he thinks about the world millions of people could die because of one decision he make yeah and that's a lot of burden to walk with yeah no i think that's right i don't think that he has bad intentions i think that he was basically put was put or maybe put himself in a position where this kind of conflict of interest was going to create this kind of this this kind of a reaction right the kind of humility that you're calling for is almost impossible when you have that dual dual role this that shouldn't you shouldn't have to have as as funder of science and also center of scientific policy i agree with everything you just said except the last part the the humility is almost impossible that uh humility is always difficult i think i think there's a huge incentive to for humility in that position now look at history great leaders that have humility are popular as hell so if you like being popular if you like having impact legacy these descendants of apes seem to care about legacy especially as they get older in these high positions like i i think the incentive for humility is pretty high well i mean the thing is is like there's a lot that he has to be proud of in his career i mean like the human genome project wouldn't have happened without him uh and he is he is a great man and a great scientist but so it is tragic to me that his career has ended in this particular way he asked you a question about um my podcast conversation with them by way of advice or maybe criticism there's a lot of people that wrote to me kind words of support and a lot of people that wrote to me respectful constructive criticism how would you suggest to have conversations with folks like that and maybe um i mean because there's i have other conversations like this including i was debating whether to talk to anthony fauci he wanted to talk and so what kind of conversation do you have and sorry to take us on a tangent but almost from an interview perspective of how to inspire humility and inspire trust in science or maybe give hope that we know what the heck we're doing and we're going to figure this out i mean i think you're i've been now interviewed by many people um i think uh the style you have really works well lex you have to you because you i don't think you're going to be ever an attack dog trying to go after somebody and and force them to to like you know admit that they were wrong about or whatever about i mean that's that i also actually find that form of journalism and podcasting really off-putting it's hard to watch also it's a whole lot of the tangent is that actually effective i don't think so do you want to ask hitler and i think about this a lot actually interviewing hitler i've been studying a lot about the the the rise and the fall of the third reich i think about interviewing stalin like i put myself in that mindset like how do you have conversations with people to understand who they are so that not so you can sit there and yell at them yeah but to understand who they are so that you can inspire a very large number of people to be the best version of themselves and to avoid the mistakes of the past i believe that everyone that's involved in this debate has good intentions they have they're coming at it from their points of view uh they they don't they have um uh they have their weaknesses and if you can paint a picture in your questioning by sympathetic questioning of those strengths and weaknesses and their point of view you've done a service um that's really all you i personally like like to see in those kinds of interviews um i don't think a gotcha moment uh is really the key thing there the the key thing is understanding where they're coming from understanding their thinking understanding the constraints they faced and how did they manage them that's going to provide a much i mean for me that's what i look for when i when i listen to podcasts like yours um is is an understanding of that of that of that person and the moment and how they dealt with it i mean i guess the hope is to discover in a sympathetic way a flaw in a person's thinking together like as opposed to discovering the positive thing together you discover the thing well i didn't really think about that yeah i mean that's what that's how science is right that's why we found it i think find it so attractive is this i i i like it when a student shows me i'm thinking incorrectly right i think i'm really grateful to that student because now i have an opportunity to change my mind about it and then start thinking even more correctly i mean that's and there are moments when uh i mean like this is probably a good time to say like what i think i got wrong during the pandemic right so like for instance you said francis collins had a moment when uh he learned that that there was quite possible to get a vaccine going yeah he must have learned that quite early and i didn't learn that early i mean i i didn't know in march of 2020 in my experience with vaccine development it would have take i thought it would take a decade or more to get a vaccine that was wrong right i didn't that that and and i was so happy when i started to see the preliminary numbers in the in the pfizer trial that strongly suggested it was going to work yeah and at the i was i mean like very few times in my life i'm so happy to be wrong and it changes kind of um i think i've heard you mention that lockdown is still a bad idea unless the vaccine comes out in like tomorrow uh there's still like suffering and economic pain all kinds of pain can still happen in even just a a scale of weeks um versus months yeah well let's talk about the vaccine what are your thoughts on the safety and efficacy of covered vaccines at the individual and the societal level so for the the vaccine safety data it's it's actually challenging to convey to the public how this is normally done like normally you would do this in the context of the trial you'd have a law a long trial with large numbers relatively large numbers of people you'd follow them over a long time and the trial will give you some indication of the safety of the vaccine and it did um i mean but you the the the trial the way it was constructed when it was came out that it was protective against covet it was no longer ethical to have a placebo arm and so that placebo arm is vaccinated what large part of it and so that meant that from the trial you are not going to be able to get data on the long-term safety profiles of the vaccine uh and also the other thing about trials although there's tens of thousands of people enrolled that's still not enough to get when you when it when you deploy a vaccine to the population scale you're going to see things that weren't in the trial guaranteed populations of people that weren't represented well in the trial are going to are going to be given the vaccine and then that they're going to have things that happen to them that you didn't didn't anticipate so i wasn't surprised when people were a little bit skeptical when the trial was done about the safety profile just the way the nature of the thing was going to make it so that it was going to be hard to get a complete picture from the trials itself and the trials showed they were pretty safe and quite effective at preventing both you from getting covid actually i think the main endpoint of the trial itself was a symptomatic covet right so um uh so that was like that was you know i mean it was really um to me like is about as amazing achievement as anything organizing a trial of that scale and running it so quickly and the final results being so surprisingly high so good right and um so the but the problem then was normally it would take a long time the fda would tell pfizer to go back and try it in this subgroup they'd work more on dosing they'd do all these kinds of things that kind of didn't we really didn't have time for in the middle of a pandemic right so you have a you have a basis for approval that it's less full than normally you would have for a population scale vaccine but the results were good results looked really good and actually i should say for the most part that's been borne out when we've given the vaccine at scale in terms of protection against severe disease yeah all right so people who have got the vaccine um for a very long time after they've had that for the full vaccination have had great protection against going being hospitalized and dying if they get covered let's separate because this seems to be um there's critics of both categories but different kids and kids and old not older people like uh let's say five years old and above or something like they're 13 years old and above so for those it seems like the reduction of uh the rate of fatalities and and serious illness seems to be something like 10x i mean for older people it is a godsend this vaccine it it transforms the the problem of focus protection from something that's quite challenging possible i believe but quite challenging to something that's much much more manageable because the vaccine in and of itself when deployed in older populations is a form of focus protection