Back to School: What Parents Need to Know - A Conversation with Dr. Geeta Nayyar, Dr. Carlos del Rio and Aneesh Chopra

Michael Rivo: Welcome back to Blazing Trails. I'm Michael Rivo from Salesforce studios. And today we're catching up with Dr. Geeta Nayyar, Salesforce's Chief Medical Officer. With an update on the pandemic, including what parents need to be thinking about when it comes to sending their kids back to school, and how companies can take the lead in fighting the Delta variant and the resurgence in infections. Joining us to discuss this is Dr. Carlos Del Rio, Executive Associate Dean of the Emory School of Medicine and Grady Health System, and Aneesh Chopra, Co- founder and President of CareJourney and formerly the first U. S Chief Technology Officer under President Obama. Welcome to the show, everyone. So welcome to the show, everybody.

Dr. Carlos Del Rio: Delighted to be with you.

Aneesh Chopra: Good morning. Pleasure to be here.

Dr. Geeta Nayyar: Thanks for having me.

Michael Rivo: Okay, wonderful. So Dr. Del Rio, I'd like to start with you. Can you give us an overview of where we are with the pandemic right now?

Dr. Carlos Del Rio: Well, thank you. I think we're not in a very good place, right? The pandemic in the last several weeks has had a significant uptake, primarily through rapid spread of the Delta variant. And we're currently having close to 150,000 new cases per day, we have over a hundred thousand people hospitalized and we have reached now 1500 deaths per day in our country. So the good news is that it looks like in the last several past few days, we are beginning to see this state- wise. So maybe we're going to start, cases beginning to not continue to go up. And neither hospitalizations deaths are continuing to go up because that's right about two to three weeks behind cases. But in a way we may be reaching that famous peak in this Delta surge. And maybe we're going to start coming down. That the other thing that has been good is we are beginning to see also an increase in immunizations. And when you think about people over the age of 12 in our country, we have now 62% of the population fully immunized. So there's good news and there's a lot of bad news. And the major message is get vaccinated because this is not going to be the last search we have. We'll likely have other searches. We'll talk about that later.

Michael Rivo: Mm- hmm( affirmative). You mentioned 12 year olds and upcoming younger children getting vaccinated. I mean, this is something we're seeing with back to school right now. In my own case, when my kids started middle school and in the first week there were multiple COVID cases in the school. What are you seeing right now? And what should parents be thinking about with kids going back to school?

Dr. Carlos Del Rio: Well, you know, many of us made the mistake of saying," Well, kids seem to be less likely to get infected." And I think the kids in the first several outbreaks were less likely to get infected primarily because they stayed home, right? And if you stay home, you don't get infected. But then what happened is during this surge, we're beginning to see children getting infected. And we're beginning to see a lot of in young children, those under the age of 12 that are not being able to be vaccinated. And that's where we're seeing a significant increase in cases. And it is related to open it up, it is related to going back to school, but it's also related to schools and school districts where they're not following the CDC and the American Academy of Pediatric recommendations. Because if we are to immunize everybody 12 and older, who's around kids 12 and under, and we were to have mass mandates in schools and do good ventilation and other things, we can significantly minimize the impact of COVID in children. And the reason we haven't done that, it baffles me and continues to just upset me a lot because we're putting politics ahead of our children. And that to me is really very disappointing.

Michael Rivo: Mm- hmm( affirmative). Aneesh, it makes me think about this from a policy perspective and drawing on your experience working with the Obama administration, lots of people are wondering, I saw this morning actually about a federal mandate now that President Biden is increasing the amount of vaccination that has to happen with federal workers. But why isn't there a federal policy and how should we think about that?

