Happened yet . In writing about what we can write about. Im not writing as they unfold or this step or that government not at that level at all. But i am standing back to say why a pandemic and why now . I could do that very quickly i have been writing about this we have been saying this will happen these are the viruses we need to worry about and what we need to do. Its already so obvious those predictions were right on and didnt do what we needed to do so this was the moment to repeat all that stuff at a time when people cant really understand and it really makes sense to them so the message comes home to the right people. And that point of the past warning of a pandemic came through strongly. And political leaders overlooked opportunities presented previously for preparedness. One quotation was a lightning that rich countries do not prevent those that cause in the first place. That thinks about colonial time. A lot of the way it is postcolonial the way it is managed. But it is a deeper issue. Prevention is not sexy to stop something people in Public Health are always complaining if we succeed people wonder what we are therefore. Nothing happens. Prevention doesnt attract attention but its way cheaper than cure. 2 percent of what it cost us to handle the pandemic i think thats an overestimate of what we knew were good preventive measures would have stopped this in the first place. What are we spending the money on . The city of toronto and los angeles. Los angeles did not go through sars but toronto did in 2003 but they both put together a stash of ventilator in case they were ever hit that was a disease causing pneumonia. Los angeles had a crisis and said what are we keeping this around four and got rid of it. Now it has the shortage i want to know how may people over the years attacked the City Government is a what are we spending money on and ventilators . And you mentioned the challenge of the self alarm that Surveillance System so part of the challenge is of that true pandemic coming so how do you think political leaders can walk the line . They spend a lot on various insurance already so what is the chance we will be hit with an overwhelming Nuclear Attack . Why do we have to renew Nuclear Defense very asked pensively . When i say we i mean the Nuclear Power but that cost a vast amount more than investing. That is insurance. People say if you by Fire Insurance your house does not burn down and used i want my money back . Know. It is similar. People just didnt see it as a risk. They guide it out of the habit to see Infectious Disease as a risk. A pandemic isnt happening now i have a chunk of money i can spend it is there a pandemic next year . Know. But it will be sometime to be very bad. I hesitate to say low probability or high impact thats at the experts call it. You might get a catastrophic explosion who could have predicted that a week ago. May be a massive flu pandemic at the same time as covid pandemic thats a possibility but nobody can say it will happen but if they do the effect will be huge so someone who has a limited part of money when you cant even in quantify the risk it matters what happens within the lifespan of this budget . Thats the first one you cannot predict when this is coming. You cannot give policymakers the tools they need to make budget decisions. Weve all seen what this can do hopefully maybe this will be more effective. Any man on mentioned some political leaders are making statements how important these are with a different approach and what you reference in the book with medicines and vaccines and Rapid Development and preparedness response so where do you start . Spent the most important thing is for the ig twenties through a meeting they said they would hold to an act that. It really did it so mark. There are a number of things you need to do. Its not a mystery. They said they would hold the meeting in the coming months. The statement was brilliant and they asked what should we be asking for. It was pretty comprehensive and all the right things. In fact i was just on the g 20 website. It hasnt. And there is 1. 1 of the things covid has brought home is the National Sovereignty still rules unchallenged of International Health management. China said we have this infection but it doesnt spread human to human they cannot say great well be there tomorrow when technical experts get to gather the truth comes out. The doctors in beijing started to talk actually we have more deaths than that. Especially if youre Holding ConfidenceBuilding Measures the truth comes out we need a mechanism to do that. The who could not go in. Except the whole planet is at risk. Shared risk and shared responsibility. Now china suffered from having delayed this spread person to person if they didnt admit that it couldnt move on. And on the 20th of january they had to shut it down. Basically we should all know we are in this together and the response we cannot leave it to the whim or the proclivities of the Different Countries to be in charge. And as you know as a Public Health expert the only treaty we have came into being because back in 1800 sports cities were not saying when they had cholera outbreaks. And there was an effort to get people to share information on the colorado break but all the major powers of the time it to the decades to reach a decision. Humans have trouble talking about disease. We have a