Susan richard horton, editor of the medical journal the lancet, you published a book, and you wrote the virus that caused covid19 is not going away. It will be with us for a long time to come. The best we can hope for is peaceful coexistence. What does that look like . Dr. Horton it means negotiating a relationship with the virus, if i can put it like that. When covid19 hit, countries locked down. The only way to cut viral transmission was to stay at home, stop social mixing, implement physical distancing and so on. That is fine in the short term. It can extinguish the outbreak, but it is not a longterm solution. It is not possible to live life like that. By peaceful coexistence, i mean we have to renegotiate our relationship with the virus, which means we need to leave our homes, go to work, send children to school. We have to do it in a way that minimizes the risks to those who are most at risk of covid19. That means we have to live sidebyside with this virus as we live sidebyside with many other pathogens like influenza. Susan bring me uptodate on the status in the u. K. And in western europe. Dr. Horton the status and the u. K. Is having to have one of the worst in terms of mortality, one of the worst outcomes of the pandemic of any european country i think belgium is worse we are now in a good phase where the numbers of deaths have been reduced dramatically. There is Still Community transmission, but we are seeing the evolution of the pandemic affecting a different demographic, part of our population. In the early days of the pandemic, tragically the virus was hitting all of the people older people, people from black and asian minority communities, People Living in nursing care homes. They bore the brunt of the pandemic and had high mortality. What we are now seeing is the infection is more in younger people. Of course younger people, the risks of severe disease and death are far less. The nature of the epidemic has shifted. We are seeing something similar in many other european countries. There are several countries in particular, spain and france, where we are seeing the outbreak shoot up again. It is not really a second wave. It is surging. Having suppressed the outbreak, it is coming back because people are mixing again and going back to work. It is a mixed picture. Some countries are doing well. Others less well. The challenge is managing quarantine. Every week it seems one country is out of risk and another is in risk. It is a fluid situation. Susan is it too early to look at the various ways those countries approached the virus and take learnings from it . Dr. Horton i dont think it is too early. There are still aspects of this pandemic that we dont understand, so i dont think we can be 100 definitive. We can say certain things now. We understand the modes of transmission better. At the beginning of the pandemic we did not appreciate as much as we do now that people who are a symptomatic may often have the infection. That is a particular challenge. If you are not having symptoms, you could be in particular danger of passing on the virus if you are circulating widely in the community. We did not appreciate that the droplet spread of the virus could be in very tiny droplets. Coming out of the mouth, gravity will take it downwards. Out of the range of people walking past you in the streets or in the store. We now know there are these micro droplets which can hang in the air. That is one of the reasons why we are more certain than we were that mask wearing is important. These droplets hang in the air. Wearing a mask can be a way of preventing getting those ingested. I would say that. Susan there is three aspects. Widely available, inexpensive and quick Testing Process. The remediation therapies and vaccine development. Let me start with the Testing Process. There are so many people working on this from around the world. From what you are able to see, is there progress being made on quick and inexpensive testing . Dr. Horton very rapid progress. Other parts of the pandemic, you would take a sample, and you would have to send it to a laboratory where it would be an involved scientific Testing Process which would take several days to come back. That was not fast enough in order to do the test tracing approach successfully. We are now getting testing which can we dont actually have any available but i think we will soon, where you can almost get instant results. Literally you do the swab and you can take it to a machine and get a result almost instantaneously. That is going to be important because if the test tracing is going to work, it needs to have a very rapid turnaround within 24 hours in order to get those contacts. That is real progress. By the end of the year we will have these very rapid tests more widely available because those will allow us to do mass testing of the population. That is what we are going to need in the winter months, when we will have two problems. We are going to have the virus and also to have to contend with influenza. Susan as you and i have this, the lancet is being cited across the globe. The study you published today on russian vaccine progress. Dr. Horton this russian vaccine is caught in a geopolitical struggle. If we strip that away and look at the science, the results of the study published today are encouraging, but it is small and it will be premature to draw any definitive conclusions. What the russian scientists did was study the component vaccines based upon the adenovirus. They gave it to 76 volunteers. Very small study. If i compare it with the oxford vaccine study published a few weeks ago, it was over 1000 volunteers. This is a small study. What they found in those 76 volunteers was the vaccine produced strong immune response, which you want to see, the right kind of immune response, and as far as we can tell, safe with no severe adverse reactions. Now what we need to do, go on and do very large scale randomized trials where