Pushkin from Pushkin Industries. This is Deep Background, the show where we explore the stories behind the stories in the news. I'm Noah Feldman. This past week brought two major developments in the fight against COVID. First, Joe Biden was elected president, meaning we're going to have a new team in Washington and new leadership working on the issue. Second, Fiser announced early results of its test of its vaccine in human subjects and suggested that some ninety percent of the people who took the vaccine were successfully protected against COVID. We'll be addressing both of these developments in episodes soon. Before we do that, however, today we wanted to reshare with you an interview with doctor Vvek Morty. Morty is one of the people just named by Joe Biden to be one of the co chairs of his Anti Coronavirus Task Force. In the interview, which we recorded on September thirtieth, doctor Morty also discusses the question of how we will get people to trust in a vaccine when and if the vaccine actually begins to work. In other words, what we have for you in this interview is one of the heads of Joe Biden's Coronavirus Task Force, laying out the policies that he will use when vaccines begin to work. It doesn't get more immediately relevant than that. For those of you who are regular listeners to the show and remember this interview, clearly, don't worry. We have another new episode coming your way in the next couple of days. For those of you who haven't heard this interview before, we really hope that you find it as valuable as we did. Doctor Morty was Surgeon General of the United States under Barack Obama and he is now coach share of the Biden Coronavirus Taskers the ECT. Thank you very much for joining me. I want to start with a question that you've spent a huge amount of time focused on, and that's a question of trust, public trust in science, public trust in medicine. And what's particularly driving me to ask you this question is that as we move through phase three trials for potential vaccines with respect to COVID nineteen, there's a lot of uncertainty about how the public will react if and when there's an emergency use authorization for these vaccines, or if there's publicity around these vaccines. It seems to be politically motivated, and that, of course, is a question that implicates science, It implicates medicine, it implicates approvals, and it implicates politics. So there's a lot to be said about this, but intervene in it wherever you would like to start. So this is a timely question, and I think the issue of trust is one that has been growing, frankly during this pandemic response. Let me just say a word about why this is so important. It's not just about a vaccine during pandemic responses, and I saw this when I served a surgeon general during the Zeka outbreak and during Ebola as well. Public trust is one of the most important resources you have and you have to cultivate it at all costs. That means being honest with people, even when you've done something wrong. It means being open to hard questions even when you don't know the answers to them. It means communicating openly, transparently, and regularly with people, and in this moment, it also means allowing them to hear directly from the source of information, which are scientists. You know, science has a guide pandemic responses, and when scientists aren't allowed to speak directly in an unfettered way with the public. It's shows doubt. What's happening here with regarding a vaccine is that we have an unfortunate confluence of factors. We have Number one trust, which has been I think badly injured over the last several months. You have a political cycle which is coming to a culmination with this presidential election, and you have a pandemic that has not gotten better. In fact, we have the most number of cases in the world. We have had nearly two hundred thousand people at this point when you and I are talking today who have died from COVID nineteen to the United States, and we do not see a sign of this ending because our response has been poor. And so all of these are coming together to make people nervous about a decision around a vaccine. And I think there's great danger to rushing a vaccine approval or an emergency authorization in this environment. The damage is not just that people may not take the vaccine. In fact, right now from September Kaiser Family Foundation poll, we know that fifty four percent of people are saying that they would not take the vaccine if it was offered today. That's a staggering number, just given the toll that COVID has taken, how much it's turned our lives upside down, how much people so desperately want this pandemic to be over. Yet fifty four percent of people are saying they wouldn't take a vaccine if it was approved before the election. So what does that tell us. That tells us that people are worried about the process, and they have good reason to be, because we've seen a couple of processes in the FDA which have been driven by politics, the issue of an emergency use authorization for hydroxy chloroquine being one. The way in which the convalescent plasma emergency authorization was issued with false numbers and hype that was political and not scientific. So if the administration really wants to ensure that people have faith in an emergency authorization, here's what they need to do. They need to, number one, make sure that they establish and communicate clearly an explicit standard for safety and efficacy that will be met before an emergency use authorization is approved. The second thing they have to do is they have to make sure that the FDA is scientific and very importantly, it's external Advisory Board, which is known by the some a clunky acronym VERPAC, which stands for a Vaccine and Related Biological Products Advisory Committee. Both of these groups of scientists must be able allowed to communicate directly with the public and share their assessment without a political filter. And finally, the data itself from the trial needs to be made available to the public so that the external scientific community can assess it, can come to their conclusions, and can share their opinions with the public. Only when these are done should have a vaccine be considered for emergency authorization, Because again, the consequences is not just people won't take the COVID vaccine, but if we allow hesitancy and doubt to be sown about the process itself, then people will doubt vaccines even after COVID is over. They'll worry that politics are not science, is driving the process, and that will ultimately hurt all of us. I have to say, when I heard those poll numbers about the number of people who wouldn't take a vaccine, at first felt shocked, but then I realized that I myself had a conversation in fact with my own parents, who are you? My father's eighty and my mothers in her late seventies, and they had similar skepticism. And I was actually horrified in the conversation, and I took it upon myself to try to convince them that, given their age and the bad outcomes that happen to people in that age group, if they do actually develop a case of COVID, that they were getting it rationally wrong. They ought precisely to be prepared to take a vaccine again and provided some emergency used to authorization. And I think of my parents is superrational and cautious and sensible around medical issues. And that leads me to ask, even if the administration, the current administration, the Trump administration, did all three of the things that you just said, you know, if they actually specified clear protocols for what counted his safety, and then they let the scientists at the FDA and on the Advisory Committee, the Vaccine Advisory Committee, speak directly to the public, and they publicized what data existed from Phase three trials. And let's just imagine in the scenario that sometime between now and the time of the inauguration of the next president, that all of those things pointed in the direction of an emergency use authorization, is there any credible way that we could get a lot of the public, even under those circumstances, to trust the vaccine. Or is the damage that's been done already so deep that we couldn't credibly imagine that certainly in any Trump authorized emergency use. Well, Noah, the damage that has been done is deep and it will take years to repair. Because people had a very high degree of confidence across the population in the CDC before COVID nineteen, and we've seen their credibility damaged. The FDA's credibility has taken a hit. Even people like doctor Tony Fauci, you know, who are very highly regarded by the scientific community and by the majority of the public. You know, even doctors credibility has taken a hit because of smear jobs and other criticism that he's received that has been politically directed. And so there's been a lot of hits to trusted sources and it will take years for that to recover. Let's just say in your scenario that there is in fact, good worthy data that tells us that vaccine candidate meets the standards for a safety and efficacy and an emergency use authorization is issued, what would happen to happen if he wanted people to actually be open to taking that vaccine as you would need number one, members of the scientific community across the country, and not just you know, nationally known scientists, but deans