way to do that that is a transnational risk and subject to global governance. We could do that with the existing International Health regulations. This happens against the backdrop of the multilateral organizations and for those that can help to drive the process. And to be such a key player for those preparedness efforts so given where we are now the events the last few weeks what can it do to bolster its own efforts with the threat of the us and general lack of trust . The who cannot do anything as people always say that it never gives said the authority to overwrite those issues or enough of a budget. We have all seen now we actually need some sort of global coordination in the management of these issues. They have got to do this in a way to collectively do this and to manage Nuclear Materials there is an expection on inspection to give up enough sovereignty and with that capability. That under the Chemical Weapons Convention those that could conceivably make nerve gas you can do that anytime. To make sure the neighbors are doing it. Everybody has to clear thats okay. We are ready have the requirement for the regulations to threaten people internationally. If its a novel disease and then to do that we can see what you got. They say i dont have any novel disease to say how good is your surveillance now the poorest countries in the world say how many diseases similar have you diagnosed in the past year . Then we know youre not looking hard enough. And they may have done that maybe now for general surveillance. And then more than anything else it is surveillance. Thats what the g 20 declaration did not mention. But it should also figure out a way to somehow band together on surveillance to make sure people can watch four diseases. One of the problems going from animals to humans that will happen the place with the most animals which is the tropics and they are not very wealthy. China is an it took a while to see it had a problem. We need to work on surveillance and get that together. We could do it under a treaty that is unlikely already signed up to. And those regimes are powerful. And then to have something parallel with that context with those disagreements. So the idea the Surveillance Systems but it was recently highlighted in those things that have been in the works. So on that note to what extent is the who giving by and . It was never an ambulance chaser. And it reinvented itself after ebola and that was only six years ago. After 2008 it had a huge cut in its budget for reasons that do not make sense. And that puts all of us are more risk. Frankly you can criticize the who. And we are supposed to do that. We are the only game in town. The only collaborative effort with a very real risk because its the only agency weve got. And the question should they be the ambulance chaser . So then who is there to fill the role . And with the new responsibility. Also with a comment about being a journalist and as a veteran reporter to what extent have you seen the challenge that scientists have and the literacy on the part of journalist . With effective and accurate communication . That is one of the few breaks some people are covering themselves with glory. But there are a lot of other people and a lot of scientist are going out there to make a point to communicate with the public which i have to say was european it nearly a make a statement in print to say sorry i cannot get back to very busy the scientist were working 24 7 toward various things having to do with covid and engaging allied of public outbreaks. And eventually saying i am writing all the opeds but unfortunately they were points that we already talked about. Also that has to be challenging and to what extent do you consider the research for have the possibility to do Public Outreach with that communication and others to change that type of information and that is definitely a challenge as well. And then i very depressing one on many levels and certainly buttress through those political spheres so how damaging has this been hitting journalist or scientist can do to counter that quick. Thats one of the reasons i wrote the book so preaching to the people so that they are sympathetic and the book hopefully to contribute what you can add a time when i can really hear it no Information System is ever perfect of course that will happen was scientist you are more articulate than others. So there are notable exceptions may be that skews what we hear but then to continue those meetings among scientist have no problems talking to each other what they have to say the rest of the world that we can get the right scientific message. They have been told that the scientist are the devil and to any conspiracy theories that evolved because they were certain psychological traits and not constrained by fax so they could be appealing as they need to be. So one that had not struck me that the vaccine industry and more broadly incredible situation the hesitancy against the vaccine that doesnt even exist yet. They probably would not take that because of their concerns and to be very challenging with the Silver Bullet it might even have enough people that are willing to take it. Strictly looking at as an information problem we seem to think if they sincerely explain the facts to people with all the research to show the impact to explain Global Warming and then why do they try to explain