we can test the vaccine to see if it works in preventing infection and disease. Those trials have begun in moscow. Susan the worldwide pickup of your report suggests how much people are hanging on the hope of a successful vaccine. You have struck a cautionary note about reliance on vaccines. What you talk more . Dr. Horton a vaccine is an important tool to help us control the pandemic and to protect us. It is important to stress it will not be a magic bullet. Vaccines have transformed life for species around the planet. But no vaccine is 100 effective or safe or will be used by 100 of people on the planet. That means it will have an important part to play. We will have to continue to negotiate this relationship with the virus. Even with a vaccine we are still going to have to be careful about social mixing, physical distancing, mask wearing and possibly also about the large Mass Gatherings as we call them, which are sadly, we have not been able to partake in. I want to be optimistic about the vaccine. I believe we will have one. I want to be cautious about saying it will be our savior because i dont believe it will be. Susan it sounds like the world will not be back to normal for quite a long time. Dr. Horton i think this is one of those changes in human history. To be fair we have known Something Like this has been coming for about 30 years or so. These types of infections, where a virus jumps from an animal to a human being, they have been documented as increasing in frequency the last 30 years. It has been the question of when, not if. What that means is we are going to have to figure out a way to get past the acute phase. We will it will take some years low. There are two ways to help reduce the risk. One is a vaccine. That is only part of the solution. The other is of course the idea that came on on early on. In the longterm it is very important. That is what is called herd immunity. The more people who build up immunity to the virus, that will reduce the possibility of there being these academic or pandemic outbreaks. That is not going to happen this year or next year. It will take several years for that to take place. We have to be in this for the long haul. Susan i want to go back to the geopolitics. From where you sit with so much information, how concerned are you about the weaponization of a successful vaccine . Dr. Horton i am anxious about this because this is a global emergency. It requires a global solution. That means countries and president s and prime ministers have to find ways to work together. It feels as if the science is being so politicized, when we published the first papers on the pandemic at the end of january this year from china, and we see the president of the United States calling this a china virus. It is no more a china virus than any other virus is. That is like saying in america you call it an american virus or my country, a british virus. It is a nonsensical statement. By saying it is a china virus, or as today in the press conference that launched the russian vaccine study that took place in moscow, where those who are presenting preventative presented as a force against the west, criticizing the vaccines, that the russian this is not the way to solve a global emergency. We seem to be putting country against country, scientist against scientist, and this is going to hamper any attempt we have to control the pandemic. We need leadership where our politicians work together, not against one another. I am very troubled by this. Susan let me go to the third leg of the stool, a treatment, clinical treatments of people who have caught the virus. There is a lot of policy about steroid use and the success of readily available steroids and treating the people in this patient in this disease. Also we hear about remdesivir and its continuing success. On that front, treatment, what are you seeing . Dr. Horton incredible. We did not even know this virus existed at the beginning of this year. But i really think we have to have so much gratitude for the scientists around the world to have found ways to work together, to test these treatments out in large numbers of people. I think we have learned an incredible amount. One of the reasons why the mortality rates have gone down the last few months in countries that have been hit hard, not the only reason but one reason is we know better about how to manage patients with this disease. It is important to say this is a nasty disease. Patients who present with covid19, they have multiple organ failures of the heart, the liver, belongs, the kidneys. They generally are in intensive care because they need intensive care. When you are faced with a patient like that, just keeping them alive is the goal. Now we have treatments that not just keep them alive but could really slow and turned back the pace and aggression of the disease. The issue is still whether it is it is really a huge the reduction of mortality in patients with severe that is a major step forward. Also we know that in fact there are trials ongoing that i believe will deliver further benefits in the coming months. Susan you have been at this field for 30 years. You think back to the earlier pandemics, ebola, sars, they have come into being. Your publications response to it, you say it feels like a lifetime. Can you comment about the speed with which the Scientific Community is responding to this compared with the recent past . Dr. Horton there has been so much criticism of china and the World Health Organization. I understand why. Because this virus has turned all of our lives and our childrens lives upside down. It is understandable we are angry about it. If you look at the timeline, this has been the fastest that International Organizations and countries like china have ever responded. If i take you back to the early 2000s when the first sars outbreak took place, a virus that is related to the coronavirus, the outbreak in 2002 took place also in