of medical schools, doctors and local communities who are trusted and respected, nurses who are known and respected. He would need them speaking out in local communities to help people recognize that people I know, people I recognize, institutions that are local to me, trust is vaccine. The second thing that you would need to see is you would need to see community organizations get behind it. People would need to hear from a non medical voices that they trust as well, whether that's the faith leader, you know, their community, they're church leader, they're synagogue leader. They would have to hear from friends and family who are getting the vaccine. They would have to hear people are getting this and they're not having significant side effects. All of this mobilization, if you will, All of this messaging will take time, and it will take regardless of who wins the presidency. One of the most complicated and challenging vaccine rollout efforts that this country has ever seen. So that is why I often say that While developing a vaccine for COVID nineteen is extremely challenging, actually rolling it out and administering it to people, getting that shot in the arm of a sufficient number of people that we can achieve herd immunity that will be just as if not more challenging. You've been advising Joe Biden on COVID related issues, and that means that if Joe Biden would be elected president and to take office in January, you're one of the very small number of people who will be in line for the single hardest, most thankless job imaginable in the Biden administration, and that would be spearheading the actual operation of doing exactly what you're just set of, actually getting the vaccine to people. So let me start by asking you about what plans you have been developing you and the Biden campaign have been developing for how to begin that process. Should keep be elected and should a vaccine become a safe and available Well, no, the Vice President has been really focused on developing and thinking about plans. He never takes for granted that he is going to win the election, but he wants to be prepared to act on day one if he does. And what that has meant is not just going about the usual process that you have on transition teams where you think about the structure of a department and you think about personnel, but it's involved thinking about some very specific areas that are going to require a whole lot more planning. So, for example, how do you actually expand testing sufficiently so that we have enough testing so that everyone who needs a test and get one. How do we ensure that we actually have enough contact tracing capacity in our country. We don't right now, but we really need that we have any hopes of getting this under control. And of course it involves how to think about the deployment of a vaccine. So these have been the topic of countless discussions that I and others have had with Vice President Biden, where he asked very specific questions. He's thinking about very specific plans. But a key parts of these plans, certainly for the Vaccine Distribution Fund, include thinking about who the trusted partners are that we will need in communities, like for example, if you think about the partners, it's not just a medical establishment, but it's also schools and employers. We know that schools and workplaces are sites where a vaccine could be administered, and having partners in those spheres is going to be absolutely essential. We know that local government and states are going to be extremely important partners. But here's the way I think the Vice President would approach that partnership differently. In the early part of this COVID response, what we saw is a transfer of responsibility from the federal government to the states, saying, you take care of this, and we will lead behind lead from a different place, we will step back. I think the Vice President realize is that you need to give states the ability to craft their own response, but you also have to lead as a federal government, and one of the places in which you have to lead is in the allocation of resources. So just think about the following question, how do you decide how much vaccine goes to Georgia or Florida, or Massachusetts or California. You can't have that driven by politics. That has to be driven by science and by need. So which raises a second issue that he's been working on, not just partnerships, but thinking about data systems right for understanding where the need is and making sure that we can meet that need. Right now, I'm worried that we don't have strong, robust data systems that are integrated in our country such that if we administered and rolled out vaccine today, we would automatically know where it was being delivered, who was getting them, so that we could target our follow up activities appropriately. We have to fix those data systems. So he's been thinking about a number of areas like this and bringing experts together, well beyond myself, you know, experts from really around the country who have done this before. He wants to assemble the best team possible because he knows this is going to be a once in a generation challenge. Let me press you on this. I think you're right from what I know that the data systems that we presently have aren't sufficiently robust to even have a clear sense of what prevalence looks like. And that's before you get to the substantive question, which is, if you're new prevalence, where should you focus resources. Because it's not immediately obvious that you want to focus a vaccine immediately on the heart of sted areas. There are actually arguments for beginning in more moderately hit areas and so forth and so on. So I mean, this is a complex topic in its own right. But given that the data systems almost only are not in place, how is it real to think that a Biden administration could take the time to build up these data systems in order to then make an informed decision. I mean, if you are doing this, you and a team of people are doing this, you are going to be doing it in media's race. You are going to be inheriting the mess that you have inherited, and you will be under enormous pressure to act quickly. Again, assuming that there is a safe and available vaccine. So I guess I want to say that sounds nice in the abstract, like let's solve the data systems, but there's no way that there's going to be the time that it would take to do that. So how do you make decisions under radical uncertainty without the data systems? So it's a great question, and you're right, we can't wait until the perfect systems are built. You can't wait until all the partners are assembled around the table either, because if this vaccine truly is safe and effective, that means that every day you lose our lives that are potentially lost. So what we would have to do is we'd we'd have to do the best we can in the beginning, use the data we have and go to areas that we know have great need, and start to deploying the vaccine through existing partners. We also have, thankfully, through the National Academies of Medicine, recommendations on what the priority population should be that we should target, So we know that healthcare workers and other workers in the front line are critical. We know the people at higher risk because of their age or other medical conditions they have, are at higher risk, so we can go to nursing homes, we can go to other locations where high risk populations are and preferentially vaccinate there. There is a lot of low hanging fruit, if you will, in terms of actions that can be taken in the very beginning, even while you're trying to build up systems and build up partners. But all of this is going to be infinitely harder if people are skeptical, if they're doubtful, if they don't trust what you're doing. And that's why the other plank of this that's so essential that we've been talking about is the importance of communicating openly, honestly about what our plans are and what progress we're making from day one. This is a kind of crisis communication that has been deployed by Republican and democratic administrations alike in prior pandemics. It's not the purview of one party, but it hasn't been done well in this response, and that's why we have a lot of ground to make up. We'll be back in a moment. I'm deeply worried that, regardless of the outcome of the election, if a vaccine becomes available and safe under a Republican administration, a lot of Democrats won't trust it, and that if a vaccine becomes available and safe under a democratic administration, a lot of Republicans won't trust it. In other words, my worry is that the profound political partisan differences that we have are fully bleeding into people's trust in scientific institutions and medical institutions. What's our long run societal solution to that problem. I mean, I'm not asking you to solve the problem of partisan division. Nobody can do that, and it's been with us in certain respects, although waning and waxing throughout our history. I'm talking about the very concrete problem, much closer to your area of expertise, which is that people's trust in science and medicine is coming to be deeply inflected by their partisan views. How do we break that linkage no matter who's president. Yeah, And the reason to be concerned because we've seen that on a number of