this to me . There must be a broader answer to establish trust to begin with. We have to get discussions going within community and people speaking in terms of values and language and the facts should be able to spread that way from one group to another. I been talking to people. Im not an expert myself i only report what i hear. We need to be a lot more aware. I know why very prominent scientist who has done a lot of work and they cannot understand the quantitative arguments that he makes. That is a problem in these dialogues. There needs to be more ways to present simple factual evidence regardless of politics or personality and i know how you do that. Maybe thats the next book. [laughter] you make a good point to make that is disrespectful. That they can be wary of vaccines because of the pandemic could cloud those important conversations we want there to be a safe and effective vaccine and we do worry the rhetoric used by some anti vaccination and advocates but to see how that evolves. Think of the concept of the vaccine to be a Silver Bullet to the pandemic. Is that the way we should think about this quick. I understand the midst the funding and the rush to get to a vaccine where is something similar . And i looked around people said were not doing nearly as much there has been some very good work done on the treatments and preventive measures but there were some very promising anti corona vaccine but then everyone decided it was not coming back and then they need to do more digging. Im not quite sure i would like to know in the who still said the coronavirus is a threat. But at the same time the whole business of the Silver Bullet that leads to a rather regrettable situation that russia has approved for general use of vaccine only been through a phase one safety trial may be a bit of a phase two not the big phase three with thousands of people to establish if it works. You need all of that. Apparently has been approved for general use as that is the arcane wh the two on to be we chose thing but it is way to get kudos for the government involved. So it is nationalistic. It is considered to be a nationalistic gold and that is a problem because it clearly doesnt care what country it is in. In the book i outlined the situation which countries cannot afford vaccines there are a few poor countries that dont get it but they will keep circulating it will evolve and then eventually it will have a vaccine that you do not work against. Its not in anyones interest. Is not that i am a survivor of the seventies. Its true. We are in this together. We cannot protect ourselves without protecting everybody. And then our people get it first after we save the world that just undermines everything. I think moret the vaccine issue in terms of manufacturing capacities and also more generally the pandemic a lot of talk about how but therethere is also a lot of differences and how it operates. To what extent do you think it is a helpful metaphor versus one that might be a bit misleading . Guest like anything that is misleading those are accurate reflections of the truth. We had a pandemic in 2009 everybody was worried about because it was a direct descendent of the 1918 virus and put everyone forgot as everyone boris everyoneborn before 1957 y immune to it. They didnt actually check that every early so they were worried it was going to be pretty nasty because 1918, but it turned out okay because anybody born between 1957, where people were the ones that normally die of the flu [inaudible] thats one of the reasons the 2009 pandemic was in that nasty. It made a small change in a protein and that wouldnt have been the case. It could have been pretty bad. Right now, weve got them both europe and china a virus like that circulated that had those changes and already is jumping to people. We have no idea what its going to turn out to be. I mentioned before wouldnt it be great, if they were still dealing with covid19. That is a possibility. One of the problems with the flu you handle it in a particular way. It travels very fast. There is no choice theyve been rightly promoting with the first. Everybodys pandemic plan votes for flu because its like that was the only pandemic they thought would happen. It doesnt say pandemic plan it this flu pandemic plan. For good reason we know that is what the flu does so we have to be prepared for it. But its something completely different and we were not prepared for this other thing. Obviously it goes both ways. We need to read the article to the end and do a lot of different things. The flu certainly. I cant believe there is currently a lawsuit talk about this information in the states against the National Stockpile of the one antiviral drug that we know works, and thats tamiflu, because people have been doing this systematic Misinformation Campaign and theyve taken in some prominent ones claiming to have science to show it doesnt work. They have science looking at how it works on the seasonal flu and how it works if somebody is dying of viral pneumonia and a pandemic. Its completely different and in that case it works very well. In the United States has stockpiles of the drug tamiflu in case there is a flu pandemic. And been subjected to legal challenges in the stat states ai think in europe as well because there are few nihilists that they have doesnt work. I honestly dont know what their problem is. Ive