Day theyre welcome to this stream home edition im josh rushing and were live from my home today were talking about the race for a vaccine for coping 1000 in the novel coronavirus. Person to bring out that this is going out live on you tube and so what you do if youre watching on you tube is join us in that you tube chat over there give me some questions to ask questions for our panelists today well get you a gauge in the discussion now were talking about cove it covered in 1000 were looking at so far more than 13000000 cases worldwide and this is this is astounding more than 573000 deaths. And how long its been around maybe what 67 months yesterday we look at 200000 new cases in the world with about in the depression when you see those so about 200000 new cases in the world today right now in about 3700 deaths a day 3700 s. Today there is no cure for it and the best hope out is a vaccine now this is a i want to share with you a comment from a doctor whos in our community dr meir khan here. Patients are often asking me about when a vaccine is going to become available because they understand that its the only way really to defeat this virus they do get mixed messages online about when it might be coming out about who will be eligible for it and that dont make them anxious so we do have to deal with that for me as a primary care doctor having a vaccine would mean everything i wouldnt have to consult in people which creates a barrier between me and my patients and be able to get on with routine clinics ask me clinics all these things that have been put on hold and get back to being done and also planning for the future the flu clinics in the winter there are so many ifs and maybes around and a vaccine would just help give us a definitive answer so as dr khan said theyre having a vaccine would mean everything heres the rub the city my computer real quick how long will the vaccine really take if you look at the typical timeline that includes Research Preclinical 3 different phases the trials that the building the factories manufacturing approval and distribution we could have this back seen out by and heres our really what youre seeking to see my mouse there may 2036. Whos ready to stay in quarantine for the next 16 years so heres the goal were going to crunch down this entire timeline which has never been done before to try to get it out on this timeline by august 2021 now the difference between this and this is everything this show is about today because when you move that red line that far that way that fast what you mean is youre taking a lot of risk youre taking a lot of risks with peoples lives but when you leave this line out this far at this rate it did a 30 a 100 a day and that number will grow so which is the safest way what do we do well when you cut this down there are loads of questions about how to most at the cli do that and thats what we want to talk about today with our exciting panel of 3 doctors and im going to have each doctor introduce themselves i want to begin with dr knot on. A dr bunky few take your shot of shot thank you george for having me asa my name is simon i am based in bhopal and said to linda i am not a sudden turning up with bioethics at the pharmacy pleasure to be on the show. Were happy to have you dr all right dr simon died. Thanks for having me josh so i was there and im about a 3rd of the theater after 4 this is my special Purpose Program for a very Large Health Care system york city im also a fellow part of the public 1000 task force for the federation of american scientists and im happy to all. Oh yeah thanks for being here and dr near a young. I think so how to eat. And the director of drugs universitys center for. Our great and this is much for my mom is the audience in a preshow discussion and we agree were going to go by 1st names here. Otherwise i would call them by their proper name but this is going to make it a little easier a little faster so our we start with you what kind of testing does it take to develop a new vaccine and get it to the people there are 2 basic options right epic testing and human challenge can you set that up for us. So you know you have as you have mentioned i think the big debate right now is the human challenge we know in getting ourselves up and running in the last 100 rosia because of those awful issues over a long time in the normal route where you are able to not lead individuals and then naturally they get to see the environment the mentality that theyre purposely put into actually you know basically you know exposed to the virus and that exposes and brings up a lot of different issues i think the 1st thing probably to stick quickly machin is that we dont have a treatment we dont have you know of all the Standard International and. So when individuals are you know to be informed and say. You know participating in these trials we still dont know the full picture of the rest that are being taken we dont answer only other diseases and we also know that just not just over a biological factors that go along with you know the example to the disease you also have the socioeconomic and then the range of the various we have to be very careful when it comes to those types of things and so i think that theres a lot of different factors a lot of different issues to obviously discuss a lot of them that you know what the people who teaches us thoughts are both occasions i think about this medicine in general but i think that at the end of the lot about the risk of benefit analysis and certainly we are in you know the biggest reason our only concern for developing a vaccine for this century and this is something that is on the minds of everybody that certainly you really need to see just what exactly is on the table right now. But not when i when i hear that were talking about testing where we intentionally infect people with a disease that has no cure. The big question for me as we whos going to do that how do we pick who does that 3 test them aware of it at that at this moment i think are looking at brazil south africa india brazil south africa test are part of an oxford study and india is a Biomedical Company leading the study there can you talk to me about