yes well by the way we'll talk about the focus protection in one segment because it's such a brilliant idea for this pandemic of future pandemics i thought the sociological psychological discussion about the letter from francis collins is um because it was so recent it was been so troubling to me so i'm glad we talked about that first but so the there seems to be the vaccines work to reduce deaths and that has especially the most transformative effects for the older so can i let you give i've told you one thing that i got wrong in the panic let me tell you the second thing i got wrong for sure in the pandemic in january of la of this year 2021 i thought that the vaccines would stop infection yes right it would would make it so that you were much less likely to be infected at all because the the antibodies that were produced by the vaccines looked like they were neutralizing antibodies that would would essentially block you from being infected at all um that turned out to be wrong right so i think it became clear as data came out from israel which vaccinated very early that they were seeing surges of infection even in a very highly vaccinated population that that the vaccine does not stop infection so you're a used car salesman and you're selling the vaccine and the features you thought of vaccine would have i mean i have a similar kind of sense when the vaccine came out vaccine would reduce if you somehow were able to get it you would reduce rate of death and all those kinds of things but it would also reduce the chance of you getting it and if you do get it the chance that you transmitting it to somebody else and it turns out that those latter two things are not as uh definitive or in fact they're i mean i don't know to which agree they're not i mean i think it's it's a little complicated because i think the first two or three months after you're fully vaccinated after the second dose you have 60 70 percent efficacy peak against infection yeah so uh that which is pretty good i mean right but by six seven eight months that drops to 20 percent some places some studies like there's a study out of sweden suggested it might even drop to zero but and then you're also infectious for some period of time if you do get it even though you're vaccinated correct although there seems to be lucy data that the period of time your infectious is short it's shorter but the the infectivity per day is about as high so you still it's the point is that that the vaccine might reduce some risk of infecting others but it's not a categorical difference so uh a unvaccine it's not safe to be in the presence of just vaccinated people you can still get infected right so i mean there's a million things i want to ask here but is there in some sense because the vaccine um really helps on the worst part of this pandemic which is killing people yes uh doesn't that mean uh where does the vaccine hesitancy come from in terms of it seems like obviously a vaccine is a powerful solution to let us open this thing up yeah so i wrote a wall street journal op-ed with sinatra gupta in december of last year yes a very night with a very naive title which says we can end the lockdowns in a month and the idea is very simple vaccinate all vulnerable people and then open up open up right uh and the idea was that uh the the lockdown harms this is related this is directly related to the great barrington declaration the great antarctic clergy said the lockdown harms are devastating to the population at large there's this considerable segment of people that are vulnerable protect them well with the vaccine we have a perfect tool to protect the vulnerable which is i still believe i mean is true right you vaccinate the vulnerable the older population and as you said there's a tenfold decrease in the mortality risk um from getting infected which is i mean amazing so that was the strategy we got we outlined what happened is that the vaccine debate got transformed so first there's so you're asking about vaccine hesitance i think there's there's first there's like there's there's the inherent limitations of how to measure vaccine safety right so we talked about a little bit about the trial but also after the trial there's a there's a there's a mechanism and this is the work i've been involved with before covet on on tracking and and identifying and checking whether the vaccines actually are safe and the central challenge is one of causality so you no longer have the randomized trial but but you want to know is the vaccine when is deployed at scale causing adverse events well you can't just look at people who are vaccinated and see what adverse events happen because you don't know what would have happened if the person had not been vaccinated so you have to have some control group now what happened is there's several systems to do to check this in that the cdc uses one one very very very commonly known one now is called vares the vaccine adverse event reporting system there anyone who has an adverse event that either either a regular person or a doctor can just go report look i have the vaccine and two days later i had a headache or whatever it is the person died a day after the vaccine right um now you vaccinate that the vaccine was rolled out to older people first and older people die sometimes with or without the vaccine so sometimes you'll see someone's vaccinated and a few days later they die did the vaccine cause it or something else cause it's really difficult to tell in order to tell you need a control group for that um there are other systems the fda and cdc have uh like there's one called vsd vaccine safety data link there's another system called best uh i forget the app with the acronym is to essentially to track uh cohorts of people vaccinated versus unvaccinated was as careful of matching as you can do it's not randomized but and then c if you have safety signals that pop up in the vaccinated relative to the control group unvaccinated um and so that's for instance how the the the myocarditis risk was picked up in young young especially young men it's also how the higher risk of blood clots in middle age and older women in with the jnj vaccine is picked up there what you have is are situations where the baseline risk of these outcomes are so low that if you see them in the con in the vaccinated arm at all then it's not hard to understand that the vaccine did this right young men should not be having myocarditis middle-aged women should not be having huge blood clots in the brain right um so when you see that you can say it's linked now the rates are low so young men maybe one in five thousand one in ten thousand of the vaccine of my vaccine-related myocarditis pericarditis um young women of middle-aged women i don't know i don't i'm not sure what the right number might be but like i'd say it's like in the you know one in hundreds of thousands something like that so these are rare outcomes but they're they're they are vaccinating linked outcomes how do you deal with that as a messaging thing i think you just tell people you tell people here are the risks you transparently tell them and just you're not you're not they're so they're not getting into something that they don't know yeah and um don't treat people like their children and need to be told lies because they won't understand the full complexity of the truth uh people i think are pretty good at um or actually you know people with time are good at understanding data but better than anything they're uh they're better at they're extremely good at detecting arrogance and bullshit and yeah give them either one of those i mean i'll give you one that's where i think it's greatly undermined vaccine has greatly undermined the demand for the vaccine is this weird denial that if you recover from kovid you have extremely good immunity both against infection and actually exchange and that denial leads to people distrusting the message given by like the cdc director for instance favored the vaccine right why would you deny a thing that's such an obvious fact it's like you can look at the data and it just i mean it just just pops out at you that people that are covered recovered are not getting infected again at very high rates much lower rates after these kinds of conversations um i'm sure after this com very conversation i often get uh a number of messages from joe joe rogan and from sam harris who to me are people i admire i think are really intelligent thoughtful human beings they also have a platform and i i i believe at least in my mind about this coveted set of topics they represent a group of people each group has smart thoughtful well-intentioned human beings and i don't know who is right but i i do know that they're kind of tribal a little bit uh those groups and so the question i want to ask is like what do you think about these uh two groups and this kind of tension over the vaccine that sometimes it just keeps finding different topics on which to focus on like whether kids should get vaccinated or not whether there should be vaccine mandates or not which seem to be often very kind of