Managing COVID-19 Vaccine Distribution in Our Communities: A Conversation with Dr. Larry Brilliant

Michael Rivo: Welcome back to Blazing Trails. I'm Michael Rivo from Salesforce Studios. I'm joined again today by my podcast partner, Rachel Levin. Welcome back, Rachel.

Rachel Levin: Thanks, Michael. Good to be here. Really excited to start a new year since 2020 was quite the year that we all had.

Michael Rivo: 2021. Yes. So, to kick off this year, we're starting with a conversation that's top- of- mind for many people these days: the vaccine. We'll be hearing from Dr. Larry Brilliant, world- renowned epidemiologist. Rachel, what do we have in store for this episode?

Rachel Levin: Yeah. Well, Dr. Larry Brilliant, he's someone that is credited with having been part of the team that successfully eradicated smallpox. So, we're really lucky to be able to hear from this expert on kind of the state of play of the vaccine rollout, what it means for the pandemic, not just in the United States, but globally. And I have to say, Michael, it's been a pretty emotional ride since it was announced that the emergency approvals were given. And I know for myself, in my own family, it was just last week that my mom, 77, finally got the vaccine. And I have to say, it was emotional. It kind of felt like," Wow, there's some light at the end of the tunnel here."

Michael Rivo: It is. It's a hopeful episode and a really interesting conversation. Dr. Brilliant was many years with the World Health Organization and has some really great insights that he's going to share with us today.

Rachel Levin: Definitely.

Michael Rivo: Well, it's great to be back, Rachel. Thank you again for joining us. And now, let's join Salesforce's SVP of Global Government Solutions, Casey Coleman, and Dr. Larry Brilliant.

Casey Coleman: It's my pleasure to welcome Dr. Larry Brilliant today. For those of you who may not know who he is, Dr. Brilliant is one of the world's leading epidemiologists, notable for his work in eradicating smallpox. Dr. Brilliant, thank you for joining us today.

Dr. Larry Brilliant: Casey, nice to see you.

Casey Coleman: I'd like to start with a little bit of context. You've been tracking this and you understand, what's been happening? Why have we gotten to such a slow start with rolling out the vaccine, and why haven't we been better prepared?

Dr. Larry Brilliant: I'm afraid that it's a tale of two cities, or a tale of two countries. Our friends in Vietnam or in New Zealand or Taiwan look at us, and they look at America, which has always been the leader. We led in Ebola, we lead in Zika and swine flu inaudible they look and they say," What's happened to you? Why are you having a quarter of all the deaths in the world? Why are your hospitals overrun?" Whereas in those countries, they've gone 100 or 200 and 300 days with zero cases. I think we have to separate out what's happened to us as the virus, and then our response to it. As far as the virus goes, epidemiologists have been predicting a pandemic like this for several decades. Amongst our little group, it's always been a question of not if, but when. And the virus has done exactly what we expected of a coronavirus. Other than the pathogenesis, what it does to blood cells and blood vessels, there hasn't been much about this virus that has surprised us. What surprised us the most is that for the first time in history, really, the federal government said," We're not going to coordinate it. We're going to leave everything to the states." I think a lot of the issues about how long it's taken to roll out the vaccines, the difficulty we've had with knowing what numbers we've had, fights over masks, and all these other things can be traced back, unfortunately, to that decision. But I think we're going to be out of the woods from that pretty soon, and things are going to look a lot better.

Casey Coleman: Well, I'm encouraged to hear you say that. So, now that we are looking forward, what do we need to do now to get the vaccination effort right?