measures, whether it's people's views of the masks and whether they're appropriate or not and useful, or people's view of other precautions related to COVID. There has been a partisan divide here. But what's interesting, as a side note is if you look at this data on vaccines and specially the COVID nineteen vaccine. I mentioned that fifty four percent of people are saying they would not take the vaccine if it was available before election day. That actually includes forty eight percent of Democrats but sixty percent of Republicans. So in a very interesting way, we're finding that both Democrats and Republicans have deep worries about the back scene. But the larger point around polarization and affecting how we take in information and what we trust is absolutely true and it will be deadly as it has been to date regards to coronavirus. I think one critical strategy and there are many here, but the one I'll mention is that we have to go local in terms of mobilizing information sources. Typically people think, well, if you get somebody on a major network in terms of news, or a national radio station, that's how you get the message out. But I think increasingly in this polarized world where people are listening to their own sources, you actually have to go much more local. You have to think, how do I ensure that an individual's doctor actually knows that the truth about this vaccine so they can recommend them. How do I ensure that other people who are trusted members of a community, like faith leaders, know the truth about this vaccine so they can advise people. Because when you have doubts about whether people are telling you the truth, all of us as human beings go to the people we know and that we have trusted for a long time, that our friends, our family, our nurses and doctor are faith leaders and other trusted populations like this. So I think if ultimately we want to convince people that the vaccines is safe and effective, if it indeed the evidence backs that up, we've got to think about how to mobilize those voices, And I think those will end up being much much more important than getting people on cable news and on national radio. That raises the really hard question of how do you reach the local leaders that you're talking about. We live in an era where local newspapers, which at one time would have been a standard way to reach people locally, because you can have a local newspaper article about the local physician or faith leader who says, you know, the vaccine is great, but they're in retreat, or in many parts of the country, they're already gone. And one of the ways that people now increasingly communicate with their trusted sources, whether it's family or friends or local leaders, is actually through social media. And in that environment, authority isn't quite as powerful as it once was in historical terms, and things can go the other way relatively quickly. There can be a decentralized distribution of distrustful information. I agree with you that we want to get people to hear an important and true message from people who may trust. But how do you at a national level think about reaching those people if it's not through going on CNN and MSNBC, which you do so frequently and so skillfully. Well, No, I think this is not easy work. It's a hard grind. If you will, because it requires a lot of conversations. This is I think why people have gravitated so much toward national news and national media. It has the illusion that seeming to be more efficient, right, you reach more people, Hey, why wouldn't that be better? The problem is it comes with a heavy filter that people don't necessarily trust. And so the way that I would think about this is that we would need to reach out, for example, to local organizations that bring together faith leaders. We need to reach out to the YMCAs, to the rotary clubs, will need to reach out to associations of librarians. We'll need to reach out to groups where we can get in front of people, talk to them, and then start engaging their local chapters. And if that sounds like really tough, tedious, tenuous work, it is. It's not easy to do because what we're really talking about, Noah, even though we haven't used this word before, is we're talking about relationship building, right, and relationship building can take time. But I think that it doesn't mean that we'll never be able to get a vaccine out for months and months. I think that there are enough people who believe that this is an urgent crisis and who will understand the science behind it, that we will have some uptake of the vaccine. The question is how to sustain that and get to a sufficient level where we have her in immunity. There's one other point I want to raise here, though, if this is indeed about relationships, and if what we need our organizations that have a lot of relationships in the local level. It's been particularly worrisome to me over the last many years that we've had a breakdown in those kind of community organizations over the last many decades, like in this country. You know, something that's been well documented by about Putnam, you know, I've been Harvard and by others. But this decline in participation in community organizations and affiliation with community groups leaves people with fewer sources that they actually trust, that are easy to access in a crisis like this, and I see that as deeply worrisome. It's one of the reasons why when I left my time in government, when I was thinking about what do I work on, what do I want to contribute to in the world. That's why I kept coming back to this idea of social connection as being such an important topic, because if you don't have strong connections in your life, then you don't have people you trust. If you don't have people you trust, then you're reliant on social media, on cable news, on other sources for your information, and you don't have people to talk through doubts and worries with. And I think we are bearing the consequences of a deterioration in social connection in social organizations. But that said, we still have many organizations in our communities that we can lean on, and that's going to have to be our priority in a new administration. Let me ask you about how deeply penetrated a vaccine would actually have to be to achieve her immunity. I mean, I realized there's not an exact number that one can define with respect to a particular pandemic, although there is some general guidance that we have from epidemiologists. And the reason I want to ask you about that is what sort of emerging in my mind as I listen to you, is that a lot of us have been thinking, well, how do we get out of this? Well, maybe the right way to get out of it is with a vaccine. But what I'm hearing from you is that actually getting a vaccine is not necessarily the way out. The way out is to have a vaccine and then have that vaccine be sufficiently trusted by a broad enough swath of population that when it is distributed and taken, it gets sufficient penetration to actually reach her immunity. And that may be a very very different thing. I'm letting that sort of seep through my thinking right now. So let's just walk through it. Start with, what percentage do you think roughly we would need to reach for the vaccine to be efficacious? So, Noah, that number depends on how effective the vaccine is. So if we had a vaccine that was one hundred percent effective, which would be exceedingly unusual, then we would have to vaccinate somewhere in their neighborhood of a seventy percent of the population, maybe a little bit less, because you know a number of people have had the virus already, they may have some short term immunity, but it would have to be around seventy percent. But if you start dropping that, if you get to a vaccine that's around fifty percent effective, which is a threshold in fact that the FDA set and it's June thirtieth guidance, then even if you vaccinated everybody in the country. You're not necessarily going to get to hurt immunity levels. Now, that doesn't mean that it's still not worthwhile. See herd immunity is not a switch that we flip on or off. There are benefits to be gained, you know, if we get halfway there. Their benefits to be gained if we get three quarters of the way there. But what this means, given the fact that getting to hurt immunity levels will take time and will be difficult, is it means that many of the precautions that we're taking right now in terms of distancing and wearing masks, and upping our game in terms of personal hygiene and washing our hands, that those behavior changes will be with us for a while, certainly through twenty twenty one and very likely beyond that. It doesn't mean that we're going to have to stay in our homes for years and years. We will learn, as we have already in the last six months, safer ways to come together in smaller groups, you know, outside, or to even improve our current ventilation systems and other measures indoors to make the risk of getting coronavirus lower. So we will find safer ways to re engage in our life. But our life is not going to go back to pre pandemic sort of ways until probably at least several years from now. I just want to make sure that everybody who's listening gets the full weight of what you're saying. First, even a perfectly effective vaccine, perfeclyifficacious vaccine, which basically doesn't exist in