specific policy kinds of questions right it's the bigger picture i think it's a symptom of the distrust that people have in public health i think this kind of schism over the the vaccine does not happen in places where the public health authorities have been much more trustworthy right so you don't see this vaccine hasn't seen sweden for instance um what's happened in the united states is the vaccine has become first because of politics but then also because of the scientific arrogance this sort of touchstone issue and people line up on you on both sides of it and the different language you're hearing is structured around that so before the election for instance i did uh uh i was a i did a testimony in the house on on measurement of vaccine safety and i i was i was invited by the republicans there were i think uh four other experts invited by the democrats or three other experts invited by democrats each of whom had a lot of experience in measuring vaccine safety i was really surprised to hear them each doubt whether the fda would do a reasonable job in assessing vaccine safety including by people who have long records of working with the fda i mean these are professionals great scientists whose main you know sort of goal in life is to make sure that safe vaccine that that unsafe vaccines don't get released into the world and if they argue they get pulled and they're casting down on the vaccine the ability to track vaccine safety before the election and then after the election the the rhetoric switched on a dime right all of a sudden it's republicans that are cast as if they're vaccine hesitant that kind of political shift the public notices if if all it takes is an election to change how people talk about the safety of the vaccine well we're not talking science anymore many people think right i think that creates created its hesitancy the other thing i think the um the the hesitancy some politicians viewed it as a political as sort of like a political opportunity to sort of demonize people who were hesitant and that itself fueled hesitancy right like the if you're if you're telling me i'm a rube that just doesn't want the vaccine because i want everyone to die well i'm gonna i'm gonna react really negatively and if you're talking down to me about my legitimate you know sort of concerns about whether this vaccine's safe to i mean i've like heard from women who are thinking about getting pregnant should i take the vaccine i don't know i mean there are all kinds of questions legitimate questions that i think should have good data to answer that we don't necessarily have good data to answer so what do you do in the face of that well one reaction is to pretend like we we know for a fact that it's safe when we don't have the data to know for fact in that particular group with that particular set of clinical circumstances you know and that i think breeds hesitancy people can detect that bullshit um whereas if you just tell people you know i don't know yeah you deal with humility yeah you're gonna you're you'll end up with a better result let me ask you about i've recently had a conversation with the pfizer ceo this is part therapy session part advice because i again i really want us to get through this together and it feels like the division is a thing that uh prevents us from getting through this together and uh once again just like with francis collins a lot of people wrote to me words of support and a lot of people wrote to me words of criticism i'm trying to understand the nature of the criticism so some of the criticism had to do with against the vaccine and those kinds of things that i have a better understanding of but some kind of deep distrust of pfizer so um actually looking at uh big pharma broadly i'm trying to understand am i so naive that i just don't see it because yes there's corrupt people and they they're greedy they're flawed in all walks of life but uh companies do quite an incredible job of taking a good idea at the scale and making some money with that idea but they are the ones that achieve scale on a good idea i don't know it's not obvious to me i don't see where the manipulation is so the fear that people have and i talked to joe about this quite a bit i i think this is a legitimate fear and and a fury should often have that money has influenced disproportional influence especially in politics so the fear is that the policy of uh the vaccine was connected to the fact that lots of money could be made by manufacturing the vaccine and i understand that and i'm it's actually quite a heck of a difficult task to alleviate that concern like you really have to be a great man or woman or a leader to convince people that you're not full of shit that you're not just playing a game on them i don't know it's a it's a difficult task but at the same time i i really don't like the natural distrust every billionaire distrust everybody who's trying to make money because it feels like under a capitalistic system at least the the way to do a lot of good like to do good at scale in the world is by being at least in part motivated by the profit i mean i share your ambivalence right so on the one hand you have a a fantastic achievement the the the manufacture the discovery of the vaccine and then the manufacturing at scale so that you know billions of people can take the vaccine in a relatively short time that is a remarkable achievement that could not have happened without companies like pfizer um on the other hand the there is this sort of corrupting influence of that money uh uh just to give you one example uh there's a there's an enormous controversy over whether uh relatively inexpensive repurposed drugs can be used to treat the the the disease um none of no company like pfizer has any interest whatsoever in evaluating it even merck i think support was merck that had the patent on ivormectin uh now expired has no interest at all in checking to see if it works not only do they not have interest they have a way of talking about people who might have a little bit of interest that's again um fringe uh full of arrogance yeah and that that is what troubles me is there not a it's back to the play of science it's not they're not a bit of curiosity one okay one the natural curiosity of a human being that should always be there and an open mind is and second in the case of ivermectin and other things like that you have to acknowledge that there's a very large number of people who care about this topic and this is a way to inspire them to also play in the space of science to inspire them with science you can't just like dismiss everybody that uh you can't just dismiss people period yeah well i mean i think here here take ivermectin right there's actually a study funded by the nih by tony fauci's nia id and the nih um called active six that's a randomized trial of ivermectin it's due to be completed in march 2023 so normally when you have uh private actors like these big drug companies that have no interest in conducting some kind of scientific experiment that would have some public benefit it's the job of the of the the government and in this case the nih to fund that kind of work the nih has been incredibly slow in its evaluations of these repurposed drugs and it's been left to lots of other private private private activities of uneven quality and hence that's why you have these these big fights because the data are not solid you're gonna have these big fights yeah but also okay forget the the process of science here the studies not enough effort being put into the studies just the way it's being communicated yeah no like horse pace i mean come on the fda put a tweet out telling people who are like they're taking iron mechanism because they've heard good things about it and they're sick and they're desperate and just call it horse pace was just that was that was terrible that was deeply responsible my hope um is grounded in the fact that young people see the the bullshit of this young phd students graduate students young students in college they see the the less than stellar way that our scientific leaders and our political leaders are behaving and then the new generation will not repeat the mistakes of the past that is my hope because uh that that's the cool thing i see about young people is they they they're good at detecting bullshit and they they don't want to be part of that um that's my hope um in the space of science let me return to this idea of the great barrington declaration return to the beginning so um what are the basics can you describe what the great barrington declaration is what are some of the ideas in it you mentioned focused protection uh what are your concerns about lockdowns just paint the picture of this early proposal sure so uh the great painting declaration first why is it called great barrington declaration it sounds it's such a great name you i mean it just it's such an epic name but the the reason why it's called that is way less than epic it's it was it was because it the the conference um which is organized by martin kuldorf who's a was a professor at harvard university