Transcripts For CSPAN Washington Journal Dr. William Moss 20240712

Studentcam. Org. Host we are joined by dr. William moss. He is the executive director of the National Vaccine center and also a professor at Johns Hopkins Bloomberg School of Public Health. Thank you for joining us. Guest thank you for having me. Thank you for having me. Host a little bit about your work at the Vaccine Access center, talk about that and in the international aspect. Guest yes, so the interNational Vaccine access center, we celebrated our 10th anniversary just last year. And our main focus has been to increase access to lifesaving vaccines throughout the world. Traditionally, we have focused on childhood vaccines, particularly making sure that there is access in africa and asia, and that the vaccines are reaching the most vulnerable children, but then we have been very involved in thinking about covid19 vaccines, particularly how such a vaccine might be distributed, how we will ensure its safety and efficacy, and how we will get equitable distribution of the vaccine around the world. Host how does that apply to the current efforts going on with the coronavirus . Guest there are a number of initiatives, both at national levels, and here in the u. S. , and at the global level led by the World Health Organization, in trying to think about how we are going to distribute a safe and effective vaccine to those people who most need it, particularly given that we will not have a sufficient number of doses, initially, to cover all people who are interested in getting the vaccine. So, we are working on thinking vaccineways in which a should be allocated. We are thinking about how to build trust in communities, this will be an important issue for the vaccine because many of the most vulnerable populations actually have mistrust, some about vaccines in general, others about this vaccine. Host you wrote in a piece, you wrote this about the topic of the coronavirus the success of the vaccine hinges on trust of vaccine scientists, which should have honest communication of potential harms. Can you expand on that . Guest yes, as everyone knows, and as the listeners will know, these efforts to develop and evaluate and approve a vaccine thesars coronavirus ii, or disease that causes covid19, have been accelerated. And we want to accelerate that process. We are in the midst of a tragic pandemic and we need ways to shorten the traditional timeline in order to have a safe and effective vaccine that will be available to those that need it. So, but part of this is part of having a vaccine work, other people have said this, just having a vaccine is not good enough, people have to be willing to take the vaccine. So we need to build trust in the process. Acceleratere ways to Vaccine Development. And we are seeing that in full force. But that does not mean that safety and our knowledge of vaccine efficacy needs to be compromised. This is a really important point to get to listeners, that there are ways to move a vaccine forward more quickly than has traditionally been done in a pandemic, yet maintaining the integrity of the science, maintaining the ethical standards that are required. We can talk more about these, but some of them are combining early things in the vaccine, the testing, particularly phases one and two, we can define those more. And with the covid19 vaccine, we are seeing the large investment, th large amount of fundse to build the manufacturing capacity while the trials are going on. That will expedite the access to a vaccine. Host 2027488000 for eastern and central time zones, 2027488001 for the mountain and pacific time zones. The matter of trust, when uc astrazeneca putting a pause on testing, how should the public take that . Guest that is a very good question. What we need to reassure the public is that this is actually how the process should work. A vaccinea is testing that was developed at Oxford University and it is what we call a vector vaccine. We can talk about the different types of covid19 vaccines. And they are conducting large phase three trials in a number of countries. Combined phase two and three trials that are ongoing. What they identified was an adverse event, and that is exactly what these trials are meant to detect. We heard through the news that one individual who received at their vaccine developed a an inflammation of can beinal cord that triggered by autoimmune diseases, immune system disorders, and possibly by prior infections and even vaccines, although we really do not understand, in detail, how this disease comes about. But it is some type of immune reaction of the body against a part of the spinal cord. So this was detected. Thethey rightfully paused trial. What they will try to do is a see if there is any reasonable evidence to even suggest that this adverse event might have been related to the vaccine, but i want to point out that that is very difficult, very difficult to determine whether a vaccine actually causes this type of rare, yet serious event. But the first thing the public should know about this is this is the process as it should work. Identified,vent is the study is paused. They look carefully at the all the and there is trials have independent data safety and monitoring boards, which is a group of independent scientists who are not invested in the vaccine, not part of the research team, and they look carefully at the evidence. And they will make a determination on if or when the trial should restart. Host since you talked about the International Nature of the Vaccine Development and who gets the vaccine, a majority of cases in the u. S. , does that suggest that those in the u. S. Will be the first ones to get the vaccine . Guest it is going to depend