the real world for almost anything that we think of being vaccinated for, would have to reach seventy percent of the population before we can say at her immunity, and we can remove various forms of social distancing and masks and separation. As you go down the efficacy numbers, you get greater and greater probability that a good number of people will still be getting the virus. And as you go down, you need more and more people to be vaccinated, And of course that's going to be actually inversely correlated in the real world. Right if we heard that the vaccine was one hundred percent efficacious, more people would be inclined to take it, And ironically, what we need is the other way around. The less efficationous vaccine needs more people to take it. But if people say it's only fifty percent effective. A lot of people will mistakenly say, and therefore I shouldn't take it. I mean mistakenly in the rational sense that rationally you really should take it if it has any capacity to help you provide it that you don't think, the danger is still great. So we could very easily get an extremely messy situation with like a ninety percent efficacious vaccine but lots of people not taking it. And then the upshot of that I'm hearing you saying is that masks are going to continue even after the vaccine is out there. Social distancing measures, including not getting together with medium groups of people or a large groups of people indoors, those restrictions are going to continue for at least twenty twenty one, and maybe for several years longer. And that is, in a certain sense, a much more depressing picture than a lot of us have been imagining as progress towards the vaccine seems to be advancing. I mean, am I getting it right? I mean You're saying it very cautiously and very rationally, But what I'm hearing is actually a pretty striking rational conclusion that we're very, very very far from anything approaching normal life, So yes, no, I mean, you know, I try never to be alarmist about these things, because there's you got to admit, there's a lot we don't know, and I'm always outing to stake hoping for major breakthroughs. But I think the realistic picture is that we are looking at our life continuing to be changed for several years now and now I want to be clear by one thing, That does not mean that we're going to be in the exact state that we're in right now in a year. In fact, I think that we will be more able to get our children back to school, that we will find safer ways to do that. In fact, we know safer ways, we're just not really implementing them right now. I do think they will see more workplaces actually up and running again, because again we will, hopefully if we have advances in testing, and if we have people more observant precautions and we get local prevalence of the virus down, we can have workplaces operating at least in a partial way or even close to normal, in ways that we haven't near these last several months. So I think we will make progress, and even with getting together socially, I think we will find ways to get together in small groups indoors and socialize and see each other, but we'll do in ways that are safer, just like how you see some schools actually able to bring children together with masks, with distancing in indoor environments to learn. So we are an incredibly adaptable species. We've adapted a lot in the last six month. We will adapt a lot more. But what I do think we should be realistic about is that when a vaccine arrives, it's not like tomorrow or even in a month or in six months that suddenly will go back to having full arenas at basketball games, and having crowded concerts and having large groups get together for birthday parties and other festive occasions. That will come back eventually, but it's going to take some time. The public pressure though the moment a vaccine is broadly available, a safe vaccine is broadly available, to go back to normal at the basketball arena, it's going to be overwhelming. I mean, I wonder how any president, even a president informed by science and advised by the best advisors, we'll be able to resist the kind of pressure that's going to be associated with that. You know, I think it is going to be increasingly difficult. But here's what I'll use this analogy. Like when you sprain your ankle, if you choose to arrest for a requisite period of time and then actually get your physical therapy, you will recover a lot faster than if you just continue to walk on it and never do any pt. If you think about our COVID response, we've been doing more the latter than the former. And I attribute a lot of this to leadership. Like what we told people our political leadership was that we got to shut down for some period of time and then we opened up quickly right before levels of the virus were truly low in communities, and we were reluctant to put in place mask mandates in many communities around the country. We were reluctant to push for bars and other higher risk indoor spaces to actually close down. And so what you saw was this stuttering response and a level of infection that never truly got low. Like almost every other country, every other developed country was able to go up and come down to a low level, and now they're trying to keep that level low. We actually never got to a low level. We're still smoldering at a very very high rate of daily cases. And the thing is that public only has limited patients, and that's the risk of taking as long as we have to get it right. So the new president will have, yes a herculean task. You know. I thought that President Obama and Vice President Biden had a massive task in front of them in two thousand and nine when they began the presidency at the time of the Great Recession. But I think the difficulty of this health economic, and really a crisis of public confidence, I think will dwarf anything we've seen in a few generations. I want to thank you back for joining me and I for one to hope that your participant in the process of rebuilding trust in institutions and in directing us to a rational and calm and efficacious way of addressing these problems. I appreciate those kind words. I do want to say that, as much as what we've talked about today is perhaps sobering and not know the message I think all of us would want in terms of feeling like this thing is going to go way tomorrow, I actually do feel optimistic overall about the future. And the reason I feel optimistic is, you know, I have been blessed in the work that I've been doing over the last six months to see the deep of scientific and medical talent that we have in our country and frankly with collaborators around the world. So many of these extraordinary individuals are standing at the ready. They want to help, they want to do their part to address COVID nineteen, and we just need to bring them off the sidelines. The takeaways from listening to doctor vieveck Morty are pretty significant. Since the time of our interview, doctor Morty was actually named by Joe Biden to be co chair of his Coronavirus Task Force. He will therefore be at the center of the new leadership that the Biden administration intends to take on regarding coronavirus. And, as doctor Morty noted in the interview, as vaccines emerge and as they become more effective, a crucial goal will be spreading them fairly and broadly and getting people to trust the system in order to take that Those distribution challenges about which doctor Morti spoke are going to be very, very significant. The vaccines about which we have early numbers require refrigeration at an extraordinarily cold temperature. They are possible to manufacture its scale, but distribution at scale is going to be challenging. That means that along the way, we will have a significant period of time where we have something much less than universal access to the vaccine. On top of that, there is the question of whether the public will choose to take the vaccine, a further issue the doctor Morty addressed, and one which he suggested can only be solved by slow patient advocacy, clarity, and transparency. I would like nothing better than to be even more optimistic than doctor Morti was in his interview about how quickly things can get back to normal, especially if lots and lots and lots of people get access to the vaccines, and the vaccines work and people actually take the vaccines. The reality may be substantially more complicated, as this conversation with doctor Morty suggests. In any case, we thought it would be valuable to share this interview with you again in light of its increased salience for our national conversation. We'll be back to you soon with a new episode. Until then, be careful, be safe, and be well. Deep background is brought to you by Pushkin Industries. Our producer is Lydia Gencott. Our engineer is Martin Gonzalez, and our showrunner is Sophie Crane mckibbon. Theme music by Luis Guerra at Pushkin. Thanks to Mia Lobell, Julia Barton, Heather Faine, Carlie mcliori, Maggie Taylor, Eric Sandler, and Jacob Weisberg. You can find me on Twitter at Noah R. Feldman. I also write a column for Bloomberg Opinion, which you can find at bloomberg dot com slash feld To discover Bloomberg's original slate of podcasts, go to Bloomberg dot com slash Podcasts, and if you liked what you've heard today, please write a review or tell Afrad this is deep background