Aneesh Chopra: Well, thank you for the question. And it comes back to the nature of our governance model in the United States. We're a 10th amendment country, where many of these decisions are deferred to states, as much as you possibly can. State and local governments make judgments about key trade- offs between science and public health, economic growth, in this case, kids in schools. And those judgments are informed by guidance, and so the federal government often issues, guidance. They're not required to be honored. I think Carlos made a very important point that we're seeing variability in implementation of the guidance, but that is the nature of our system. And one of the challenges we've always had in the Obama administration, I served as Chief Technology Officer, so I swim in my lane, the data and the technology and the information lane. H1N1, we had a real concern about its transmissibility and its potential lethality. And thankfully that was an area where we were dodged a bullet in the sense that it wasn't nearly as lethal, but we didn't have the information. And so, one of the challenges Michael is, to inform policy, you sort of have to have local truth in order to make those trade- offs realistic. So if you happen to operate a school, that's in a high community transmission environment, you might adopt a different set of protections than if you're in a community with low spread, in terms of judgments on masking and mandates for vaccination. So you'll have broad guidance and then you'll have a lot of community led judgment, hopefully informed by science and local truth.

Michael Rivo: Dr. G, I've been thinking about this from, as the Chief Medical Officer at Salesforce, thinking about this from a business perspective. How should companies be thinking about this right now? How to communicate with employees? How to develop policy as a company? What should we be thinking about?

Dr. Geeta Nayyar: Sure. So, first of all, I won't pretend to have all of the answers, right? This remains my first pandemic, our company's first pandemic. So I think leading with that first, because number one, we've learned how important the currency of trust is. And if you want to retain your employees and your customers, you need to lead with trust. And so being transparent in saying," Look for today's moment, this is the best information we have. This is the best way that we see health and safety being a priority, both for our employees, as well as our customers." I think leading with that, leading by example, whether it's around vaccinations, testing, access to health care for employees, helping customers with their own policies and procedures and mental health, right? I think that it's really important to remember mental health access, and supporting employees and customers through this. This has been a tremendously stressful time for many folks, particularly now, as we think about children being part of the equation for many families wrestling with working and also being parents. So, I think it's really that Michael, right? And just recognizing that it's dynamic, right? So policies and procedures of today may not work in tomorrow's environment. So really leading with that dialogue, I think goes a very long way in today's environment.

Michael Rivo: Mm- hmm( affirmative). Yeah, I think that point that it's dynamic, we've seen this is going to change. This is a moving situation and decisions are made at one point that aren't valid in another, which doesn't necessarily mean it's wrong or somebody wasn't being truthful, it's just the nature of this situation. And Dr. Del Rio back to you, you've said in the past that pandemics end, but right now that feels like a very far off. Do you think this is something we're going to be living with? Like the flu, you get your shot every year and we're living with it or will it end?

Dr. Carlos Del Rio: Oh, I think pandemics will end, but the virus will become a part of the endemic viruses. I go back to reminding people of the 1917, 1919 flu pandemic. But when that pandemic ended, that virus remained in the circulation for many, many years, until 1958, when the H1N1 virus was substituted by the Hong Kong flu virus. But the virus remained in circulation for many, many years. We had in 2009 H1N1 pandemic, and now that H1N1 virus continues to be in circulation. And in fact, it's part of the vaccine. So I think this virus will become endemic and will be with us for some time. What I see the future being is, I think we're going to see in the future increasingly, we're going to see what we're seeing in our country. You're going to see parts of the world highly vaccinated, where are you going to have small outbreaks, localized outbreaks in areas that are not as well vaccinated. And then you're going to have a lot of the world, which is mostly un- vaccinated, where the deceased transmission is going to continue in a significant way. And that is a good reminder that in order to make this pandemic end, we need to address the global pandemic. We cannot just be U. S Centric because we're just U. S- centric, we are simply not addressing the pandemic. And I think the U.S has a tremendous role to play in leading the global response. And I am hoping that we will assume that leadership role, because I think it's a critical component.

Michael Rivo: Mm-hmm(affirmative). Aneesh, it makes me think again about, you've got this unvaccinated group for variety of reasons, but a lot of people are hesitant or refusing to get vaccinated. And it kind of goes back to this idea of this crisis of trust that we have right now, where people aren't trusting the vaccine, they're not trusting the government. What do you see that we can do about that to, this is a very big question, but about that crisis of trust and how to get trust back and get that information disseminated to the people?

