Theyre welcome to the stream home edition im josh rushing and were live from my home today they were talking about the race for a vaccine for coping 1000 in the novel coronavirus. Person to bring out that this is going to live on you tube and so what you do 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 gauged 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 573000 deaths. And how long its been around maybe what 67 months yesterday were looking at 200000 new cases in the world with about in the depression when you see those 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 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. 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 when it might be coming out about who will be eligible for it and that dont 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 and be able to get on with routine diabetic clinics ask 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 phases of trials that the building the factories manufacture approval distribution we could have this vaccine out by and heres our really what youre seeking 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 far at this rate it did a 3800 a day in 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 awesome my name is sam im. Based in bhopal in central india and i am not a sudden turning up of the bioethics and for the sake of pleasure to be im sure. 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 actor for this is my special Purpose Program for a very Large Health Care system york city im also a fellow pilot of a 19 task force for the federation of american scientists and im happy to all. Oh yeah thanks for being here and dr near a young. I think so. And the director of drugs universitys center for occupational. Arent great and this is much for my mom is the audience in a preshow discussion we agree were going to go by 1st names here. Otherwise i would call them but 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 as you have mentioned i think the big debate right now is the human challenge we know in getting ourselves up and running in the last 100 rows the record books are full of shoes over along the wall route where you are able to not lead individuals and then naturally they get to see the firemen the mentality of their purposely and actually 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 and harassed and. So when individuals are you know to be informed and that being 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 them that you know what the people who teaches us the awful creations of it about this medicine in general but i think that at the end of the day since a lot about the risk of benefit analysis and certainly we are in you know the biggest race of our life in terms of developing a vaccine for this century and this is something that is on the minds of everybody that certainly 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 a month if i seem kind of that size of cotton gown which up in the face 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 frank i mean this one child 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 size ation and a good understanding of the disease in the case of cover one thing and one 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 cotton discussion on the one politician for example you know that youve been having with so we dont really know enough about the needs these so in the boston has been done for. Us to fight these conditions like. Probably also talked about for typhoid mary at least have definitive treatment available i was using 2 but hadnt caught 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 you would actually be participating in the studies thats a good question you know if these are studies to be conducted by say you know us do you want to be done inordinate Income 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 them to 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. Mere youve actually argued for these test wrote correct. How do you do im serious. 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 you 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 especially 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 worldwide 34000000 are in developing countries your birth this for any one month that you expedite the arrival of the scene and importantly even if very unjustly very negatively the next is initially billable in high Income Countries so you basically lobby person from content you dont just as we do for any donation are you willing to help us are you willing to be very altruistic and help us and take on some risk for the sake of a Wider Community you minimize the risk i think once you do it right and of course it would have to go by the highest standards but to do it right its in the torah i dont like the risk 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 an acceptable 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 the audience 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 than 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 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 cost does ation it sol there are a predictor of how well there will be with the cutlet of complications that might go into long term i mean if these and even if there are i think that what were talking about still me standards or 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 informants and since 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 we have for you we didnt verify comprehension did you understand this you know tell me dont tell me what i told you why do we know the liberal press we know exactly what if we verify the debate over head general state and we use medical studies. Or 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 know theres a couple of things i think the 1st you know what we know about half of the 19th is its not a great great equalizer as people are the i think the own no one is immune no one is as of all so even if we are looking at you know doing these study and those that are healthy you know those that are in the u. S. If you look at the you know well for example United States the are less than 10 percent of those that are in the ages of 25. 