Pushkin from Pushkin Industries. This is Deep Background, the show where we explore the stories behind the stories in the news. I'm Noah Feldman. This past week brought two major developments in the fight against COVID. First, Joe Biden was elected president, meaning we're going to have a new team in Washington and new leadership working on the issue. Second, Fiser announced early results of its test of its vaccine in human subjects and suggested that some ninety percent of the people who took the vaccine were successfully protected against COVID. We'll be addressing both of these developments in episodes soon. Before we do that, however, today we wanted to reshare with you an interview with doctor Vvek Morty. Morty is one of the people just named by Joe Biden to be one of the co chairs of his Anti Coronavirus Task Force. In the interview, which we recorded on September thirtieth, doctor Morty also discusses the question of how we will get people to trust in a vaccine when and if the vaccine actually begins to work. In other words, what we have for you in this interview is one of the heads of Joe Biden's Coronavirus Task Force, laying out the policies that he will use when vaccines begin to work. It doesn't get more immediately relevant than that. For those of you who are regular listeners to the show and remember this interview, clearly, don't worry. We have another new episode coming your way in the next couple of days. For those of you who haven't heard this interview before, we really hope that you find it as valuable as we did. Doctor Morty was Surgeon General of the United States under Barack Obama and he is now coach share of the Biden Coronavirus Taskers the ECT. Thank you very much for joining me. I want to start with a question that you've spent a huge amount of time focused on, and that's a question of trust, public trust in science, public trust in medicine. And what's particularly driving me to ask you this question is that as we move through phase three trials for potential vaccines with respect to COVID nineteen, there's a lot of uncertainty about how the public will react if and when there's an emergency use authorization for these vaccines, or if there's publicity around these vaccines. It seems to be politically motivated, and that, of course, is a question that implicates science, It implicates medicine, it implicates approvals, and it implicates politics. So there's a lot to be said about this, but intervene in it wherever you would like to start. So this is a timely question, and I think the issue of trust is one that has been growing, frankly during this pandemic response. Let me just say a word about why this is so important. It's not just about a vaccine during pandemic responses, and I saw this when I served a surgeon general during the Zeka outbreak and during Ebola as well. Public trust is one of the most important resources you have and you have to cultivate it at all costs. That means being honest with people, even when you've done something wrong. It means being open to hard questions even when you don't know the answers to them. It means communicating openly, transparently, and regularly with people, and in this moment, it also means allowing them to hear directly from the source of information, which are scientists. You know, science has a guide pandemic responses, and when scientists aren't allowed to speak directly in an unfettered way with the public. It's shows doubt. What's happening here with regarding a vaccine is that we have an unfortunate confluence of factors. We have Number one trust, which has been I think badly injured over the last several months. You have a political cycle which is coming to a culmination with this presidential election, and you have a pandemic that has not gotten better. In fact, we have the most number of cases in the world. We have had nearly two hundred thousand people at this point when you and I are talking today who have died from COVID nineteen to the United States, and we do not see a sign of this ending because our response has been poor. And so all of these are coming together to make people nervous about a decision around a vaccine. And I think there's great danger to rushing a vaccine approval or an emergency authorization in this environment. The damage is not just that people may not take the vaccine. In fact, right now from September Kaiser Family Foundation poll, we know that fifty four percent of people are saying that they would not take the vaccine if it was offered today. That's a staggering number, just given the toll that COVID has taken, how much it's turned our lives upside down, how much people so desperately want this pandemic to be over. Yet fifty four percent of people are saying they wouldn't take a vaccine if it was approved before the election. So what does that tell us. That tells us that people are worried about the process, and they have good reason to be, because we've seen a couple of processes in the FDA which have been driven by politics, the issue of an emergency use authorization for hydroxy chloroquine being one. The way in which the convalescent plasma emergency authorization was issued with false numbers and hype that was political and not scientific. So if the administration really wants to ensure that people have faith in an emergency authorization, here's what they need to do. They need to, number one, make sure that they establish and communicate clearly an explicit standard for safety and efficacy that will be met before an emergency use authorization is approved. The second thing they have to do is they have to make sure that the FDA is scientific and very importantly, it's external Advisory Board, which is known by the some a clunky acronym VERPAC, which stands for a Vaccine and Related Biological Products Advisory Committee. Both of these groups of scientists must be able allowed to communicate directly with the public and share their assessment without a political filter. And finally, the data itself from the trial needs to be made available to the public so that the external scientific community can assess it, can come to their conclusions, and can share their opinions with the public. Only when these are done should have a vaccine be considered for emergency authorization, Because again, the consequences is not just people won't take the COVID vaccine, but if we allow hesitancy and doubt to be sown about the process itself, then people will doubt vaccines even after COVID is over. They'll worry that politics are not science, is driving the process, and that will ultimately hurt all of us. I have to say, when I heard those poll numbers about the number of people who wouldn't take a vaccine, at first felt shocked, but then I realized that I myself had a conversation in fact with my own parents, who are you? My father's eighty and my mothers in her late seventies, and they had similar skepticism. And I was actually horrified in the conversation, and I took it upon myself to try to convince them that, given their age and the bad outcomes that happen to people in that age group, if they do actually develop a case of COVID, that they were getting it rationally wrong. They ought precisely to be prepared to take a vaccine again and provided some emergency used to authorization. And I think of my parents is superrational and cautious and sensible around medical issues. And that leads me to ask, even if the administration, the current administration, the Trump administration, did all three of the things that you just said, you know, if they actually specified clear protocols for what counted his safety, and then they let the scientists at the FDA and on the Advisory Committee, the Vaccine Advisory Committee, speak directly to the public, and they publicized what data existed from Phase three trials. And let's just imagine in the scenario that sometime between now and the time of the inauguration of the next president, that all of those things pointed in the direction of an emergency use authorization, is there any credible way that we could get a lot of the public, even under those circumstances, to trust the vaccine. Or is the damage that's been done already so deep that we couldn't credibly imagine that certainly in any Trump authorized emergency use. Well, Noah, the damage that has been done is deep and it will take years to repair. Because people had a very high degree of confidence across the population in the CDC before COVID nineteen, and we've seen their credibility damaged. The FDA's credibility has taken a hit. Even people like doctor Tony Fauci, you know, who are very highly regarded by the scientific community and by the majority of the public. You know, even doctors credibility has taken a hit because of smear jobs and other criticism that he's received that has been politically directed. And so there's been a lot of hits to trusted sources and it will take years for that to recover. Let's just say in your scenario that there is in fact, good worthy data that tells us that vaccine candidate meets the standards for a safety and efficacy and an emergency use authorization is issued, what would happen to happen if he wanted people to actually be open to taking that vaccine as you would need number one, members of the scientific community across the country, and not just you know, nationally known scientists, but