the ethics of who would get infected with this. So as you describe it more than a month 55 vaccine candidate size of cotton gown which up in the face and part of the challenge as you also showed in the timeline is how do we get blowback seen as soon as possible given the kind of mortality and morbidity that youre seeing and then multiple Companies Want to go to such groups and the great one be a frank i mean this one child in studies. But john in studies also you know have been out on sort of the big lead on in these conditions where we have some got to say zation and a good understanding of the disease in the case of covered 91 understanding of the disease is evolving i mean we still dont know many things about the disease its about the physiology its impact its going to impact on patients and the sequel of the disease you know part of the. Discussion on the mission for example you know if youve been having over the last couple of weeks so we dont really know enough about the needs these so in the boston has been done for. Us to fight these conditions like. Probably also talked about for typhoid mary at least have definitive treatment available i was using too but hadnt caught it 90 may only have some dramatic treatment we dont have definitive. That have been built yet at least not but just. So the question then is is it worth putting people that buy into instilling thanking them because that is what is at the hotel for doing human time in studies and if you do you need to do to ensure that you are taking those who would be participating in these studies. You know and you also add you to the fact that who would actually be participating in the studies thats a good question you know if these are studies to be conducted by say the newest you want to be done inordinate Income Countries like brazil china India South Africa then you know what kind of talk about talking about what kind of what im talking about. What we need to discuss is do we have to invite them to these studies and if not but should they be done and what kind of protections should we have to ensure that no one is exploited and that these are done in a safe manner by minimizing up. Mir youve actually argued for these test wrote correct. How do you do im sorry. You. You have to apply the highest standards of. Informed consent of risk limitation and that includes primarily selecting people who are young and healthy so all without the preconditions that predict worse. So if you get infected theyre likely not to experience severe outcomes if if you look at the general population among people in their twentys the risk of dying from. Covert infection are commensurate with those of kidney donation which is a practice that we all accept not because its somehow for the kidney donor but because of what it does the one of the present only in this case were going to trials that will help us avoid a lot calamity that affect economically especially livelihoods in the philippines countries colleagues and i have work in progress where we calculate how in just set aside the life years are saved by even one month of expediting the the arrival of the scene were going to be now 40000000 years in poverty verted worldwide 34000000 are in developing countries your birth this for any one month that you expedite the arrival of the mixing and importantly even if very unjust and very negatively the roxy is initially bearable in high Income Countries so youre basically where i was informed consent you dont just as we do for kidney donation are you willing to help us are you willing to be very ill christy can help us and take on some risk for the sake of a Wider Community minimize the risk i think once you do it right and of course it would have to go by the highest standards but to do it right its in the torah i dont like the risk i wish we already had a therapy that would your rescue therapy that would ensure there would be much less risk even before we have that i think its already an acceptable level if we go with the right we must. Neer i want to bring in someone whos actually volunteering or volunteered for the risks he was Thomas Smiley and hes part of a medical one day sooner guys commit to a pool of thomas is by going to share this with the audience i wanted to volunteer for this because i see a great need for x. But i mean all this every day i turn on the new its something worse and worse the problem is not getting any better i want to do something to help lived and loved and danced and had always great times there are people that need more help than i do i need to do something and if that cost me this much but we get this much it seems like a no brainer. Thomas has a voice that would convince me to take it but test but the question here is if you say lets target the younger population they have a lower risk of dying so far but what do we really know about the long term impact cove it has on the organs of younger people have there been studies on the. Its very this is really a question for the doctor in the group but ill say as a bioethicist. You look at the risk of hospitalization it out there are a predictor of how well there will be with the cutlet of complications that might go into long term i mean if these and even if they are i think that what were talking about still me standards for massimo risk in medical studies again this is not something we like we wish we knew more about it but if you are fair to its people and if the informed consent system is like no we dont even know what exactly the risks are. Take it or leave it so to speak this is it there is real with for you we didnt verify comprehension did you understand this tell me dummy tell me what i told you why are we do we know the liberal press that we know exactly what if we verify the debate over head gen 7 we use medical studies. How do you do that how do you do that in countries where you know theres really high poverty risk are you preying on peoples desperation if they even understand the risk involved. Well i dont know if theres a couple of things i think 1st you know what we know about 1900 is its not a great great equalizer as people are and think you know no one is immune no it isnt as of all so even if we are looking at you know doing these studies and those that are healthy you know those that are in the us if you look at the media you know for example and i say its you know less than 10 percent of those that are in the ages of 2554. 