Latest / The Capitalism and Freedom in the Twenty-First Century Podcast / Jay Bhattacharya on the COVID-19 Pandemic and the Public Health Response

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Jay Bhattacharya on the COVID-19 Pandemic and the Public Health Response · The Capitalism and Freedom in the Twenty-First Century Podcast

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>> Jon Hartley: This is the capitalism and freedom in a 21st century podcast where
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we talk about economics, markets and public policy I'm John Hartley, your host.
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Today I'm joined by Jay Bhattacharya,
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who is a professor of medicine at Stanford University and
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a research associate at the National Bureau of Economic Research.
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Jay has been one of the most thoughtful and prominent public health voices
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throughout the COVID -19 pandemic, and has been one of the most critical of COVID -19
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lockdowns in their knock on effects on economic growth and livelihoods.
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Welcome, Jay >> Jay Bhattacharya: Thank you for
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having me, John thank you for those kind words.
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>> Jon Hartley: Jay so you're to start from the beginning you were born in
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Calcutta, India.
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Tell us about how you came to the US, how you came to Stanford, and
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how you got into our undergrad program here you went to medical school here.
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You got an MD here you got an economics PhD here, and
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you also became a professor here you spent, I think, most of your life here.
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How did you become so fascinated with Stanford?
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How did you fall in love with Stanford?
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If it's very enough to say, I don't know if you're still in love with it, but.
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>> Jay Bhattacharya: I once was in love with Stanford I mean,
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[LAUGH] I was born in Calcutta in 1968, well, near Calcutta.
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And my mom actually grew up in Calcutta, in a slum in Calcutta my dad in a little
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more middle class neighborhood, when my dad was a PhD student,
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before he met my mom, he applied for the visa lottery.
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And when I was like three or four, he won the visa lottery.
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>> Jon Hartley: This is the one that's like, it's like 1% every year or
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something.
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>> Jay Bhattacharya: Yeah there were some, like, quotas for
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different countries I don't know I didn't, know quite the details of it, but
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what I do know is that my dad came to the US one year before he actually,
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he was a PhD in electrical engineering.
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Couldn't find a job, so he worked at McDonald's for a year.
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>> Jon Hartley: Wow.
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>> Jay Bhattacharya: Then we came up we, my brother and
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my mom came a year after I think it's like 1972 and, or
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1971 when I was very little, I grew up in Cambridge,
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Massachusetts in this housing development until I was eleven.
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My dad got a job my dad eventually got a job as an electrical
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engineer building jet engines for GED in Lynn Massachusetts.
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>> Jon Hartley: From McDonald's to GED engine.
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>> Jay Bhattacharya: Yeah and then he, then he got a job in general dynamics
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essentially as a rocket scientist in southern California, which is where I was
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there, I went to high school in southern California and then Stanford let me in.
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I mean my parents told me I could only apply to in state schools and Stanford,
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Washington in state school, I was, I mean I really liked math and
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I liked sciences and I was pretty good at them, so
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I mean I don't know, it was, it seemed like a natural place.
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>> Jon Hartley: Wow I mean that's fantastic and so you got here,
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you got in here as an undergrad and like at what point did you decide to become
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health economist, go to medical school and get an economics PhD?
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>> Jay Bhattacharya: [LAUGH] >> Jon Hartley: It's
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a pretty rare combination.
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>> Jay Bhattacharya: Yeah I mean that, well that I'm still not, I'm sure it's,
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sure it's not the same, but there was a, so I came to Stanford as an undergrad in
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1986 and I was really interested in chemistry actually.
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Like I really liked and I wanted to be, I thought I had the back of my head,
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what can I do with these sciences?
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I figured being a doctor would be a really good use of it,
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my dad had some heart, had had a heart attack actually,
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before I came to Stanford and I was really impressed by the ability
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of doctors to help in situations like that, like what my dad faced.
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And I figured I wanted to use my knowledge and, or my capacities in math and
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sciences to become a doctor that's all I really wanted.
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Arrived and they used to have,
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or maybe I think they still have these general ED requirements, and so
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I just took Econ because I wanted to fulfill general ED requirement from.
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So Professor Gavin Wright taught econ one yeah so
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he's a great economic historian, I think he just retired, has been retired for
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a little while from Stanford Gavin Wright and I just fell in love with it.
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I thought it was really, really interesting, the idea that you can use
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math and statistics for something other than chemistry and other sciences was,
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just blew me away, these were topics that were so obviously important to
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the health and well being of huge numbers of people, vulnerable people.
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And so I majored in econ, I met another Stanford MD PhD economist
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named Alan Garber, who's now the provost at Harvard and
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did an honors thesis with him and just fell in love with economics,
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fell in love with the idea that you could use the methods of economics,
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the statistical methods.
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The basic idea of economics, which is that there's trade offs for literally
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everything and apply to medicine, so obviously, clearly applied to medicine.
