The quest for the coronavirus vaccine Seth Berkley
Transcriber: Joseph Geni
Reviewer: Camille Martínez
Whitney Pennington
Rodgers: Hello everyone,
and welcome back to TEDConnects.
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so I’d like to turn things over
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who will introduce today’s guest.
Chris Anderson: Hello.
WPR: Hi Chris. How’s it going today?
CA: Nice to see you again, Whitney.
It’s going pretty good here. Amazing days.
WPR: That’s good. That’s great.
We have sunshine here in the Northeast,
which is nice.
CA: So look, I am excited
to introduce this guest,
because I’ve known Seth Berkley
for a long time.
I count him as a friend.
He’s a man who has really devoted his life
to the most profound questions
about public health.
Vaccines are extraordinary.
They save millions of lives.
The quest for a coronavirus vaccine
is, I think, the biggest single question
that the world faces now
if we’re going to get out of this.
So it’s just a delight
to welcome Dr. Seth Berkley
to TED Connects.
Come on in, Seth.
Seth Berkley: Good
to see you there, Chris,
and delighted to be with you
and all of the TED community.
CA: Well, so look, on Tuesday,
Bill Gates was here,
and he mentioned that
your organization, Gavi,
is really at the heart
of the quest for a vaccine.
So tell us a bit – what is Gavi?
SB: So Chris, thank you for that.
What’s interesting is that
20 years ago –
we just celebrated our 20th anniversary –
there were all these powerful new vaccines
that were being used in wealthy countries,
and the challenge is,
they weren’t getting to the places
that they could make the most difference:
the developing world.
So Gavi was formed as an alliance –
WHO, the World Bank, the Gates Foundation,
UNICEF – all working together
to try to bring these vaccines
to the developing world.
And it’s been very successful.
We’ve launched 433 new vaccines
in the most difficult
countries in the world,
in the Somalias and Yemens
and DRCs and Nigerias.
But we’ve also set up emergency stockpiles
for outbreak-based vaccines,
so if there’s an outbreak
anywhere in the world
of yellow fever or of things
like cholera or meningitis and now Ebola,
we have vaccines
that are available to do that.
And the last thing we are trying to do
is build the health systems out
to deliver these vaccines,
but also to make sure that we can
pay attention to new diseases that pop up
in different parts of the world.
CA: And just give us a sense
of the scale of this.
How many vaccines
do you distribute in a given year?
And how many lives do you believe
that that may be saving?
SB: So, let me give you a macro number.
We’ve immunized more than
760 million additional children –
760 million additional children –
and prevented more than 13 million deaths.
In an average year, we give
about a half a billion doses
because we started out with six diseases,
but now we vaccinate against
18 different diseases.
CA: Yeah, the scale of that is incredible,
and amidst all the bad news
that’s happening,
it’s kind of amazing that this
intervention can save so many lives.
I mean, help us understand
what a vaccine is.
SB: So, the original idea,
the word “vaccine,”
comes from “vaca,” or cow.
And the observation made in the 1700s
was that milkmaids had beautiful skin,
whereas everybody else had pockmarks
from having gotten over smallpox.
And the concept was that she
was getting infected with a zoonosis,
that is, with naturally occurring cowpox,
not smallpox.
That then protected against smallpox.
And it was tested in those days:
Could you artificially do that?
They of course didn’t understand virology,
they didn’t understand
any of those issues.
But what a vaccine
is is something that you give
to artificially stimulate
the immune system,
hopefully to not make you sick.
But then later on, when the body comes
in contact with the real disease,
it thinks it’s already seen it
and it is able to fight it off
without making the person sick.
CA: I mean, it’s kind of
a miraculous thing to me
that they work that way,
that your body is always there
looking for these threats.
And a vaccine, I guess, the body
perceives it as a threat,
and therefore arms itself
against that threat, right?
And that’s what gives the protection.
So, is that why some people are sort of –
irrationally, I will say –
irrationally scared of vaccines
and feel that they may be dangerous,
because they are a kind of threat
that you’re putting into your body
in a very subtle way?
SB: Well, of course,
when this first started,
there were two ways to make vaccines.
You could grind them up and inject them,
so-called “whole killed vaccines.”
So you took organisms
and you got an immune response,
and sometimes those organisms,
even though they were dead,
gave you a pretty whopping
immune response:
your arms were sore, you got fevers.
Then we moved to these
weakened live viruses,
and frankly, those are the best vaccines.
That’s what measles is.
That’s what yellow fever is.
These are weakened viruses.
They don’t give you disease,
but because they look
like the natural viruses,
your body gets protection and, frankly,
you get protection for your whole life.
Today, because people
are worried about side effects,
we’ve begun to use molecular biology
and use little bits of it,
and therefore, it’s moved forward.
But the reason people are mostly scared
is because, frankly, vaccines
have been so successful.
You don’t expect, if you have
a child or two children,
that those children are going
to die of these diseases,
unlike in the past, when three or four
out of your five or six or seven kids
would die.
So today, people think, well, gee,
these diseases aren’t around,
they’re not that bad and, by the way,
if I’m injecting these things,
maybe they’re not organic,
maybe it’ll make my child cry,
maybe it’ll make them sick,
and I don’t need to do it.
And that’s the challenge.
You don’t want to scare people to death
on how bad these diseases can be,
but at the same time,
you want them to understand
that these diseases are serious
and can cause really bad
disease and sequela.
CA: So yesterday, you issued
a really powerful call
for this massive, coordinated
global response
to tackle the search
for a coronavirus vaccine.
We’re going to come that in a bit,
because I think
that’s a very exciting topic.
But I think we need
some more background first.
I want to go back five years
to when you stood on the TED stage
and you held up
two candidate Ebola vaccines.
This was just a few months after Ebola
had been terrifying the world.
It was basically amazing how quickly
those vaccines had been developed.
What happened to them?
SB: It’s a great question,
and let me tell a little bit of the story,
but at the end, there were two vaccines.
One, it turned out,
couldn’t finish its testing,
because the epidemic died down.
The other one was fully tested.
It had a hundred percent efficacy.
We then went on to work with manufacturers
to produce that vaccine,
at least temporarily,
in an investigational form,
just in case there were more outbreaks.
There were, and those
are the vaccine doses
that we’ve used in the DRC.