tried to understand it. Its just a thing theyve latched onto. There are facts showing its not. But weve actually got preparation there. You sort of feel like throwing your hands up in the air sometimes. Host in investigation that needs energy and attention. On that note, i think one of the things i thought was interesting in terms of what youre saying about influenza and the we recognize that didnt have to be influenza. Who couple of years ago had a list of threats they recognized as the next thing that could be something and [inaudible] covid19 is a virus certainly an unknown type of virus. Host guest they said the sars virus was on that list. Host [inaudible] its been discovered in baths in china over the last few years and raised concerns about the possible transmission to humans and Nothing Happened so where is the link missing between scientists and policymakers . Guest i was talking to david, and the needs right hand man. He knows where things are buried on this kind of issue and basically i was encouraged to hear him say the same thing i did. Its the scientists try to discover the virus and say this is what they can do. This is a threat. We are putting pandemic risk and the title in case you missed it. What else can they do . In North Carolina they went to work on some drugs because nobody else was doing it even though they are primarily [inaudible] its no ones job to take the warnings and sit down together and say what are we going to do. Now the who effectively do that, you mentioned by putting together a list of providers and that did include the viruses like what turned out to be covid19, so we can say we were not warned. And they said we should be working on vaccines for these. They had a roadmap working on drugs, diagnostics. All very good. A lot of hours were put in, top scientists of the book came together and agreed. Whos job was it to say you do this, you do this, heres the money . Thats what we need, some kind of agency, someone whose job it is to take the warnings and act on them, not just put them out there and hope someone bites. They put together the coalition group, the preparedness Innovation Group that is leading the research now on some of the vaccines that was the only Organization Funding coronavirus vaccines when this hit. Thats all that was going on and that was only set up a couple of years ago. One of the thing that was set up in the wake of ebola come everybody is scared about it possibly being usepossibly beina biological weapon a few years ago. So while canada went to work on it, but it was never really developed for the market because there was no money to do it and it took an entire year to get it tested to the field during the pandemic of 2014, they finally got it on the field in 2015. They said okay weve got to do this faster. Weve got to do this better and put this together more systematically. Good, they took that lesson home. But it wasnt really enough because they didnt have a multimillion dollar effort to develop because they have the warning in the roadmap. We also need to stuff when i talk to scientists that is the one they tend to say they are worried about. Speak to guest basically, you know, i actually was in a meeting indiana we were all talking about this sort of thing. They said i found this interesting coronavirus. This was in 2016 an 2016 i justo point this out. But every one of them, they said i dont need them. It kills anywhere up to 75 of the people who got it. So far its been limited because you catch it directly. A bat is contaminated and you know, but its moved into Southern India as you probably know. Its starting to spread between people and respiratory droplets. Where have we heard this recently, thats scary. If its spreading like ebola, shared bodily fluids, thats scary, but respiratory droplet, its hard to control. The flu spreads that way, covid19 spreads that way. If this virus learned to do that and it didnt become less lethal, i know scientists who call that civilization and i think they are right. The thing about this there is a worrying belief which i havent come onto i would have thought there were some scientists. I think they are working so hard they dont have time to do that. If something goes pandemic if it has to become wild. I was told that once dead on straight in my thats okay. Bird flu kills 16 . It will become milder. How do you know that . It just has to. Evolutionary rationale has advanced for this and the other rationale out there. Its not necessarily in a virus to become milder that learns to spread from persontoperson very readily. Look at hiv. Its been out there for a while since i think about the 1920s, the latest s. And certainly since the 1980s its been spreading and hasnt gotten any milder yet. They go got the last mutation tt allows it to spread between people i dont think we can count on that. It didnt happen with bird flu invaded the experiment. That is scary. Covid19, everybodys going my daughter turned our world upside down. Sars had a 10 fatality rate. Covid is 1 . Half the people over 60 who got sars died. What if that had gone pandemic and we were on the edge of it. If it had gotten loose, people were telling me, senior people at the who were telling me if it gets loose in bombay or manila or somewhere we cant control it, we will never get rid of it. Fortunately, we got lucky and the who led a very effective campaign. We