Dr. Larry Brilliant: First, there are no approved vaccines. We do have two that have gotten Emergency Use Authorizations. They're both vaccines that are made in a way that would make us celebrate science. We often say the virus is traveling at exponential speed, but in this world, science has also been traveling at exponential speed. Usually it takes a decade to get a vaccine. The fastest we've ever had one before was the mumps vaccine, four years. The work I did in smallpox, we had a vaccine for 200 years before we had a program. We will have, from start to vaccine in people's arms, less than one year for these two mRNA vaccines. It'll be a little lumpy. The manufacturers are having difficulty predicting how quickly they'll be able to deliver, we've had some difficulty in creating a reservoir or a storage of the vaccine, there've been some disputes about how many vaccines there were in a cartridge and things like that. I think that's to be expected. We should take a deep breath, the vaccine will reach us. The United States government has pre- purchased 200 million doses of Moderna, 200 million doses of Pfizer, 100 million doses of J& J with more to come. And then there's six other vaccines. We have purchased and have coming 150% of all the vaccine that we would need to give two doses to every man, woman, and child. And we will get it all in people's arms as fast as possible.

Casey Coleman: Well so, on that note, what role do you see technology playing in this effort? It seems like that's a key enabler.

Dr. Larry Brilliant: Well, there's been a phenomenal response from technology in two very different places. First in the biotech, to understanding how to do the test, to understand the monoclonal antibody cures, to understand how to get the vaccine. And in Infotech, it's really been fantastic. Salesforce's contact- tracing system, which, I've been involved with Marc Benioff since the Ebola outbreak when Marc, in a weekend, got 1, 000 hours of pro bono engineering time to make a contact- tracing system for use in West Africa. Those kinds of systems, I think some of the digital tracing systems, and the digital component of testing has been phenomenal. We really couldn't have come so far without the tech revolution. I'm leaving out the question of social media because, of course, that's rather controversial.

Casey Coleman: Yeah. Good point. Well, I'm encouraged to hear about the vaccines and the number that have been purchased. But what about all the new variants we're hearing about, how the virus has been mutating and there are new strains emerging? What effect does that have on vaccine effectiveness?

Dr. Larry Brilliant: So, this is really important. We're really in a foot race, there's a race, and I want to be careful and have everybody understand it. When there are only 10,000 cases of coronavirus like this in the world, you would expect a dozen mutations to occur. When there are 100, 000, if the rate of mutation was the same, you'd expect 10 times that. If there were a million, 10 times that. But there's hundreds of millions of cases now, and they're going to be billions of cases. And with every increment, it is natural to expect more and more mutations. And if there's enough mutations, then we call the new virus a variant. One of those will surely figure out, if you want to assign human properties to the virus, will figure out how to elude and evade our vaccines, our treatments, our tests. So far, that's not the case. So far, the new variants seem to be stopped by the vaccination, found by the test, and cured by the treatments. But it is urgent for us to not allow the virus to replicate so many times that the roulette wheel game of chance goes against us. And that's why I say it's really a fight. But today's variants will be stopped by today's vaccines and today's treatments.

Casey Coleman: I see. All right. You spoke about other controversies that have emerged. The whole vaccination program and the COVID- 19 response more generally have raised crucial issues that are critical to human rights and privacy. How should we as business leaders, community leaders, and as citizens consider these factors in our response planning?

Dr. Larry Brilliant: Well, I would first start out by looking at the world as a whole. I mentioned that the United States will have enough vaccine for one and a half times our needs, Canada will have enough for three times its needs, England three times its needs. There's a pattern here. The wealthy countries were able to pre- purchase the best vaccines. And it has squeezed over 100 poor countries that are supported by a different kind of arrangement called Covex, which is a kind of consortium of the World Health Organization, Gavi, which is the vaccine distributioner, and CEPI, which is another philanthropic group that makes vaccine. But they've only got enough doses for 1 billion people. The world population will require that that group will have to vaccinate maybe 4 or 5 billion people. That shortfall will mean that the disease will continue going in places like India, much of Africa, Latin America. That's not good for us or for them. Enlightened self- interest makes us say," We have to help those countries." Otherwise, the virus will keep replicating, more and more mutants will come. It doesn't matter where they come from, we'll all be at risk. So, that's the first thing that I would say. As far as the US goes, we're going to be doing pretty well, it's just going to take a while for us to get enough vaccine every place. And we have a lot of questions to answer. It is logical to want to vaccinate people who are at risk of dying, that's why we allocate a lot to the over- 70 group. It's important to vaccinate people who, if they are absent from work, the hospitals will crash, that's why it's important to vaccinate the doctors and the nurses and the housekeepers and the respiratory therapists. It's important to keep the rest of society going, that's why we prioritized essential workers. But now, as those get vaccinated, there'll be a struggle. Do we prioritize schools and school teachers? Do we prioritize people who are in an outbreak? Those decisions will be made by the new administration. And I just want you to know the new task force that the Biden administration is bringing in is world- class. These are some of the best epidemiologists in the world and I've got tremendous confidence that these issues will be solved in an equitable, fair, and quick way.