In the last two outbreaks,
280,000 people have been vaccinated
with this experimental vaccine,
and today, there is a licensed vaccine,
and we are now procuring a global
stockpile of a half a million doses.
But let me just say, Chris,
the reason they came so quickly
at that moment is, after September 11th,
there was concern in the US
about bioterrorism.
Remember, there were anthrax attacks.
And so what happened was
there was a list of agents,
and Ebola, for a short time,
was on that list of agents,
so people started making vaccines,
and later on, they decided that was
not necessarily a good bioterrorism agent,
so they dropped that off the list.
But in the freezers were vaccines
that had been started,
and they were dusted off,
and that’s why we could move
so quickly in that moment.
CA: And yet, how long was it
from that moment on the TED stage
with the candidate vaccine
to actual deployment?
SB: So, what happened was,
the epidemic began to go down.
The clinical trial
I told you about was done.
It was a heroic
clinical trial done by WHO,
and it showed that it had these results.
That epidemic then stopped.
We didn’t know if there were going
to be more epidemics.
It took another number of years
to finish the work on the vaccine
to make sure it was pure,
to figure out how
to manufacture it at scale.
It’s during that period
that we put vaccine away
and had it available in case
there were other outbreaks.
And it turned out,
there were three outbreaks.
One went away quickly, but there were two.
I was there on day 13
of the second outbreak.
We injected the vaccine, cases went up,
then they went down, and controlled it.
And then this DRC in North Kivu outbreak,
which really was terrible
because it was in a war zone.
And that’s the one where we’ve been
not only vaccinating in DRC
but in surrounding countries.
By the way, that is now, I believe,
day 38 or 39 out of the 42 necessary
to say it’s over.
We hope it is.
And that would be, again,
an enormous example
of what vaccines can do,
even in a very difficult setting.
CA: And yet, in one way, Seth,
it’s kind of shocking
that the outbreak that happened
at the start of 2015, end of 2014,
that it happened at all,
because the world has known
about Ebola for a long time.
It’s been sequenced and so forth.
A vaccine could have been developed
and got ready for a possible outbreak.
Why didn’t that happen?
SB: Well, there had been
26 outbreaks before,
but each one of them was small –
couple of hundred people
or a couple of dozen people –
in the poorest African
countries in the world.
There was no market for it.
People didn’t know how to test it
because they would just pop up
and then go away.
And so even though it was obviously
a disease that potentially could spread,
it had never really spread before.
Of course, in West Africa,
they didn’t have
a good surveillance system;
it spread for three months before
people identified that it was Ebola,
and by that time, it was too late.
It had spread.
What’s important about that lesson
is that then caused huge disruption
across Africa, across the world,
because cases went to other places.
And the challenge then was,
and the reason we had to step in,
was because there still was no market.
So the Gavi board said,
“We will put out 390 million dollars.
We’ll put it out there and tell companies,
we’re open for business,
we’ll create a market,
we’ll buy the vaccine.”
And that led to companies
being willing to finish the investment
to get us to where we are today.
CA: Right, right.
So it’s a real paradox, right?
In a way, the very thing
that makes vaccines so extraordinary,
that once they’re developed,
they are so cheap to administer,
for a few dollars, I guess,
you can administer this dose
that will save someone
maybe a lifetime of illness
or save their lives,
and yet so much of medical research
and invention and development
is done by companies
who need to see a revenue stream,
and so they don’t see it
from those tiny little cheap things
that might save a lot of lives.
So it’s a real market failure
that in this circumstance now –
That’s one of the things
I guess you’re thinking hard about,
how on earth do we get round
and avoid that market failure
crippling the response this time?
SB: Well, first of all, one of the reasons
Bill Gates likes vaccines is,
in a sense, it’s a little bit
like software creation.
You put a lot of money and effort
into creating it,
but once you’ve got it,
you can produce it pretty cheaply
and use it in different places
around the world.
I don’t want to beat up
the pharmaceutical industry here
because they were heroic in Ebola,
but I think realistically,
they are for-profit entities,
and they have to say
to their shareholders,
“Somebody’s going to pay for this,
or we’re going to do it
as a charitable thing.”
And if we do it as a charitable thing,
they can’t keep doing it.
Since then, there is a new initiative
called CEPI, the Coalition
for Epidemic Preparedness Innovations.
It was set up at Davos a few years ago,
and its purpose is to try to make vaccines
for the list of diseases
that aren’t yet known epidemics
but that can potentially be there.
And the idea would be
using public sector money
to get us prepared.
Of course, they jumped in
on this coronavirus as well.
Last thing is, of course,
I’m not worried on a coronavirus stage
that this is a problem,
with not having a market.
One of the challenges here is that
there may be too big a market for this,
and therefore, how do we make sure
there’s access for developing countries.
CA: All right, so talk about
this virus, Seth.
How is it different from Ebola?
How challenging is it
to create a vaccine for it?
SB: So what’s interesting
about coronaviruses
is that they are animal viruses,
probably primarily in bats.
They jump into other animals sometimes,
and then they jump into humans.
So this shouldn’t have been a surprise.
This is the third coronavirus
that has jumped into humans.
We had SARS in early 2002,
we had MERS a number of years later,
and now we have this virus.
What’s interesting is there is a database
that shows there are 30,000-some-odd
isolated coronaviruses in animals,
and one of the things
that people tried to do
was say the way these coronaviruses work
is they have a spike on them.
They’re called “corona”
because they look like the sun.
That spike is where it attaches
to a certain receptor in people’s lungs.
And so somebody said, well, maybe
we can begin to look at those spikes
and see if they’re similar
to the human receptors
and they can be predicted.
But the problem is people don’t invest
in those types of research.
And, of course, I think that,
given it’s an evolutionary certainty,
we’re going to see this,
that we should be.
But one other point about this is
coronavirus jumped into humans
in ancient history as well,
and so we have now about a third
to a quarter of the common cold viruses
are actually coronaviruses.
And what’s interesting about those
is they don’t make you deathly ill
like these,
but you also don’t have
long-term immunity to them,
so you can get reinfected
with these viruses
after 10 months, a year.
And so that does raise
an issue on vaccinology,
because you want to ideally
have lifetime immunity.
CA: The reason why we get reinfected
is because the virus mutates slightly,
and so it escapes the antibodies?
SB: No, no, not in this case.
Not in this case.
So in flu, that’s what happens.
The viruses are always mutating.