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And so, yeah, that's what I did at Stanford as an undergrad,
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finished undergrad with an econ major, but also a pre med,
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had finished the pre med requirements, figuring that was going to be behind me.
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I'm done with economics that was a fling I'm gonna go to medical school,
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applied to medical schools.
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Actually, my dad died right around like, the end of my senior year,
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and I was gonna go medical school outside of California, but
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I wanted to be, sort of still in range of my mom,
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so I, and when Stanford let me in, I was thrilled.
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>> Jon Hartley: Awesome I mean what a great feeling and
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also fantastic that you're still here, so
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you graduate, you're doing a PhD in economics and an MD in medicine.
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That takes a little while you graduate,
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you then enter tenure track can you describe what
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I guess your research agenda was for, I guess,
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the past couple decades coming up to the COVID pandemic?
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I know the COVID pandemic obviously changed the trajectory of your career, but
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I'm curious, what were you doing before the COVID pandemic?
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>> Jay Bhattacharya: Yeah, I, in graduate school so eventually in medical school,
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I decided I needed a PhD in econ I couldn't let it go,
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and at some point during grad school and medical school,
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every time I would do medicine, I would feel like I was missing doing research.
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I didn't want to live my life thinking I'm doing something really important,
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clinical medicine, very important the life of people and
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I didn't wanna feel like I was only half heartedly doing it,
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whereas I was wholeheartedly, really interested in research.
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Research, my thesis in economics was on physician labor markets.
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The question of why do surgeons earn so much money relative to
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non-spec sort of the family practice doctors, for instance.
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And my first job out of grad school was at the Rand Corporation, which is,
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for folks who don't know, it's a think tank in Southern California.
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The history of it is that it tends to be focused on defense industry things, but
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it'd actually become quite famous in health economics.
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They've conducted this large randomized experiment in the 70s of providing
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insurance to people.
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And the question, what effect did it have on demand for care?
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What effect did it have on health?
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>> Jon Hartley: This is the Rand Health Insurance Experiment,
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very famous within those who know.
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>> Jay Bhattacharya: Yeah, the Rand Health Insurance.
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And there were still people around the Rand Health Insurance Experiment days.
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It was just a vibrant place to do health economics.
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And one of the things that happens at Rand is you walk around and
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there are people with data and questions, and
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they're just looking for people to help on these projects.
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And I got involved very early on with a project on HIV, and
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in particular on why it seemed insurance coverage didn't seem to
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be improving the health of patients with HIV in the late 90s.
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It turned out really, it had to do with the timing of when people got Medicaid for
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HIV, it was often too late.
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People would have HIV, get sick, lose their jobs,
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not qualify for Medicaid for a long time.
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And then when they finally did qualify for Medicaid, it was too late,
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the Medicaid coverage didn't really help.
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So the idea was that if you extended insurance coverage so
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they could afford medicines earlier, you'd save the live HIV patients.
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Anyways, that project was really, really interesting, and
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it got me interested in infectious disease epidemiology.
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And health policy surrounding infectious disease epidemiology,
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an interest I've maintained throughout my entire career.
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And so it's impossible in Rand to work on one issue,
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[LAUGH] I worked on a very large number of issues.
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I got interested in the economics of obesity.
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In 2001, Alan Garber had started here at Stanford, this center
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called the Center for Primary Care and Outcomes Research in the medical school.
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And he had opened up the search for new faculty.
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I'd been out at Rand for about three years, and when Alan called me,
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I mean, it's really hard to say no to your former advisors.
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And of course, coming back to Stanford was an absolute thrill.
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>> Jon Hartley: Wow, I mean, amazing, I feel like Stanford's benefit here is so
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fortunate to have you here for your career as well.
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And you've also got, I think, cross-appointments at virtually every
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possible institution, I think you possibly could at Stanford, too.
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I'm sure that must be a record.
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Now, I wanna sort of get into the COVID pandemic.
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How did the COVID pandemic change the trajectory of your career, and
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how has it changed sort of what you're focusing on now?
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And we can sort of get a little bit more into the Great Barrington Declaration,
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what does it mean?
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And how did that come about?
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>> Jay Bhattacharya: Well, in the early days of the pandemic,
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I had a couple of sorts of twin inspiration.
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So first, I mean, I was born in a poor country.
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My mom grew up in a very, very poor part of Calcutta.
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I'd actually spent a little bit of time there when I was little
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in this Calcutta slum, living in this slum called Kirtipur,
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where my mom's parents lived, and her sister and brother lived.
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So I had the experience of seeing what poverty really means.
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And, of course, in economics, we spent the last 30,
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40 years being very proud of the fact that globalization had lifted
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almost a billion people out of dire poverty.
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And one thought I had was that, look, if we lock down, the West locks down, what
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will happen to them is that there will be these knock on effects, will essentially
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reverse the gains from globalization in poor countries of the world.
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Now, globalization, what it actually means is that many poor countries
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reorganize their economy so that they fit in better with the world economy.
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That meant many jobs, that was the engine that drove the uplifting of
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people out of poverty, people had jobs that were not previously available.
