A movie discussing the impact the potential Uncontrolled Development could have on these diverse wildlife these living here if im protecting. They theyre welcome to this dream home edition im josh rushing and were live from my home today were talking about the race for a vaccine for kovan 1000 in the novel coronavirus. Person to bring out that this is going to live on you tube and so what you do if youre watching on you tube is join us in that you tube chat over there give me some questions to ask questions for our panelists today well get you in caged in the discussion now were talking about it covered in 1000 were looking at so far more than 13000000 cases worldwide and this is this is astounding more than 500 in 73000 deaths and how long its been around maybe what 67 months yesterday we were looking at 200000 new cases in the world with a bow in the depending on when you see this 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 check this out. 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 it 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 be able to get on with routine diabetic clinics asked me clinics all these things that have been put on hold and get back to being done and also planning for the future the flu clinics in the winter there are so many ifs and maybes around and a vaccine would just help give us a definitive answer so as dr khan said theyre having a vaccine would mean everything heres the rub my computer real quick how long will the vaccine really take if you look at the typical timeline that includes Research Preclinical 3 different bases the trials that the building the factories manufacture approval distribution we could have this back seen out by and heres are really what you see if you 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 lead this line out this far at this rate it did a 3800 a day in that number will grow so which is the safest way what do we do well when you 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. Hey dr bunky few take your shot of shot thank you josh for having me awesome i mean. I am based in bhopal and said to linda i am not a sudden turning up with bioethics i want to see a pleasure to be on the show. Were happy to have you doctor upon our dr simon died. Thanks for having me josh so i was there and im about a 3rd theater actor for this is my special Purpose Program for a very Large Health Care system york city im also a fellow part of the public 1000 task force for the federation of american scientists and im happy to all. Yeah thanks for being here and dr near a young. I think so having. The director of drugs universitys center for occupational. Are great and this is much for my mom is the audience in a preshow discussion we agree were going to go by 1st names here. Otherwise i would call them by their proper name but this is going to make it a little easier a little faster so are we start with you what kind of testing does it take to develop a new vaccine and get it to the people there are 2 basic options right epic testing and human challenge can you set that up for us. So you know you have as you have mentioned i think the big debate right now is the human challenge we know in getting those trials up and running in the law. School and those awful issues over a long time the normal route where you are able to not play the individuals and then naturally they get to see the firemen the mentality of their purposely intentionally you know basically you know exposed to the virus and that is and brings up a lot of different issues i think the 1st thing probably to stick quickly imagine is that we dont have a treatment we dont have you know a Gold Standard and harass and open 18 so when individuals are you know going in for and that being you know participating in these trials we still dont know the full picture of the rest that are being taken we dont see a way of the disease and we also know that just not just overall biological factors that go along with you know being subject to the disease you also have the socioeconomic and then the range of the various they 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 the people who teaches the philosophical patients about this medicine in general but i think that at the end of days the lot about risk 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 really need to just see what exactly is on the table right now. But not when i when i hear that were talking about testing where we intentionally infect people with a disease that has no cure the big question for me as who is going to do that how do we pick who who does that 3 test them aware of it at the at this moment i think are looking at brazil south africa india brazil south africa test are part of oxford 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 fake one be a faint 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 fair got a prize ation and a good understanding of the disease in the case of covered one thing and one understanding of the disease is evolving i mean we still dont know many things about the disease its about the physiology its impact its going to impact on patients and the sequel of the disease you know part of the. Discussion on the mission for example you know that youve been having over the last couple of weeks so we dont really know enough about the needs these so in the boston 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 90 only have some dramatic treatment we dont have definitive. That have been yet at least not just globally established. So the question then is is it worth putting people at by intentionally in thanking them because that is what is at the courthouse 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 in some countries like brazil china India South Africa then you know what kind of talk about talking about what kind of. 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 people get infected they are likely not to experience severe outcomes if if you look at the general population among people in their twentys the risk of dying from. Covert infection are commensurate with those of kidney donation which is a practice that we all accept not because you somehow if you dont or because of what it does one of the present only in this case were going to trials that will help us avoid a lot calamity that affect economically especially livelihoods in the 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 is 4 and one month that you expedite the arrival of a scene and importantly even if very unjustly very negatively the roxy is initially bearable in high Income Countries so you basically were a lot of people informed consent you dont just as we do for kidney donation are you willing to help us are you willing to be very altruistic and help us and take on some risk for the sake of a Wider Community minimise 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 rest i wish we already had a therapy that would your rescue therapy that would ensure there would be much less risk even before we have that i think its already an acceptable level if we go with the right we must. Neer i want to bring in someone whos actually volunteering or volunteered for the risk is he was Thomas Smiley and hes part of a movie called one day sooner guys commit to a pool of thomas is by going to share this with audience i wanted to volunteer for this because i see a great need for x. But i mean all this every day i turn on the new its something worse and worse the problem is not getting any better i want to do something to help live didnt love didnt dance and had 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 ticket the test but the question here is if you say lets target the younger population they have a lower risk of dying so far but what do we really know about the long term impact cove it has on the organs of younger people have 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 insall there are a predictor of how well there will be with the cutlet of complications that might involve into long term i mean if these and even if they are i think that what were talking about still me standards or massimo risk in medical studies again this is not something we like we wish we knew more about it but if you are fair to its people and if the informed consent says things like we dont even know what exactly the risks are. Take it or leave it so to speak this is it there is real risk 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 general so dont 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 know theres a couple of things i think 1st you know what we know about africa 19 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 u. S. If you look at this you know for example when i say its you know less than 10 percent of those that are in the ages of 2554. 00 are. 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 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 all that are healthy that have no Underlying Health conditions theres a big difference what were seeing even in health and the reason disparities so we have to be very careful especially when we are looking at doing some of these studies in other countries that they are low income but i think one of the things that i really 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 in our region has been doing diagnostic testing i cant imagine that one thing thats exactly available or 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 won in south we have been doing so well in informing the general public here for example that well and you know particularly in a state you know theres so much politics involved that people now are hesitant to do way to get that who need it it was the World Health Organization thanks in hesitancy 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 and what we know about viruses is what made them what we know about microbes in general there is a kind of receive help what is that full of herd immunity for her and actually i was never in the one percent there. So that theres a big variability between the c. E. O. But i think at the end of the you know its our very our the community and that ok so. Youve got a little area but i think the court and its the same you want to make sure that youre looking at the community youre educating me to be in iraq but what are some of the disparities what are some of the hell outcomes that in that community is that these are the you know the things like that you really want to start addressing. So i want to bring in a comment from our community Beatrice Thomas a doctor down to sale 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 for 100 senses brazil is how to meaningfully communities not only doing their own kuchma 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 any because of their inherent vulnerabilities we need to be able to 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. More people of color this is being tested on that access to it is wealthier people white people essentially. Absolutely and i think that that reinforces one of the key elements in that takes on just 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 being on our bodies is something which has led to a lot of controversy in the boss its in our best interest hence to keep that in mind and then book on the strategy bridge at the piece of it in charge that there is an understanding with. Communities that you book in maybe you want to know if you want to talk a childs for them to understand by vetoing it how he had doing it and what kind of protections filling it in the absence of that actually enhancing the waxen has it been seen sentiment which i did it do and that is going to be a major issue but just push back 1000 science it what then should be pushed back on the forms of the such and also impact any agreement whats being willing to take a backseat as and when it becomes available that might not be. Given the implications that bill have any kind of. So its extremely important to get you know. The individual the Community Leaders in these communities we want to hook in and make them understand that this is something that we want to get them on and this is not meant to come in and experiment on them in any way and thats what i think the more. Scientific 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