In HIV, the reason we don’t have a vaccine
is because they’re all mutating.
In this case, the immune response
seems to get weaker and go away,
and people get reinfected
with the same viruses.
Now, that is potentially
a solvable problem using vaccinology
and many different techniques,
but the point is, we just can’t assume.
Some people now
are talking about herd immunity
as a way to deal with this virus,
and the idea there is if you could get
enough people infected –
you know, forget for a moment
that a lot of people are going to die
and be miserable while that happens –
but the idea is that you get
a certain level immunity in the community,
and then the disease will go away.
Well, that is only true
if you get long-term immunity.
If you don’t, then you could go
through all of that horrible experience,
have all those deaths,
and then not have the protection you need
to protect against this disease.
CA: OK, so in a way,
the quest we’re looking for
is a vaccine that will work
for the long term.
I mean, I guess any vaccine
that works at all will be a huge gift,
but it could well be one
that we have to retake every year,
or something like that.
SB: Right. That is certainly possible.
Of course, we have to remember, though,
that SARS and MERS both had even higher
mortality than this virus does,
and they give a much
more profound immune response.
So it may be that they react differently
than the common cold viruses.
The challenge, of course, is that
we haven’t had the opportunity
to study these over a long time,
and this new disease –
three and a half months, we’ve had it.
More science has been done
for this disease
in this short period of time,
but we don’t understand fully
the epidemiology of the virus,
the immune response, what’s protective,
which is the best animal model.
All of that is being worked on by science
and at breakneck pace,
but a lot to learn.
CA: So talk about how the medical
and the research community responded.
Because, the Chinese authorities –
I guess we heard it yesterday –
only found out about this
sometime in December.
Already, early in January –
I think the virus started in November,
they found out about it in December –
by early January, they had already
released a sequence of the virus
to the world,
and now here we are.
And I think I saw that
more than 40 companies
are already claiming candidate vaccines.
What does it mean to have
a candidate vaccine?
Like, have companies tested this
already against animals or something?
Or are they just looking
at a computer model where they go,
“That should work”?
SB: Well, it’s an interesting
question you ask there.
So first of all, China was heroic on this.
They did post the genetic sequence of it.
Today, we have companies
that can sit down with a computer
and from that genetic sequence,
make what is a candidate vaccine.
Now, a candidate vaccine obviously means
it’s not a licensed product.
It’s something that somebody
wants to work on.
But you’re right, you have to have
the right nomenclature,
because “candidate” can mean
I’m working on something, it’s in my head,
I’m just doing a little work on it,
I’ve got something in a vial,
I’m beginning to do testing on it.
And so what we saw in that case
was a company called Moderna.
That was the first vaccine
that went into humans.
It’s a messenger RNA-based system.
I actually visited the company,
not in this outbreak but before,
because the technology is interesting.
And what they were able
to do was, in 42 days,
make a candidate vaccine
from the genetic sequence.
They didn’t need the organism.
That now is in clinical testing.
Now, there is no licensed mRNA vaccine,
so we’re going to have to figure out,
is it safe?
Does it work in different age groups?
How are we going to scale it up?
All of that.
But there are many others who are using
conventional vaccinology.
An example would be, the French
are working on a measles-based vaccine.
The idea is to put the spiked protein
in the measles vector,
and it takes a little bit longer
to do that work,
but once you have that done, of course,
we know how to make measles vaccine.
We make hundreds and hundreds
and hundreds of millions of doses
and provide it to the whole world.
If that was to work,
that might be easier to scale up.
So I think what we want in the race
is to have multiple different vaccines
moving forward.
We don’t want one or two.
We don’t want a hundred
in the late stages,
because it’s expensive and hard to do.
But we want to have a diversity
of science approaches going forward.
CA: Which of the other candidates
out there are you excited by
or at least intrigued by?
SB: Well, for me,
the critical issue here is going to be
we have to optimize for speed,
and so that means, as I said,
having examples of all
the different new technologies
that could potentially work,
as well as conventional doses
moving forward at the same time.
So what you’re going to want to do
is have this bubble up.
And it’s not just companies,
or big companies.
It’s also biotech companies.
It’s also academic researchers
that are working on this.
You want all of those to bubble up.
Then you want to be able to look at
what’s the most promising,
and that will depend upon animal results.
It’ll depend upon being able
to produce those vaccines,
have a pathway,
and eventually, you will want to put those
into human clinical trials.
That requires a certain amount
of safety work.
You can try to accelerate that.
But then you need to say, OK,
we need to know, do we need one dose,
do we need multiple doses,
do we need 50 micrograms, 100, 150?
Do we need a chemical stimulant
we call an adjuvant?
Given that this disease,
its big problems in outcomes
are in the elderly,
we might need to put some stimulants in
to make it a more potent immune response.
So all of that work has to go on.
That’s what the clinical testing is.
Eventually you say, “Aha!
Here’s the vaccine we’re going to use.”
Now you test it in an efficacy trial.
And that is to see, does it work?
And at that point,
you then have a vaccine
that you know works.
But there is a stage after that,
and that stage is, you’ve got
to work out the manufacturing,
have it all worked out
so that the regulators know
that you can really make this,
and that it’s pure,
it doesn’t have any problems with it.
And during that period,
and that’s what we did in Ebola,
we were able to use those vaccines
to help in outbreaks
under a clinical trial protocol
while monitoring them and learning.
So there’s a lot of steps there,
and it’s complicated,
and I’ve shortened it a little bit.
CA: But summarize the steps
that they basically need to go through.
I heard probably an animal test,
and then –
SB: Well, for example, Moderna.
They went into humans at the same time
they’re doing animal testing.
We don’t have a perfect animal model.
But normally it takes
10 to 15 years to do this,
and that’s the compression
you’re trying to do here.
So the challenge is, we can compress
all those different clinical trials.
The basic way you think about it is,
preclinical studies, animals,
understanding it, purity, reproducibility.
Then you move into human studies.
You start off with a small number
of healthy people.
You then work on the dosing,
how much, how often.
Then you move into people
at risk for the disease –
that might be in this case the elderly
or people with other conditions –
and then eventually do an efficacy trial.
Now, one of the cool new
things we can do today
is something called
“adaptive trial design.”
So rather than do these sequentially,
what you can begin to do is enroll people
and then, as you get the data you need,
you can just begin to bring in
the next set of groups,
and by doing that,
you can speed it up dramatically.