deans of medical schools, doctors and local communities who are trusted and respected, nurses who are known and respected. He would need them speaking out in local communities to help people recognize that people I know, people I recognize, institutions that are local to me, trust is vaccine. The second thing that you would need to see is you would need to see community organizations get behind it. People would need to hear from a non medical voices that they trust as well, whether that's the faith leader, you know, their community, they're church leader, they're synagogue leader. They would have to hear from friends and family who are getting the vaccine. They would have to hear people are getting this and they're not having significant side effects. All of this mobilization, if you will, All of this messaging will take time, and it will take regardless of who wins the presidency. One of the most complicated and challenging vaccine rollout efforts that this country has ever seen. So that is why I often say that While developing a vaccine for COVID nineteen is extremely challenging, actually rolling it out and administering it to people, getting that shot in the arm of a sufficient number of people that we can achieve herd immunity that will be just as if not more challenging. You've been advising Joe Biden on COVID related issues, and that means that if Joe Biden would be elected president and to take office in January, you're one of the very small number of people who will be in line for the single hardest, most thankless job imaginable in the Biden administration, and that would be spearheading the actual operation of doing exactly what you're just set of, actually getting the vaccine to people. So let me start by asking you about what plans you have been developing you and the Biden campaign have been developing for how to begin that process. Should keep be elected and should a vaccine become a safe and available Well, no, the Vice President has been really focused on developing and thinking about plans. He never takes for granted that he is going to win the election, but he wants to be prepared to act on day one if he does. And what that has meant is not just going about the usual process that you have on transition teams where you think about the structure of a department and you think about personnel, but it's involved thinking about some very specific areas that are going to require a whole lot more planning. So, for example, how do you actually expand testing sufficiently so that we have enough testing so that everyone who needs a test and get one. How do we ensure that we actually have enough contact tracing capacity in our country. We don't right now, but we really need that we have any hopes of getting this under control. And of course it involves how to think about the deployment of a vaccine. So these have been the topic of countless discussions that I and others have had with Vice President Biden, where he asked very specific questions. He's thinking about very specific plans. But a key parts of these plans, certainly for the Vaccine Distribution Fund, include thinking about who the trusted partners are that we will need in communities, like for example, if you think about the partners, it's not just a medical establishment, but it's also schools and employers. We know that schools and workplaces are sites where a vaccine could be administered, and having partners in those spheres is going to be absolutely essential. We know that local government and states are going to be extremely important partners. But here's the way I think the Vice President would approach that partnership differently. In the early part of this COVID response, what we saw is a transfer of responsibility from the federal government to the states, saying, you take care of this, and we will lead behind lead from a different place, we will step back. I think the Vice President realize is that you need to give states the ability to craft their own response, but you also have to lead as a federal government, and one of the places in which you have to lead is in the allocation of resources. So just think about the following question, how do you decide how much vaccine goes to Georgia or Florida, or Massachusetts or California. You can't have that driven by politics. That has to be driven by science and by need. So which raises a second issue that he's been working on, not just partnerships, but thinking about data systems right for understanding where the need is and making sure that we can meet that need. Right now, I'm worried that we don't have strong, robust data systems that are integrated in our country such that if we administered and rolled out vaccine today, we would automatically know where it was being delivered, who was getting them, so that we could target our follow up activities appropriately. We have to fix those data systems. So he's been thinking about a number of areas like this and bringing experts together, well beyond myself, you know, experts from really around the country who have done this before. He wants to assemble the best team possible because he knows this is going to be a once in a generation challenge. Let me press you on this. I think you're right from what I know that the data systems that we presently have aren't sufficiently robust to even have a clear sense of what prevalence looks like. And that's before you get to the substantive question, which is, if you're new prevalence, where should you focus resources. Because it's not immediately obvious that you want to focus a vaccine immediately on the heart of sted areas. There are actually arguments for beginning in more moderately hit areas and so forth and so on. So I mean, this is a complex topic in its own right. But given that the data systems almost only are not in place, how is it real to think that a Biden administration could take the time to build up these data systems in order to then make an informed decision. I mean, if you are doing this, you and a team of people are doing this, you are going to be doing it in media's race. You are going to be inheriting the mess that you have inherited, and you will be under enormous pressure to act quickly. Again, assuming that there is a safe and available vaccine. So I guess I want to say that sounds nice in the abstract, like let's solve the data systems, but there's no way that there's going to be the time that it would take to do that. So how do you make decisions under radical uncertainty without the data systems? So it's a great question, and you're right, we can't wait until the perfect systems are built. You can't wait until all the partners are assembled around the table either, because if this vaccine truly is safe and effective, that means that every day you lose our lives that are potentially lost. So what we would have to do is we'd we'd have to do the best we can in the beginning, use the data we have and go to areas that we know have great need, and start to deploying the vaccine through existing partners. We also have, thankfully, through the National Academies of Medicine, recommendations on what the priority population should be that we should target, So we know that healthcare workers and other workers in the front line are critical. We know the people at higher risk because of their age or other medical conditions they have, are at higher risk, so we can go to nursing homes, we can go to other locations where high risk populations are and preferentially vaccinate there. There is a lot of low hanging fruit, if you will, in terms of actions that can be taken in the very beginning, even while you're trying to build up systems and build up partners. But all of this is going to be infinitely harder if people are skeptical, if they're doubtful, if they don't trust what you're doing. And that's why the other plank of this that's so essential that we've been talking about is the importance of communicating openly, honestly about what our plans are and what progress we're making from day one. This is a kind of crisis communication that has been deployed by Republican and democratic administrations alike in prior pandemics. It's not the purview of one party, but it hasn't been done well in this response, and that's why we have a lot of ground to make up. We'll be back in a moment. I'm deeply worried that, regardless of the outcome of the election, if a vaccine becomes available and safe under a Republican administration, a lot of Democrats won't trust it, and that if a vaccine becomes available and safe under a democratic administration, a lot of Republicans won't trust it. In other words, my worry is that the profound political partisan differences that we have are fully bleeding into people's trust in scientific institutions and medical institutions. What's our long run societal solution to that problem. I mean, I'm not asking you to solve the problem of partisan division. Nobody can do that, and it's been with us in certain respects, although waning and waxing throughout our history. I'm talking about the very concrete problem, much closer to your area of expertise, which is that people's trust in science and medicine is coming to be deeply inflected by their partisan views. How do we break that linkage no matter who's president. Yeah, And the reason to be concerned because we've seen that on a number of