on where the vaccine is developed and which country has put the Financial Investment in. There is no doubt that we are going to have a limited supply of a vaccine early on. And and they will have to be there will have to be decisions made prioritizing who gets it. Because of the large investments from the u. S. Government, it is highly likely that citizens of the United States could be one of the first to get a covid19 vaccine. We already know that the vaccines being administered, perhaps prematurely we can talk about this in russia and china. They have granted limited to beals for vaccines used. This received criticism, justifiably, because they had not sufficiently completed a large phase three trial, which really demonstrates efficacy. But i think it is likely that of aargescale rollout vaccine may happen first in the u. S. , because of the large investment of the u. S. Government into Vaccine Development. And the commitment of several pharmaceutical companies and vaccine manufacturers, to provide vaccines to the United States. But we will face a challenging set of decisions about who in the United States gets prioritized for a vaccine early. There are a number of groups thinking through that process. Host dr. William moss is our guest here to talk about Vaccine Development with the Johns Hopkins Bloomberg School of Public Health interNational Vaccines center. The first call is from washington, d. C. Go ahead. Caller thank you. Priored to speak to the doctor, but i have a general comment about trust and building trust. And the United States. I think the key is to get politics out of medicine. Large a roplays too le. It is a rare cancer, concourse in the and i would like to thank President Trump for getting a drug approved that has prolonged my life. It is not a cure, but it certainly has kept me alive. Ludicera. This drug was available in europe for decades. And we didnt bring it to this because it hadk to do with money. To me,es not make sense but anyway the fda would not approve this drug. In it had been discovered the netherlands at a university, and so Much Research had been done, and so much scientific documentation. And the fda could have clinicalmped the trials and all of the research and approved this drug. Host ok, thank you. Go ahead. Ller makes an interesting point. It is the role of the fda to ensure that drugs and vaccines, approved in the u. S. , are safe and effective. That is their main role. The public has to have trust in that process. I agree with the caller that if politics is even perceived to be involved in that process, that results in or can result in serious mistrust in the public. Unfortunately, there have been a number of incidents in the past few months, within the pandemic, where decisions by the fda have been questioned related to the emergency use authorization of hydroxychloroquine and some of the statements around convalescent plasma. So, that kind of mistrust of the decisionmaking process and approval process at the fda has serious implications, potentially, for the approval process for the vaccine. We have been assured the process will be free of politics. We have seen nine vaccine manufacturers pledge that that process will uphold scientific integrity. Even theg politics, perception of politics, interfering with the approval process undermines trust in vaccines. I will also point out that i think it is important for listeners to be aware that we need to be much more rigorousin the approval more rigorous in the approval process for vaccines than we are for drugs for diseases. This is because, one, vaccines are given to Healthy People rather than people with disease, so that riskbenefit ratio is different for vaccines. They are given two huge numbers of people, rather than to huge numbers of people, rather than drugs for individuals with diseases. A covid19 vaccine could potentially be given to hundreds of millions, if not billions of people in the world. There is mistrust of a covid19 vaccine, there is potential for a spillover effect, where that leads to mistrust of other vaccines and could undermine our immunization system that has been so successful in preventing many lifethreatening diseases in the United States and globally. Host barbara in massachusetts. Caller i have an idea for confidence building. We have seen months of video of emergency doctors, nurses and respiratory therapists treating people, and it makes sense that those people should be the front line people to get the vaccine. But what it also shows is they are the most highly educated in medical and scientific fields. So if those emergency room doctors have a professional association, through which they can communicate the fact that they have reviewed the data and they trust it, and that they are taking it, and just to have a simple website that shows the names of the nurse or person who administered the vaccine to dr. A and they both go public and it,y, and say, i took that would be a confidence builder to me. If my doctor took it and considers it safe, that would go a huge weight in Building Confidence for me. The last thing, on the astrazeneca trial, did the person that got the negative effect, himself or herself have the meningitis vaccine . That would be fascinating to know. Host ok, thank you. Guest yes, barbara makes a really good point about addressing the issue of how do we build trust among the general public and then in specific communities. And she is raising the point that one of the most trusted be emergencys may room doctors and people who are on the front lines fighting and working to save patients with covid19. There has been, and there are ongoing efforts, to try to think through what that allocation process would be. One came out of the