uh by a statistician he actually designed the the safety system the statistical system that the fda uses for tracking vaccine safety he and i had met previously just the summer before that summer and he invited me to come to this small conference where he was inviting me and sinatra gupta who was a professor of theoretical epidemiology at harvard at oxford university and i mean i jumped at the chance uh because i knew that martin and sinatra were both smarter than me and uh it would be fun to like talk about what uh what the right strategy would be on the drive in i didn't know what the name of the town was and i asked as they said was great barrington i had in the back of my head um martin and i arrived a little early and we were writing an op-ed about some of the ideas i hope we get to talk about very soon um about focus protection and the right strategy and uh when sinetra arrived we realized we actually come basically to the same place about the right way to deal with the epidemic um and i i thought well why don't we put issue why don't we write something like the port hearing statement that was what i had that in the back of my head yes and i'm like well what's the name of this town again it was great barrington yeah so it's not barrington it's great bear it's which is fantastic right it's so over the top that it's perfect it's it's literally like the big bang there's something about these over-the-top fun titles that just really deliver them so that's why that's my my main contribution was the word is the title the name great barrington decor um but yeah so it was it was kind of uh so the and the the idea is actually while the title is great um and i think that it was written in a very stylish way um it's you know like it's a go it's less than a page you can go look online and read it it's written written for not for scientists but for the general public so people can understand the ideas really simply but it is not actually a radical set of ideas it actually represents the old pandemic plans that we've used for century dealing with other similar pandemics um and and there's it's twofold uh first let me talk about the science it rests on and then i'll talk about the plan the science actually some of what we already talked about uh there's this massive age gradient in the risk of coven infection older people face much higher risk than younger people the second bit of science is all that's not controversial right that even if you think the ifr is 0.7 or or or 0.2 no matter what everyone thinks everyone agrees on this age gradient the second bit of science is also not controversial the lockdown focused policies that we followed have absolutely devastating consequences on the health of the population let me just give you some examples uh and this is this was known in october of 2020 we wrote it right so um the un was sounding alarms that there would be tens of millions of people who would starve as a consequence of the economic dislocation caused by the lockdowns and that's come to pass hundreds of thousands of children in places like south asia dead from starvation as a consequence of lockdowns um the the the the uh uh priorities like the treatment of patients with tuberculosis in poor countries stopped because of lockdowns uh childhood vaccinations of measles rubella dpt diphtheria so on pertussis tetanus all those standard vaccination campaigns stopped tens of millions of children skipping these doses for diseases that are actually deadly for them is there just a on a small tangent is it well understood to you what are the mechanisms that stop all those things because of lockdowns is it some aspect of supply chain is it just literally because hospital doors are closed is it because there's a disincentive to go outside by people even when they deeply need help it's all of the above uh but a lot of those efforts especially especially those like vaccination efforts are funded and run by what western efforts like gavi is a i think it's a gates funded thing actually that produce provides vaccines for you know millions of kids worldwide and those efforts were scaled back malaria prevention efforts so in the developing world it was a devastating effect these lockdowns um there was also direct effects like in india the uh the lockdowns when they first instituted there was an order that 10 million migrant workers who live in big cities and they live hand-to-mouth they buy you know coconuts they sell the coconuts with the money they buy food for themselves and coconuts for the next day to sell um walk back to their villages or get or get go back to their villages then overnight so 10 million people walking back to their villages or taking a train back a thousand died on route overcrowded trains dying essentially on the side of the road i mean it was it was absolutely inhumane policy uh and uh the lockdowns there what what it's it's actually it's kind of like what's happened to the west as well but it was so severe uh there was a zero prevalence study done in mumbai by a friend of mine at the university of chicago what he found was that in the slums of mumbai there were 70 surah prevalence in july or august of seven of sept of 2020 whereas in the rest of mumbai is 20 yeah right so it was incredibly unequal the the lockdowns protected the the relatively well off and spread the disease among the poor um so uh that's in the developing world in the developed world the health effects of lockdowns were also quite bad right so we talked already about isolation and depression there was a study done in july of 2020 that found that one in four young adults seriously considered suicide now suicide rates haven't like spiked up so much but the depths of despair that would lead somebody to seriously consider suicide itself should be should be a source of great concern for in public health yeah this is one of the troubling things about measuring well-being is we're okay at measuring death and suicide we're not so good at measuring suffering it's like people talk about um maybe even harder more in the under stalin or the concentration camps with hitler we talk about deaths but we don't talk about the suffering over periods of years by people living in fear by people starving psychological trauma that lasts a lifetime all of those things i mean and just to get back to that that point we close schools especially in blue states we close schools now richer parents could send their kids to private schools many of which stayed open even in the blue states they could get pods they could get tutors but that's not true for for poorer and middle class parents and as a result what we did is we took away life opportunities for kids we we tried to teach five-year-olds to read via zoom in kindergarten right uh and uh the consequence actually you think okay we can just make it up but it's really difficult to make that up there's a literature in health economics that shows that even uh you know relatively small disruptions in schooling can have lifelong consequences negative consequences for kids right so they end up growing up poorer they they lead shorter lives and less healthy lives as a consequence that's and that's what the literature now shows is likely to happen with the interruptions of schooling that we had in the united states many european countries actually managed to avoid this there were in the early days the epidemic great indications that children first were not very severe severely at risk from covet itself nor are they super spreaders schools were not the source of community spread communities spread spread the disease to schools not the other way around um and if we can talk about the scientific basis of that if you'd like but that was pretty well known even in october um it that we we closed hospitals in order to keep them like available to covet patients but as a result women skipped breast cancer screening as a result they have are showing up with late stage breast cancer that should have been picked up last year men and women skipped colon cancer screening again with later stage disease that should have been picked up last year with earlier stage for patients with diabetes it's very important to have regular screening for blood sugar levels and and sort of counseling for lifestyle improvement and we skipped that people stayed home with heart attacks and died at home with heart attacks so you had this like sort of wide range of medical and psychological harms that were being utterly ignored as a result of the lockdowns plus there's the economic pain so like you said the whatever is a good term for the non-laptop class people would lose their jobs yes there might be in the in the western world support for them financially but the the big loss there that is perhaps correlated with the depression and suicide is uh loss of meaning loss of hope for the future a loss of kind of a sense of stability all the pride you have and being able to um make money that allows you to pave your own way in the world and yes just having less money than you're used to so your family your kids are suffering all those kinds of