Aneesh Chopra: Yeah. So, like everything in life, I think we have a portfolio of at least three vectors of change that we must pursue. One, I think is we need to reassert your caregivers, your primary care doctor, your frontline trusted physicians in the distribution of vaccine and in the conversation around vaccine. So we had some debate about whether we plus up the payments to doctors for administering the COVID vaccine. And I think that's a dial we have the ability to turn a little bit more. I think generally speaking individuals will trust their physician on medical recommendations. And so we have room for improvement, I think in that vector. Secondly, we have this policy question that the Surgeon General has really put forward around social media disinformation. And one of the challenges is that, you know, we have a scenario where the most popular Facebook video viewed was of someone commenting about a breakthrough infection that resulted in death and some misinformation about the negative effects of the vaccine. Now, one of the challenges of this policy debate on social media disinformation is who really should decide? Do you want Facebook internally to decide? Do you want the U. S government to have sort of a macro list of all the content that you can or can't talk about that feels very 1984? There may be a middle ground, which is that we achieve some kind of multi- stakeholder consensus on what constitutes social media disinformation around the vaccine, and to have all stakeholders at the table weighing in and have the industry kind of agree on how it would flag or treat content that is deemed not only potential purveyor, not only the content itself, but the purveyors of that content, the account holders to see what we should do about canceling accounts or constraining the propagation of disinformation. I think the third category is accessibility. And so we've done a great job. You can walk into almost any retail pharmacy and get the vaccine, but I do believe that if you look at the objective data, underserved communities, that may not be subject to disinformation and may not be vaccine hesitant, but just don't have access or to know about what it would take to get the vaccine. We may need to do more on tackling access issues. I feel like we've done a lot to the savvy. You can go to vaccines.gov, you can type in, but large swaths of the population may not be on the internet, may not be connected or aware of these options. And so I think we've got to take this and all three vectors, but to Carlos, his final point, I'll leave you here. It strikes me that we need to reach some equilibrium on what is a reasonable amount of COVID activity and the community that doesn't have us worry. But I think at the 150, 000 level we're at today, Carlos, I'm guessing we've got a lot of variation mutation risk and that we just can't tolerate the current status quo.

Dr. Carlos Del Rio: Yeah. I couldn't agree with you more. The status quo, what we are right now is totally unacceptable. I think that, what would be an acceptable level? I think many of us have said," Well, you know, we can bring deaths down to about a hundred desperate days, which would put you right around where the flu is, and you can bring hospitalizations to a place that the hospitals wouldn't be overwhelmed and ICU would be overrun, and you would not need states like Idaho, declaring this fester crisis mode. We need this to be really like the flu, in which case we would be at a level that we could continue functioning as a society. But we're far from there.

Michael Rivo: Yeah. I mean, it seems like we need everybody to get on board with this effort and Aneesh, what you were talking about with bringing all the stakeholders together and taking action. Dr. Del Rio, when you were talking about the hospitals being overwhelmed, is there a role for government to set up triage hospitals? Should government be going, or private companies be going to those underserved neighborhoods with mobile vaccination? What can we do to mobilize these efforts?

Aneesh Chopra: Yeah. We should definitely get Geeta's perspective on how public private partnerships might drive this. But I'll tell you, from my perspective, I volunteered for Chicago, the City of Chicago built a data hub that allowed them to pinpoint roughly where all the challenges were. And the policy lever is as follows: Michael, look at where we distributed the provider relief fund, the billions of dollars that Congress set aside. Unfortunately, most of those went to institutions that were not really driving the kind of clinical transformation and saving the kind of lives that we know we could have saved if we proned early and did all these clinical interventions. And so there was a little bit of a mismatch between doing the right thing, conceptually, and what we rewarded with cash. And I think in that scenario, if we align the incentives to close the gaps, we might've had a slightly different response. And we have ability to make influence over that moving forward. Really rewarding better clinical, which means finding the underserved communities, getting them prevent the spread of COVID, reward that and reward if one gets COVID, the outcomes to reduce disease progression with more effective treatments. Rewarding that in our financial system could be a way. But Geeta, I would imagine public private partnerships have to be the key.