china. The chinese response was to deny the outbreak, to cover it up and hope it would go away. It took months for the World Health Organization to force china to come clean about what was going on. What happened this time . The first patient that we are aware of what was admitted to hospital was on the first of december, 2019. And one month later, the Chinese Government informed the World Health Organization there was an outbreak of an unknown virus and severe disease. One month after that, the World Health Organization had sounded the most important alarm signal it can, declaring a Public Health concern. It took eight months with the recent Ebola Outbreak for the w. H. O. To call this, and ebola is much nastier. It took them eight months. On this occasion it took one month. China and the w. H. O. Outperformed themselves from any previous pandemic. Although we have questions to ask of the Chinese Government, we have reasons to be concerned about some of w. H. O. s response and the government responses, such as mine and the american government, we also need to recognize parts of the response were really very quick. Susan i want to dig into that a little bit. I would like to spend some minutes on the lancet itself. Lots of laypeople were saying, tell me what the lancet is and what its vision is. Dr. Horton the lancet was founded by a 27yearold young surgeon called thomas whackly in 1823. He founded it to do two things. He called it the lancet for two reasons. A lancet was a surgical implement. It was there to cut out the diseased parts of the body that was causing illness. The idea was the general should cut out the corruption he saw in medicine in the 19th century. It had a political objective. And it was also going to be a scientific journal. That is another meaning of the word, lancet. It is an arch that lets light into a building. So these twin ideas, whichever was going to throw light on knowledge and at the same time fighting corruption and informing medicine, these are the two ideas that founded the journal. We try to reinvent those ideas for a new generation. We try to publish the best science that we can find and at the same time act as advocates for health as an important issue in our societies and communities. Susan how are you funded . Dr. Horton we are a magazine. We are just like the New York Times or the economist. We rely on subscriptions. We rely on advertising. We rely on pharmaceutical companies that buy reprints from the journal of studies we have published. We have a kind of mixed model of how we are funded. We are very similar to any other magazine or newspaper. Susan what do you know about your readers and how they use the material you publish . Dr. Horton dr. Horton we publish for physicians, but our readership goes beyond. I started to read it when i was a medical student. I hope we still have the idea we are reaching out to doctors and providing them every week with information that can shape the practice and thinking, keeping them up to date. We have deliberately tried to do this in recent years, reached out to a broader audience of people who work in public policy. Because health is such a Critical Force in our culture, society. It is a politicized subject. Because of debates about the Affordable Care act. We want to be advocates for the best science that can help inform policymakers and politicians about what they do. No politician or policymaker will read a 20 Page Research paper in the lancet. What we can do through editorials or podcasts or videos is we can translate the research into ideas and prose that will be understandable by the layperson. That is what we hope for. We hope to be a scientific journal. We also want to have that other role of the lancet, trying to reform society, make society fairer, healthier and kinder. Susan the lancet published the very first study of the coronavirus from the chinese all the way back in january . Dr. Horton january 24. Susan can you give us a sense of when this hit your Editorial Group conversations that were happening about publication . Dr. Horton we have been working in china the past 10 or 11 years. We became aware there was this outbreak of virus in wuhan. We contacted our colleagues in the Chinese Ministry of health, the National Health commission. And in the China Centers for Disease Control and prevention. And we asked them, what is going on . Can we help . By that, what we meant was, can we help by publishing any work you have to show the International Community . This is where some of the criticism of china has been unfair. The chinese have been accused of covering up the outbreak. Far from it. When we first made contact, we had editors who wrote in beijing. When we first made contact with the Chinese Government and offered a hand to help tell the International Community about what was going on, they said yes. Very quickly gathered the data they had been assembling in december and january and wrote up four or five research papers, which we were able to publish at the end of january. It is strange to go back and report these things we did not know but this was the first descriptions of how severe the infection was, putting patients into intensive care with a high mortality. We have published papers showing human to human transmission. We did not know those human to human transmission publishing papers showing what you know, characterization, that this was a sars virus. Publishing that showed and the very phrase was used in january, we are at risk of a global pandemic. All of this information came from the chinese themselves. Everything that has happened in the last six months was described in those papers, and they came from china. To accuse china of covering up and not telling the world is unfair. Susan we in the states saw a report by combined intelligence agencies coming to the conclusion that local authorities in wuhan hid the extent of the virus from the national government. Can you corroborate