things and there's a there's again an economics literature on this on deaths of despair it was called 2009 there was the the great recession it led to an enormous uptick in overdose from drugs uh suicidality depression as a result of the job losses that happened during the great recession well that's happening again like an enormous increase in drug overdoses that's not uh that's not a an accident that's a lockdown harm right same same thing with uh with the job losses the job losses by the way are like it's so interesting because the um the states that stayed open have had much much lower unemployment than the states that stayed closed uh the labor force participation rates declined by three percent it's women that separated because they stayed home with their kids um we've reversed a generation of women uh when proving women's participation in the labor force do you think it has to do with institutions that we mentioned that there is so much priority given or so much power given to maybe nih versus um other civilian leaders or do people just not care about the economic pain the leaders i mean uh because to me it was obvious i mean probably it's just studying history whenever i listen to people on twitter on mainstream news or just anything i realize that's the very kind of top the the people that have a voice represent a tiny selection of people and so whenever there's hard times i always kind of think about the the quiet the voiceless the quiet suffering of the tens of millions of the hundreds of millions um do the political leaders not just give a damn i mean i think it was actually a very odd ethical thing at the beginning of the pandemic where if you brought up economic harms at all you were seen as callous right so i i i had a reporter calling me up almost the very beginning of the epidemic asking me about about the about uh uh like a very particular phenomenon so like uh he he was anticipating a rise in child abuse because children were gonna be staying at home child abuse is generally picked up at school and that actually happened like so like the the child reported child abuse dropped but actual child abuse increased um because normally you pick up the child abuse at school and that you apparently you have the intervention right so yeah so i was talking about like well there's gonna be some economic harms and they're going to have health consequences but the economic harms matter but the but he's he he counseled me and i think he was he had his bet my best interest at heart like if if we were to put that in the story i would be i'd essentially be canceled because the what the what the uh the the narrative that that arose in march of 2020 is if you if you care about money at all you're evil and crass if you you must only care about lives the problem with that narrative is that that money which we're talking about is is actually lives of poor people right when you throw 100 million people around the world into into poverty you're going to see enormous harm to their health enormous increases in their in their mortality it's not immoral to think about that and and worry about that in the context of this pandemic response our mind focused so much on kovid that it forgot that there are so many other public health priorities as well that need our attention desperately and this is the thing i sensed about san francisco when i visited i was thinking of moving there for startup this is the thing i'm really afraid of especially if i have any effect on the world through a startup is losing touch in this kind of way that uh you mentioned the laptop class um living in this world where you're only concerned about this particular of class of people and also uh you know perhaps in early on in the pandemic amongst the laptop class there was a legitimate concern for health like you're not sure how deadly this virus is you don't you're not sure who to listen to so there's a real concern and then at a certain point when the data starts coming in you start becoming more and more detached from the data you don't start carrying less and less and you start just swimming in the space of narratives like existing the space of narratives and you have this narrative in san francisco in the laptop class that you just are very uh proud that you know the truth you're the sole possessors of the truth you congratulate yourself on it and you don't care what actually gigantic detrimental effect it has on society because you're mostly fine that i'm so terrified of that well i think the answer to that is just to you remember yeah yeah i don't think um you know remember where you came from remember who who who you're doing is for at the back of your head should always be what's what's the purpose like why am i here what's the purpose of this and if i'm if if the purpose is simply self-aggrandizement then you should rethink because it'll just end up being a hall of life all of us will be forgotten in the end focus protection the idea the policy what is focus protection right so those i was saying that there's two scientific bases right so one is this the steep age gradient the second is the existence of locked arms again i think there's not very little disagreement in the scientific community of both of those facts if you put those facts together the obvious policy is to protect the people who are at the most severe risk from the disease itself and that's the idea of focus protection that's the general principle of it the actual implementation of it depends on the living circumstances of the people that are at risk the resources are available in the community uh the the uh the technology is available to do this and so it's almost always going to be in fact it'll always be a local thing because it'll depend on the the the all of those those things which are all local in nature right so one very very obvious thing in a country like ours where so many older people live in institutionalized settings in nursing home settings and that's where older really vulnerable chronically ill patients often live it is and you know this disease affects that group most like most most commonly it is absolutely vital to protect that group um we should have known that in february 2020 from just from the chinese data and we should have thought about that group as the as this as the key constraint in our policy making um instead we thought about in february march 2020 as hospital beds as the key constraint hospital beds and ventilator shortages and that we so we we ran around trying to like address that constraint you know like a linear programming problem you figure out what the which constraints binding and you address that one thing and then you go to the next one right um if that's it's that one constraint we said okay the constraint is hospital beds that led to the decision in many of the northeast states to send covet infected patients who were on on the verge of like it looked like they were about to recover back to nursing homes who then spread the disease all through there because they wanted to preserve the hospital beds well for somebody who loves the miracle optimization i love the way you frame this but those are kind of connected right if you actually focus on protecting the vulnerable you will also have the effect of not hitting the ceiling of the available that is that's the irony if we protected the vulnerable the vulnerable the most likely to be hospitalized and so by protecting the hospital about protecting the vulnerable we would also have addressed the shortage of hospital that's more effectively so that little shift in priority would have had a big impact okay but specifically the idea is to and we could talk about different ideas of how to actually do this but uh you know you basically do a lockdown or something like that on a very small set i mean you may have to do that if it's community spread is very high but generally i think it would depend on again the living circumstances and the uh so so for instance um if you are in a if you have a here's a very simple idea that doesn't require a lockdown forced on them i i don't actually generally are not in favor of that kind of force lockdown because you just won't get cooperation um but what you could do is provide resources to that group of people so like ima imagine you live next door to somebody uh an older couple um and it's there's high community spread well they have to go grocery shopping um we did like some of these some communities did these like senior only grocery hour right but but they have to still have to go out and they might get exposed in when they're shopping amongst other seniors yeah well why not organized home delivery of groceries to them we did that for the laptop class right uh or or you can even just there's a volunteer effort you know the older people living next door just call them up and say can i help you get uh go out and go shopping for it and so you would have potentially federal support of that kind of thing so these kinds of efforts and identify where the vulnerable people live uh it's really challenging in multi-generational homes in l.a