Host thank you so much for being here, debora mackenzie. Much of your work over the years i was delighted to read your book which is the first that youve done in this way. Guest the first that ive written. Host it must have been challenging to create such a factual account of a pandemic while it is ongoing. Can you tell us about that . Guest i understand why people would think why are you writing about this now. I deliberately took a step back. As things unfold im not about this misstep or that by the government. Not that level of. What im doing is saying why a pandemic, why now and this is something i could do because if youve been reading my book you would say this is going to happen, these are the viruses we need to work on and this is what we need to do. Its already obvious those productions were spot on and we havent done what we need to do so this is kind of the moment to repeat that stuff at the time that people can understand it and it would make sense to them and therefore the message might come home to the right people. Host held a political leaders have looked at the opportunities presented to them previously and i want to read a quote its almost as if they are interested in writing but not presenting in the first place. Almost as colonial overtones. Is this somethin that somethingo you when you were writing the book . Guest it is kind of postcolonial but i think that its a deeper issue than that. Going in and of stopping something from happening people are always complaining when we succeed people wonder because nothing happens. Prevention just doesnt attract a lot of attention prayer as it is so obvious that its way cheaper and its been estimated that 2 of what its costing to handle this pandemic and that is probably an overestimate if it had been invested in what we need to be good preventive measures to stop this from happening in the first place and then what are we spending this money on. For example at the city of los angeles, los angeles didnt go through this in 2003 but both of them took the warning and put together ventilators for a case if they were hit by it is these that caused pneumonia and required people to do one ventilators. There was a crisis a few years ago that said what are we keeping this around for. So now they still have it and i wonder how many people over the years attack and think what are we spending money on these centiliters for. Host they will also bring up instances if they dont go anywhere so again the spread of the true pandemic so how do you think they can walk that line . Guest they spend a lot on various kinds of insurance anyway. What is the chance that we will be hit with an overwhelming Nuclear Attack and why do we need to rename them very expensively to guard against it as it seems to be very good questions. But people will say if you buy insurance and your house doesnt burn down, it is another. People dont see this as a risk. People have gotten out of the habit of seeing Infectious Disease as really being the risk and they sort of go a pandemic isnt happening now. I have money i can spend on something a is there going to ba pandemic next year, nobody we know that there will be one sometimsometime and its going , very bad. But i hesitate to say that this is low probability. You might get a catastrophic explosion in your port. Those are in the realm of possibility but if they do have been the impact is going to be huge. How do you convince someone that has to spend a limited time when you cant even quantify the risk within the lifespan of the budget you cant do that. Weve seen what this can do and hopefully this has got to happen sometimes. You mentioned some have made statements about how important these things are and in a way of different approaches towards different preparedness that you referenced in the book leveraging the preparedness response so where do you start . Guest the most important thing would be the meeting in order to enact. They really did their homework. There are a number of things we need to do. I dont think that its a mystery but we will hold a meeting of health and finance ministers in the coming months to discuss this and the statement was pulling and then. They went to the team to ask what should we be asking for. It was a pretty comprehensive list. I was just on the website to see if anything changed. I heard some things that maybe the meeting is happening in september but i dont see it scheduled anywhere yet. There is a point of david and hit. One of the things that its brought home is the National Sovereignty is still challenged. China said it doesnt spread human to human and they couldnt say grade we will be there tomorrow and talk to your technical experts. Usually when they get together the truth comes out. That is what thousand. They started talking and all of a sudden we have had more than that. If you have your technical experts getting together and especially if youve been Holding ConfidenceBuilding Measures the truth comes out. We need a mechanism to do that. The who couldnt go in. They would say you dont have the right to comments. Except its the whole planet that is at risk. There has to be shared responsibility and there is currently no way to ensure about. I think china suffered from having delayed admitting because of long as it did that get cut and institute these measures on the 20th of january when they finally did it do if they had to shut the city down. Basically i think we should all know that we are all in this together and need to share information. We cannot leave it to the governing countries whatever they are to be in charge of responding to these things. As you know as a Public Health expert the only treaty that we ought came into being a because they were not telling people when they had outbreaks and they were discovering they couldnt set sail again because nobody would have them. There was so much resistance to that that it took them decades to reach a decision. This is an old problem. We have to find a way to do that but isnt held hostage to National Sovereignty. Its a transnational and global risk that has to be subject to some kind of governance. We could do that with the existing regulations. We just take them a bit and i suggested that in the book. Host disposition of courses and