Dr. Geeta Nayyar: You know, there's certainly one part of it, a niche, right? So in the absence of this unified leadership, and in the absence of a unified strategy, this is exactly what our CEO Marc Benihoff talks about, which is that business can be the greatest platform for change. So whether it's public or private or both together, it's certainly an all hands on deck crisis, and we need to do more of that. At Salesforce we're doing much in this regard, whether it's with our partnership, with the Gavi Alliance, whether it's in our work across the globe, because as Carlos mentioned, this is going to be unfortunately here for years. And it's also going to be the folks, the haves and the have- nots is what we're seeing, right? And so, as we think about equity and the underserved, it's very much the underserved across the globe that we need to make sure we are addressing if we're truly going to get to a place where this is a virus we can live with and go about our lives. So no lack of leadership, I would say that many companies are leading in this regard. We've seen Google, Facebook, many folks who have said," We were going to go back to life as normal by the end of the year." And as this situation has become dynamic have said," Nope, stay home, take care of your kids, do what you have to do, get vaccinated. That's how we're going to do business as a business." So these kinds of partnerships need to continue, and we need to continue to also partner on leadership, right? Whether it's advocacy, whether it's working with local and regional states at the federal level, having medical and scientific experts, both in the private community and the public community talking and making sure strategies align is really, really critical, and just another tactic for us to get to the end of this, which is a long way away.

Dr. Carlos Del Rio: But I also think the private sector has a major role to play. For example, modifying the sick leave policies. I think we all have gone to work when we've been sick, because presentism is a reality. A lot of people cannot afford to be out of work. And we need to really change that culture that we have. And we really need to make it easy for people to say," Look, I'm sick today. I'm not going to go to work, because there's a risk of transmission." And that's really a mentality change that has to happen in our workforce.

Dr. Geeta Nayyar: A hundred percent. And I think hospital policies, right? Carlos? Our doctors and nurses that come to work sick because they feel so-

Dr. Carlos Del Rio: Oh, we're the worst.

Dr. Geeta Nayyar: We're the worst. So I would say the hospitals need to leave, but absolutely every employer needs to leave. But every resident, every doc, every attending, they pushed themselves to the limit. As we're seeing with physician burnout, that this is a whole different dynamic, you're right.

Michael Rivo: Mm- hmm( affirmative). It's interesting that at this point, we're still at the point of needing to get vaccinated and needing to manage sort of the most basic level of this pandemic. But I was thinking about the technical solutions that I haven't heard about as much, with contact tracing, with other technical infrastructure to help us go back. Aneesh, Maybe you can speak to that a little bit, around what does that future look like when we do, hopefully get a little over the hump here with just getting people vaccinated and healthier?

Aneesh Chopra: Yeah. And I look when you're putting out this massive forest fire and you're down to, as my friend Farsad refers to as embers, then you can implement the strategies that we know work. Which is to say, some relatively simple and ubiquitous testing to identify hotspots before they really spread, to address the kind of not locked down, is not the right word, but the kind of more isolation, quarantining in a micro environment, get people safer comfortably at home while they wait out the spread. We have the capacity, we have the tools, we have the know- how on what it takes to constrain rapid growth. And unfortunately, right now we're so variable in America, we have hotspots that aren't really doing the basics and we have low transmission in communities that have built up the muscles to do it well. And so we've got a misallocation a little bit. We kind of need political consensus on how to drive like the prioritization of stamping out this forest fire, which you would have thought we would have had agreement on many, many months ago, but that will take political leadership. And I think that hopefully.. Well, vaccines did bring us together for a little while. And so hopefully we can kind of go back to after we tamped down the current outbreaks to get back to a new normal, better surveillance, testing and the like.