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By locking down the economy, we have a supply chain disruption.
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You're gonna get a very large number of people at the very bottom of
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that supply chain losing their jobs and be at risk of dire poverty,
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at risk of starvation, can't feed their families.
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That thought was very clear in my head when the lockdowns first got proposed.
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The other thought was an epidemiological thought.
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During the swine flu pandemic in 2009,
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the World Health Organization suggested that
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it was a 3, or 4, or 5% mortality rate.
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What they were talking about was a case fatality rate.
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The numerator was all the people that had died from the swine flu and
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the denominator was the set of people identified by public health and
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hospitals, and so on to have had swine flu.
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The problem is that public health only had a limited visibility on the spread of
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the disease.
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There was a whole series of sero-prevalence studies,
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sero-prevalence meaning studies of prevalence in the blood,
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sero's blood of antibodies to swine flu.
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And those sero-prevalence studies in 2009 found that there were hundreds or more
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infections out in the community of people who had the swine flu and recovered.
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And had antibodies that had never come to the attention of public health
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because the disease was so mild for them.
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Swine flu did kill some people, and it was severe disease for some people, but for
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most of the population, it was a mild disease.
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And in fact, that literature found that the infection fatality rate wasn't 3 or
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4%, it was more like 0.01%, 99.99% survival.
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That made it so that the initial panic of swine flu
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subsided very rapidly as that information came out.
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And so the second thought I had about COVID in the early days was, well,
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this is a very highly infectious disease, we don't know how far and wide it spread.
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What we need is a study to measure that spread of the disease,
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just like was done with swine flu.
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>> Jon Hartley: Got it, and so I guess one question is, I know early in the pandemic,
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there was this question about, was it NPIs lockdowns,
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non-pharmaceutical interventions that were causing or
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that would cause losses in economic activity or GDP or output?
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Or was it the pandemic itself that people are so scared,
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they don't wanna go outside, they don't wanna do business?
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And that regardless of whether you had NPIs or not or lockdowns or
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not, that you would have some shortfall in economic activity,
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regardless What Emil Werner and I think a few others sort of argued.
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Is it fair to say that you're pretty squarely in that other camp that
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lockdowns, NPIs do cause significant losses in economic activity, which
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has sort of these knock on effects of sort of lower welfare as a result of these?
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>> Jay Bhattacharya: Yeah, so it's complicated.
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So, first of all, I do think the lockdowns had a tremendously bad negative
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economic effect, but the mechanisms,
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the idea that people lock them themselves down anyways for fear is true.
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That is absolutely true.
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But it's important to understand the limitations of that idea, so, first,
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and this is really important to stress the fear itself was a policy choice.
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The World Health Organization chose to send out the signal that 3 or
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4% of the people would die if they got infected.
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That was a policy choice to put out a very inaccurate mortality number,
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way too high, relatively the truth, in order to spread fear.
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It was a policy choice by public health to spread the message that everyone was
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effectively equally at risk of COVID even though it was clear from the Chinese data,
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from the Diamond Princess data.
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That it was really older people that were the highest risk group.
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There's a thousand fold or more difference in the mortality risk of
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COVID infection from the oldest to the youngest.
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And that young people were actually relatively low risk, much lower risk than
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many other threats to their lives, for instance, not going to school.
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So that fear itself was endogenous.
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The second thing, and
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this is really important about the limitations of that argument,
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the set of people who could actually lock themselves away
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without risk to their health and well being was very limited.
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Worldwide maybe 2% of the population in the United States, maybe 20 or
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30% of the population, I call them the laptop class,
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the set of people who would not lose their job, not lose their livelihood.
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Because they could replace the work that they were doing in person with work
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from home.
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Stay home, stay safe, was an incredibly classist, elitist message.
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The vast majority of the world population could not abide by this,
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and you look at the mobility data from around the world,
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around the initial lockdowns, it's very, very clear that it's
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only the richer neighborhoods that had low mobility that extended past two weeks.
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The first two weeks after the initial scare in March 2020,
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you see decline in mobility for everybody.
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But very soon, the poorer neighborhoods, you start to see upticks in cases,
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upticks in mobility because poor people can't abide a lockdown.
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They can't afford to stay home and stay safe,
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because if they do, their children will starve.
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So I think that there are very strong limits to that argument, and
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I think the fact that people do have behavioral responses to perceived threats,
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that's a classic idea in economic epidemiology.
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It's an idea I've taught, it's an idea of where I've written papers on,
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you know, because, for instance, it has consequences for weather, for
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vaccination demand, right?
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That's a classic idea, it's not new to me,
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but it was very badly misapplied by economists early in this pandemic.
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>> Jon Hartley: Wow.
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And so you're one of the three signatories of the Great Barrington Declaration.
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Can you explain, like, what its sort of original intent is or
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sort of, and maybe more importantly,
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just what your optimal policy approach or prescription is for
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dealing with COVID-19 and perhaps other pandemics in general?