whether that rings true . Dr. Horton i think it is a complex picture to try and understand. Let me just try and explain how it might have played out. I see how it can be seen but we will have to put oneself in the position of the authorities at the time. You start to have patients presenting with an unknown disease in early december in hospitals in wuhan. The doctors and others dont really know what is going on. People are dying, and this is perhaps taking place over the first one or two weeks in december. At that moment you start to notify Public Health officials in wuhan something strange is happening and you think it is a new viral infection, but you dont know for sure. At that point, do you sound the alarm in beijing and say you are worried, or do you try and investigate further . Of course there were doctors, one in particular who sadly died, who did sound the alert and was heavily cautioned by the wuhan police for doing so. We know there was an attempt to suppress the dissemination of the fact of this outbreak by the wuhan police. I think among Health Officials there was uncertainty about what was taking place. I know beijing Health Authorities were informed thoroughly and they went to wuhan to investigate what was taking place in december because they were anxious. People really did not know what was going on in december. I think that there were parts of the system in china that were trying to suppress information. There were parts of the system that were trying to understand what was taking place and they were passing information on to beijing and the rest of the world. I dont think it is a simple story. I think it is a more complex vector. Susan it seems important to understand the origins. There are the the prevailing theories, but what market and the wuhan laboratory. I know a team of International Researchers went to china in july to understand. How forthcoming has the Chinese Government to been in letting people get to the root cause . Dr. Horton not forthcoming enough. My understanding is knowing the scientists have been able to investigate the origin of the outbreak either in the laboratory in wuhan or in the live animal market, of course we know that this is what the w. H. O. Has established in independent panel to learn the lessons and investigate what did happen in china. I hope they will have the ability to carry out that independent inquiry. So far it hasnt happened. I will say certainly talking with people who worked in china and studied coronavirus very carefully, the hypothesis that the virus came from a laboratory in wuhan and was somehow bioengineered in a way that made it powerful, i am told by those people who know the area and understand these issues better than i do that the theory does not seem credible at all. The most likely explanation is if it did come, maybe not from a single place, but this is where a virus jumps on an animal to human getting maybe it has been on one than more more than one occasion. That remains the most credible explanation. Susan returning to the discussion about your organizations role, if you go to your website now, it says, it warns scientists, you are receiving unprecedented numbers of submissions. The focus globally has been on aspects of the coronavirus. In your role, how are you deciding what you should publish with this amount of popular information coming . Dr. Horton what has happened at the lancet is what has happened at every Health System affected by the opry. We stopped not 100 , but we stopped giving as much attention to research about noncovid19 related areas. Heart disease, cancer, we paid less attention to because we were faced with the avalanche of research being submitted on covid19 and it remains and it will for some time be a global emergency. It was right we dropped everything to focus on covid19. There is a cost that comes from that. What this pandemic is is an acute emergency, but on chronic. It is a crisis that comes at the same time as other conditions that are affecting people in society. It would be a tragedy and terrible mistake if we stopped paying attention to all of these other causes of ill health in society. It is only now to be truthful, as we come out of the summer and look ahead, that we are trying to get some bounceback. The number of papers, if we looked at the curbs of submissions, they have an uncanny resemblance to the curves of infection. They went up very rapidly, and they are coming down more slowly. We are returning to a little bit more or melody, but it was a rush of science. Some of it was excellent. Unfortunately some of it was less excellent. Some of it was disinformation and misinformation. But is a big challenge. The w. H. O. Is calling this an infodemic. We will have to watch carefully. Susan what is the motivation of bad actors . Dr. Horton i dont think there is a single reason why people do it. If i take the antivaccination movement, the antivaccination movement is a pernicious grouping of those with an extreme position on the safety and efficacy of vaccines. It is actually quite a small group, but they exert enormous influence. You can think of vaccinations antivaccination movement as a Small Nuclear cell on one side areas and also you have a fairly small in total numbers of scientists who are very knowledgeable about vaccines. Then there is the majority of the population who are not doctors or Health Professionals in the middle who dont know and they are listening to both sides. This is where the antivaccination movement can make inroads and have such harmful effects. Now with social media, it is very easy to put out a virus of misinformation about vaccine and to make incredible baseless allegations about individuals related to vaccines. Make claims that seem to doubt in the minds of ordinary people who are trying to weigh out what to do for themselves and families. We have an environment unfortunately that allows the false ideas and theories to germinate and