county for instance there's a lot of older people living together with younger people in relatively crowded they're they're it's really quite a challenge but there again you can use resources so if grandma uh is worried that grandson has come home but is potentially been exposed grandson calls grandma says i've been i might have been at a party where i might do that where covid was grandma calls public health public health and then says okay you can have this hotel room for a couple of days until you check to turn negatives in case it wasn't clear the idea of focus protection is the people that are vulnerable protect them and everybody else goes on with their lives open up the economy just do as it was before and there was still fear abroad so there still would be some restrictions people would pose on themselves they probably would go to parties less the grandsons probably wouldn't go so many parties right um uh that there would be less less participation in big gatherings uh you may even save like big gatherings in order to restrict community spread again i'm not against any of that but you shouldn't be closing businesses you shouldn't be closing churches and synagogues you shouldn't be closing you shouldn't be forcing people to not go to to school you should you should not be shuttering businesses you should just let just allow society to go on some disease will spread but as we've seen the lockdown didn't stop the disease from spreading anyways right so what do you make of the criticism that this idea like all good ideas cannot actually be implemented in a heterogeneous society where there's a lot of people intermixing and once you open it up people like the the younger people will just forget that this is even existing and they'll stop caring about the older people and mess up the whole thing and the government will not want to fund any kind of the great efforts you're talking about about food delivery and then the food delivery services be like why the heck am i helping out on this anyway because like it's not making me much money and so therefore like all good ideas it will collapse that might be true i mean i think it's always a risk with policy thing but i think like think back to the moment we actually felt like we were in this together to some extent yes right i think i think that that um that empathy that we had that was used to like tell people to stay in and like happily not don't rule in happily but like stay in um to to like wear a mask or to to do all these things that we thought would help other people could have been redirected to actually helping the people who most needed to be especially i do remember [Music] march uh so this is even way before barrington all that kind of stuff march april may there was a feeling like if if we all just work together yeah we'll solve this right and that maybe started to when did that start breaking down i mean the unfortunately the election is mixed into this yeah that it became politicized but i think it lasted quite a long time i think into the summer i think there was some some of that sense uh i don't know they're obviously varied among different people but um but i think that it's true it would have been challenging it's also true that it's heterogeneous exactly the way you said um but what that means is you need a local response a response so like like my vision of a public health officer is someone that understands their community not not necessarily the nation at large but their community and then works within their community to figure out how to deploy the resources that have available um to do the kind of protection policies we're talking about that's that's what should have happened instead they spent a huge amount of efforts closing making sure businesses stayed closed businesses that i mean there were you know like hardware stores that closed what good did closing a hardware store do for the spreader club if it had an effect on spread covert spread i mean it's going to be checking to make sure that plexiglas was put up everywhere which now in retrospect turns out to have probably made the disease worse um you know masking enforcement so shaming around mask i mean a huge amount of effort on things that were only tangentially related to focus protection what if we turned our energy that enormous energy put into that instead into focused protection of the vulnerable that's essentially the conversation i was calling for and it wasn't i mean i didn't think of it as we had every single idea i mean we gave some concrete proposals and we got but the criticism we got was that those those concrete proposals weren't enough and the answer to that i have is that's true they weren't enough i wasn't thinking of them as enough i was thinking that they would i wanted to involve an enormous number of people in local public health to help think about how to do focus protection in their communities the question that's interesting here is about the future too uh so uh covet has very specific characteristics like you mentioned about the curve of the the the death rate based on the like it's it's uh it seems like with covid it's a little bit easier to actually identify a group of people that you need to protect so other viruses may not be this way so might lock down be a good idea like hard core lockdown for future virus that's 10 times deadlier but spreads at the same rate as covid or maybe another way to ask that is imagine a virus that's 10 times deadlier what's the right response i mean i think it's always going to be focus protection but the group that needs the focus protection may change depending on the biology of the virus right so the polio epidemic in the 40s and 50s in the u.s the the great the people at most risk were children we didn't know really at the beginning there was this vehicle oral spread and so we did all kinds of crazy things um including like spreading spraying ddt in communities which was somehow supposed to get rid of polio um but the focus was on whenever there was an outbreak they would close a school down and that was the right thing to do because that group that needed protection where it was children and those the disease was spread we thought in schools i don't think there's a single formula that works but there's a single principle that works right no matter i can't it's hard to imagine a disease that's uniformly deadly across every group and every single person there's always going to be some group that's differentially harmed uh there's always going to be some group that's differentially protected and that that may change over time right so like the in the uh in this disease in this epidemic as people got infected and recovered we now had a class of people that were pretty well protected against the disease they should be they would like instead of ostracizing them because they don't want a vaccine we should we should be allowing them to work i mean we're having staffing shortages in hospitals now because we forgot that principle is uh quite a bit of this a technology problem so being able to so some of it how much of it is this uh sociological problem uh how much of it is a technology problem like where do you uh put the blame sort of on why this didn't go so great and how it can go great in the beginning i mean think about lockdowns like if we didn't have zoom we wouldn't have lockdowns right there's there's a reason in 2009 we didn't lock down i mean we didn't have the technology to replace work with this remote um with this remote technology so we had good lockdown technology yeah and zoom we didn't have good focus protection technology yeah i mean focus protection is always going to be complicated especially for something like this that's spread so easily it's going to be complicated and i'm i'm very i'm the last person to say would have been perfect there's there would have been people that would have gotten sick but they got sick anyways the hope was that if we suppress community spread low enough we can protect the vulnerable that was the hope by lockdown the reality was that only a certain class of people were able to benefit from a lockdown the rest of society we call them essential workers had to keep working and they got sick yeah and the disease kept spreading it didn't actually have a substantial effect on community spread in the in in non laptop class populations and also we should probably expand the class of people who call vulnerable to those who would suffer who have the capacity to suffer given the policies they're you're weighing it's very disingenuous to call the vulnerable just the people obviously we had the very specific meaning but broadly speaking vulnerable should uh include anybody who can suffer based on the policies you take in response to a virus there's something this is that principle you just said as i completely agree with is is uh something i think has been lost uh and unfortunately lost right so the policies themselves if they have harm those are real yeah and we shouldn't pretend like they're not and and and essentially demonize the people that that that suffer them or