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>> Jay Bhattacharya: The Great Barrington Declaration we wrote in October 2020 with
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Martin Kulldorff, then of Harvard.
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He's on leave at Harvard now, and then Sunetra Gupta of Oxford,
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two very fantastic epidemiologists.
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Sunetra is a theoretical epidemiologist, first order at Oxford,
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she's designing a universal vaccine for the flu,
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that was the thing that she's doing immediately before the pandemic.
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Martin Kulldorff was a biostatistician who had designed the statistical
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infrastructure used by the FDA and the CDC to track vaccine safety.
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We come together in Great Barrington, Massachusetts,
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in October 2020, basically because the lockdowns.
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Which I explained to you why I was already skeptical about them,
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had already done tremendous damage.
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School closures had already harmed the lives of tremendous number of
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children worldwide, and the effects on the lockdowns on the poor,
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the working class, had already become manifest.
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The UN World Food Program was already issuing statements like,
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100 million people are going to starve as a consequence of the lockdowns,
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and yet the world was ignoring this.
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And October 2020, the summer had come, and the disease wasn't quite so
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panic making as it had been in March of 2020,
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looked like it was starting to go away to some people.
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But it was really clear from the epidemiological data to me that
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the disease was coming back, that there was some sense that
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the seroprevalence studies showed maybe 15 20% of the population.
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Depending on the country and place in the US, it was like 10,
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15% of the population had been infected.
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That meant there was a large fraction of the population that was still quite
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uninfected, the disease was very clearly coming back, it wasn't gone.
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Still a very highly infectious disease in the summer, you'd seen the spread, for
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instance, in places like Arizona, causing all kinds of problems.
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And it was also clear that if it came back, the lockdowns would come back.
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And with the lockdowns, the same damage to the poor, the same damage to children,
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the same damage to the working class.
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So we wrote the Great Barrington Declaration to propose a strategy,
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which we call focus protection.
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The idea is very simple, that the highest risk people are people that are elderly,
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there are some chronic conditions that can affect the risk as well,
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but the single most important risk factor for a bad outcome is your age.
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And roughly every seven years of age doubles your infection fatality rate,
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according to the infection fatality rate data that have been out.
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So what we proposed was focused protection for older people and
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then lifting lockdowns, that is actually a completely unoriginal idea.
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It's the same strategy that had been followed, basically,
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in every single respiratory virus pandemic from going back a century.
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In 2009 that's what we did,
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we didn't lock down our society when there was a swine flu pandemic.
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What we did is we tried to develop as rapidly as possible vaccines and
23:19
therapeutics and deploy them at scale for
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the people that were highest risk, excuse me.
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And at the same time, disrupt the lives of everyone else as little as possible,
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that's what we did in the United States.
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Mexico actually locked down, and it caused tremendous damage,
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they decided that it was a mistake in 2009.
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And if you go back a century, you see respiratory virus pandemic,
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after respiratory virus pandemic, you see the same strategy, and it works, right?
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Don't panic society, cuz by panicking society,
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you harm the people who can least afford it and do work.
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To protect vulnerable people as best you can, given the technologies you have.
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And we were calling for a conversation by people in public health,
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local public health, because the exact kind of what focus
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protection actually means is a very local thing.
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It depends on local living circumstances.
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And it was a one page document.
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We're calling for change in strategy, but in that we also included a lot of
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suggestions for exactly what focus protection could look like.
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So, for instance, giving leave to people who were older,
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sabbatical leave when the disease was spreading rapidly,
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all kinds of ideas included in the website that we wrote for
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how to do focus protection.
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>> Jon Hartley: Got it.
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I'm curious, in terms of school shutdowns,
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I think there's sort of an interesting example where there
24:54
was a pretty rapid change in the so called consensus around whether or not.
25:00
Schools should be reopened and
25:02
the potential damage that could have in terms of educational outcomes.
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I'm curious what you thought about that whole episode and
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how it played out in, I guess, the sort of intellectual
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public health establishment and how that change so quickly.
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And I'm curious what your thinking has been around.
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You've been, you and others have been dismissed
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by folks at the NIH, by folks certainly, I think,
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on YouTube and elsewhere and here at Stanford.
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And I'm curious, what has that whole experience been like?
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I don't think you've ever in your entire career been seen or
25:54
viewed in any way as being a partisan figure.
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You're still, in my opinion, not a partisan figure at all.
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And I'm just curious, how has this saga changed your
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thinking around, really, do we value truth?
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Is truth at all really a value, or
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is it sort of more so about promoting early
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hypotheses that people tend to cling to?
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Science ultimately is about postulating hypotheses and
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ultimately ruling out incorrect hypotheses.
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I'm just curious,
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how is your view of how science is being done in some of these great institutions?
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How has that changed in your mind?
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And what has this experience been like for
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such an incredible scholar such as yourself?
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>> Jay Bhattacharya: Well, so why don't we start with the schools?
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Because that's a good way to get into the rest of the question.