CA: When you say enroll people,
you mean enroll people
who have their eyes wide open.
They have informed consent.
I think that’s the term.
SB: Absolutely.
CA: And they’re willing to,
I guess, take the risk
that this isn’t a fully tested vaccine
but it may well be efficacious,
and so that obviously can help a lot.
That’s crucial to this, right?
SB: Absolutely. They are
the unsung heroes of vaccinology,
because people go out,
they volunteer to take a substance,
particularly early on,
that don’t know how it’s going to react.
Is it going to make the disease
worse? Make it better?
Is it going to protect them?
Is it going to make them sick?
So you try to predict that
if you can with animals,
but people do do that,
and the informed consent says
not only you may have
these side effects or these problems,
but also this vaccine may not work.
And so it’s important
for people to understand that,
because you don’t want people
to go and put themselves at high risk,
saying, “Oh, gee, I had a vaccine,
and so I’m protected.”
We don’t know that until
we get to the efficacy stage of trials.
CA: But Seth, even putting
together all those dots,
what I’ve heard most people say
is that it is likely to take
at least 18 months
before the world will have
a vaccine available
at any kind of scale.
Is that time line right?
And can the world remotely afford
18 months on this?
SB: Well, I think, you know,
I’ve given you many questions.
I could raise lots more questions.
So part of it’s going to be luck:
How easy is this particular
candidate vaccine going to be?
How lucky will we be in getting
a good immune response?
Which approaches will work?
Will they be scalable?
So I think there’s lot of questions there.
The world will do everything
they can to squeeze it down,
but I think that’s the time line
we’re talking about.
And remember, it’s 10 to 15 years usually.
In the case of Ebola, we did it
in five years to a licensed product.
In this case, we are hoping
to squeeze it down dramatically,
but there are many things
we’re going to have to go through,
and it’s really about making sure
that vaccine works and it is safe for use
in what ultimately
may be billions of people.
CA: Whitney.
WPR: Hi. So we have
lots of questions coming in, Seth.
One of them that’s kind of
related to this is, you know,
a lot of us right now are isolating,
and we’re not building
our exposure to this virus,
so how will that affect us
in the long term?
Will this make us vulnerable
to the virus until a vaccine is available?
SB: So that’s a great question,
and, as you know,
we don’t fully understand
the epidemiology of this virus,
but there is some sense
that there may be asymptomatics.
Do they get immune protection?
Are they afterwards
resistant to infection?
We don’t know that, but we do know
that people do get sick,
including young people,
and that sickness can be quite severe.
Obviously, a lot of it is mild,
but some of it is quite severe,
and then it gets more severe
in the elderly.
So I wouldn’t recommend
that anybody go out
and intentionally try to get
exposed to this virus now.
The whole idea of having isolation now
is to try to stop
the chains of transmission,
protect health workers in hospitals,
with the idea being that if you
can suppress it enough –
and Bill talked about this
in his talk –
and later on have testing available,
you might be able to go back
to somewhat of a normal life
and then watch for
reintroduction of this virus.
Of course, at the end of the day,
we will probably need a vaccine
to be able to completely control that,
but the experiment is going on,
in China …
Japan has done an amazing job
of controlling this
with slightly less severe interventions.
We’ve seen in Korea similar things.
So the hope would be that
if we take it seriously,
we actually damp down the exposures
and stop this epidemic now,
we’ll be able to remove
to some form of normalcy.
And we also may have drugs,
and drugs will change
the dynamics as well,
because people will then know that they
are able to get treatment as well.
WPR: Great. I’ll be back later
with other questions I’m seeing.
SB: Thanks, Whitney.
CA: Thanks, Whitney.
Thanks everyone watching.
Keep those questions coming.
Seth, this time line,
I’ve been puzzled about this,
because I get that
there are so many things
that have to be checked out,
but I still worry
that the rules are not
adapting rapidly enough
for the scale of the emergency.
I mean, my analogy would be:
you’re going about your lives,
and suddenly there’s this emergency,
you see that there’s this enemy force
approaching you from the horizon
and coming your direction.
You don’t, in that circumstance,
spend a week trying to test all your guns
and make sure they’re operating
absolutely safely and in the right way.
You galvanize and you do take
some additional risk
for the sake of avoiding the bigger risk.
Is that thinking prevalent right now?
Are there people trying
to make those kinds of trade-offs?
How should we think about that?
Or do you really believe
that the community is galvanizing
and moving forward
as fast as it humanly can
and appropriately balancing the two risks?
SB: I think we’re seeing heroics
in moving forward here.
Obviously, you’re right, and the reason
we talk about going from 10 to 15 years
down to something like 18 months
is about squeezing those steps
as much as possible.
The regulators in the Ebola experience
were really fabulous.
They worked with us
and tried to keep any bureaucratic delays
down to the smallest amount possible.
And I think that’s what’s going
to be important here,
is we have to look at every single step
and say, “Is it critical?”
But you do need to answer
a lot of these questions.
For example, if you have a vaccine
that works in healthy people,
it very well may not give
an immune response to the elderly.
We may need to change that vaccine
to make it work there.
It may not work in young children.
So you need a certain amount
of studies done.
Of course, if you work in areas
that have big outbreaks,
you’re able to also enroll more quickly
and follow people more quickly.
That’s one of the reasons
we’ll have to think about this globally,
because we don’t know in 12 to 18 months,
or even six to 18 months,
if we’re really lucky,
where the epidemic will be raging and
where we want to do the clinical trials.
We should be prepared to do them
wherever in the world it’s possible,
and also do some
in different types of countries.
Developing countries may have
different immune responses
than in wealthy countries.
CA: What alarms me a bit
is that on the models I’ve looked at,
with the possible exception
of what happened in China and Japan,
by distancing, we can bend the curve,
we can reduce infection.
But as soon as you go back to normal,
there’s this huge risk
of a massive resurge,
and until the vaccine comes along,
it feels like your choices are:
one, sort of recklessly expose
the whole population to the bug
and develop some kind of herd immunity,
or try and do this scary dance
of really cramping down on the economy
and all the risks
that are associated with that,
and risking, if you lift the lid on that,
risking these really dangerous
second surges.
So is that the right way
to think about it?
There’s a scenario where,
until this happens,
and if it’s 18 months,
that’s an incredibly long time
for the world to be
in that sort of dangerous, scary dance.