to exceed take seed in our society. It is difficult to figure out how to shut that down. Susan what kinds of checks and balances do your Editorial Team have to make sure you dont add to that by publishing studies that turn out not to be as valid . First there was press around the hydroxychloroquine. Dr. Horton dr. Horton absolutely. We have been on the receiving end of that as well as our colleagues we both have papers we have had to retract. This is, very briefly, when the paper is submitted to us and we decide we want to send it for external review by independent scientists, we will send it to four or five scientists, ask her their opinions and the negotiate with the authors if they are still interested and to revise the paper and send it back to the reviewers. That is what we did with the russia vaccine paper we were talking about. It is a process that has been tried and tested since the first scientific journal in the 17th century. It is an imperfect process because it is not repeating the experiments. It is not actually going out and saying lets see if we can reproduce this work, because that is the real test. If you can reproduce it, we notice 100 true. Clearly that is not what peerreviewed is doing. It is taking on trust, what the scientist is presenting, and then scrutinizing that work, critiquing it and asking for more explanation, clarification, more experiments, analysis. And that then is what we will publish. The flaw in the system, and it is a flaw, but it is very difficult to eradicate. The flaw is the entire process of science depends upon trust. I have to trust you that you are telling me the truth. If you or someone who is not telling me the truth, if you are lying to me, if you have falsified or fabricated your data, peerreview is not an effective means of picking up fabrication or falsification. That is what happened in this case we are talking about on hydroxychloroquine. We took on trust the paper submitted to us contained reliable data. It turned out that was not the case. Because we did not go back to the particular database and literally check for ourselves, independently validate every single piece of data that went into the study. No journal does that routinely. The system is open to exploitation should somebody wish to do so. Susan we have a little more than 15 minutes left. In the middle of this enormous volume of work, you have found time to publish a book. What does a book on this subject matter provide, that the lancet journal yourself or your frequent public appearances and scientific panels and the like does not . Dr. Horton as we were saying earlier we publish the lancet for scientists and medical audience. We have touched on the reason why i wrote the book. I became very angry i say in the book, because i did not feel that the science that we were publishing was being paid attention to by both the politicians, policymakers that we have guiding the response in our countries or even the scientists advising those governments themselves. As i saw this flood of papers coming into us and the papers we were publishing and seeing how knowledge was building up and looking at press conferences, president s and prime ministers saying certain things and advisers saying certain things, there was no match between what we were publishing and what was being said. I wanted to write this book because i wanted to try and understand why there was a mismatch between the reality of the science and the practice of governments in managing the pandemic. Susan your criticisms of the scientists and the government are strong. Failure of leadership. Let down the people they were supposed to protect. One of the things is the 2008 financial crisis and what happened in countries drawing inward with less money to spend and new kinds of governments elected. My secondary question is how are governments supposed to prepare in a Public Health situation for enormous amounts of unpredictable pathogens . Dr. Horton it is very easy to be guilty of hindsight. I need to be careful about what i say. I want to put this in the context of what i said earlier. 30 years of experience of a rising rate of these episodes where viruses jump from animals to humans. We have known this was coming and we cant attend we did not know it was coming. Pretend we did not know it was coming. Every generation of politicians has put this problem off, thinking they can get away with it and leave it to the succeeding generation. It has been called out on this occasion. I would also know that we were at risk of a pandemic but not one of this virus. All western countries will have run pandemic preparedness scenarios in the belief that influenza was going to be the greatest risk to their populations. Pretty much all countries, pandemic of influenza will be at the top of a National Risk register. Influenza, we have it every year. We survived it. It can be more severe one year then another. In a severe case we know we are dealing with situation like 1918 where millions of people are at risk of dying. That is what we were preparing for, a pandemic of influenza. That said, we did not prepare. In the noted kingdom they ran a pandemic preparedness exercise for influenza and found we were unprepared. The recommendation was to get prepared for a pandemic. What did we do . Nothing. When this pandemic hit, we did not have personal protective equipment ready. We did not have a test, trace and isolate system ready. We did not have the National Health service ready. Why is that . This is where there are some very fundamental questions about how our societies work. It is going to be a test of our government to see whether we can absorb a lesson. The fundamental lesson is this. We have built our society on the notion of efficiency. Just in time, distribution, very tight margins in the way we run our Health Service, education service. That doesnt work in a pandemic. Instead we need to be building our societies not on the principle