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In August of 2020, it was really clear to me that one of the worst
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mistakes we've made in the spring was closing schools.
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There was data out of Iceland that suggested that kids were not super
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spreaders.
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They could spread the disease, but they were not super spreaders like they might
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be with some of the other respiratory viruses, and so
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they didn't pose any special extra risk.
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Sweden had kept its schools for kids 15 and
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under open the entire pandemic with no restrictions, no social distancing,
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nothing, just normal school, even in the spring of 2020.
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And there were reports that had come out of that experience that
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not only did no children die in that spring from COVID.
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But also that the teachers themselves were relatively lower risk of getting Covid and
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dying than the rest of the population being around kids that actually
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protected them against Covid.
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There were some arguments for why that might be the case.
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For instance, if you were like parents with young kids,
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actually compared to age matched, other adults did better on Covid.
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Maybe because they were exposed to other virus, other coronaviruses
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that had some measure of protection against Covid, which is also coronavirus.
28:18
There's some theories around that and
28:19
there's some data around that that suggested that was true.
28:21
In any case, the point is that there was not a special risk to teachers, and
28:26
kids themselves are very, very low risk.
28:30
And so on the basis of that evidence, Europe opened its schools,
28:36
and the governor of Florida decided to open schools in Florida.
28:42
He sent an email out.
28:45
He sent an email, he sent an order out, executive order out,
28:49
saying that every school in Florida had to provide an in person option.
28:55
And what happened next was that the Florida teachers union sued the governor
28:59
to close the schools.
29:01
And the folks in Florida couldn't find an expert to defend the Florida,
29:06
the governor's decision in court.
29:10
So when they contacted me, I jumped at the chance on this because
29:15
I knew what the literature had said, and we eventually won.
29:20
But there were experts on the other side who were didn't understand the data.
29:25
It was really clear they didn't understand it.
29:27
And it was also clear they were very scared by Covid, and yet they were there.
29:33
They were from prominent institutions on the other side arguing that kids
29:38
should have their schools closed in Florida.
29:43
A lot of what happened during the pandemic revealed big gaps in the ability
29:48
of people in prominent institutions, including at Stanford,
29:53
to read the data appropriately and react appropriately.
29:57
A lot of what happened was decision making out of fear and panic and inability to
30:02
understand that there could be other views and to seek to learn from other views.
30:08
There was no at Stanford campus, for instance,
30:11
there was no debate ever set up between me and
30:14
other people who disagreed with me regarding the safety of school closures.
30:20
For instance, there was a JAMA pediatrics paper in 2020
30:25
that found that just the spring closures will lead to
30:30
almost 5.5 million life years lost for American kids.
30:35
And this is just a classic result in the literature, in the health economics
30:40
literature that if you have that school is an incredibly good investment in health.
30:49
If you increase the amount of time kids stay in school for
30:53
just a short while, it actually has long term positive consequences.
30:57
They lead healthier, longer lives as a consequence of more complete schooling.
31:05
That was a well-established finding in the literature Health economists for
31:09
the most part stayed silent about that finding, which still shocks me.
31:14
What should have happened was debates, right?
31:16
That's how that it's not bad or wrong for
31:18
scientists to be wrong about something that's just normal.
31:23
What was bad was that it was seen as so far outside the bound to say that
31:27
kids should go to school in August of 2020 in the United States.
31:32
That a place like Stanford University wouldn't even host a debate about it.
31:41
>> Jon Hartley: Wow, so pivoting toward sort of the scientific establishment.
31:49
I'm curious personally, how have you experienced this whole,
31:54
what does it feel like to have, you're such a decorated scientist.
32:00
What does it feel like to have peers, people who you've held in
32:06
highest esteem for, I'm sure your entire career,
32:11
sort of had this about term that seems to be not sort of
32:16
true to the scientific method, and, well, you must be wrong.
32:22
Even though maybe they don't have all the evidence or
32:26
they're seeking certain studies or certain sort of pre-drawn narratives.
32:31
I'm curious, what is that personal experience like?
32:35
>> Jay Bhattacharya: I felt like excommunication.
32:37
It was through the summer of 2020 and
32:41
especially spring of 2020.
32:45
Almost from the first moment I started speaking out publicly about my ideas about
32:49
the pandemic, I've received death threats.
32:52
I've received racist attacks.
32:54
But on Stanford campus.
32:57
So a hundred of my colleagues signed a letter attacking Scott Atlas for
33:03
the crime of being President Trump's COVID advisor, on ridiculous grounds.
33:11
The letter attacking him hinted at the idea that he was opposed to handwashing,
33:16
which was not true.
33:17
It was ridiculous.
33:19
They never even approached him and asked him what his ideas actually were.
33:24
And Scott and I got to know each other, actually, during the pandemic.
33:27
We were exchanging papers with each other, just talking with each other all the time.
33:33
He knew a lot more about the pandemic than those hundred people that signed that
33:37
letter against him.