going to help. Speaking about the who end of the preparedness efforts are given where we are now and the events of the last few we, the census that came out what can they do particularly with a general lack of trust . Guest they cant do anything until they let them do something as people always say it is its member state and theyve never given it the authority to override National Governments in these issues. Theyve never given it enough of a budget to do very much although i think we have seen we need some sort of global coordination and management of these issues and another thing its fair game and their power. Theyve got to do this in a way that will allow them to collectively do this and it isnt beyond their capability. They collectively manage materials. Theres an inspection everybody is subject to. If they give up sovereignty for enriching nuclear fuel and you can see if we are telling the truth. We declared we had the following if you want to come in and check you can come in anytime we can be subject along those lines because we want to make sure that the neighbors are not doing it, too. Anybody has declared its okay. We have declarations in the regulations and it might threaten people internationally. Why do we have a requirement countries declare what diseases they thought. Is it a novel disease, they will say we can be there tomorrow. And they can see what weve got and talk about it. Everybody can be in this together from the start. The who can say how good is your surveillance. How do you know that and now they say grade, how many how have you diagnosed in the past year and we know that you are looking for enough and if you havent diagnosed very many, you are not looking very hard. Lets Work Together on improving that capability and theyve done that in all of the companies in africa and they could do it now for general surveillance. If theres one thing that we need all the experts say as im sure you know we need anything else that is surveillance. That is the one thing the declaration did. They figure out ways of getting the diagnostics and tests to people, thats great. But it should also figure out a way of somehow getting us together on surveillance and making sure people can watch for diseases. One of the problems is they are mostly viruses that almost they have been in the places with the most animals which is the tropics and those countries are not very wealthy. China managed to take a while. Its not easy so we need to work on surveillance and we could do it in a treaty. Its very powerful and we talk about the verification particles and having something in the biological conventions context. Theyve gone for decades theyve highlighted in 2014 that have been in the works. When it comes to strengthening systems, to what extent are they in power to make these kind of decisions and how much buyin is needed . To the extent that its an underfunded organization gets accomplished some miracles in the last few years. People blame them but it did contribute to that in west africa as you say the main problem the who but it was slow. In an organization that is running in this budget given that thats the case, its totally reinvented itself as a global Emergency Response organization to say this is how you should be giving your program and we think that this works very well preapproved the vaccine and that kind of standard was never and it reinvented itself. Lets forget that it was only six years ago but at the same time after her 2008 it had a huge cut in its budget and thats just putting all of us at risk because frankly you can criticize the who. Im a journalist, they do it all the time. We are supposed to do that. But its the only game in town with the global collaborative effort to control the rest of the pandemic disease, the who is where you have to start because it is the only agency weve got. I dont think that its done that badly with this. Host the question should they be the ambulance chaser or driver that is the question of. The comment he made about being a journalist as a veteran reporter here to what extent have you seen the challenge in terms of communicating their findings and in terms of the Effective Communication . Host guest thereve been some just covering themselves in the way theyve been reporting this like everybody else but thereve been lots of other people doing really well and going out there and making the point is to communicate which i have to say was a moment of panic when i was writing the book. Usually i make a statement and check on the two sides. I was getting a lot of email back saying my dad is sorry he cant get back to you. After having reworded of the research towards various things having to do with covid and also engaging in a lot of public outreach. A case in point calling me up and helping me with things eventually they said i cant do this anymore i am writing all of these oped and its great that hes doing that. It wouldve been mora lot of thi already talked about. To what extent do you continue your research . Im sure that some are getting back to that change that comes out i think that is something other scientists feel is definitely a challenge. A hugely prominent feature on many levels certainly perhaps even buttressed through some political spheres so how damaging has this information then and what do we think they can do to capture that . Thats one of the reasons i wrote the book. Usually preaching to the crowd but hopefully will not be similarly limited. Contribute what you can. This is a moment i can tell people what i know at the time they can hear it and i think a lot of scientists have been doing that as well. We are hearing from those that are more articulate than others. They dont go into science. Some have notable exceptions but theres also people that have trouble and thats why its important to continue. They dont seem to have a problem talking to each other. As long as its what they have to say to the rest of the world i think that we will be getting the right scientific message. As you say the concern with the scientists theyve been told they are the devil or something and because they appear to certain psychological trades they are not constrained by fa fact. Kind of like viruses in that respect. Host one that hadnt struck me