pretend i mean like us a lot of times like the depression that we've been talking about that's thought of as like not as not so important but it is important uh and uh uh especially the the harm to the people in poor countries it's like been out of sight item out of mind in much of the rich parts of the world once again i've hoped that we seeing this learning the lessons of history with the communication tools who have now will learn this it's like going to another country and bombing targeted terrorist locations and there's going to be some civilians who die pretending that that the child who watches their dad die is not going to grow up first of all traumatized but second of all potentially bring more hate to the world than uh the hate that you were allegedly fighting in the first place that's another sort of um considering only one kind of harm and not the full range of harms that are being caused by your policies you know like the good return to focus protection we we still should be following the policy now for covet and we're not right so the vaccines are there's a great shortage in vaccines you wouldn't know it in the united states and in rich parts of the world but in there's a great shortage of vaccines we're not going to be able to vaccinate the um most of the like the entire set of elderly at least and or larger groups until late 2022. huge numbers of older people around the world in poor countries that have not had not covered recovered yet so they're still quite vulnerable have not had the vaccine and yet we're talking about vaccinating five-year-olds yeah who benefit if at all from the vaccines of just a very little bit because they face such a low risk of harm from covid well something that's a little bit near and dear to our specific the two of our hearts uh so you're at stanford so stanford recently announced that they're going back to virtual at least for some period of time in response to the esc maybe you can clarify but i think it's in response to the escalated um holiday phrase it's related to omicron and uh a few other universities are kind of like uh considering back and forth in my perspective as somebody who loves in-person lectures who um sees the value of that to students to young minds also looking at the data seems the [Music] risk aversion in university policies around this given how healthy the student population is seems not well calibrated let's put it this way also pathological pathological is one way to put it given that i believe depending on the university but i think many universities require that the student body is vaccinated at this point so i think it's a big mistake by stanford to do this and um i i'd like to say that because i just hope mit doesn't but what are your thoughts about everything things i completely agree with you i think um we have failed in our mission to educate our students by these this decision uh and i think i frankly just more broadly i think we failed generally over the course of the last year and a half in living up to our educational mission the in-person teaching is vital for and now i can understand you have you have older faculty the principle of focus protection says provide some alternative teaching arrangements for them that makes sense to me from the kids point of view they're more harmed by not getting the education we promised them than by than by covid so applying this principle of this focus protection let young professors teach in person this is before the vaccine after the vaccine let everyone teach in person yeah this this the part i don't understand the discussion we're even having um okay let's leave focus protection aside here because that's a brilliant policy for perhaps for the future when there's no vaccine now with the vaccine i'm i'm misunderstanding something here because we're now in a space that's psychological not it's no longer about biology because uh with the booster shots which i believe mit is now requiring before january with the booster shots the data shows no matter how old you are the risks are very low for um ending up in a hospital relative to all the other risks you face when you're older i don't i don't understand can you explain the policy around closing a university but also just a policy about just being so uh scared still in the university setting i think the universities the great university has done great harm by modeling this kind of behavior yes that to me decided to keep interrupting but to me the university should be the beacon of great behavior not not the beacon of like scared conservative let's not mess up let's not make it pathological it's not make anybody angry let's it should be a place to play in the space of ideas yes so i think um the central problem is actually related to the central problem of covet policy more generally the goal seems to be to stop the disease from spreading rather than to reduce the harm from the disease if the if the goal is to stop disease and spreading the sad fact is we have no technology to stop to accomplish that at this point yes because like uh it's already deeply integrated into the human civilization well i mean it's here forever right there's a zero survey of white-tailed deer in the u.s it turns out 80 percent of white-tailed deer in the u.s have coveted antibodies dogs get it cats get it there's almost certainly human human animal transmission of it um i mean presumably i mean i've heard bats get it apparently so so you you have uh you have a situation where you have this disease that's here to stay yeah and it and the vaccines don't stop the spread of it the lockdowns don't stop spread it we have no technology to stop the spread of it um and so we're burning the earth trying to stop do something that's impossible rather than working on what's possible uh and so like you know like letting regular college happen that's a great good universities are a wonderful invention and it's contributed so much to society to decide to shut it down the universities should be fighting tooth and nail to not be shut down not the other way around yeah whatever the mechanisms that uh results in the universities doing that that's probably this is me talking it probably has to do with certain incentives for the administration probably has to do with lawyers and legal kinds of things to to avoid uh legal trouble but once again it's when the administration has too much power and too much uh definition of what the policy is for the university that's when you get into trouble the beauty the power of the university should be about the faculty and the students administration just gets in the way get out of the way i mean they can help organize things they they play some important role but they certainly do but they need to remember what the mission is the mission is not safety the mission actually university should be dangerous places you know for ideas and and and whatnot what is the role of fear in a pandemic we've been dancing around it is it useful is it destructive or is there sort of a complicated story here because uh instead of taking us back into january 2020 there's so much uncertainty this could have been a pandemic that um is black death the bubonic plague it could have killed hundreds of millions of people we don't know that we're we're very new to this it's been a while we're rusty so like there is there is some value to fear so that you don't do the stupid thing you don't just go on living i guess where i come from i think it's almost entirely counterproductive i think fear should never be used as a tactic to manipulate human behavior by public health so the fear on the individual level that feeling of fear you should be very hesitant about that feeling because it could be easily manipulated by the powerful exactly so i think um that fear is natural and it it uh it's not something that you have to you have to nest you have to stoke to get when the facts on the ground suggest it right uh in fact the tendency for humans in the in the face of threats from infects disease is to is to exaggerate the fear in their own minds of the being contaminated by the environment and by others that's just natural to humans and the role of public health is not necessarily to eradicate the fear but like obviously technological advances can help eradicate the fear but like but it's really to help manage that fear and and uh help people put the the sort of incentives that come out of that to useful things as opposed to harmful things what's happened in this pandemic is that there's been a deliberate policy to stoke the fear to help make people think that the disease is worse than it actually is in survey after survey you see this and that's been incredibly damaging so young people have readily given away their willingness participating in regular life because a they fear covid more than they ought and b they feared that they're going to harm the vulnerable in their lives you put those two together and you just that you get this powerful demand for lockdowns you see this all over the world broadly speaking you have a powerful demand for rational policies irrational policies