Casey Coleman: I'm encouraged to hear that. But having vaccine is one thing, but taking it, and at a rate that's efficacious, is another. What about people who, for whatever reason, don't want to be vaccinated? What would you say to them? And what advice can you give to the rest of us on the months ahead?

Dr. Larry Brilliant: First, to be kind of gentle with each other, I suppose, is what I would say. The first vaccine was in 1797. Edward Jenner took a little bit of pus from a finger of a milkmaid who had been milking a cow, the utter had some pus on it, and took that purse and put it into the arm of a boy and he was now immune from smallpox. But I'm not so sure that I would let my child have that vaccine with that pus- y origin. So, if the first vaccine was 1797, the first anti- vax movement was 1798. And I've been through vaccine resistance in India to the smallpox campaign, because the smallpox vaccine requires killing cows to make the vaccine. We've had tremendous anti- vax movements against polio, and in fact, over 100 polio workers in Pakistan were murdered. So, we should not think that we alone are suffering from this difficulty in understanding where that anti- vax movement is coming from. Look, I would say this. As people see that their neighbors who have been vaccinated are healthier, that their children are not getting the disease because they have been vaccinated, a lot of the anti- vax part, which is based on fear and uncertainty, will go away. Right now, we're doing better. 60% of the US population says they will take a vaccine, a COVID vaccine, and another 20% are saying they're not sure. My guess is that the anti- vax movement will, if not melt away, it will decrease. Now, there is a part of the anti- vax movement that has become very political. And it's inaudible along with some of these issues of freedom and personal rights. That gets very confusing. That's not the anti- vax movement that I'm talking about; that's a political movement and a conversation for another day. But the anti- vax movement that's based on concerns about this vaccine, I think that will be reduced as the results of the vaccine. We will go from, as we do in life often, something to" I'll never do that" to" I can't live without it."

Casey Coleman: Yeah. So, as more and more of us do that, eventually we'll get to the herd immunity. When do you see that happening? At what threshold and what point in time?

Dr. Larry Brilliant: There's a Greek myth of someone being punished, his name was Tantalus. And the image is that he's in a pit and there's a bunch of grapes dangling from the top, and every time he reaches for the grapes the grapes recede. That's what herd immunity is like. For the mathematicians, think about an asymptote. You almost quite reach it, but you never get there. If we reach that magical number, which, about 60-65%, 70%, there won't be rainbows and unicorns, bells won't ring in all the churches, and everybody will get out of school with a free day. It will be a continuous variable in which we suddenly find dampening of viral transmission because the density of susceptibles has decreased so much. If the percent of vaccinated and immune goes up, the percent that are susceptible goes down. And as that happens over time, different places will do better. Maybe New York will be totally free of the disease because everybody's been vaccinated, maybe Los Angeles will lag, or the other way around. So, we will see a hopscotch pattern of places that have almost no transmission and places that still have work to do. I think that's sort of what the future looks like. It won't all happen overnight.

