Latest / Uncomfortable Conversations with Josh Szeps / "Will The Virus Win?" with virologist Peter Kolchinsky

Transcript

"Will The Virus Win?" with virologist Peter Kolchinsky · