Hey theyre welcome to this dream home edition im josh rushing and were live from my home today were talking about the race for a vaccine for kovan 1000 in the novel coronavirus. Person to bring out that this is going out live on you tube and so what i want you to if youre watching on you tube is join us in that you tube chat over there give me some questions to ask questions for our panelists today well get you in caged in the discussion now were talking about cove it covered in 1000 were looking at so far more than 13000000 cases worldwide and this is this is astounding more than 500. 00 in 73000. 00 deaths and how long its been around maybe what 67 months yesterday we were looking at 200000 new cases in the world with a bow and then depending on when you see this so about 200000 new cases in the world today right now in about 3700 deaths a day 3700 s. Today there is no cure for it and the best hope out is a vaccine now this is a i want to share with you a comment from a doctor whos in our community dr meir khan here check this out. Patients are often asking me about when a vaccine is going to become available because they understand that its the only way really to defeat this virus they do get mixed messages online about it when it might be coming out about who will be eligible for it and that does make them anxious so we do have to deal with that for me as a primary care doctor having a vaccine would mean everything i wouldnt have to consult in people which creates a barrier between me and my patients be able to get on with routine diabetic clinics asked me clinics all these things that have been put on hold and get back to being done and also planning for the future the flu clinics in the winter there are so many ifs and maybes around and a vaccine would just help give us a definitive answer. So as dr khan said theyre having a vaccine would mean everything heres the rub my computer real quick how long will the vaccine really take if you look at the typical timeline that includes Research Preclinical 3 different bases the trials that the building the factories manufacture approval distribution we could have this back seen out by the years are really what you see if you see my mouse there may 2036. Whos ready to stay in quarantine for the next 16 years so heres the goal were going to crunch down this entire timeline which has never been done before to try to get it out on this timeline by august 2021 now the difference between this and this is everything this show is about today because when you move that red line that far that way that fast what you mean is youre taking a lot of risk youre taking a lot of risks with peoples lives but when you leave this line out this bar at this rate it did a 3800 a day and that number will grow so which is the safest way what do we do well when you conscious this down there are loads of questions about how to most at the cli do that and thats what we want to talk about today with our exciting panel of 3 doctors and im going to have each doctor introduce themselves i want to begin with dr knot on. Hey dr bunky few take your shot of shot thank you josh for having me asa my name is sam im. Based in bhopal in central india and i am at a sudden churning up of the buyer at the pharmacy a pleasure to be on the show. Were happy to have you doctor upon our dr simon died. Thanks for having me josh so i was there and im about a 3rd theater after 4 this is my special Purpose Program for a very Large Health Care system york city im also a fellow part of the public 1000 task force for the federation of american scientists and im happy to all oh yeah thanks for being here and dr near a young. Hi thanks for having me im a bioethicist and the director of bugs universitys center for occupational if i thought it. All right great and this is as much for my mom as the audience in a preshow discussion and we agree were going to go by 1st names here. Otherwise i would call them by their proper name but this is going to make it a little easier a little faster so are we start with you what kind of testing does it take to develop a new vaccine and get it to the people there are 2 basic options right epic testing and human challenge can you set that up for us. So you know you have mentioned i think that the big debate right now is the human challenge we know in getting those trials up and running in the last 100 votes the recall of those awful issues over a long time the normal route where you are able to not play to individuals and then naturally they get deceived vironment the mentality that theyre purposely intentionally you know basically you know exposed to the virus and that exposes and brings up a lot of different issues i think the 1st thing probably to stick quickly imagine is that we dont have a treatment we dont have you know a Gold Standard international and. So when individuals are you know to be informed and that have been you know participating in these trials we still dont know the full picture of the rest that are being taken we dont answer eliot as he is and we also know that just not just over a biological factors that go along with you know the example to the disease you also have the socioeconomic and then the range of the various we have to be very careful when it comes to those types of things and so i think that theres a lot of different factors a lot of different issues to obviously discuss a lot of that deal with people who teaches us the awful patients about this medicine in general but i think that at the end of a lot about the risk of benefit analysis and certainly we are in you know the biggest reason our only concern for developing a vaccine for this century and this is something that is on the minds of everybody that certainly you really need to just see what exactly is on the table right now. But not when i when i hear that were talking about testing where we intentionally infect people with a disease that has no cure. The big question for me as we whos going to do that how do we pick who does that 3 test them aware of it at that at this moment i think are looking at brazil south africa india brazil south africa test are part of an oxford study and india is a Biomedical Company leading the study there can you talk to me about the ethics of who would get infected with this. Sure as you describe it out more than 155. 00 vaccine kind of the size of cotton gown which out in the free and part of the challenge as you also showed in the timeline is how do we get blowback seen as soon as possible given the kind of mortality and morbidity that youre seeing and then multiple Companies Want to go to such groups and the great one be a find. Out in studies. But john in studies also you know have been out on sort of the big lead on in these conditions where we have some got a phase ation and a good understanding of the disease in the case of covered 91 understanding of the disease is evolving i mean we still dont know many things about the disease its about the physiology its impact its going to impact on patients and the sequel of the disease you know not just the current discussion on the ad one consolation for example you know that youve been having over the last couple of weeks so we dont really know enough about that these so in the boston for. Us to fight these conditions like. Probably also talked about for typhoid mary at least have definitive treatment available i was using too but hadnt called it 90 may only have some dramatic treatment we dont have definitive. Yet at least not just. So the question then is is it worth putting people that buy into instantly and thanking them because that is what is at the. Human time in studies and if you do you need to do to ensure that you are taking those who would be participating in these studies. You know and you also add you to the fact that who would actually be participating in the studies thats a good question you know if these are studies to be conducted by say the newest you want to be done inordinate in some countries like brazil china India South Africa then you know what kind of power we talk about talking about what kind of what im talking about. What we need to discuss is do we have to invite into these studies and if not but should they be done and what kind of protections should we have to ensure that no one is exploited and that these are done in a safe manner by minimizing of. Mir youve actually argued for these test wrote correct. How do you do im sorry. You. You have to apply the highest standards of. Informed consent of risk limitation and that includes primarily selecting people who are young and healthy so all without the preconditions that predict worse. So if people get infected they are likely not to experience severe outcomes if if you look at the general population among people in their twentys the risk of dying from. Covert infection are commensurate with those of kidney donation which is a practice that we all accept not because you somehow if you dont or because of what it does one of the present only in this case were going to trials that will help us avoid a lot calamity that affect economically actually livelihoods in the following countries colleagues and i have work in progress where we calculate how and just set aside the life years saved by even one month of expediting the the arrival of the scene were going to be now 40000000 years in power verted worldwide 34000000 are in developing countries your birth is 4 and one month that you expedite the arrival of a scene and importantly even if very unjustly very negatively the next is initially billable in high Income Countries so youre basically where a lot of peoples informed consent you dont just as we do for kidney donation are you willing to help us are you willing to be very ill christy can help us and take on some risk for the sake of a Wider Community minimize the risks i think once you do it right and of course it would have to abide by the highest standards but to do it right its in the torah i dont like the rest i wish we already had a therapy that would your rescue therapy that would ensure there would be much less risk even before we have that i think its already in the 2nd level if we go with the right we must. Neer i want to bring in someone whos actually volunteering or volunteered for the risk is he was Thomas Smiley and hes part of a movie called one day sooner guys commit to a pool of thomas is by going to share this with what i wanted to volunteer for this because i see a great need for x. But i mean all this every day i turn on the new its something worse and worse the problem is not getting any better i want to do something to help live didnt love didnt dance and had all these great times there are people that need more help that i do i need to do something and if that cost me this much but we get this much it seems like a no brainer. Thomas has a voice that would convince me to ticket the test but the question here is if you say lets target the younger population they have a lower risk of dying so far but what do we really know about the long term impact cove it has on the organs of younger people have there been studies on the. So its very this is really a question for the doctor in the group but ill say as a bioethicist. You look at the risk of hospitalization it up there are a predictor of how well there will be with the cutlet of complications that might develop into long term i mean if these and even if they are i think that what were talking about still me standards for massimo risk in medical studies again this is not something we like we wish we knew more about it but if you are fair to its people and if the informed consent says things like we dont even know what exactly the risks are. Take it or leave it so to speak this is it there is real with we didnt verify comprehension did you understand this you know tell me dont tell me what i dont do why are we do we know the liberal press do we know exactly what if we verify the debate over head general so dont use medical studies. Center how do you do that how do you do that in countries where you know theres really high poverty risk are you preying on peoples desperation if they even understand the risk involved. Well i dont know if theres a couple of things i think 1st you know what we know about 1900 is its not a great great equalizer as people are and think you know no one is immune no it isnt its the fault so even if we are looking at you know doing these studies and those that are healthy you know those that are in the u. S. If you look at this you know well for example when i say its you know less than 10 percent of those that are in the ages of 2554. 00. But theres also a lot of different factors of t. Interest if you look at a given population and Given Community particularly for example the next if we have a high level. Meeting in hypertension even in the ukraine thats a really big problem 6 6 people who smoke them at higher risk of having a more severe illness that have a 97 if you are currently looking for that are healthy that have no Underlying Health conditions theres a big difference and what were seeing even though in health and the reason the scary so we have to be very careful especially when were looking at doing some of these studies in other countries there is they are low income but i think one of the things that i would like to highlight is well were talking about some developing vaccines the really big issue that were going to start seeing is the main factor in that being able to distribute these vaccines we dont know once that i have seen the light behind it already were seeing it use implication is fighting. It is lies and there are multiple providers and people. Having now regions but doing diagnostic testing i cant imagine that was the thats exactly available are you going to require has your child have to be refrigerated you know how many people can actually get it it will be any and so these are all the things that need to be discussed now and we need to have a very robust Educational Campaign one that the that it won in south we have been doing so well is informing the general public here for example that well and you know particularly you know theres so much politics involved that people now are hesitant to do make it to get that you need it it will the World Health Organization thanks in has indeed is actually one of the top who will help thats that we have so we really need to make sure that were starting to educate the general public now in terms of this is my support to get vaccinated because if we try to obviously going to get her you know the level through vaccination were looking at least 202324 i mean what celery is highlight so we really need to make sure that were starting to discuss the importance of getting back in providing some of the education and the fact that i dont now do we even know there was herd immunity even possible or are we certain about. You know theres a lot of controversy but certainly i think based on that meeting these and what we know about viruses based on what we know about microbes ringback in general there is a kind of receive help what is that full of herd immunity for her and actually i was never in the one percent there you know i have so that theres a big variability between the c. E. O. But i think at the end of the you know its our very are the community and that will. Do graphical area but i think the core tenets is the same you want to make sure that youre looking at that you know youre educating community in iraq what are some of the disparities what are some other hell outcomes that in that community is that these are the you know the things like that you really want to start addressing. So i want to bring in a comment from our community. As a doctor down to sail paulo she talks about how you can engage community at the do it do we have the. I mean one of the key challenges in conducting research in science. And such as president is how to meaningfully communities not only during the recruitment phase the research and her but also doing this hes 9 of the. Procedures. And in particular if you think about such things these things might be the hardest hit and anyway because of their inherent vulnerabilities we need to be rich and listen to their voices and address so this is. Not how do we make sure the power structures before your 1st answer how do we make sure that. People of color this is being tested on that access to it is wealthier people white people essentially. Absolutely and i think that that reinforces one of the key elements in ethics such as the importance of public and human and Community Engagement ive spent time in south africa looking at this issue in the context of. This is also come up in microbicide trials etc communities can have backlash biomedical intervention if they feel that they have being exploited out if they feel that its not in that interest or anywhere from feeling that theyve been deliberating fake dead that it is the white scientists coming in and experiment thing on our bodies is something which has led to a lot of controversy in the boss its in our best interest hence to keep that in mind and then book on the strategy bridge at the piece of it and charge that there is an understanding with. Communities that you book in maybe you want to know if you want to talk a childs for them to understand by vetoing it how he had doing it and what kind of protections filling it in the absence of that actually enhancing the waxen hesitancy sentiment which i did it do and that is going to be a major issue but just push back 1000. 00 science it would ensure the pushback all forms of the such and also impact any agreement whats being willing to take a backseat as and when it becomes available that might not be. Given the implications that but have any kind of. So its extremely important to get you know. The individual the Community Leaders in these communities we want to look in and make them understand that this is something that we want to get them on and this is not meant to come in and experiment on them in any way and thats what i think the more. Scientific and the such bodies becomes important so that its not seen as a done you know a stick coming in and experiment on us its seen as something which is more to do in nature. Well thats happening right now near down in south africa one of 3 places were talking of doing this kind of testing there were some protests recently against this where they said were not your guinea pigs and theyre actually coming from this. Bit of south africas had a really dark history of some