SB: Well, I think the issue here is that
is a little bit the way to think of it,
but the experiment is going on now.
China is now releasing its controls,
and we will see what happens there.
We’ll see where they have
to clamp back down
and what’s going to happen,
and we’ll get a good idea
of what that’s like.
Right now, in many countries,
we’re still in the upscale period
when we’re seeing lots of cases.
And so we have to break
that transmission first
before we can have that conversation.
I’m the first person that would like
a vaccine to occur quicker,
and, of course, my job
is to underpromise and overdeliver,
not the other way around.
And I think we have to be careful
not to think about,
“Oh, we can just have a vaccine
in a couple of months.”
It may be that we’re lucky.
It may be that it’s easy to do.
It may be the first few candidates
will show promise,
we get efficacy, we can scale those up
for at least some limited use
while it’s being worked out.
But a lot of things have
to fall in place for that to happen.
And that’s why we want to have
an organized, global effort
to absolutely incentivize
the best possible chance
for that to happen in the fastest way.
CA: There’s some kind of debate out there
about whether there might be
way, way more cases,
mild cases, basically zero-symptom cases
of coronavirus out there
that may have granted more people
immunity than we know.
Is that a credible suggestion?
More cases and much lower
fatality rate than we know,
because so many of the cases
could be invisible?
SB: You know, Mayor Bloomberg
used to have a saying that I loved.
He said, “In God we trust.
Everybody else, bring data.”
And I think the answer here
is we haven’t done enough testing to know,
and we started out with PCR tests
to look for virus,
and therefore, if you had recovered,
didn’t have the virus anymore,
we weren’t able to pick it up.
Now there are beginning
to be antibody tests
to look to see if you’ve been exposed
and don’t have the virus now
but have an immune response to it.
Once we have those tests
operating at scale,
we’ll be able to understand
what the epidemiology is
and what’s happening,
and then we’ll be in a much better place
to understand how this is playing out.
Also, I mean, even the question:
We don’t see a lot of
cases in children –
is that because the children get infected
but they don’t get symptoms,
and therefore they might be
potential spreaders?
Or, is it because those children
don’t get it at all?
CA: So tell us, Seth, about this call
that you issued yesterday.
I mean, you’ve said that scientists
are behaving heroically.
But you’ve called for something more here
from both scientists,
companies, governments.
Tell us what your call is.
SB: So, first of all, I believe
that, given the situation here,
this is not the time to just let
the normal system work,
as we’ve talked about.
I think we have to think about vaccines
as a global public good.
And what that means is that initially,
it ought to be public sector financed.
Obviously, if others want
to contribute resources,
I believe they should, fine.
But we want to make sure
the best approaches come,
and it doesn’t matter
where they come from in the world.
We want to make sure if the best approach
is in China or Japan or in South Korea
or in the US, wherever it comes from,
whatever company has the ideas,
get them on the table.
Then we want a process
to say, realistically,
how are these being compared?
How do we decide which ones
are most likely to succeed?
And then, as I explained,
some diversity in taking those risks.
Maybe some new technology,
some old technologies to drive forward.
Once that happens, then,
to try to get clinical trials
to drive forward as quickly as possible.
Now, the delay here is actually
likely to be in manufacturing,
because we might want
billions and billions of doses,
so how do we then begin to invest,
at risk, in manufacturing plants?
If it’s a big company, they may have
adequate manufacturing,
but we may want to work
with contract manufacturers,
other companies, or even build plants
or use new technologies,
modular technologies to do this.
And then, of course, at the end
is going to be the process
of getting the vaccine out
to all those who need it,
and that’s going to need to be
dependent upon the risk at that time.
CA: Help me understand this better, Seth,
because right now, it feels like
there’s this huge effort going on,
but companies are operating,
in a way, competitively with each other.
To an extent, countries are operating
competitively with each other.
Are you saying that what the world needs
is some kind of widely supported
global – I don’t know – vaccine czar
that is pulling together
different efforts,
coordinating, encouraging everyone
to work together for the common good,
and trying to get agreement
on these big decisions
like what are the smart
few candidates to get behind,
rather than this confusing explosion?
And then, how do we
coordinate manufacturing, etc?
Like, is that a person
or a small organization
that some combination of governments,
WHO, UN needs to put together?
SB: So, first of all, you want science
to bubble up at the beginning.
You don’t want to have
centralized control,
somebody saying, “I know best
and I’m going to predict this.”
So you want it bubbling up
from all over the place,
but then you want a coordinated effort.
The group that is best-placed to do that
is the World Health Organization,
maintaining a list of all
the different programs that are going on.
We also have other organizations.
I mentioned CEPI before.
CEPI has now supported
eight different candidates.
I think it’s going to support more.
Right now, WHO has
on its list 44 candidates,
but some people think
as many as double that.
So what you want to do is say,
which are the most likely to succeed,
and then put them through
some type of standardized set of criteria
to pick a few of them to move forward
aggressively for the world.
Obviously, science is going
to keep moving,
they’re going to keep changing,
and it may be that your original approach
isn’t right and new ideas may come up,
but you do need to have some process
of moving this forward.
And really, that’s what I called for.
What we need to make sure is that
if companies have adequate resources
to do this on their own,
that’s fine,
but if not, they need to be supported
by the public sector
and, again, making sure there’s adequate
manufacturing and ultimately distribution.
Then, after a period of time,
we can go back to normal
and return to the normal way
vaccines are handled.
But I think that’s probably
the best way to get there.
CA: How much might this cost,
and who should pay for it?
SB: Well, it depends
how many cases there are.
The good news is, we’re talking now about
trillions of dollars in economic loss,
and this is going to be –
CA: I would hardly call that good news.
SB: I mean, I’m making the comparison.
Sorry, you’re absolutely right, Chris.
I mean, we’re talking about
tens of billions of dollars here,
not trillions of dollars,
and the reason that’s important is
you want to make sure that any good idea
has its best chance of moving forward,
and we ought to, again,
optimize for speed
and not optimize for being
cost-effective at this time.
CA: So I guess you’re saying that, like,
the rich countries may well be able
to afford some kind of vaccine program.
I think what I hear you doing here
is representing a lot of the countries
that can’t afford it,
and what you’re saying is that the world
may have to find a way
of spending tens of billions of dollars
to avoid trillions of dollars
of economic damage
and all the hardship that goes
with it around the world.