because i would like to mention the flip side of that i've been saddened to see how much money there is to be made by the martyrs the people the conspiracy theorists that tell you you should be afraid of the government you should be afraid of the man it feels like fear is the problem i think there's some guy that once said something about we should be we should fear fear itself uh he was a president or something i vaguely remember that so i i so i'm worried about both sides here that well i just i think the general principle is that should not be a tool of public policy right right the true the public policy should attempt and public health policy in particular should attempt to address that fear uh it's not that you should tell people lies of course not tell people accurately what the risk is give people tools that have evidence that they can address their risk with um and level with people when we don't know i think that is the right adult way for to deal with this pandemic from public health point of view and that's that is not the policy we have followed instead public health has intentionally stoked the fear in order to gain compliance with his edicts and i think the consequence of that is people distrust public health what you're talking about the distrust of government i think is a partly a consequence of that that that movement which is much smaller once upon a time is much larger now because of essentially people look at what the what public health has done and said i mean they've lied to me a whole bunch of times a whole bunch of things is the general sense and there are consequences of that we're going to have to work in public health for a long time to try to regain the trust of the public throughout all of this you've been inspiring to me to a lot of people you've been uh fearless uh bold in these kind of challenging the policies and not in in a martyr kind of way because you're walking the line gracefully and beautifully i would say and looking at that i think you're an inspiration to a lot of young people so i have to ask what advice would you give them if they're thinking of going into science if they're thinking of having an impact in the world what advice would you give them about their career and maybe about their life thinking about somebody in high school maybe an undergraduate college i'd say a few things one is this is a wonderful profession you have an opportunity to improve the lives of so many and do it by having fun the kind of play we're talking about it's an absolute privilege to be able to work in this kind of area um uh and to young people looking to say that that have some gifts or desired for for this area i say please you know go for it like do serious science broadly yeah i mean it could be it could be i mean i'm not i don't have any gifts in ai but like you know it could be your buddy but you know or in health or or in medicine or whatever whatever your gifts lie develop them work hard and develop them because it's worth it it's worth it not just um not just because you get some status but because the the journey is fun and the result is uh improvement to the lives of so many so i think that that is the encouragement i give i'd also say if you're looking at this ugliness of this debate that's happened over the pandemic i i'd say to young people we need you to come come in and help transform it many of the people you see in this debate that behave poorly i actually forgive them i've done my best to try um because their act their many of them are acting out of their own sense that they're that they need to do good but they've but the mistake they've made is is in in is in this arrogance and this power but when you come in remember that example as a negative example and so that you when you join the debate you'll join it in a spirit of humility in the spirit of trying to learn um while keeping that that love of that led you to enter the field in the first place and yeah choose forgiveness versus like derision [Music] um like the people that you know have messed up like give them a pass because that's how it feels like that's how improvement starts funny i've been thinking this it's like uh i told you i'm christian right so like i thought like god has given me many opportunities to forgive people learn learn to practice how to do that give you a gift it's a very humbling thing i guess is there a memory from when you were young that was very formative to you so you just gave advice to some young people is there something that stands out to you that uh a decision you made an event that happened that made you the man you are today i actually grew up in a relatively poor environment like i was born in india and i moved when i was four my dad had uh eight brothers and sisters and my mom had four brothers and sisters she uh grew up in the salomon in calcutta my dad his dad died when he was young and he supported his family his kid his brothers and sisters with university scholarship money came to the u.s and my dad worked in a mcdonald's even though he's an electrical engineer couldn't find a job in 1971 and so he worked at mcdonald's um we lived in a in a uh like this this basically like this the housing port like development uh in in in cambridge this like this middle building of the 17th floor of this like housing development um i mean i i think that was transformative for me like i didn't realize so much at the time how that experience of being essentially like poor lower middle class what effect it had on my outlook you mentioned to me offline that you listened to a conversation that i had with my dad what what impact did your dad have in your life what uh what memories do you have about him he was a rocket scientist actually he helped design rocket guidance systems he died when i was 20 and i still miss him to this day and i think that experience of seeing him sacrifice his hidden self for his family a brilliant man but uh in many ways frustrated with like the the his opportunities in the world which publicly would let him to come to the u.s in the first place that's transformed that's had a transformative effect on me and i wish i could tell him that looking back do you think about your own mortality do you think about your death your dad is no longer with us you're the the old wise sage that represents it's funny i've only worried about death uh once in this pandemic although i've had two of my cousin who was 73 and my my uncle was 74 die in india during the pandemic and i grieved them both from covid um like the fear of covid really has only hit me only really literally once during this it wasn't for me and i recognized it's irrational so on the eve of the santa clara county zero prevalent study um it was it was a really interesting thing because so many people volunteered to help and um my my my daughter who's 20 she was i guess was 19 at the time and my wife also volunteered to help with like various aspects of the study and so the eve of the study they were going to go out in public and i didn't know what the death rate was because we hadn't done the study and i suspected it was lower than people were saying but i didn't know i knew about the age gradient because i'd seen the chinese data and my my daughter is young but my wife is my age and i didn't know the death rate and i couldn't sleep the night before like what if i'm putting my family my kid my daughter and my wife at risk because of some some activity that i'm doing um it was kind of i don't know i mean it was so worried about the well-being and of others yeah when you look in the mirror i if i die i die i mean like i just it's not i again i'm christian so i don't death is not the end for me uh i believe um and so i don't i don't particularly worried about my own death but i i do i mean i just i think we can't help but we worry about the the well-being of our loved ones so from the perspective of god then let me ask you um what do you think is the meaning of this whole journey we're on what do you think is the meaning of life no it's very simple love one another treat your neighbor as yourself it's love yeah simple as that well i'd love to see a little bit more of that in this pandemic it's an opportunity for the best of our nature to shine it's so i've seen some of the worst um but i think some of that is just good therapy and uh i'm hoping in the end what we have here is uh is love at the very least make your dad proud with some incredible rockets that we're launching i think you get along well with my dad lex i definitely would thank you so much this is an incredible honor to talk to you jay he's been an inspiration to so many people and keep fighting the good fight thank you so much for uh spending your valuable time with me thank you for having me here appreciate it thanks for listening to this conversation with jay about acaria to support this podcast please check out our sponsors in the description and now let me leave you some words from alice walker the most common way people give up their power is by thinking they don't have any thank you for listening and hope to see you next time