had contact tracing, gordon quarantine. Everybody cooperated and playful. Eventually the chinese were very open. They tried to deny that he was there that when they couldnt anymore, they launched an Incredible Campaign just as they have with covid19. And when they go to work on something they really go to work on something and so did everybody else. They finally got it back under control. That is ten times. People dont realize we are going through a lot of disruption the biological aspects are so important and the lack of transmission. Particularly early on in this pandemic it was a part of the challenge index stand a. Thats the confusion in the challenge in terms of this early response effort. I want to come back to the idea, another example when you mentioned sars in crowded cities, i think back to july, 2014, when the first case arrived and everyone was talking about the worstcase scenario and how many people died, this incredible deadly disease in one of the densely populated cities [inaudible] they were isolating and developing that vaccine and that comes back full circle to the earlier conversation, what would you say we can do now to really focus on preventing should it strike later this year or next year . Guest the nigerians had in place the structures to give polio under control. Right now india is talking about its infrastructure and its trying to transition back into the general Public Health monitoring implementation agency. What we need is for surveillan surveillance. We need to know whats out there and to be on top of it. They have that structure in place. The [inaudible] what we need is for surveillance and to find out what diseases people have and where the novelties are coming in and thats what we dont have. We need much more work to do that and to totally retool aging. The who to spearhead an effort to do global surveillance. Some societies want to just characterize every virus and that would be an enormous waste of money on the scientists, too. Basically seeing whats in people, developing good diagnostics, going to places that are hot spots of emerging diseases. India is going to cut down a forest and put in coal mines, that was the latest announcement from that government. That comes to mind here, those fruit bats have these things. Is anybody talking about going in and getting regular surveillance of exactly what the viruses are the people are carrying, we could do that. We have the technology that nobody is really organized it. We could do that in Southern China where we already have a track record of coronavirus jumping. We could do to places where people are in contact with species like various baths and a few others that carry a lot of these viruses and regularly monitor what theyve got and catch things early. That shouldnt be difficult. Somebody needs to do it and i think globally and going together is the way forward on that. Host in preventing those spillovers from becoming pandemics and by far the most Cost Effective tragedy we do need to think about the response infrastructure when there are cases and i think one of the startling things about covid19 is how its only the weak Health Systems that are affected by these. [inaudible] what are your thoughts on pitching the school of thought when we neeby many to be thinkie holistically . Guest i like the fact that uk put together a Response Team within 24 hours of an epidemic being announced. And excuse me, has the highest death rate in europe. But when it came to the response, it was just a dithering. There need to be clear plans and people who are not politically in charge of them. They need to be scientific experts. There needs to be a lot of thinking and planning and investment and a response at all levels. I am currently residing in the European Union and countries for being polle. Coupled in the samen and they were doing that, too. This has taught us where the problems are. Obviously countries are going to stand by their independence in many respects. Thats a good thing. But we need to work together. If one country is doing a bad job the country next door is doing a great job, its not going to really help because thats country next door is going to spill over. We can really only do this if we coordinate what we do. New zealand has done a fantastic job. It helps to be an island and have extremely leadership some suggest that wasnt a factor, but it helps to not be boarded by people that arent doing as good a job. To just let the scientists take the lead because they tend to agree with each other a lot and disabled, we need to do this. And we need to sit down before it happens to decide who is going to do that and what the options are, how we are going to deal with the possibility of what we thought we were going to have to do that we were prepared to. Nobody had thought to beef up the capabilities and tracking and tracing and i think britain still doesnt have a map. Its just an incredibly disorganized and a number of countries. We should all sit down and organize that. A lot of the viruses that are not that well used to us in fact even a pandemic flu when its just Getting Started up my spot spread so fast that the containment as an option. We could do tracking and tracing and all that good stuff. Even in the flu pandemic if that is the way that its beginning. So we need agencies that are nimble on their feet and top scientific advice as