Is that about right?
SB: That’s absolutely right,
but I think the important point is,
this needs to be a global perspective.
I mean, look at what happened with Ebola.
We had a vaccine
that was originally made in Canada
by the Public [Health] Agency of Canada.
It was then transferred to a US biotech,
then to Merck and Company,
which is obviously
a global player based in the US,
and they’re manufacturing it in Germany.
That’s the way science works,
and these vaccines may need
components from other places.
So how do we think about this
in a global way and make sure that –
By the way, the second vaccine
that’s in humans is from China.
Of course, they’ve had a lot of time
to work on it compared to some others.
And they have a candidate
that’s moving forward.
If that candidate is successful,
we want to make sure
that’s the one that’s scaled up.
And so for me, it’s making sure
that we’re looking at this
as a global ecosystem
with the best candidates moving forward
for the good of the world.
CA: Whitney.
WPR: We have a lot of people
watching from all over the world
and we’re seeing questions,
especially from some of our friends
in India who are watching,
connected to this just basically about
how are poor nations
going to get access to this vaccine?
And then, specifically, when we think
about who gets the vaccine first,
will there be some sort of payment
that people are paying for this vaccine
and those who can afford it
will get access before others?
SB: Well, the decision
on who will pay for it
will ultimately come
from the political leaders,
and my recommendation would be,
you start off as a global public good,
you make the vaccine available
because we’re trying to stop the epidemic.
Later on, we can have tiered pricing
in different places.
But one of the concerns, of course, is:
Where is the epidemic
going to be at that point,
and who needs it first?
I would argue that people that will need
it first are probably health workers,
because health workers are going
to be on the front lines
and we want them to be there
to be able to take care of people.
They’re at risk of both contracting it
as well as spreading it.
Then you probably want to think about
the high-risk individuals,
the elderly, people who have
preexisting conditions,
and then eventually, the rest
of the population, if it’s needed.
So having some type of way
of thinking about that.
We’ll also need to be thinking
about equitable access,
and that is going to mean
thinking about the entire world.
Now, Gavi, in the past,
including in India,
has worked to make sure
these new technologies are there,
but these are vaccines that existed
and, in this case, it’s a new vaccine.
We have to make sure that it isn’t hoarded
only in wealthy countries
or in a select set of countries.
And one way to do that would be to have
vaccine production in multiple places.
So today a lot of the vaccines
that Gavi uses are made around the world.
Some are made in
the United States and Europe,
but some are made in South Korea,
in India, in China, in other countries.
And so what we could do is have a vaccine
transfer the technology and manufacturing
in multiple different sites
so we could have enough vaccine
for that original launch.
But whatever happens,
there will always be a period of time
when we’ll have an exciting vaccine
and not enough doses to go around,
and that’s when we need
to take hard decisions
based upon science on who should get it.
WPR: Thanks for that, Seth.
I’ll be back later with other questions.
CA: Thanks, Whitney. SB: Thank you.
CA: How confident are you
that we’ll eventually get one?
I mean, we still don’t have
a vaccine for HIV,
nor for the common cold.
How can you be confident
that we can get one this time?
SB: Well, first of all, as you know, I did
a TED Talk even before the one of 2015
talking about HIV and flu
and how new science needs to come in,
and frankly, we are making progress
against some of these
incredibly difficult organisms.
You talked about variability.
That’s the problem with HIV.
It’s constantly changing,
and so you’re chasing.
You get a good immune response,
but it’s to the strain
that was there before,
and now you’re chasing new strains.
There are ways to work around that.
It’s new science.
I, actually, I am optimistic.
I’m optimistic because we have
some experience with SARS vaccines
and with MERS vaccines,
and so people have worked on it.
They’ve been able to get good immune
responses in animals and in people
for those vaccines.
And so we can build on that experience.
I can’t tell you
how long they’ll last for,
how effective they will be.
Will they need to have
local mucosal immunity,
which is in the mouth and nose,
as well as serum immunity
in the bloodstream?
Will they need to have just antibodies
or the other arm of the immune system,
the cellular arm?
These are questions
that will need to be answered,
but I am a great believer
in the power of science,
and I think in this case the organism
is not going to be quite as difficult
as the ones you’re talking about
that are much more difficult.
CA: You mentioned in your TED Talk
five years ago, Seth,
that we’ve got this situation
where we’re spending billions of dollars
on nuclear submarines
patrolling the oceans
for a possible incoming threat,
nuclear war threat or whatever,
and almost nothing on preparation for
a pandemic like the one we’re suffering.
If the world is adequately shaken up
by what’s happening now
and gets rational about this,
what is the key structural shift
that would be the pandemic equivalent
of having those nuclear submarines?
How do we prepare for a new virus
that we don’t know what it will be
or when it will come?
How do we prepare to have
a much more rapid response?
SB: Well, it’s a great question
and I think the TED community
has a role to play here.
So first of all, we need
better surveillance.
We need surveillance
everywhere in the world,
and that’s why we don’t want
to have another outbreak
like in West Africa with Ebola.
You want to have a resilient health system
in every country that reaches
out to the periphery.
And that’s an important priority.
We’re doing pretty good with immunization.
We’ve reached 90 percent
of the kids of the world
with at least one dose of routine vaccine.
That’s the best of health interventions.
But we need to reach that last 10 percent
and put that health system in place.
Then we need to have a different view.
We need to start working,
where are our likely hot spots?
It’s where we’re cutting down forest.
It’s in urban slums,
where there’s density of populations.
It’s with climate change
and movement of different vectors.
And what we need to do
is use predictive science,
and that’s where big data can help,
that’s where AI can help
in terms of trying to do that.
And we need to have a one-health approach,
because we tend
to think of animal diseases –
and by the way, people have worked
on coronavirus vaccines for animals,
because they also cause disease there –
we need to make sure that the scientists
working on veterinary vaccines
are connected to humans, are thinking
about those whole ecosystem.
And we need to invest in that.
And unfortunately, after an epidemic,
everybody wants to invest,
and they say, “Whatever it takes,”
and then we move to on other things,
and investments go down.
What’s different about the military
is that there is a baseline of investment
that goes on all the time
and nobody questions that.
It continues, and that level
of preparedness seems to be there.