until i read your book is about this incredible situation that we are in where it is against the vaccine that doesnt even exist yet and Something Like and six printed in this day and age its challenging putting the vaccine we may not have enough people willing to take it. I think that its wrong to look at it as this problem. When i talk to Risk Management they say the scientists sincerely explain the facts to people. All the Psychological Research shows that in fact you explain Global Warming to the Climate Change denier it will make them more informed why is she trying to explain this to me. There must be a broad answer in establishing trust in the communities to begin with. And also not so much speaking from one community to another. And speaking to the language they understand and somehow the facts should be able to spread that way as well as from one self defined group to another. I dont know how you get around that. I only report what i hear one prominent scientist has done a lot of work to promote because they dont understand the necessarily quantitative arguments that he makes and that is kind of a problem. They are not dialogues, they are lectures. There need to be more ways to present simple factual evidence anyone can relate to in terms different groups of people can relate to regardless of the politics are her personality is there has to be more of the i dont know how you do that. If i did, i wouldnt be writing another book and who knows maybe that will be the next one. If you want there to be a safe vaccine i do worry that the rest is used by some antithaksin a antivaccine advocate and we will see how that evolves over time. What do you think about this concept of the vaccine became Silver Bullet in the neck. We have to wait until there is a vaccine and maybe we should be thinking about this. Guest i understand amidst the funding and the rush to get to a vaccine. Ive been wondering where is something similar for the antiviral drugs. I looked around and i discovered there arthat there are people se lesson we are not doing as much as we should be. Theres been some good work done on the use of these treatments and preventive measures that there were some promising drugs all of that was abandoned because for some reason they decided that it wasnt coming back. So i need to do more digging or someone needs to do more digging. Im not quite sure. Everybody just gave up on it and they said its a threat. At the same time the whole business of the Silver Bullet is leading to the situation this week where its being reported that russia has been approved for general vaccines that apparently has only been through a phase one safety trial. Certainly not phase three that they need to establish whether it works and plan and against what the its become a nationalistic thing. Its considered to be a nationalistic goal then that is a problem because they dont care what country it is then. In the book i am applying a situation where lets say that rich countries cant afford a vaccine. They make sure that their friends, there are a few poor countries that dont. A virus is going to keep circulating and its going to evolve individually you will have a virus on your hands that your virus doesnt work against so this isnt in anyones interest. When you say we are in this together it is in some kind of an eye and a survivor kind of thing. It really isnt. Its true. We are all in this together. We cannot protect ourselves without protecting everybody and im worried about if it is sort of put in this frame of the Silver Bullet that we are going to be the hero scientist saved the world as it was seen in some countries is a way to undermine everything and its going to be impossible to get it distributed. Getting a vaccine in many ways is the easy part. None of the problems that we know can arise with the virus. Getting it out there to people is going to be the rough one. The guy that runs the organization here said make sure they get ordinary vaccines and the budget. One of the smartest people i know here and he says getting it distributed as the battle. Looking at as something o it asa nationalistic cries i cannot see that helping somehow. We talked about already a nationalistic impulses that are very detrimental and regardless whether they are antivirals are vaccines. For very good reasons in terms of the manufacturing capacities and also our understanding of the pandemic theres been a lot of talk about what lessons from that we can bring to the pandemic and also a lot of Different Things so to what extent do you think it is helpful versus one that might be a bit misleading . Guest those are accurate descriptions of the truth. We had a pandemic in 2009 and everybody was worried about it because it was a direct descendent of the virus and what everyone forgot his id was probably new to it. They were worried that it is going to be pretty nasty and as it turns out it was okay because anybody before this are the ones that normally die of the flu anyway. It only needed a change and i wouldnt have been the case. Right now we have got in europe and china viruses like that circulating that are already jumping to people and we have no idea what its going to turn out to be. And i mentioned before they are still dealinbut theyare still dd that is a possibility. One of the problems it travels very fast and there is no point in doing the containment efforts theyve rightfully been promoting. Everybodys plan that was the only pandemic they thought could happen. It doesnt is a pandemic access flu. We know that is the one that is going to go so we have to be prepared for it. Its something completely different. Obviously it goes both ways. We need to read the article to the end and learned that we need to do a lot of Different Things. I cant believe that there is currently a lawsuit taken in the states against the National Stockpile of the one antiviral drugs that we know works because people have been doing this systematic Misinformation Campaign and theyve taken some prominent ones on this claiming to show that it doesnt work because theyve got signs looking at how it works and in that case it works very well including in the United States in case there is a pandemic and that is being subjected to challenges in the states and i