00. But theres also a lot of different factors that teach us if you look at a given population and Given Community particularly for example the next if we have a high level. Meeting in hypertension even in the ukraine thats a really big problem 6. You know smoke them at higher risk of having a more severe illness that over 90 so even if you are currently looking for that are healthy that have no Underlying Health conditions theres a big difference what were seeing even in health and the reason is scary so we have to be very careful especially when were looking at doing some of these studies in other countries that they are low income but i think one of the things that i would like to highlight is well were talking about some developing vaccines the really big issue that were going to start seeing is the main factor in that being able to distribute these vaccines we dont know once that i have seen the light behind it already were seeing it use implication its. Just not needed to rise and there are multiple providers and tb. Having now regions been doing diagnostic testing i cant imagine that was the thats exactly available are you going to require has your child have to be refrigerated you know how many people can actually get it it will be any and so these are all the things that need to be discussed now and we need to have a very robust Educational Campaign one that the play one itself we have been doing so well is informing the general public here for example that well and inevitably in a state you know so much politics involved that people now are hesitant to do make it to get that you need it it will the World Health Organization thanks in has indeed is actually one of the top total Health Threats that we have so we really need to make sure that were starting to educate the general public now in terms of this is my support to get back to it because as we try to obviously get into her you know the level through back nation were looking at least 202324 i mean look its hillary is highlight so we really need to make sure that were starting to discuss the importance of getting back in providing some of the education and the fact that i dont now do we even know there was herd immunity even possible or are we certain about. You know theres a lot of controversy but certainly i think the sun at that meeting these the what we know about viruses based on what we know about microbes in general there is a kind of receive help. Battle of herd immunity the curve and actually i was never in the one percent there. So theres a big variability between the c. E. O. But i think at the end of the you know its our very are the community and that will. Do graphical area but i think the court and it is the same you want to make sure that youre looking at that you know youre educating community in iraq but what are some of the disparities what are some of the hell outcomes that in that community is that these are the you know the things like that they really want to start addressing. So i want to bring in a comment from our community Beatrice Thomas a doctor down to sail paulo she talks about how you can engage community ethically do we do we have the. I mean one of the key challenges in conducting research in science. And such as the president is how to meaningfully communities not only during their recruitment phase their research and her but also doing. Of the. How the procedures. And in particular if you think about. These things might be the hardest hit and then it because of their inherent vulnerabilities we need to be rich and listen to their voices and address so this is. Not how do we make sure as you mention the power structures before your 1st answer how do we make sure that. People of color this is being tested on access to it is wealthier people white people essentially. Absolutely and i think that that reinforces one of the key elements in ethics such as the importance of both public and human and Community Engagement ive spent time in south africa looking at this issue in the context of. This is also come up in microbicide trials that cetera communities can have backlash biomedical intervention if they feel that they have being exploited out if they feel that its not in that interest or anywhere from feeling that theyve been deliberating fake did that it is the white scientists coming in and experiment thing on our bodies is something which has led to a lot of controversy in the boss its in our best interest hence to keep that in mind and then book on the strategy bridge at the piece of it in charge that there is an understanding with. Communities that you book in maybe you want to know if you want to talk a childs for them to understand by vetoing it how he had doing it and what kind of protections filling it in the absence of that actually enhancing the waxen has it been since sentiment which i did it do and that is going to be a major issue but just push back 1000 science it wouldnt be pushback all the forms of the such and also impact any agreement whats being willing to take a backseat as and when it becomes available that might not be. Given the implications that will have any kind of. So its extremely important to get you know. The individual the Community Leaders in these communities we want to look in and make them understand that this is something that we want to get them on and this is not meant to come in and experiment on them in any way and thats what i think the more. Scientific organizations and the such bodies become so important so that its not seen as a done you know as to coming in and experimented on us its seen as something which is more to do in nature. Well thats happening right now near down in south africa one of 3 places were talking about doing this kind of testing there were some protests recently against this where they said we are not your guinea pigs and theyre actually coming from this that you know south africas had a really dark history of some medical testing