33:38
And it essentially created this atmosphere,
33:42
this hostile work environment at Stanford, where people who didn't
33:47
agree with the lockdowns felt like they didn't belong on campus.
33:51
Every single person I know who had reservations about
33:56
lockdowns on campus felt the same exact way.
33:59
And it felt not anything like the Stanford that I fell in love with in 1986.
34:08
I kept thinking the motto of the university is let the winds of freedom
34:12
blow in German, which I can't pronounce.
34:15
But the winds of freedom did not blow at Stanford during the pandemic.
34:18
In fact, it was very stifling environment, designed to create a false
34:23
sense of unanimity around lockdown policies that did not exist,
34:28
neither on campus and, of course, not in the broader scientific community.
34:33
>> Jon Hartley: I want to shift a little bit toward vaccines, and I'm curious.
34:38
One, it seems so interesting to me how starkly different the public
34:44
health element of sort of COVID response should we have lockdowns and so forth.
34:51
How different, really, it's been from the biotechnology side of things,
34:57
which is just how quickly we were able to develop a vaccine that I think
35:02
exceeded many expectations.
35:04
So I'm curious, what do you think about, one, the sort of race to develop vaccines,
35:09
about things like Operation Warp Speed, advanced market commitments for vaccines.
35:14
Do you think that that's a huge success story?
35:17
And I'm just curious, do you think that maybe it's somewhat underappreciated
35:23
because it was President Trump that was in office while this was sort of started?
35:29
And I think President Biden is taking some credit for
35:32
this too, and probably deserves some credit too.
35:35
But I'm curious what you think about that.
35:38
And I'm also curious, what you think about.
35:42
Since then there's been this huge movement that is opposed to vaccines,
35:47
and there's many people that have advocated very strongly for
35:51
vaccine mandates, whether it's governments or
35:55
private sector bodies that should be implementing these things.
35:59
I'm curious, what are your views on this moment of the pandemic,
36:06
sort of since the vaccine started coming online in 2021?
36:12
>> Jay Bhattacharya: So the first part of the question,
36:13
what do I think of Operation Warp Speed?
36:15
I have to say that it's a full confession.
36:19
One of the things I got the most wrong during the pandemic is that in February,
36:24
March 2020, I thought it was not possible to develop a vaccine within months.
36:30
I thought it would take years.
36:32
And the reason for that was that we didn't have a coronavirus vaccine.
36:36
And there was a history going back at least two decades
36:41
of attempts that didn't seem to me were going anywhere.
36:46
So I didn't see how it would be possible to develop a vaccine so rapidly.
36:51
And so when President Trump ordered Operation Warp Speed,
36:56
I was very skeptical whether we would succeed.
37:00
Then as the season wore on,
37:03
it became clear to me that this was actually potentially it might work.
37:08
And in any case, of course, there's some uncertainty around that.
37:12
Let's say in July 2020 whether it will work.
37:14
The government makes an advanced commitment, says, look,
37:17
we're gonna buy your vaccine whether it works or not,
37:20
in order to provide some incentive to do this rapid development, change what all
37:25
your research is doing to focus on this very expensive for a drug company.
37:30
I actually thought that was a really good idea.
37:32
And the reason is the asymmetric loss.
37:37
If the vaccine doesn't work, then you lose some billions of dollars.
37:41
What's the big deal?
37:42
But if it does work, you've done something really amazing.
37:46
You potentially save the lives of a tremendous number of people.
37:51
And so I was actually,
37:52
I was okay with that policy even as I thought it's unlikely to work.
37:57
And then when the vaccine actually the trial came out, it actually worked.
38:02
I was over the moon happy.
38:04
I was absolutely thrilled.
38:06
To me still is a triumph of science.
38:10
Now, there's some ambiguity around this.
38:13
How is it that we had a spike protein target for the vaccine so quickly?
38:19
Normally it would take a long time.
38:21
A lot of that is actually based on a research program of finding
38:26
viruses that are potentially pathogenic in the environment,
38:32
and then augmenting them and doing vaccine research with them early.
38:38
So that when, if and when there's a pandemic, you have a lot of knowledge.
38:44
But what if that research itself was the cause of the pandemic?
38:49
So there's certainly some ambiguity about how this technological advance came about.
38:56
But the fact that the vaccine did come about,
38:59
I think was an amazing thing to me in December of 2020.
39:03
Now, it's one thing to develop the technology of this mRNA platform, or
39:08
the adenovirus platforms for the vaccines, or even the traditional vaccine platforms.
39:15
That's one thing.
39:16
It's another thing for how do you assess clinically whether it's worthwhile or
39:21
not, or will it work or not?
39:22
The trials themselves were these huge trials, like 40,000 people,
39:27
I think, in the Pfizer house, something on that order.
39:31
And the fact that it could be run so quickly was an amazing thing to me.
39:35
So first, if it's run quickly, that means you will only know
39:39
about what the effects are of the vaccine for the duration of the trial.
39:43
So in this case, like two or three months.