think in europe as well because they see that it wasnt work. They honestly dont know what their problem is. Ive tried to understand it. Its just the thing that they have latched onto. We have actually got the preparation there. The one bit of prepared as some have actually done. Its like throwing your hands up. To be focusing on that in areas of investigation that need energy and attention and on that note one thing that is interesting is of course the all recognize that it didnt have to be influenza. They put out this list of threats. Its certainly not an unknown type of virus. We knew that it was used in that sense but if it was discovered in china over the last few years and it raised concerns about the possible transitions and Nothing Happened so where is the link. I was talking to david. I was encouraged to hear him say the same thing i did. Its the scientists job to say this is a threat we are putting pandemic risk in in case you missed it. What else can they do. They went to work on some drugs and even though they are primarily it is no ones job to take those warnings and sit down together and say okay what are we going to do putting together a list of the viruses that are most talked about and those like what turned out to be covid19 so cant say that we were not warned them they said we should be looking at the vaccine disease. We have a roadmap, drugs, diagnostics, a lot of hours were put in. Whose job was it. Thats what we need, some kind of an agency someone whose job it is to take the warnings and act on them and not just hope somebody bites. They put together the preparedness innovations leading the research on some of the vaccines and it was the only Organization Funding the aroma virus vaccine when this hit. That is all that was going on. One of the things that was set up we have a vaccine that works because everybody was scared that it was possibly being used as a biological weapon so when canada went to work on it they developed for the market because there was no money to do that and it took the entire year to get it tested in the field during the pandemic, epidemic, sorry. Basically they said weve got to do this faster, weve got to put this together more systematically. They took that lesson home. That is all that was done. They didnt have a multimillion dollar effort. They had the roadmap. They said we need this stuff. How much of that scares you . Basically i was in a meeting in the ann vienna and i talked o those guys from the eco health alliance. This was in 2016 i just want to point out. It kills upwards of 75 . So far its been limited and if something is contaminated its moved into Southern India as you know its starting to spread between people in respiratory droplets. Where have we heard that recently . If it was spreading that would be bad enough, but respiratory droplets we all know now its hard to control. If you learned to do that and it didnt become less lethal, i know scientist scientists do but civilization and i think that they are right. The thing about this is that there is a belief that i havent come onto there were some scientists out there i think they are working so hard they dont have time to read the bo book. There is the belief that if something goes pandemic it has to be compiled. I was told about ones. It kills 60 it will become my older. How do you know that, while it just has to. So it uses advanced and various other rationale. Its not necessarily in the interest if it learns to spread from person to person. Its been spreading and it hasnt gotten anywhere yet. They got tha the last one that allows it to spread between people i dont think that we could count on that. That is scary. Covid19 everybodys going its turned my world upside down. Im going this is a mild virus. There was a 10 fatality rate with sars. Half the people over 60 died. What if that had gone pandemic and we were on the edge of it. People were telling me at the time this is serious. Fortunately we got lucky and who had a very Effective Campaign and we stood up with contract tracing. It was the spread but it was pretty easy to quarantine people that have it and everybody cooperated eventually the chinese were open about it. It is kind of like they tried to deny that it was thereupon they couldnt anymore, they launched an incredible campaign. And when they really go to work on something they got it under control eventually. I speak as a canadian hear about they finally got it back under control. People dont realize we are going through a lock for the virus that is and like it could be. Postcode you mentioned the transition is largely before any symptoms and we dont have that here and i think particularly early on in this pandemic that was part of the challenge with the extent it wasnt really known and that confusion and challenge led to a lot of difficulty. I want to come back to another example of i think back to july 2014 was the first case. One of the worlds most densely populated cities with a Weak Health Infrastructure and i think that comes back to the earlier part one of the things that need to be put in place what would you say we need to do now to really focus on the next pandemic this year or next year . Guest they had the organization to give polio under control and right now they kept the infrastructure at place to transition back into the general Public Health implementation agency. I think what we need is surveillance. We need to know whats out there and to be on top of it. The reason they were able to get it under control is because they have that structure in place. What we need is to get out there and find out what diseases people have. We need more work to do that. I think that they need to spearhead the effort. There are some that want to go out there and characterized and that would be an enormous amount of money. Basically going out and seeing people develop good diagnostics i understand they are going to o cut down an old growth forest and coal mines was the latest announcement. Those fruit bats, is anybody talking about going in and doing regular hightech surveillance, we could do that. We have the technology. Nobodys really done it. We could do with where weve already had a track record. We could do to places where people are in contact and just regularly