Dr. Carlos Del Rio: I do think, when you think about technology, I think the technology we haven't utilized effectively, even this late in the pandemic has been rapid testing. I mean, I think every access to rapid testing needs to be readily available so people can test themselves. And if they have a contact, they have been testing for schools. I think that many of the available rapid tests over the counter are simply too expensive for most of the population to be using. And I think making rapid tests that are readily accessible and available to people could be very transformational.

Michael Rivo: Mm-hmm(affirmative). Yeah, it's true. We just used a rapid test this morning. It was 30 bucks for that test.

Dr. Geeta Nayyar: I would agree with both Carlos and Aneesh. I would also add that telemedicine as much as it's seen a boom here during the pandemic, as I think about what the schools are going through, as I think about you, Michael, doing the test on your daughter this morning, right? Folks need help. And sometimes they just need a nurse, or a PA, or a pharmacist and of course the doc, if the doc is available. But I don't think that we have gotten people to practice at the top of their license and gotten creative about scaling with virtual resources. And I know we think of telemedicine as a video visit, but telemedicine a phone call, it's a text, it's an email. It's anything that is reaching the patient where they need at the point of care, which right now is increasingly at home, at school, in places everywhere, but the hospital. And I think we have a lot of work to still do in that regard.

Michael Rivo: Is there an opportunity for the federal government to be involved with providing that testing at a lower cost of setting up the infrastructure, the technological infrastructure, to be able to test, et cetera?

Dr. Carlos Del Rio: Let me tell you what I think, what should have happened and continues to not happen. Testing infrastructure cannot be moved, right? So when Boston created a lot of testing infrastructure bill, suddenly there was an epidemic in Texas, and there was not enough testing in Texas or not enough testing in Florida. There needed to be some sort of air traffic control that said," Okay, we can take testing samples from this place and move them rapidly over here, test them and send the result back electronically." But we don't have that. So what you end up having is states competing. From the very beginning, we had the federal government tell states," You guys compete against each other." So that we're bidding each other for ventilators, that we're bidding each other for testing. It's just insane, you cannot allow a system that allows... Right now, we're all bidding out each other for nurses. It's unbelievable that this late in the pandemic, there's not an air traffic controller managing this critical resources.

Michael Rivo: And why is that? How do we end up here? We've had two administrations, we're in a different situation. Aneesh, do you want to take a pass at that?

Aneesh Chopra: Well, I actually think that stabilizing. I think that was a true advocation of duties in the prior administration on this issue. I think that's an objective fact. I try to be nonpartisan in my comments, but I just feel like that was an advocation. We have all the authority we need to coordinate effective buying. But I think the way to think about this as Operational Warp Speed was about a financing model to reward an innovative approach to the problem. And that was all role of government. I think, well, public private partnerships with the government's decision to pay in advance of whatever the product is, that's a policy choice. And so on the range of things one can do to invest, to bring closer to D, you know, the R& D closer to D to market, that's a natural white space for the U. S government to help bring, what does it take to get a$ 2 test into the hands of every American? That is a judgment that could be funded with rewards and incentives. So that's all very possible.

Dr. Geeta Nayyar: So, I'm just going to add to Aneesh's answer in saying, for me and Carlos, you'll appreciate this right, as the two dorsum podcasts here. I also think that this is our first pandemic truly, right? At this level, in terms of a global crisis, all at the same time. And two, there has just been an absence of science and medical advisors at the table. So, so many decisions were made without a real understanding of how complicated this virus was, and what the public health implications were globally. And I think we continue to see that happen regionally, we continue to see that play out on the globe. So many folks have underestimated what the medical and scientific community were saying from the beginning. And making sure that we raise the health literacy globally and domestically remains very important. The fact that we let misinformation spread like cancer, right? Because people were so health illiterate. There's illiteracy, but then there's health illiteracy, right? The fact that folks couldn't understand that a virus was spread when you don't wash your hands, or by a simple cough or sneeze, and how far that went. I think there's an opportunity here to invest in literacy around your health and basic knowledge. And as we talk about leadership in businesses, everyone now has a chief medical officer, everyone needs a chief nursing officer. We're seeing the importance of science play out in real life. And I think that we underestimated nature on many levels and we should learn from that and move forward.