center for health security, which is at my own institution, the Johns Hopkins school of Public Health, the National Academy of medicine also has a High Level Committee thinking through these issues. Raised, Frontline Health care workers, in addition to people who are most vulnerable, from severe disease or dying from disease, essential workers in the economy those are the people who will be prioritized for a vaccine. Yet, i agree, that of those people can come out and say, t hat they have reviewed the data and they feel like the vaccine is likely to be safe and effective, and that they accepted the vaccine, that could be a powerful voice in the community. But we also need to go beyond that and have other community leaders, celebrities, people with influence, come out, when the data is available and when the experts agree that we have a safe vaccine, and build the trust within the communities. I want to highlight the fact that we need to build trust in communities of color. These communities justifiably have had mistrust of the the government and of science. And scientific experiments, because of some of the history, but these are the communities that have been most affected by the pandemic. And working through community leaders, whether these are religious leaders or other Leaders Within the community that can help build trust, this is really important. I want to clarify one point, that the adverse event that was meningitis, and it is not due to the bacterial which of meningitis for we have a vaccines. Host reviewer says when a trial is paused, do they tweak to thecine in reaction event or is the entire thing stopped . Guest the process stops in order for the data safety and monitoring board, this group of independent investigators, as well as the investigators engaged in the the Vaccine Development and testing, can do their best to try to understand isther that adverse event likely related to the vaccine. As i said, from one single instance it is impossible to directly say that the vaccine was the cause. So, it is a judgment call of a probability. And it is its important that review oferation and the evidence go forward as rigorously as possible. I think it is unlikely after a single adverse event like this, that there would be any modifications made to the vaccine. Betainly, one would have to or have a better understanding of whether the adverse event was related to the vaccine and what the actual pathogenesis or pathology might be. Speculation is that they are not making changes to the vaccine, but they are doing their best to try to understand whether it is possible this event was related to the vaccine. They will look at the timing, when did this occur . Or two daysed one after the vaccine, it is probably less likely, actually, that is due to the vaccine because it is too early for the body to develop this autoimmune phenomenon. That is one example of something that the investigators will be looking at. Host lori, hello. You are on. Caller i would like to say that i appreciate dr. William moss acknowledging the vaccine history here in america. It has notey, that been a good one. And i would like to ask about people with preexisting conditions taking this vaccine. There were numerous gulf war veterans that took experimental vaccines, who have had adverse reactions. And how this new vaccine would interact with vaccines that have already been administered to them, contraindications. And i would also like to have dr. Moss address Robert F Kennedy juniors lawsuit against the government over vaccines. Of not doingyears any kind of studies on some of these vaccines. And i would like to get his comments on all of those. Thank you. First, let me say een, andcines have b continue to be, one of our, if not the most Important Health intervention. Saved hundredsve of millions of lives around the world. There have been adverse events. There have been various adverse events following some vaccines. And some vaccines have been withdrawn because of that. But the vast majority of vaccines have been well studied and they have been shown to be safe and effective. So, i am a big vaccine proponent. And do not want to give listeners the indication that, ant vaccines are not important part of our toolkit in fighting diseases. In the United States and around the world. That said, the purpose of the , that haveials enrolled in an number of individuals, are designed to detect adverse events and to make sure that the vaccine is both safe and efficacious against the disease of interest. That is the process that we are going through. Comorbidities, i do not think there is a likelihood that any prior vaccine will have any impact on a covid19 vaccine. But the caller raises an important point about, this a new covid19 vaccine being effective in people with comorbidities. And the particular interest is with those people, does we know for example that individuals with asthma, or individuals with diabetes are at higher risk of severe disease. Risklderly are at a higher of severe disease. We want to make sure that he knew covid19 vaccine that a new covid19 vaccine is effective with the populations most vulnerable to severe disease. What happens with aging is the immune system changes it weakens. Vaccines that might effective with young, Healthy People might not be effective with the elderly, or older adults. Maybe the elderly or older adults need more doses. They might need a boost in immune response. The caller makes a very important point we need to understand how this vaccine works in individuals with comorbidities and the elderly. We need to ensure those people are participating in these phase three trials so we can have a better understanding before a vaccine becomes approved. Host earlier, you