monitor the. That shouldnt be difficult and certainly somebody needs to david and getting it together is the way forward. Working on preventing them from becoming by far we need to think about the structure when there are cases and i think one of the startling things is how they suffer the epidemics. We have seen the responses for various reasons and i think what are your thoughts on bridging those schools of thought when we need to be thinking more holistically . I like the fact they put together a Rapid Response team 24 hours of an epidemic being announced. When it came to its own response there need to be clear plans and people that are not politically in charge of them. They need to be the scientific experts. There needs to be thinking and planning and investment response at all levels, but i think that there needs to be leadership at the top. I am currently residing in the European Union and they were having trouble doing that, too. I think this has taught us where the problems are. Obviously the countries are going to stand by their independence. In many respects that i this isd thing that we need to Work Together because if one country is doing a bad job in multiplying, the country next door is doing a great job it isnt going to help. We could really only do this if we coordinate what we do. New zealand has done a fantastic job. It helps to be an island of extreme leadership. But it helps. Everybody should see that their interest to coordinate what they do and what the scientists take the lead because they tend to agree with each other a lot and say we need to do this and we need to sit down before it happens to decide who is going to do that, how will we deal with ththey dealwith the possibe thought we were going to have to do my small to be the right thing but we were prepared to do social distancing. Nobody thought to be up the capabilities in tracking and tracing. We should sit down and organize data. A lot of the viruses that are not that well used to us even in the pandemic when its just Getting Started might not spread so fast that the containment as an option. We could do tracking and tracing and all that good stuff even if that is the way that its behaving so we need the agencies that have the top advice as it becomes available to change as it becomes necessary. Anybody that specializes in this response to anything does that this is the fact to consider. Nobody has done that. Is there a Pandemic Response agency, there are cold agencies and ministries and the ranking laboratorielaboratory is the deh these viruses. There is the chief scientist. It is not a Pandemic Response agency and not one sufficiently equipped they are starting to bring in social scientists to help. It makes serious mistakes in some cases. Its starting to take those things on board. When it retooled itself as an Emergency Response agency attempt to bring people from the humanitarian response community. They only hired and then started hiring more that were going into the Emergency Response with a rough learning curve im told but they said it is like trying twas like tryingto teach a peng. I dont know if you saw this in the book. You can default to deal with risks that you know are coming as long as you bring everybody in and everybody is likely to be a stakeholder. I suppose there is a case to be made for bringing organizations that traditionally might be against so they will know the risks are and why this is in their interest. All i can say is expecting the small delete to do the right kind of planning is probably not going to work and we need to find a way past. To wrap up, we talked a lot about the past examples of the neglect and response. How do we break that cycle and come out of his . They are driving this both a liberal perspective. How do they say now is how we change our approach . Guest we should sit people down and say that it could have been worse in our response could have been a whole lot better. Almost everybody could have done a better job of this. Lets put money into this. It built up an establishment and a bunch of people whose job it is to do this. We need networks of experts. We have a complex problem here we need people coming up with joint solutions to various problems. Those are the general principles of Management Entity in the private industry is starting to become aware of. We need more of that in the public sphere. Public health as you know is neglected by the governments of persons they all decided back in the 70s and we have known for some time that this was coming but basically we are left waving our arms. We need to create networks of agencies in Different Countries that talk to all the other agencies in the countries so we set up a kind of Community Globally of people that are used to dealing with this and visit each others laboratories and know how their Surveillance Systems work for advice on how to make things work and who can abdicate for more money for preparedness with the governme government. I think as a result of this but we need more than anything else is that kind of network that is sufficient to face off these programs. Its going to be some unlikely country. There was a system that would have allowed him directly. That kind of system if they can told them so local people are worried about the account it was a good system to chinese set up and i think we should all have that. Its a shame they decided to tell their doctors to disregard it for whatever reasons they may have had. But if we all have a job talking to each other, issuing alerts where if theres a problem we find out about it and theyve done a lot of things like that but on the level where everyone is talking to everyone. I was talking to an economist who also wrote a book during lockdown and also thinks we need a way of getting past the National Sovereignty. He uses an example its interesting hes thinking the same way and he says its primarily an information problem. I wish that i included that in my book. Preventing it is primarily an information problem. Talking and institutions to get things done. I cant agree more. Host these are the type of lessons that will continue and i hope they read the book and ive really enjoyed reading the book. Keep us posted on the next one. Guest im excited to have them here