Dr. Carlos Del Rio: Yeah. I mean, I agree with you, but I would also like to add that this is a totally novel virus, this is a new virus, and our knowledge as scientists has been evolving, has been growing. And the problem that I've seen is that many of us have been painted as flip- floppy and unreliable, because," Hey, you said one thing, and now you're saying something different." I mean, at the very beginning, we said," Don't use a mask. Don't wear a mask, because we need them for medical providers." But that was interpreted as you don't need a mass. Then we said," You need a mask." And I think the communication has changed. This is how science is communicated, but for the general public, they want facts, they want things that are," You can do this, you cannot do this." And that has been really hard. So, I also think we need a literacy and science communication, literacy and understanding what is the process of science, the process of discovery. But at the same time, we need to train the scientists to be better communicators. And we need to know how to say," This is what we know today, and these are the unknowns." And knowing what the unknowns are, I think is very important. And how are we working to try to solve the unknowns. To me, the biggest problem in this pandemic has been how populous leaders, and this is not just in the U.S but around the world we see, also now in Brazil and in Mexico, the President, in England, the prime minister that have been saying, frankly, misinformation. And that misinformation from a leadership point from the bully pulpit that they conduct really has been very, very hard to deal with. Because those people have a responsibility to provide adequate information, and they have the responsibility to provide the information that is needed. And during a pandemic to have people like that say," Well, you know, yeah, Dr. Fauchi says, a mass may be useful. If you want to use it, use it, but I'm not going to use it because I don't believe in them." Has a lot of power. That influences a lot of people. And that changes, no matter what we say after that, you have a segment of the population that has already been sort of misinformed, and no matter what you do, you're not going to change that. So I think also the politicization of public health to a point of destroying public health, in my mind has really been one of the sort of tragedies of this pandemic. Because regaining trust is incredibly difficult to do once you've lost it. And I think we lost trust a long time ago.

Michael Rivo: And I think this is, this crisis of leadership and crisis of trust that we have right now, which does open up this opportunity for the private sector, and for companies. And I wondered Dr. G, is there an opportunity for companies to come together? Basically, who's going to argue on the other side?

Dr. Geeta Nayyar: There are endless opportunities. Unfortunately, because there are so many pockets of leadership lacking, as we look through, the regional landscape, as well as the global ones. So, 100%, I think there's opportunities for businesses to collaborate, cooperate, again, making sure they have medical and scientific advisors at the hip, right? Helping them make decisions, whether it's for advocacy, whether it's leading health and safety initiatives for employees, for customers. But I think we have seen that, right? We continue to see that, we see in businesses saying," Look, we're happy to serve you dinner. We're happy to serve you a meal, but we need to see your vaccine card," right? Or you need to present a negative test within a certain time period. So I think we are seeing businesses doing that. The more we lead together is really where we make the biggest impact on this virus, right? So there are endless opportunities here, but I do think Carlos is right, which is that it all goes back to trust. And the foundation of trust is good communication. No matter what relationship you're talking about. Your spouse, your doctor, your employer, it leads with good communication. And certainly the medical and scientific community are not known for that, and we've worked to improve. But I also think that if the government makes an effort to invest in that, I'd love to see an army of TikTok doctors, and using social media and flipping the dynamic of using social media to spread good information and fact based information. Give Carlos a channel on YouTube, right? We need more of that, not less of that. And that's where I think businesses can also lead, which is giving medical, scientific community a voice, because that's a big part of it is there is no pulpit for doctors, right? There really isn't. It's one- on- one patient care, and that's where so much of this is happening and falling down because that doesn't scale.