spoke about in thes and chinas role process. Can you clarify that . Guest both china and russia have worked on covid19 vaccines. There are a number of vaccines in development in china of different types. There are Chinese Companies different vaccines. My understanding is the Chinese Government has approved the use of these vaccines in limited populations. For example, military populations. Fanfare, too much Vladimir Putin announced the approval of a vaccine after some very early small phase i, phase ii studies. The results of those trials were recently published in a premier medical journal. Used twohowed was they different types of vaccines, one called adenovirus 26 and one called adenovirus 25. By oxforde developed university is a chimpanzee adenovirus vaccine. From early publications the phase i, phase ii trials show the vaccine was at least safe in the short term, and we can come back to this how do we assess safety . And induced enemy response that was potentially protective, but we dont know for sure whether a vaccine will be protective until the large phase iii trials. Ofse trials on the order 30,000, 40,000 people, where we can really look to see whether a vaccine protects individuals against covid19 disease. Host you might have c s, but there is a story today you aght have seen this, there is shortage. Can you expand and what that means for the Testing Process . All vaccinesif not i will say all before the enter into humans undergo frequent clinical testing, this means the vaccine is being tested outside of humans. Very Early Research on vaccines can involve cells growing on a plate in a laboratory. Then what happens is the next phase that looks promising is that vaccines move into animal studies. They often begin with a small rodents studies, studies in mice , but monkeys provide what is called nonhuman primate studies, provide a better glimpse into what might happen in humans than in mouse studies, because the immune system, the immune response to a vaccine is much more similar in a monkey to a human than a mouses immune system is. A shortage of monkeys might impact that preclinical testing stage. Than 130e have more potential covid19 vaccines in development, with at least nine in later stage trials and humans. There is a very large pipeline, already, of potential vaccines. I have no doubt we will have multiple vaccines against covid19, eventually. Host enid, oklahoma, this is matt. Caller thank you for taking my call. Speaking about the trust in vaccines, a good example with the explanation, you start to talk about monkey trials, i will give you a few questions that spell out the apprehension people have. Have there ever been any more vaccines for any of the other coronavirus is . Most people are under the impression that you cant cure the common cold. The common cold can, if im correct, because my other coronaviruses. My second question is, in the elderly population, when they start passing away, how many people who passed away from Natural Causes at any given time in the last or years will test positive for a virus period. What is to keep another dna sequence popping out and for us to discover that sequence in a Large Population . Thank you. Guest thank you. Two interesting questions. Regard to the second question, around detecting , the caller raises the point that in our nose, in our nasal passage, we can have viruses, such as coronaviruses or rhino viruses that cause these viruses can persist for some time. That is true. Viruses canm persist in the body for some time after the acute infection. It is not entirely clear whether these are just fragments of acid in the virus, or actual complete viral particles. They could very well be causents of acid that can that cant cause disease or be transmitted. I dont think that is a big problem in estimating the number of covid19 deaths. I think that is the implication of the callers questions. On what we might call a postmortem study, after death, if we look for potential pathogens, we can look for it is notf acids and always clear, and i think that caller is correct, it is not always clear if that is what caused the death or not. I think we have good evidence about the excess number of deaths and the deaths due to covid19. My guess is we are probably underestimating those deaths for a number of reasons. In regard to the first question about other vaccines against coronaviruses, the listeners will remember that sars i was an epidemic around 2003 that affected a number of countries around the world. There was work to develop a vaccine against sars coronavirus epidemic went away before we had an opportunity to really test the vaccine. Another coronavirus is called mers, that has resulted in some sporadic cases largely in the middle east, largely due to contact with camels. Isis not a pathogen that directly passed from human to human. Able we were not able to do the large trials for that. Some of the laboratories that worked on sars coronavirus 1 vaccine, theymers had a jumpstart in developing a vaccine against sars coronavirus 2. There are many different types of rhinoviruses that can affect humans. That is a challenge in creating a vaccine against rhinoviruses. Host florida, barbara. Caller i am so glad you are taking my call put i put my number in many mornings and this is the first time you ever answered. I appreciate the washington thesel and meeting all of wonderful people and being able to speak. I am 92. I would be willing to set myself thetake the virus injection, but my children would not want me to do that. I am glad we have these doctorsl scientists, and everybody working on this virus. Host now that you are on with one of those people, do you want to ask him a question . Caller the question