down there how do you address these concerns near to these communities. Martin 2 of these are people who are protesting the conventional efficacy trials that are being conducted this summer this is not about time trials down trials are actually a theoretical possibility john trials are something that you dont need to go to a place with a lot of drug a lot of ongoing infections at the time of the trial for one advantage if you will ethically is that you can conduct if were at her you would presumably conduct it near a Large Research centers typically in developed countries you can recruit volunteers nobody will recruit. Referring to sars more fairly or not you are somebody with their be nice to such trial everybody so w. H. O. Working group has now the subject recriminations on this theres another group that has i wish to and science on this nobody says recruit people who have 3 conditions that were inclined to have bad outcomes everybody says recruit people who are in great help some people have even said theyre not in our obligations to me personally they said maybe we should focus only on white patients because they are constant to be where people of color and the truth dont go there but if anything the push is to conduct trials in i think im setting asians are highly educated people started the International Movement of volunteers were they are which now has 31000 volunteers and and north of and remember these are small trials we need maybe 150 max people so the people who started there are stanford graduate i think largely white its the mirror image of the worry that were talking about which may arise about regular efforts even there i would say our main concern right now sure we should absolutely engage communities and explain and have great Risk Communication but i wouldnt hesitate to conduct a trial of anybody suggest that just because there are some the scene hasnt been so far so if you protest its another africa. Ok so one of your going to you to come in here says how would the mistrust of Clinical Trials be addressed especially in the black community in the u. S. I talked about south africas dark history with medical testing we certainly have a kind of dark history here in the us as well expression in african commit American Community lets bring in clint ellis hes a medical ethicist as part of our community with this comment here as a bioethicist im deeply saddened that at this stage of the Vaccine Development what were seeing is that theres no attention being paid to ensuring that theres adequate representation of africanamericans in these trials and we also need to consider whos going to get this vaccine 1st if as the evidence shows that africanamericans are more vulnerable because of existing conditions and chronic diseases they should be at the front of the line. They start were coming down to our final minute here but who should get this vaccine 1st once its developed how do you make those decisions. Its very hard and i think unfortunately were not seeing much of that discussion happening at the federal level now where i would step to come out of a travel guide that because thats where the impact is are going to start being a little i mean we need to make sure that its given to the high risk operation 1st though not just those that have Underlying Health conditions that from my Health Care Workers are probably given are really looking at the high Risk Communities you know the black or latino you know all the individuals that alcee have been marginalized and we see that there are much more vulnerable i think when he thinks no one else seems likely mention is it will distribution of vaccines no one is safe until everybody is safe is that if you need to make sure that we need to provide vaccines that will this is a global threat this is you can have a nationalistic approach that we did it doesnt and i you know i was courting vaccines and things like that you understand everything they can have. Their own citizens but this is really it will help that and one of these days everybody has access to. You have to leave it there and no one is safe until everyone say this is going to require a global effort thank you to our guests so much for today and this conversation will continue and you to see you next. Coronavirus may force us to change the format of head to head for the time being that would stop me doing robust interviews with challenging direct questions in a u. S. Election year ill be seeking accountability from both sides of the political spectrum on whos to blame for the horrific coronavirus doesnt tell them how to fix the us Health Care System and whether the war of words with china is entering a new and dangerous phase joined me by the awesome or special series of head to head on aljazeera. Stories of life. And inspiration. A series of short documentaries from around the world. That celebrate the human spirit against the odds. The base of a. Aljazeera selects change makers. 0 is here to report on the people often ignored but who must be hurt how many other channels can you say will take their time and put extensive thought into reporting from under reported areas of course we cover major global offense but our passion lives in making sure that youre hearing the stories from people in places like palestine but young man the sahara legion and so many others you go to them you make the effort we care we stay. The u. S. Is a Tipping Point scientists are telling us right now that we have just 12 years as the worlds leaders to agree on a solution. Taking matters into their. Which is significant because its one of the songs that it kills people and it kills people now its ridiculous both fronts were to the peoples doors on 00. Coronavirus crisis gets worse across the United States prompting a plea from the Infectious Diseases expert whos been an old president trying. Weve got almost reset this and say ok lets stop this nonsense and figure out how can we get control over this now. Over there on the planet this is al jazeera from our World Headquarters and also coming up a family celebration shattered by strike in yemen the rebels say at least 25. 00 civilians
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