54. But theres also a lot of different factors a teacher so if you look at a given population and Given Community particularly for example i notice if we have a high level. Meeting in hypertension even in the ukraine thats a really big problem 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 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 really like to highlight is well were talking about 2 developing vaccines the really big issue that were going to start seeing as 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 as fighting the media lies and our molecule provider. Having now read has been doing diagnostic testing i cant imagine that was the vaccine back to the available are you going to require has your child have to be refrigerated you know how many people can actually get it in the beginning 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 play won in south we have been doing so well in informing the general public here for example who will and you know particularly you know theres so much politics involved that people now are hesitant to do a good. That you need it it was the World Health Organization thanks inheritance is absolutely one of the top total Health Threats that we have so you 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 get into her you know the level through back nation 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 to the new and providing some of the education and the fact that i get now do we even know there was herd immunity even possible or are we certain of that. You know theres a lot of controversy but certainly i think the sun at that meeting these the what we know about viruses but based on what we know about microbes in general there is a kind of receive help what is it that full of herd immunity the person actually and i was never in the one percent there you know as high as 70 percent so that theres a big variability between the c. E. O. But i think at the end of the you know its also going to vary on the community and of ok so youve got a little area but i think the core tenets is the same you want to make sure that youre looking at the community youre educating you to be in iraq but what are some of the disparities what are some of the hell outcomes that in that community is that these are the you know id say the things like that they really want to start addressing. So i want to bring in a comment from our Community Tom as a doctor down to sale pollo and she talks about how you can engage community ethically do we do we have the. Do you want to the key challenges in conducting research in science for. Brazil is how to meaningfully communities not only during the recruitment phase of the research and there are but also doing these 9 of the trials how the procedures. And in particular if you think about. These things might be the hardest hit and then because of their inherent abilities we need to be able to 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 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 both 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 anywhere from feeling that theyve been deliberating faking did that it is the white scientists coming in and experiment being 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 in 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 are 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 push back on the 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 will have any kind of. So its extremely important to get you know. The individual the Community Leaders in these communities we want to hook 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 become so important so that its not seen as a done you know as to coming in and experimented on us its seen as something which is more to do in nature. But thats happening right now near down in south africa one of 3 places were talking about doing this kind of testing there were some protests recently against this where they said we are not your guinea pigs and theyre actually coming from this that you know 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 town trials are actually a theoretical possibility john francis something that you dont need to go to a place with a lot of drug a lot of ongoing infections at the time of the trial for one 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 were earlier known to recruit somebody with their babies to such trial everybody so w. H. O. Working group has now to suggest recriminations on this theres another group that does i 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 they are constant to be where people of color and after that i would go there but if anything the push is to conduct trials in i think im sending. Our highly educated people started the International Movement of volunteers were gonna be our which now has 31000. 00 volunteers and and north of and remember these are small trials we need maybe 150. 00 max people so the people who started there are stanford graduate i think largely white if its the mirror image of the worry that were talking about which may arise about regular efforts even there i would say our main concern right now sure we should absolutely engage communities and explain and have great Risk Communication but i wouldnt hesitate to conduct a trial of anybody suggest that just because there are some the scene hasnt been so far so if you protest its not that. 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 clint 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 as 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 i would step to come out of trouble because thats where i think its a good start but. I really need to make sure that its given to the high risk operation though not just those that have underlying conditions that from my Health Care Workers are 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 vulnerable i think when he thinks no one else seems likely mention is if it will just be. No one is safe until everybody is safe is that if you need to make sure that we need to provide vaccine this is the locals that this is you can have a nationalistic approach that we did it doesnt and i you know recording vaccines and things like that you understand every they can have. Their own citizens but this is really a global ringback health that and one of these day 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 later. Business wagers just go to by no brass power. They come in who did such a plan to provide a better life for the families think left behind. But then to me that is vital to the nice food industry. They risk exploitation by corporations and boogie nights crying. Trapped in a system with little hope of escape people empowering. All humans nations on iran lifted under u. N. Security Council Resolution 2231 this process will lead to those sanctions coming back into effect 30 days from today our message is very very simple United States will never allow the Worlds Largest state sponsor of terrorism to freely buy and sell planes tanks missiles and other kinds of conventional weapons these u. N. Sanctions will continue the arms embargo. A place to say to that these restart sanctions will also reimpose accountability for other forms of iranian aligned activity that the authors of the nuclear deal foolishly downplayed iran will again be prohibited from Ballistic Missile testing iran will be back under sanctions for Ongoing Nuclear activities such as the enrichment of Nuclear Material that could be applied to a Nuclear Weapons program