it becomes available can change as it becomes necessary. Anybody who specializes in organizing the response does kns that these are the factors we need to continue. Nobodys done that. Is there a Pandemic Response agency, there are Health Agencies and ministries and the ranking laboratory, the chief scientist who might be a physicist. Theres not a Pandemic Response agency and not one sufficiently funded and equipped and advised by people, people that are experts at that risk assessment, risk communication. The who is starting to bring in social scientists to help. Theyve made serious mistakes in some cases to communicate this to people in africa during the ebola. It started to take those things on board. When it retooled itself as an emergency refund effort they had to bring in people from the humanitarian response community. They started hiring people that didnt even have doctors that were really into emergency response. They said its like trying to teach a penguin to fly. [inaudible] we can evolve institutionally to deal with the risks we know are coming as long as we bring everybody in and anybody is likely to be a stakeholder in mass. I suppose there is a case to be made for bringing organizations that might be against vaccines or dont trust the science. They will know what the risks are and why this is in their interests. They are expecting that you leave to do the planning. We need to find a way past that. Going a little bit deeper into that, we talked about the past examples of the panamax and cycle of neglect. How do we break that cycle and come out of it, they are on board and have been for a long time. How do we convince the government and the big funders that now is how we change to start the investment moving forward . We should sit people down and say it could have been worse. It was just every country you could make. Almost everybody could have done a better job at this. Lets put money into this. I think where there is money it builds up an establishment and a bunch of people whose job it is to do this. We need institutional framewor frameworks, we dont need more hierarchies. We need experts around the world to be talking to each other. Weve got a very complex problem here. We dont need one at the top telling us what we need to do. We need a lot of people saying their peace and having ways of coming up with joint solution to various problems, identifying the problem from the start. Those are the general principles i think anybody in the private industry is probably starting to become aware of. We need more of that and more in the Public Health sphere. Its been neglected over saenz we all decided we defeated Infectious Disease back in the 70s. We havent and weve known for some time that this was coming. Basically what we were talking about a minute ago, that its nobodys job to deal with this. People are waving their arms. We need to create networks in Different Countries to talk to all the other agencies so we consider the kind of community of people that are used to dealing with this and visiting each others laboratories and know how their Surveillance Systems work that can swap advice on how to make things work and abdicate for more money for preparedness with the governments. I think as a result of this but we need more than any thing else is to continue to phase out these problems. Its going to be a Little Agency in an unlikely country that spots the next outbreak. It was probably a doctor in the hospital but said weve been getting an awful lot of pneumonia lately, i dont know what it is. And then there was a system that would have allowed the doctor to tell beijing directly. That kind of system, if its everybodys job and they have too told the Central Authority directly from local people who are kind of worried about the economic impact, that was a good system for chinese set up. I think we should all have that. Its a shame the local people decided to tell the doctor is to disregardoctors todisregard forl reasons they may have had. But if we all have the people whose job it is to monitor these diseases talking to each other, issuing alerts, theres the online permits where if theres a problem, we find out about it and they were the first to let everybody know about sars. Theyve done a lot of that. But on an official level where everybody is talking to everybody. I was talking to an economist at the university but also wrote it up during lockdown and also thinks we need a way of getting past National Sovereignty in the matter of dealing with disease. He uses an example of the brand and want wants agreements and treaties. Its interesting that hes thinking the same way. He says the pandemics are mainly an information problem. I wish i included that idea in my book. Preventing a pandemic is primarily an information problem. People talking to people and institutions that can get things done. Host i couldnt agree more and certainly these are the type of lessons that will continue and i hope all of the World Leaders read your book and at least use these principles moving forward. Its been a pleasure to discuss these issues with you today. Ive really enjoyed reading it. Guest guest co. I will havek about the next one. This program is available as a podcast. All after words programs can be viewed on the website at booktv. Org. It is great to do this and thinking for join us with this chat but when we were planning