measures, whether it's people's views of the masks and whether they're appropriate or not and useful, or people's view of other precautions related to COVID. There has been a partisan divide here. But what's interesting, as a side note is if you look at this data on vaccines and specially the COVID nineteen vaccine. I mentioned that fifty four percent of people are saying they would not take the vaccine if it was available before election day. That actually includes forty eight percent of Democrats but sixty percent of Republicans. So in a very interesting way, we're finding that both Democrats and Republicans have deep worries about the back scene. But the larger point around polarization and affecting how we take in information and what we trust is absolutely true and it will be deadly as it has been to date regards to coronavirus. I think one critical strategy and there are many here, but the one I'll mention is that we have to go local in terms of mobilizing information sources. Typically people think, well, if you get somebody on a major network in terms of news, or a national radio station, that's how you get the message out. But I think increasingly in this polarized world where people are listening to their own sources, you actually have to go much more local. You have to think, how do I ensure that an individual's doctor actually knows that the truth about this vaccine so they can recommend them. How do I ensure that other people who are trusted members of a community, like faith leaders, know the truth about this vaccine so they can advise people. Because when you have doubts about whether people are telling you the truth, all of us as human beings go to the people we know and that we have trusted for a long time, that our friends, our family, our nurses and doctor are faith leaders and other trusted populations like this. So I think if ultimately we want to convince people that the vaccines is safe and effective, if it indeed the evidence backs that up, we've got to think about how to mobilize those voices, And I think those will end up being much much more important than getting people on cable news and on national radio. That raises the really hard question of how do you reach the local leaders that you're talking about. We live in an era where local newspapers, which at one time would have been a standard way to reach people locally, because you can have a local newspaper article about the local physician or faith leader who says, you know, the vaccine is great, but they're in retreat, or in many parts of the country, they're already gone. And one of the ways that people now increasingly communicate with their trusted sources, whether it's family or friends or local leaders, is actually through social media. And in that environment, authority isn't quite as powerful as it once was in historical terms, and things can go the other way relatively quickly. There can be a decentralized distribution of distrustful information. I agree with you that we want to get people to hear an important and true message from people who may trust. But how do you at a national level think about reaching those people if it's not through going on CNN and MSNBC, which you do so frequently and so skillfully. Well, No, I think this is not easy work. It's a hard grind. If you will, because it requires a lot of conversations. This is I think why people have gravitated so much toward national news and national media. It has the illusion that seeming to be more efficient, right, you reach more people, Hey, why wouldn't that be better? The problem is it comes with a heavy filter that people don't necessarily trust. And so the way that I would think about this is that we would need to reach out, for example, to local organizations that bring together faith leaders. We need to reach out to the YMCAs, to the rotary clubs, will need to reach out to associations of librarians. We'll need to reach out to groups where we can get in front of people, talk to them, and then start engaging their local chapters. And if that sounds like really tough, tedious, tenuous work, it is. It's not easy to do because what we're really talking about, Noah, even though we haven't used this word before, is we're talking about relationship building, right, and relationship building can take time. But I think that it doesn't mean that we'll never be able to get a vaccine out for months and months. I think that there are enough people who believe that this is an urgent crisis and who will understand the science behind it, that we will have some uptake of the vaccine. The question is how to sustain that and get to a sufficient level where we have her in immunity. There's one other point I want to raise here, though, if this is indeed about relationships, and if what we need our organizations that have a lot of relationships in the local level. It's been particularly worrisome to me over the last many years that we've had a breakdown in those kind of community organizations over the last many decades, like in this country. You know, something that's been well documented by about Putnam, you know, I've been Harvard and by others. But this decline in participation in community organizations and affiliation with community groups leaves people with fewer sources that they actually trust, that are easy to access in a crisis like this, and I see that as deeply worrisome. It's one of the reasons why when I left my time in government, when I was thinking about what do I work on, what do I want to contribute to in the world. That's why I kept coming back to this idea of social connection as being such an important topic, because if you don't have strong connections in your life, then you don't have people you trust. If you don't have people you trust, then you're reliant on social media, on cable news, on other sources for your information, and you don't have people to talk through doubts and worries with. And I think we are bearing the consequences of a deterioration in social connection in social organizations. But that said, we still have many organizations in our communities that we can lean on, and that's going to have to be our priority in a new administration. Let me ask you about how deeply penetrated a vaccine would actually have to be to achieve her immunity. I mean, I realized there's not an exact number that one can define with respect to a particular pandemic, although there is some general guidance that we have from epidemiologists. And the reason I want to ask you about that is what sort of emerging in my mind as I listen to you, is that a lot of us have been thinking, well, how do we get out of this? Well, maybe the right way to get out of it is with a vaccine. But what I'm hearing from you is that actually getting a vaccine is not necessarily the way out. The way out is to have a vaccine and then have that vaccine be sufficiently trusted by a broad enough swath of population that when it is distributed and taken, it gets sufficient penetration to actually reach her immunity. And that may be a very very different thing. I'm letting that sort of seep through my thinking right now. So let's just walk through it. Start with, what percentage do you think roughly we would need to reach for the vaccine to be efficacious? So, Noah, that number depends on how effective the vaccine is. So if we had a vaccine that was one hundred percent effective, which would be exceedingly unusual, then we would have to vaccinate somewhere in their neighborhood of a seventy percent of the population, maybe a little bit less, because you know a number of people have had the virus already, they may have some short term immunity, but it would have to be around seventy percent. But if you start dropping that, if you get to a vaccine that's around fifty percent effective, which is a threshold in fact that the FDA set and it's June thirtieth guidance, then even if you vaccinated everybody in the country. You're not necessarily going to get to hurt immunity levels. Now, that doesn't mean that it's still not worthwhile. See herd immunity is not a switch that we flip on or off. There are benefits to be gained, you know, if we get halfway there. Their benefits to be gained if we get three quarters of the way there. But what this means, given the fact that getting to hurt immunity levels will take time and will be difficult, is it means that many of the precautions that we're taking right now in terms of distancing and wearing masks, and upping our game in terms of personal hygiene and washing our hands, that those behavior changes will be with us for a while, certainly through twenty twenty one and very likely beyond that. It doesn't mean that we're going to have to stay in our homes for years and years. We will learn, as we have already in the last six months, safer ways to come together in smaller groups, you know, outside, or to even improve our current ventilation systems and other measures indoors to make the risk of getting coronavirus lower. So we will find safer ways to re engage in our life. But our life is not going to go back to pre pandemic sort of ways until probably at least several years from now. I just want to make sure that everybody who's listening gets the full weight of what you're saying. First, even a perfectly effective vaccine, perfeclyifficacious vaccine, which basically doesn't exist