is, how long do you think it will be before we get the virus the injection the average person . Host thanks, barbara. Guest thank you, barbara, and god bless you. Makeuestion about when we it a vaccine, and particularly for the general public, is an important one and it is asked over and over again. Maybe i can try to give listeners a sense of why there is some uncertainty about that. I will just give barbara my guess, i think for the general public, we are probably waiting until midtolate 2021 until the real manufacturing is scaled up and we have enough doses, perhaps it could be earlier than that. Here is what determines the timeline, at least from the phase iii Clinical Trials first, we want to ensure the vaccine is efficacious, it protects against disease. Wayweighty face i the these phase iii trials work to figure and who gets the vaccine and who gets a placebo, they are called randomized Clinical Trials to determine if a vaccine is effective. Volunteers ins these studies are randomized, who gets the vaccine and who does not, and they are followed over time to see who gets the disease. If the vaccine is effective, what will happen is there will be fewer cases of covid19 in the group that got the vaccine then in the group that did not get the vaccine. Accumulateme to arme cases in the vaccine we use the term arm compared to the placebo arm. In a pandemic, that will happen thanearlier, much faster perhaps for other vaccines, where we are not in a pandemic and we have to wait much longer for enough cases to accumulate in the two arms. One thing that determines that timeline is just how fast people are getting infected who are participating in these trials. Manufacturers and investigators running these trials try to set these trials up in places where there is a large number of infections, but sometimes other factors may play in. Sometimes there are changes in behavior, more mask wearing, more social distancing which is a good thing from a Public Health point of view, and we want that to happen but it can slow down the number of take in each arm and just longer to get definitive results from a phase iii trial. We want to be sure about the safety of the vaccine. What we can determine early on in a phase iii trial as people get the vaccine is shortterm side effects. Orally, people get pain soreness at the site of infection, do they have muscle aches . Those are what we can see early on in a phase iii trial. Later, even after a vaccine is approved, that we have the ability to detect rare adverse events. Rare adverse events are impossible or very difficult to detect in very large phase iii trials. It is important countries that introduce a new covid19 vaccine have a Surveillance System set up so they can detect any rare adverse events. Host new york, good morning. Caller good morning. I wanted to say i have lost my trust in vaccines and therapeutics largely because of money. 1980s, a very dear friend of mine had aids and friends of his were dying from pneumonia and were waiting from this trial. There were things that were working for that were discouraged. It concerns me. And also that there are so many natural medicines print i am in my 60s, i dont take a flu shot, i am healthier than other people my age because i go through the hard work of having a Healthy Lifestyle and keeping things in my household at the first time of any problem, i wash my hands, face, nostrils when i come home during flu season and corona. I am worried about mask wearing and germs, if they are going to make me sick. Back in the 1980s, the cdc was saying i could not feed my friend any food that was left over, his own germs would multiply and certainly with his poor immune system could kill him. Shot. T intend to take the i would like to know if you have any comments on that or anything that could convince me otherwise . Guest thank you. I know there are many people in the United States who feel similarly. First off, there is no doubt that a Healthy Lifestyle, good frequent, exercise, washing of hands, are very important Public Health measures. People who practice healthy risk ofes are at lower severe disease and death from covid19, likely. Public healtha practitioner and researcher, and value ofbelieve in the vaccines. Vaccines are not perfect, and i think part of the problem in the United States is that some people may want the perfect vaccine, the vaccine the protects everyone, and the vaccine that has no side effects. Unfortunately, we live in an imperfect world and we have imperfect vaccines, but the benefit of vaccines far from a publicrisk health point of view. There are diseases in the united many, that used to kill many children smallpox, measles, polio and we dont have those problems anymore in the United States because of vaccines. We do not have to worry about our children dying of measles because of vaccines. salso understand the caller concern, i will say, about a new covid19 vaccine. We are in unprecedented times with this for number of reasons for we talked earlier, the vaccine pipeline has been accelerated. That i donthasize think that has compromised our assessment of safety and efficacy. Where we have some of these vaccines that are moving forward, they are novel vaccine platforms, vaccine platforms for which we dont have a licensed vaccine. Vaccines, the first one was licensed in july of this year for ebola. These are new vaccines and i can concernsd people have and i think rightly so. We want to make sure science drives this process, communication around his vaccines is transparent, open and telling the truth, and if aboutare concerns adverse effects, that those are communicated to the public and the public knows. People will have a choice about this vaccine. I dont foresee