Dr. Carlos Del Rio: But I would say that I have been honestly impressed about this pandemic about how good the private sector, the corporate sector has been throughout the pandemic. And I have the opportunity to work with many companies, even early on in the pandemic, with the NCAA and in counseling, the final four back in March of 2020, and be involved in that decision and then working with, for example, Delta Air Lines, and many other corporations. And I've been impressed about how they have put safety of their employees and other customers first, and they have implemented policies and they're doing things, and they're still doing things that are actually putting public health at the center. And I think corporate America, many areas of corporate America have finally understood what I think many still haven't understood out there that story out there that is not public health versus the economy, that you need good public health for the economy to work, that in order to do your business, to be successful, you need to provide safety to your employees and to your customers. And that to me has actually been one of the eye- openers of this pandemic, is how corporate America really has responded and continues to respond, creating policies and content, make some really tough choices in order to provide safety for their employees and safety for their customers. You know, Tyler Perry that I've worked with since the very beginning from early on, he said," I want to continue my business. I cannot shut down my productions, too many people depend on me to support their families. How can we do this safely?" And we implement that process of testing and quarantining, a bunch of things, and bringing people in for a bubble and created bubbles. And he was able to continue his business and giving people jobs and continue employing people because we implemented the necessary procedures for him to do what he needed to do. So I also think we in public health have learned that it's not just telling people what you cannot do. We have to tell people how to do things, because saying," No, you can't do this. No, you can't do that." I come from the world of HIV. Abstinence only education doesn't work, telling people don't have sex, does not decrease HIV transmission. You have to tell people risk reduction. And that approach, I think, is something that many in public health have still to embrace. And I think that's a lot of the tension that we continue to see between," Oh, if we listened to public health we're destroying the economy." No, actually you can do public health very well and support the economy.

Michael Rivo: Mm- hmm( affirmative). Yeah. I mean, I think it's a great point. And telling people they can't do something, we see exactly what we're seeing in response from the public, where people are just going to reject that. Dr. Del Rio, I'm curious about sources for information because you've had the opportunity to provide that kind of information to these corporate customers or partners. Where can people go right now to get good information to be able to understand how to set things up and how to follow along?

Dr. Carlos Del Rio: Oh, I think there's a lot of really good information. I think the CDC has really done a great job updating their website and having all sorts of information in there that it's really, really very good. I mean, they have the science briefs around school opening, they have all these different things that I think are really good to look at. The Infectious Disease Society of America has a big website. I think there's a lot of organizations that have very good information, but you still need that information when you are an executive in a corporation, when you're the HR director, when you're the... You need that information translated to you. So I think that's when you need to then rely on epidemiologists, infectious disease specialists, others that can speak to you at the level that you understand. In other words, they can translate the evidence into policies that work for the corporation and that work for your business. And they may be a little different, depending on what your business is. I mean, the policies that you implement for a cruise line industry, maybe very different from the ones you implant for a nursing home company. But you need to understand the business and then translate the policies and apply them and learn as you're doing so and get the buy- in of all the stakeholders. So it's not only having the information, is really translating the information into something that is practical and feasible. Because if you go to a company and you say," You have to do all these things. Otherwise it can't function, or you have to close down. Or if you have one case you're going to have to close down for the next 10 days." Well, they're going to say," Thank you very much, but I'm not going to do that."

Michael Rivo: Right.

Dr. Geeta Nayyar: And I'll just add to that, Michael. I'll say that you need translators and then you need ambassadors to get that message out, right? For big multinational companies, such as ours, there's cultural, there's language, there's so many aspects, there's gender. The messenger matters, right? And making sure that the message is heard, part of that is the messenger, and of course, how they relay it. But I think we're seeing that also play out throughout the globe.

Michael Rivo: Mm- hmm(affirmative). And Geeta and I were talking yesterday, we're preparing for the interview. We talked about the polio vaccine and where everybody just lined up. It seems like there was not really a question and all the hesitancy and misinformation around that. Do we ever see it getting back to that, where there's just going to be the trust? Yeah, this vaccine's here. I mean, there is that in a particular part of the population, but there's so much hesitancy. Do we see that changing any time, or what is going to change that?