Bill Gates in his talk in TED,
when we did that back-to-back, said,
look, the military are doing war games,
they’re constantly testing,
they have all this preparatory activities.
Why are we not doing that in diseases?
And, as you know, since then,
there has been some war games,
and they’ve basically said
we weren’t prepared,
and I think we’re seeing
now that, in fact,
we’re not as prepared as we could be.
So my hope, the silver lining would be
that we prepare for the next big outbreak,
because it’s absolutely
evolutionarily certain
we will continue to have outbreaks.
The question is: How prepared
are we to deal with those?
CA: As we wait for a vaccine,
are there other interventions
that could be made,
for example, the serum from people
who have been infected and have recovered?
SB: So, that technique has been used
in other infectious diseases
and throughout history
and even in Ebola recently.
That’s something that could
potentially be done.
Of course, today, it’s more attractive if
you can make antibodies in the laboratory
and then have those available at scale
and use those,
and I know of a lot of companies that
are working on producing those antibodies,
which could be infused
in an emergency situation, and do that.
Obviously, drugs may play
an important role here.
There’s a similar effort
to try to create drugs
that are active against this organism,
and if we knew that you’d get sick
but there was an effective treatment,
that would also change
a little bit of the dynamics
of the fear that exists
around this pandemic.
So I think there are
lots of interventions.
Of course, traditionally,
a preventive vaccine is the best way
to deal with these types of epidemics.
CA: So paint us – it’s the inner
optimist in me, begging for something –
paint us the best case scenario, Seth.
Lots of people are saying,
we don’t want to be huddled in our homes
by ourselves for 18 months,
lovely though the internet is.
What’s the best case scenario,
putting all the pieces together here?
SB: Well, I think what is
likely to happen,
but I don’t want to predict,
because we’re in unprecedented times here.
What’s likely to happen is that countries
who don’t take this seriously
will have severe outbreaks,
those that really take it seriously
and put these extraordinary
mechanisms in place
will control the disease.
It’ll take some time, it’ll take –
you know, this is weeks, maybe months,
not years, to do that.
And then you end up with a situation
where the disease is controlled,
and you then can go back to life as normal
with some cautions around it.
Now there’s beginning to be new tests
that are going to be home tests.
We’re going to be able to figure out
whether classrooms, regions,
countries have disease.
We can go back to some level of normalcy,
but one thing that’s really important
is we can’t have areas of the world
with raging disease.
So for example, if people said,
“Oh, we’re not worried about Africa,
we’re only worried about our countries,”
you might end up in a situation where
you have large numbers of infections,
the virus is mutating,
it’s actually adapting to humans.
We saw some of that with SARS.
And then it is easy to reintroduce.
So what you want to do is dampen it down
everywhere in the world.
And maybe it’ll burn out.
Maybe that’ll be it.
I personally think
we’ll probably need a vaccine,
but best case scenario is that those alone
will stop the epidemic,
and what we’ll need is then a vaccine
just in case it comes back,
but of course if I was a betting man,
I’d say let’s get a vaccine
as soon as possible,
because that’s the best way
to control a viral infection,
particularly one
that is spread respiratorily.
CA: Yeah. It’s so interesting
what you said there.
Like, the vaccine doesn’t know
what continent it’s on,
what country it’s in.
It just does its thing.
SB: That’s correct.
CA: So in terms of people listening here,
what kind of psychological advice
can you give them?
What should expectations be?
Like, do we have to be ready
to settle in for the long haul here,
or should we be looking forward
to getting back to business
around about Easter time and celebrating?
SB: Well, again, I don’t want
to put a time line on it like others do.
What you’re going to want to see
is that bending of the curve.
I think Bill talked about this.
You want the reproductive rate below one.
You want to get it
way below one if you can,
and then to begin
to see the disease spread.
And what you don’t want to do
is, in the middle of that,
jump out and start having parties.
It’s not time to go on spring break
and start mixing again.
But with careful control,
you can begin to release the controls
if that’s what science shows us.
And I think the most important thing here
is we need the data to tell us that.
That’s why testing is so important.
With the wide availability of testing,
we’ll be able to keep tabs,
know what’s happening.
We’ll know how many people
are asymptomatic, what’s happened.
We’ll know where
there are hot communities,
and we’ll be able to deal with this,
is my prediction.
So I don’t think this is
over a very, very long time,
but I wouldn’t rush it
during this unprecedented moment.
Otherwise, we’re going to end up
seeing what we saw in Italy.
What we’re seeing in New York right now
is the overwhelming of the health system.
CA: Yeah, no kidding.
New York is a scary place right now.
I was out walking today.
I hope that was OK.
But there was no one. There was no one.
Like, you couldn’t get within six feet
of someone if you tried right now,
on the busiest walk spots.
That was nice to see,
but man, it’s startling.
SB: I mean, recent data has shown
that droplets can spread the disease,
and so people are rightfully
being cautious.
And we didn’t know that.
You remember when we started,
we said it’s a point outbreak,
out of Wuhan, wet market,
you had to be in the market
to get the disease.
Then it was, if you were with sick people,
you got the disease.
Then it was maybe asymptomatics.
I think as we understand better,
that gives us the tools
to do the right thing.
CA: There’s a debate out there that
seems to be growing again about masks.
The East and West take
very different advice on masks.
We were hearing from Gary Liu yesterday
that everyone in Hong Kong and China
is basically wearing masks,
and arguably, that has been effective.
The advice in the West
against not wearing masks –
how much of that has been driven by just
the fact that there’s a shortage of masks
and that if anyone needs to wear them,
it’s medical professionals?
If it’s water droplets, it seems like
masks could be effective in prevention.
SB: I mean, the most important
intervention, as you know,
is some isolation and very careful
handwashing or use of sanitizers,
because what happens is,
you touch your face –
I forget the number, I think
it’s like every one to two minutes –
and you touch your eyes,
so if you reach a door handle
or you have contact with a surface,
and we know the virus
can live on those surfaces,
and then you touch your face,
touch your mouth, touch your nose,
you can spread it.
So the purpose of a mask
for a person who is not infected
is not so much to keep them
from getting infected.
It is to keep them
from touching their face.
So I think what’s interesting here is,
how do we get people
to have this personal sanitation?
If we have unlimited quantities of masks,
people want to do it as a way
to remind themselves
not to touch their face.