Casey Coleman: What you've talked about are kind of competing situations where the virus might mutate, new strains emerge, and then our vaccine, we're racing to get into everyone's arms. But in our pre- discussion before the show, you were also talking about the importance of rapid, easily available, inexpensive testing as sort of the other piece of dealing with this crisis. Can you say a little bit more about that?

Dr. Larry Brilliant: So, for everybody who can hear this, everybody on this broadcast, you can help stop the emergence of new variants. The more you wear your mask and social distance, the more you get vaccinated, the more you encourage your friends to and help reduce the rate of new cases, you are actually playing an active role in reducing the risk of new variants. That's one way in which you can help. I think your other question was, what will normal look like? Or, what will the new normal look like, and how will we get there? And what does the crystal ball say? I think what will make us feel normal, while in the background that process of getting really genuinely safer because more and more people are being removed from the" susceptible pot," as it were, what will make us feel better are a totally increase in the speed and quality of testing. Right now, if you want to have a point of care test, it's an antigen test, there's 150 antigen tests, they're of unequal value. Sometimes they're pretty good, sometimes they're terrible. So you get the speed, but not the excellence. The excellent test, the PCR, sometimes takes two or three days to get it to you, it's$ 150. When we combine those and you can have a home test that takes five minutes, costs$ 5 or$ 10, and is almost 100% accurate, you can do it every single day. And I think we're three months away from that. When you have that kind of a test and it's available in a sufficient supply, everything changes. Schools open up because the kids can be tested, the teachers can be tested every day. Live musical performance opens up because everybody will be tested. Travel opens up. That's when we will feel like it's more normal. The vaccine is actually making us move incrementally towards it being normal. But that change in testing, I think, is something that we'll all perceive as being closer to normal. And I'm optimistic that we'll be moving towards that. I think the fall semester in school will begin to look really normal. This summer, there'll be some kids' camps that'll be okay, some schools that'll work, some places will reopen. And we're getting there, I wish it were faster. But you mentioned earlier that 2020 was the year of the disease and 2020 is going to be the year of the solution, most pandemics do last a couple of years. I think this one's going to be no exception.

Casey Coleman: I'm just curious about the availability of home tests. Is that going to be the deep nasal swab? Because I personally am not sure I could perform that test on myself. I've had that inaudible.

Dr. Larry Brilliant: It's interesting that we, as scientists, we're reluctant to use saliva or spit. Not because they didn't want people to be able to do it at home alone, but because the science wasn't there yet. I'm pleased to say that the science has really gotten there. In the last few weeks, there's been paper after paper saying that saliva is at least as good as the brain tickler that you describe.

Casey Coleman: Well, I'm glad to hear that. So, any final thoughts as we go into 2021 and maybe have a bit of optimism about where we are and what's next?

Dr. Larry Brilliant: You know, the Second World War brought all of us together. We created NATO and inaudible the UN and all these other agencies. The Vietnam War was acrimonious, but afterwards we did come together as a country. I'm hoping, and maybe I'm naive and pollyannic, that this experience that we have, once we're able to kind of put it a little bit in the rear view mirror and understand the totality of it, I'm hoping that it will bring us together. Pandemics are not a right- wing or left- wing, Republican or Democrat, phenomenon. Democrats and Republicans, you may not believe this, have 99.9% of the same genome. We have to use this as an opportunity to come back together and to heal. And I hope that that will be the legacy of COVID-19.

Casey Coleman: Well, I hope so, too. And I'm encouraged by your thoughts on this, Dr. Brilliant. Thank you so much for being here today. We appreciate your perspective and your expertise.

Dr. Larry Brilliant: Thank you for having me. It's a pleasure. Go, Salesforce!

Michael Rivo: That was Dr. Larry Brilliant speaking with Salesforce SVP of Global Government Solutions, Casey Coleman. For insights into this topic and others, head over to salesforce. com/ blog for resources to help guide you through today's changing economic and social environments. I'm Michael Revo from Salesforce Studios. Thanks for listening.