39:45
So you don't know any long-term effects of the vaccine from the trial
39:50
itself in December of 2020, you just know two or three months of data.
39:56
The trial had as an endpoint the prevention of symptoms.
39:59
Symptomatic infection,
40:01
that is actually not that important from an epidemiological point of view.
40:06
From an epidemiological point of view,
40:07
there's two other outcomes that are more important.
40:09
One is prevention of all infection and prevention of transmission of the disease.
40:16
That's an endpoint that you could look at that the trials didn't look at.
40:21
Symptomatic infection,
40:23
95% effective, but that doesn't mean that it's 95% effective against all infection.
40:28
And it certainly doesn't mean that it's gonna be long-lasting protection.
40:31
You only know for two or three months.
40:32
The other clinical endpoint you could have looked at but
40:36
didn't was prevention of death or prevention of hospitalization.
40:40
That would have required a much, much larger trial, but
40:43
that also has a really important epidemiological consequence.
40:47
So the reason why those are two really important epidemiological endpoints
40:52
is because if you just have knowledge that you prevent severe disease and
40:57
death, then what you do is you just use the vaccine for focused protection.
41:03
Give it to people who are at highest risk, reduce their risk of death, roll it out
41:07
rapidly for those groups first, and then make it optional for the rest.
41:11
It's not nearly as important for
41:13
people who have a very low risk of infection from dying from the disease.
41:16
But you can make it available, but it's not the highest epidemiological priority.
41:20
If, on the other hand, you have prevention of transmission, well, then what
41:25
you need is a very large fraction of the population to get vaccinated.
41:29
And the disease will just sort of die out to low levels because such a large
41:33
fraction of the population is vaccinated.
41:36
The problem was that we didn't know it would prevent transmission with certainty.
41:42
We didn't know with certainty they would prevent hospitalizations and
41:46
deaths in December 2020.
41:48
Public health then had to make a guess which was more likely and
41:51
what was gonna happen.
41:52
Public health guessed wrong.
41:55
And I actually wrote an op-ed in December 2020 in the Wall Street Journal with
41:58
Sunetra Gupta, arguing that we should use the vaccine for
42:00
focused protection of elderly people.
42:01
And the reason was that if it prevents symptomatic infection,
42:05
it is very likely it also prevents severe disease.
42:08
You don't get severe disease unless you've had some symptomatic infections,
42:11
the way I reasoned.
42:12
So we were pretty certain that that would prevent
42:14
severe disease from the randomized trials, at least for two or three months.
42:19
And if we rapidly rolled out the vaccine to older people, there was a wave coming.
42:26
We were in the middle of a wave of cases, we could prevent a lot of deaths.
42:31
That was the argument.
42:33
I think that argument's still right.
42:35
The other side, Tony Fauci and others pushed for, he kept raising the number.
42:42
70, 80% of the population has to be vaccinated to meet the herd immunity
42:46
threshold, which he didn't actually know what that number was.
42:49
No one did.
42:50
And that's what led to this tremendous push to vaccinate everybody,
42:57
even at the cost of telling people falsehoods.
43:01
After a couple of months of experience of the vaccine, it became very clear
43:06
the vaccine does not stop transmission, does not stop you from getting infected.
43:11
Heavily-vaccinated countries in late spring 2021
43:16
started to see big outbreaks of cases.
43:19
We knew from then that the vaccine could not be used for
43:24
suppressing the disease down to zero.
43:27
But nevertheless, we went on with these vaccine passports,
43:30
where we essentially discriminated against unvaccinated people,
43:34
treated them like pariahs, second class citizens.
43:36
Vaccine mandates, where many people who didn't want the vaccine, actually,
43:41
probably, clinically was not particularly beneficial to them cuz they were low risk,
43:47
they lost their jobs.
43:48
A lot of people who have family abroad, where the vaccines weren't even
43:52
available yet, they couldn't have the family come visit.
43:56
Because of this discriminatory policy,
43:58
where unvaccinated visitors were not allowed in the United States.
44:01
That's still in place today.
44:03
And what it did is it created this sense that the public health doesn't know what
44:07
it's doing.
44:08
It said that if you get the vaccine, you wouldn't get infected.
44:10
Well, so many people got the vaccine and then were infected.
44:14
That happened to me.
44:15
I was fully vaccinated in April of 2021, and August 2021, I got Covid.
44:21
>> Jon Hartley: Wow.
44:23
>> Jay Bhattacharya: So it's one of these things where public health will blame
44:27
misinformation, but they should point the fingers at themselves.
44:31
They were the main source of this misinformation.
44:33
Long after it became clear in the scientific data that the vaccine didn't
44:37
stop transmission, they kept insisting that it would,
44:39
that it was vitally important.
44:40
And it is no wonder that people have lost trust in public health when they were so
44:46
wrong and so adamantly wrong.
44:48
And then they tied that to policies that damaged the lives of people,
44:52
disrupted their lives.
44:54
People started treating unvaccinated people like pariahs.