Now, that’s very different
if you’re infected,
because if you’re coughing,
having a mask on does reduce
the spread of droplets,
and that’s why they recommend it
in a situation where somebody is infected
and has to go to the hospital
or has to go out and be seen.
CA: Yeah, I was touching my face
all through the Bill Gates
interview, apparently,
and I got called to task
by our online friends,
which was very nice.
I don’t know if I’ve
been doing that today.
It’s funny, you’re unconscious
of it. It’s weird.
SB: Yes. No, it’s automatic.
And in fact, there was a WHO
challenge for safe handwashing,
and I did a video, and I left
my water running while I did it,
and my friends in the developing world
came to me and said,
you know, I live in Switzerland
by a lake where we have a lot of water,
and I wasn’t careful,
and they were absolutely right.
So it’s really good we correct each other,
that’s an important point,
and help each other in doing this
to get us to be as compliant
as we possibly can for these issues.
Whitney.
WPR: Yep. So feedback online
is overwhelmingly positive.
You’re really answering
all of everyone’s questions out there,
and people really appreciate
what you’re sharing, Seth.
I think one big question is just
for folks who are watching from home
and maybe who are not part
of your community
in terms of the science community.
How can they contribute
to this global response effort?
How can they do something to advance this?
SB: That’s a great question.
So first of all, I think it’s really
important that citizens support leaders
who are following science,
are using science,
because, as you know,
sometimes political leaders say,
“Well, I don’t want to do this
because it’s not good for my image
or it’s not good for the economy
or it’s not good for whatever.”
And I think you want to have
all of your decisions taken by science,
understanding that they’re
not the best science.
So, citizens need to applaud,
even if it’s a tough decision
that politicians take for the good
based upon science, that’s a good thing.
The second thing
that really would be helpful
is this concept: How do we keep
our world focused on the fact
that these epidemics will occur?
Another example I didn’t answer,
which Chris, when he asked me
about what could be done,
we talked about this idea
of platform technologies.
These are vaccines that you can test,
get them all ready,
and then, when a new organism occurs,
you can put it in there
and you know how to manufacture it,
how to scale it up.
These types of things can be done.
CEPI is trying to do that now.
But the challenge is,
if we, a year after this,
go down to having no money
available for these types of issues,
that will be a problem.
So what you need is citizens to say,
“I understand now
that health is precious,
and I want my government, my leaders
to invest in this, in the science,
in the ways of working
so that we will be as safe
as we can be going forward.”
And I think I can’t emphasize enough
how important a message that is
for citizens everywhere in the world.
CA: Mmm.
Hey Whitney, stay on as we wrap up here.
I guess what I’d like to give you
a chance to do, Seth,
as we wrap this up
is just to look at the camera
and make your call to the world’s leaders,
companies,
politicians, scientists, citizens.
How do we move forward?
How would you wrap this up?
SB: So from my perspective,
what we need is the world
to come together at this moment,
not to talk about our national programs,
not to talk about
our science are the best,
and they may be the best,
but how do we, as a world,
pool our best science, our best resources,
our best ways of working,
our best manufacturing,
our best clinical trials,
to move this forward as fast as possible?
The WHO is a global organization
whose job is this normative function,
and we can get scientists to help them
make sure that the normative function
is as strong as it can be.
We can get the leaders
of the world to come together
and put the resources in place.
Given the cost it’s having on the economy,
this will be a real bargain
to invest in it.
But what we need is to have that mindset
of having science drive us
and to make sure that we have no barriers
in stopping that science going forward.
That’s my request to the world,
and I think we can do it,
and if we do that, we will end up
seeing the power of science,
which will give us the tools we need
to either stop it –
hopefully, it’ll be stopped by then –
but stop it and then prepare us
for the next one.
CA: Mmm.
Powerfully said.
I have to say, Seth,
it’s incredibly encouraging
to know that there are people
like you out there in the trenches,
trying to coordinate this immense
and crucial effort on behalf of all of us,
and also that there’s
an organization out there,
that your organization is tasked
to carry any effective vaccine
to the many billions of people
who may live in countries
that can’t afford to pay the same prices
that the West can pay.
That’s really cool that you’re doing that,
and thank you so much
for explaining so clearly to us
what the situation is.
I guess I speak for
the majority of people listening
to say all power to you
with pulling these threads together.
Thank you, Seth.
WPR: Thank you, Seth.
SB: Thank you, Chris and Whitney
and the TED community
for all of your support over the years.
Let’s continue to use
science and technology
for the good of the world
to solve problems like this.
CA: Brilliant, brilliant, brilliant.
WPR: That was wonderful.
I learned so much from this conversation.
It seems like everyone online
also really did, which was helpful.
And I’d like to remind everyone that,
if you missed part of this interview,
you can watch it on our Facebook page
as soon as we finish,
and then also –
and I’m going to read the link –
it’s go.ted.com/tedconnects.
So our Facebook page,
or go.ted.com/tedconnects.
CA: Thanks so much for joining us.
We get the sense people,
literally all over the world
and in so many different circumstances,
and yet, this moment has
given us a new excuse
to bring you all together.
Part of me,
even though you really could wish
that we weren’t in this situation,
it does give us a chance to explore
some ideas in greater depth
than we’re normally able to,
to have these conversations.
These are not 15-minute talks
on a red circle.
You can just go a little bit deeper,
and there’s something
really cool about that
that I think we want to do more of,
and we want to figure out
how to hear from you and include you
and make sure that your questions
and your thoughts are coming in.
As we speak, we’re dreaming up
what speakers to bring next.
We know about Friday.
We don’t necessarily know beyond that.
But watch this space.
Whitney, talk about
what’s going to happen tomorrow.
WPR: So we’re really excited.
We’re going to have Priya Parker
on to finish out the week for us.
She is the author
of “The Art of Gathering,”
and she’s going to give us
some really helpful tips, I think,
about how we can stay connected
during this time,
which is something I’m sure
all of us are struggling with
as we’re trying to practice
social distancing
and are just spending more time
physically apart.
So going into the weekend,
that feels like the type of thing
I think all of us can
really benefit from hearing.
CA: If you’ve got value
from this conversation,
consider sharing it, sharing those links
with people you know.
That would be cool.
And hang in there, everyone.
These are hard days.
We know many people are struggling hugely.
Hang in there. We’ll get through it
together somehow.
And until tomorrow, take care.
Bye for now.
WPR: Take care, everyone.