of efficiency but on the principle of resilience. That means you have to have extra capacity in the system to be able to absorb shocks, that hit the system. Resilience means money. It costs. The question for our societies, the governments, those who elect politicians, is, are we repaired to pay for resilient societies that can absorb shocks like the one we are going through . That is going to mean higher taxes, less personal freedom and governments that are going to have to be stronger in terms of state intervention. Saying all of those things, it sounds a political statement. That is what we needed to respond to this pandemic. We needed a Health Service that was a system that had extra capacity for sick patients, which it did not have. We needed government that could intervene in the economy, paying workers losing their jobs, supporting communities, spending government money on those communities. Are we prepared for that . I cant answer that. It will be very interesting on november 3 in the United States because it will be the first major test of whether we are willing to invest or not in a different kind of society. Susan President Trump gives the harshest criticism in test kits the harshest critic President Trump gives the harshest racism in your book. I do have a brief clip of President Trump talking about the decision and the head of the w. H. O. And his response. Today i am instructing my administration to halt funding of the World Health Organization while a review is conducted to assess the World Health Organizations role in mismanaging and covering up the spread of the coronavirus. We regret the decision of the president of the United States to order a hold in funding to the World Health Organization. The w. H. O. Has been fighting the pandemic with every ounce of our soul and spirit. We will continue to do that until the end. Susan you say the president s decision, to cut funding, was a crime against humanity. Strong stuff. Can you tell us why you came to that conclusion . Dr. Horton absolutely. Global emergency requires a global response. We cant have a Global Health emergency and have 195 countries in the world working separately. We need to have coordination of responses so we learn from one another. The organization is responsible for coordinating national responses, for building the knowledge we need to prevent this pandemic getting worse is the World Health Organization. At the moment of global crisis, all countries need to be supporting w. H. O. The u. S. Government has been a generous i mean this sincerely a generous supporter ever since its inception in 1948. It is a key partner. Something like a quarter of its entire budget. To withdraw money in the middle of a pandemic, of such a large proportion of w. H. O. s budget is to undercut the global response, to harm, hurt the agency that is responsible for trying to save lives around the world. A crime against humanity is a knowing act of harming people. Withdrawing money from w. H. O. In the middle of a pandemic is a knowing act of harming people. This will harm people. That is why it is by definition a crime against humanity. It was an appalling action, terrifying mistake and it needs to be rectified. The u. S. Government is absolutely critical to Global Health. We need a Strong America. We need a successful america. We need america as a partner in the world. What we have currently is an america that has been withdrawing from the world. Whether it is w. H. O. , the paris climate agreement or any other multilateral initiative. This is a tremendous tragedy for our societies. I want a Strong America to rejoin global efforts to defeat of pandemic because we need you. Susan you feel comfortable as your role with your role in the lancet with these questions. Dr. Horton im saying we need a Strong America as a partner in the world. That is necessary to protect and strengthen Health Systems that can advance the health of our citizens. If America Withdraws from the world, that damages our ability to advance the health of citizens worldwide. My motivation comes from a concern for health. I am a physician. That is all i am qualified to make a comment about. The policies of the american government, the British Government or the french government, all have an impact on world health. It is important for Health Professionals and Health Care Workers to speak out and to hold their governments and others accountable when they take positions and actions that will inevitably harm the health and wellbeing of people worldwide. Susan we have three minutes left. In the close of your book you look further down the road and you write that disasters can be a catalyst for significant and surprising societal and political change. What were you thinking about . Dr. Horton i was thinking, this pandemic has been a moral provocation to us. I mean it has held a mirror up to our society. We have seen who is most at risk in our society, our seniors. Black and asian minority ethnic populations. Key workers on the front line of services from healthcare to education, transport to food distribution. Women and children who are at home often in settings of violence, domestic abuse. This is our society today. Having seen these key workers, these key populations have been most vulnerable, we cant work walk away now and forget that. We have seen how inequality kills. It is now the responsibility of all of us surely to say we must do so much more to eradicate inequality and to protect those vulnerable populations and people in our midst. It is a moral provocation we have to act upon, looking to the future. I hope we have the courage to act on what we have seen. It would be a tragedy if we turned our back on our fellow citizens. Susan the editor of the lancet medical journal. Thank you for your time. Dr. Horton thank you. It has been a pleasure. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. 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