44:57
Thanksgiving of 2021,
44:59
I kept getting emails from people very unhappy because their families had
45:04
uninvited them from Thanksgiving because they weren't vaccinated.
45:09
I mean, that is a consequence of public health misinformation.
45:13
It's a campaign that has resulted in widespread, a much broader
45:18
anti-vaccine movement that has ever existed that I've seen in my career.
45:24
And it is directly the consequence of public health.
45:30
Not understanding the science, not understanding the limits,
45:35
the basic civil liberties, and not understanding its vital role in making
45:39
sure that it doesn't create social division.
45:43
And it failed on all those bases.
45:47
>> Jon Hartley: I guess sort of just one last question here.
45:49
So I mean, one going forward in terms of preventing pandemics,
45:54
addressing pandemics when they occur.
45:57
It seems like one pattern that sort of emerged is that these things,
46:02
like Operation Warp Speed or advanced market commitments,
46:07
do seem to be useful mechanisms now to build up capacity for vaccines.
46:12
And these are things that we didn't have before,
46:17
when we can sort of have sort of incentives aligned to make effectively
46:23
billions of vaccines in the shortest possible period of time.
46:28
And perhaps, I know it's been done before for and
46:32
I think potentially in the future, maybe for malaria.
46:36
I'm curious, looking back on all of this and this entire experience.
46:42
What do you hope we have learned as a community, both scientific and
46:47
somewhat non-scientific as well, or public health, biotechnology, and so forth?
46:53
What do you think we should have learned from this pandemic?
46:57
And what should we be doing to prepare or get ready for
47:01
the next pandemic when it comes?
47:03
>> Jay Bhattacharya: I think that the primary lesson for
47:05
public health from this pandemic should be humility.
47:08
Public health did everything, almost everything wrong.
47:11
And as a result, public trust and
47:13
public health is at its lowest point I've ever seen in my career.
47:18
And it needs to ask itself why all of this went wrong.
47:24
The answer is not going to be other people.
47:26
It will be public health officials, it will be academics in public health.
47:29
It will be public health itself that is to blame.
47:36
We violated the civil liberties of a tremendous number of people with lockdown.
47:39
We harmed the lives and health of literally tens of millions of
47:44
people with the policies that were pushed by public health,
47:49
that were told by public health, would solve the epidemic.
47:54
And if there isn't introspection on the place of public health,
47:59
Honest introspection, and then tied to public health
48:03
leaders who made these mistakes losing their positions.
48:07
I don't see how the public will ever trust public health again.
48:13
As far as preparing for the next pandemic,
48:16
I actually think the old plan worked pretty well.
48:20
I'm okay with newfangled things like pre commitments for
48:24
vaccines and essentially, contests to produce vaccines rapidly.
48:30
I mean, I think that's fine, but as long as that
48:35
kind of effort isn't tied to really, really bad policies.
48:41
So here's what I have in mind.
48:43
Imagine another pandemic starts and some president says,
48:47
look, we're gonna do an operation warp, warp speed,
48:52
warp ten speed, and we'll have a vaccine in three months.
48:56
Well, the push to lockdown will be tremendous,
48:59
given the structure of public health we have now.
49:03
But three months of lockdown is not a trivial thing,
49:06
it means that a very large number of people around the world will starve.
49:11
It means that our children,
49:12
their schooling will be interrupted with consequences for health and well being for
49:17
the rest of their lives, that the working class people will suffer.
49:23
>> Jay Bhattacharya: Tying lockdown policies to the potential for
49:26
whether a vaccine may or may not, which may or
49:30
may not work at warp speed, is tremendously bad policy.
49:34
And so that's what I'm afraid is going to happen.
49:38
It's okay, in fact, an active good to have this technological capacity.
49:43
We don't know for certain it'll work, but it's really good to have this.
49:46
It's the kind of thing we ought to be able to do, well,
49:48
ought to be able to invest in.
49:50
But public health has to draw a firm line and say, we're never gonna
49:55
use this as an excuse to do tremendously stupid things like lockdowns.
50:01
>> Jon Hartley: Wow, it's been such a fascinating conversation,
50:05
Jay, and really just a real pleasure to hear your thoughts and
50:10
you sort of summarizing your views on all of these issues.
50:14
I know you've been certainly one of the most prominent voices and
50:18
commentators throughout the entire pandemic.
50:22
And I salute you for contributing to such important public service,
50:28
especially when lives and livelihoods are both on the line.
50:33
Thank you so much for joining us, Jay, this has been a real pleasure.
50:36
>> Jay Bhattacharya: Thank you, John, thank you for this conversation.
50:37
It was fun.
50:39
>> Jon Hartley: Today our guest was Jay Bhattacharya,
50:41
who is a professor of medicine at Stanford University and
50:45
is a research associate at the National Bureau of Economic Research.
50:49
This is the Capitalism and Freedom in the 21st Century podcast,
50:52
where we talk about economics, markets, and public policy.
50:55
I'm John Hartley, your host, thanks so much for joining us.
50:58
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