Dr. Carlos Del Rio: I don't know what's going to change. I think that to me, vaccines have been some of the most amazing discoveries of our lifetime. They have changed our lives so much. I remember talking to my dad about how, when he was growing up, people were so afraid of polio. I mean, you were not allowed to go play here, you were not allowed to do this because polio was so prominent. Things that we never suffered as kids, that we never saw. I saw my kids, I've had measles as a kid, my kids didn't because of vaccines. My kids had chickenpox as children. They're children aren't going to get the chickenpox vaccine. So they're not going to have that. I mean, we have seen so many diseases essentially disappear as major public health problems as a result of vaccination. I'm a big fan of vaccines. I think that vaccines have changed the way we behave. And as I said, I researched, my focus has been HIV. I wish we had an HIV vaccine because that's what we need to end the pandemic. And we're not going to end it by treating everybody, we're not going to end it by doing other things, we need vaccines. So, to me having a vaccine for this infection and this such an effective vaccine, it's like, why are we not using it more? I mean, I get very, almost upset when I think that we live in a country where there's abundancy, there's plenty full of vaccines. 95% of the population lives within five miles of a place you can get a vaccine. The vaccine is free, it's accessible. And in the meantime, 90% of the global population cannot get a vaccine and would like to get one. And that to me also creates, I would say, a lot of anger in me, because it's a little bit of an American exceptionalism, right? We have all this vaccines and we reject them when people around the world are desperate to get a vaccine.

Michael Rivo: Mm- hmm( affirmative). Yeah. It's not a great look for America. And I'm curious if this vaccine, maybe it's just the nature of time, which is, this will be a vaccine that once it's fully authorized for younger children, that you're going to get just like measles or chicken pox in the future, and we're just not quite there yet. But in five years or 10 years, that that's where we're going to be. Do you see that playing out that way dr. G?

Dr. Geeta Nayyar: I think so, Michael. I mean, look, we also forget, I mean, I was in training at the time of the HIV epidemic. And to see HIV now become a chronic disease, to see breast cancer become a chronic disease. We forget how awesome actually medical advancements are. And the fact that we have developed so many vaccines in such a short amount of time, it's tremendously inspiring for me as a physician. I think it is unfortunately lost on so much of the lay public with the dynamic we're in with all the misinformation. But I do think we are going to get to a place where this is chronic, where we all forget how terrible this has all been, and how a simple vaccine could move us forward to getting back to our lives as we know it from before. And I also spent my childhood in India. So a lot of what Carlos is saying resonates with me. Polio was a really big deal. I have grandparents relatives that suffered many chronic issues from polio. And so we are incredibly privileged to live here, domestically in the U. S and I would just hope that we don't forget. I think before we know it, this actually will become something chronic that we do figure out how to live with, but the only person standing in our way is ourselves. Right. My number one message I think to our audience today is that this pandemic ends with you and me, right? Go get vaccinated, go get someone else vaccinated, go help someone you don't know abroad get vaccinated. That's all we got to do. I mean, that's truly all we got to do. It's not a tall ask, but we need to start and we need to all start together.

Dr. Carlos Del Rio: Yeah. When one of the people say," When will the pandemic end?" And I say," It's really up to us. It's up to you. The more we do the right thing, the sooner we can end the pandemic.

Michael Rivo: Okay. Well, this has been a fascinating conversation. I'm so glad we got some extra time. Dr. Carlos Del Rio. Thank you so much for joining us today.

Dr. Carlos Del Rio: Its has been a pleasure.

Michael Rivo: And Dr. Geeta Nayyar, thank you. Dr. G, our Chief Medical Officer. Thanks for joining us today.

Dr. Geeta Nayyar: Thanks Michael. Thanks Dr. Del Rio.

Michael Rivo: That was Salesforce's Chief Medical Officer, Dr. Geeta Nayyar and Executive Associate Dean of the Emory School of Medicine and Grady Health System, Dr. Carlos Del Rio. And Aneesh Chopra, Co- founder and President of CareJourney and the first U. S Chief Technology Officer under President Obama. Thanks for listening today. If you liked this episode, be sure to subscribe wherever you get your podcasts. I'm Michael Rivo from Salesforce studios.