medical testing down there how do you address these concerns near to these communities. Martin 2 of these are people who are protesting the conventional efficacy trials that are being conducted this summer this is not about Charles County cross or possibility john cross is something that you dont need to go to a place with a lot of drug a lot of ongoing infection at the time of the trial for what advantage if you will ethically is that you can conduct it were at her you would presumably conduct it near Large Research centers typically in developed countries you can recruit volunteers nobody will recruit. Referring to sars more fairly or know what somebody with their beast of such trial everybody so w. H. O. Working group has now to suggest recriminations on this theres another group that has a wish to and science on this nobody says recruit people who have 3 conditions that were inclined to have bad outcomes everybody says recruit people who are in great help some people have even said theyre not in our obligations to me personally they said maybe we should focus only on white patients because the outcomes and to be where people of color are untrue that i would go there but if anything the push is to conduct trials in i think im saying the patients who are highly educated people who started the International Movement of volunteers were government which now has 31000 volunteers and and north of and remember these are small trials we need maybe 150 max people so the people who started there are stanford graduates i think are hugh white its the mirror image. The worry that were talking about which may arise about regular efficacy even there i would say our main concern right now sure we should absolutely get them if you can explain and have great Risk Mitigation but i wouldnt hesitate conducts anybody suggest that just because there are some books even has a think. So if you test its not thats. Ok so one of are going to you to come in here says how would the mistrust of Clinical Trials be addressed especially in the black community in the u. S. I talked about south africas dark history with medical testing we certainly have a kind of dark history here in the us as well expression in african commit American Community lets bring in glynn ellis hes a medical ethicist as part of our community with this comment here. As a bioethicist im deeply saddened that at this stage of the Vaccine Development what were seeing is that theres no attention being paid to ensuring that theres adequate representation of africanamericans in these trials and we also need to consider whos going to get this vaccine 1st if the evidence shows that africanamericans are more vulnerable because of existing conditions and chronic diseases they should be at the front of the line. They start were coming into our final minute here but who should get this vaccine 1st want to develop how do you make those decisions. Its very hard and i think unfortunately were not seeing much of that discussion happening at the federal level not where it is that they come out of a travel guide it because thats where the impact is are going to start but it will i mean we need to make sure that its given to the high risk operation 1st though not just those that have Underlying Health conditions that from my Health Care Workers are probably given theyre really looking at the higher Risk Communities you know the black or latino you know all the individuals that have been marginalized and we see that there are much more on her all i think whether he thinks no one else seems likely mention is it with distribution of vaccines no one is safe until everybody is safe as they really need to make sure that we need to provide vaccine will this is the locals that this is you can have a nationalistic approach that we did it doesnt and i you know i was hoarding vaccines and things like that you understand every even. Their own citizens but this is really it will help that and one of these days everybody has access to. They have to leave it there and no one is safe until everyone safe this is going to require a global effort thank you to our guests so much for today and this conversation will continue on you to see you next. Business where. Youll find a bright spot. Business leaders just bow to you by the brass part. The ultranationalist marks connected with one of the worlds worst humanitarian crisis we doe as illegally maigret joining with the military to impose that deadly political agenda we have devoted our nation what has happened to the engine thats one of the biggest stains on the country as a whole. As in our religion this is the politic me and an unholy alliance on aljazeera. If you want to help save the world. Sneeze and euro. Hello norn tater nandan the top stories on our jazeera egypt has demanded urgent clarification from ethiopia over whether it started filling a mega dam on the river nile a controversial project will transform the lives of millions but control over its waters has led to nearly a decade of contentious negotiations and a final deal still hasnt been reached John Stratford has more its taken 10 years to build and cost close to 5000000000. 00 if you hope is flagship Infrastructure Project is a great source of national pride. But the grand ethiopian renaissance dam on the blue nile has caused tension with downstream countries sudan and egypt from the start be coping government says the hydroelectric dam is vital for the development of this immense landlocked country which is a population of around 108000000 the country plans to exporter electricity across the region and says the dam will stop seasonal flooding in neighboring sudan. But egypt says there are a number of outstanding legal issues that need resolving and filling the reservoir too quickly could reduce its water supply and may pose an existential threat and egypt does have legitimate concerns i mean that egypt relies on 90 percent of its fresh water needs and the largest share of the river runs each direction or tree and what we have has had in egypt is a situation where they have a significant gap between the amount that they produce and the motherboard vacancy and with the rapidly growing population of iran to