in the real world for almost anything that we think of being vaccinated for, would have to reach seventy percent of the population before we can say at her immunity, and we can remove various forms of social distancing and masks and separation. As you go down the efficacy numbers, you get greater and greater probability that a good number of people will still be getting the virus. And as you go down, you need more and more people to be vaccinated, And of course that's going to be actually inversely correlated in the real world. Right if we heard that the vaccine was one hundred percent efficacious, more people would be inclined to take it, And ironically, what we need is the other way around. The less efficationous vaccine needs more people to take it. But if people say it's only fifty percent effective. A lot of people will mistakenly say, and therefore I shouldn't take it. I mean mistakenly in the rational sense that rationally you really should take it if it has any capacity to help you provide it that you don't think, the danger is still great. So we could very easily get an extremely messy situation with like a ninety percent efficacious vaccine but lots of people not taking it. And then the upshot of that I'm hearing you saying is that masks are going to continue even after the vaccine is out there. Social distancing measures, including not getting together with medium groups of people or a large groups of people indoors, those restrictions are going to continue for at least twenty twenty one, and maybe for several years longer. And that is, in a certain sense, a much more depressing picture than a lot of us have been imagining as progress towards the vaccine seems to be advancing. I mean, am I getting it right? I mean You're saying it very cautiously and very rationally, But what I'm hearing is actually a pretty striking rational conclusion that we're very, very very far from anything approaching normal life, So yes, no, I mean, you know, I try never to be alarmist about these things, because there's you got to admit, there's a lot we don't know, and I'm always outing to stake hoping for major breakthroughs. But I think the realistic picture is that we are looking at our life continuing to be changed for several years now and now I want to be clear by one thing, That does not mean that we're going to be in the exact state that we're in right now in a year. In fact, I think that we will be more able to get our children back to school, that we will find safer ways to do that. In fact, we know safer ways, we're just not really implementing them right now. I do think they will see more workplaces actually up and running again, because again we will, hopefully if we have advances in testing, and if we have people more observant precautions and we get local prevalence of the virus down, we can have workplaces operating at least in a partial way or even close to normal, in ways that we haven't near these last several months. So I think we will make progress, and even with getting together socially, I think we will find ways to get together in small groups indoors and socialize and see each other, but we'll do in ways that are safer, just like how you see some schools actually able to bring children together with masks, with distancing in indoor environments to learn. So we are an incredibly adaptable species. We've adapted a lot in the last six month. We will adapt a lot more. But what I do think we should be realistic about is that when a vaccine arrives, it's not like tomorrow or even in a month or in six months that suddenly will go back to having full arenas at basketball games, and having crowded concerts and having large groups get together for birthday parties and other festive occasions. That will come back eventually, but it's going to take some time. The public pressure though the moment a vaccine is broadly available, a safe vaccine is broadly available, to go back to normal at the basketball arena, it's going to be overwhelming. I mean, I wonder how any president, even a president informed by science and advised by the best advisors, we'll be able to resist the kind of pressure that's going to be associated with that. You know, I think it is going to be increasingly difficult. But here's what I'll use this analogy. Like when you sprain your ankle, if you choose to arrest for a requisite period of time and then actually get your physical therapy, you will recover a lot faster than if you just continue to walk on it and never do any pt. If you think about our COVID response, we've been doing more the latter than the former. And I attribute a lot of this to leadership. Like what we told people our political leadership was that we got to shut down for some period of time and then we opened up quickly right before levels of the virus were truly low in communities, and we were reluctant to put in place mask mandates in many communities around the country. We were reluctant to push for bars and other higher risk indoor spaces to actually close down. And so what you saw was this stuttering response and a level of infection that never truly got low. Like almost every other country, every other developed country was able to go up and come down to a low level, and now they're trying to keep that level low. We actually never got to a low level. We're still smoldering at a very very high rate of daily cases. And the thing is that public only has limited patients, and that's the risk of taking as long as we have to get it right. So the new president will have, yes a herculean task. You know. I thought that President Obama and Vice President Biden had a massive task in front of them in two thousand and nine when they began the presidency at the time of the Great Recession. But I think the difficulty of this health economic, and really a crisis of public confidence, I think will dwarf anything we've seen in a few generations. I want to thank you back for joining me and I for one to hope that your participant in the process of rebuilding trust in institutions and in directing us to a rational and calm and efficacious way of addressing these problems. I appreciate those kind words. I do want to say that, as much as what we've talked about today is perhaps sobering and not know the message I think all of us would want in terms of feeling like this thing is going to go way tomorrow, I actually do feel optimistic overall about the future. And the reason I feel optimistic is, you know, I have been blessed in the work that I've been doing over the last six months to see the deep of scientific and medical talent that we have in our country and frankly with collaborators around the world. So many of these extraordinary individuals are standing at the ready. They want to help, they want to do their part to address COVID nineteen, and we just need to bring them off the sidelines. The takeaways from listening to doctor vieveck Morty are pretty significant. Since the time of our interview, doctor Morty was actually named by Joe Biden to be co chair of his Coronavirus Task Force. He will therefore be at the center of the new leadership that the Biden administration intends to take on regarding coronavirus. And, as doctor Morty noted in the interview, as vaccines emerge and as they become more effective, a crucial goal will be spreading them fairly and broadly and getting people to trust the system in order to take that Those distribution challenges about which doctor Morti spoke are going to be very, very significant. The vaccines about which we have early numbers require refrigeration at an extraordinarily cold temperature. They are possible to manufacture its scale, but distribution at scale is going to be challenging. That means that along the way, we will have a significant period of time where we have something much less than universal access to the vaccine. On top of that, there is the question of whether the public will choose to take the vaccine, a further issue the doctor Morty addressed, and one which he suggested can only be solved by slow patient advocacy, clarity, and transparency. I would like nothing better than to be even more optimistic than doctor Morti was in his interview about how quickly things can get back to normal, especially if lots and lots and lots of people get access to the vaccines, and the vaccines work and people actually take the vaccines. The reality may be substantially more complicated, as this conversation with doctor Morty suggests. In any case, we thought it would be valuable to share this interview with you again in light of its increased salience for our national conversation. We'll be back to you soon with a new episode. Until then, be careful, be safe, and be well. Deep background is brought to you by Pushkin Industries. Our producer is Lydia Gencott. Our engineer is Martin Gonzalez, and our showrunner is Sophie Crane mckibbon. Theme music by Luis Guerra at Pushkin. Thanks to Mia Lobell, Julia Barton, Heather Faine, Carlie mcliori, Maggie Taylor, Eric Sandler, and Jacob Weisberg. You can find me on Twitter at Noah R. Feldman. I also write a column for Bloomberg Opinion, which you can find at bloomberg dot com slash feld To discover Bloomberg's original slate of podcasts, go to Bloomberg dot com slash Podcasts, and if you liked what you've heard today, please write a review or tell Afrad this is deep background