there will be any kind of government mandates about this vaccine, there could be employers that require their employees get vaccines, particularly healthcare workers that are dealing with patients, there could be some requirements around that, but people have a choice, and it is up to the Public Health community to communicate very clearly and transparently about the benefits of the vaccine and the safety of the vaccine. Toms from james, he is in river, new jersey. Good morning. Caller good morning. Old, i am as healthy man. Allears ago, i was tired the time so my doctor sent me to. Blood cancer doctor i had a virus. He said you are immune from hiv aids. Id ever get the flu, i do get codes and headaches. I do get colds and headaches. Could i be immune from the coronavirus . A i am, could my blood help person who is infected with coronavirus . That is my question. By the way, Rolling Stones gather no moss. Thank you. Raises ae caller number of questions. First of all, it is a very common viral infection, but it it is a fascinating virus that can cause mononucleosis or mono. It is associated with the number of different cancers, including a cancer in africa and a number of others. Virus that wast known to cause cancer. We know of others, including the human papilloma virus. I am not sure about the callers statements about resistance or immunity to hiv. Coronaviruses are very different types of viruses. I would not imagine any cross activity, but the caller makes an important point about, whether infection with other coronaviruses and we alluded to this earlier there are a number of coronaviruses that cause a common cold type of illness in people. It is unclear if there is any kind of cross protection across the different coronaviruses, that is an important area of research. Blood can helps someone else with coronavirus, that is an issue about plasma. It is an old idea going back to the late 19th century, whether plasma take blood the from individuals who recover from an infection, that plasma has antibodies to that pathogen, or in this case sars coronavirus 2, and whether administering those antibodies from the plasma of someone who recovered from covid19 to someone else can help them is a really important, Ongoing Research question. There is some evidence, although it is little controversial right now, but there is some evidence that might be valuable in some patients, particularly when given early. Idaho, joe, hello. Caller i have a question. Are they still using a certain monkey . You talked about the efficacy. Whehter efficacy vary it is stage ii or iii . Does the efficacy vary with a common ailment like asthma . Guest there are a number of interesting questions. Of first one around the use animals to study vaccines, the answer is yes. Theyre one of the most commonly used monkey in biomedical research. Second question is around trials and iii measuring efficacy. Assessed inonly phase iii trials. And is assessed in phase i ii does the vaccine induced a measurable immune response . Whether thatell immune response is protective. Efficacy really only comes out trial. Phase iii host you were talking about the international efforts, is there a combination of countries that Work Together on various stages of trials . Guest yes. First of all, i will answer that question that there is an effort it is called covax. It is a large, global effort to coordinate the development, distribution and allocation of covid19 vaccines. It is a Coalition Led by three large and very important a vaccineons alliance, a really important Global Institution that gets vaccines to those, particularly children, in low income countries, and the World Health Organization the develops the policies around who should be prioritized. There is this global effort to coordinate responses. For individual vaccines, like lets say a vaccine we have been talking about, they will conduct their phase iii trials in multiple countries brazil, for example and the United States. Vaccinendividual manufacturer level, there is coordination. What i really want to emphasize is this Covax Initiative that is a coordinated global effort. Host in a matter of politics, the president of the United States is speaking out against the World Health Organization as far as pulling funds. Does that affect the work on a vaccine . Guest i am very troubled by that. With the World Health Organization, many of my friends are there. These are the most dedicated, committed people to Public Health i know of. To hear them disparaged like that really pains me. The United States not being part of this global effort, i see it as a real tragedy. They will move forward, other countries will step up, but this really should be an effort in which the United States is fully engaged. Host dr. William moss, he is director, heonal is also professor at the Johns Hopkins Bloomberg School of Public Health. He has coming up sunday morning Michael Hamner on the results of the recent Washington Post university of maryland poll on how americans plan to vote this november. And we will talk about the reelection strategy with American Conservative Union chlapp, selena zito talks about campaign 2020 in the battleground states. Author and republican strategist rick tyler will talk about his new book, about accomplishing american makes the case for conservatism. Washington journal 7 00 eastern sunday morning. Be sure to join the discussion with your phone calls, facebook comments, Text Messages and tweets. Up next, fridays medal of honor ceremony at the white house for a soldier who led rescue raid to free hostages held in iraq. , the university of pittsburgh professor talks about antifa and leftwing extremism. 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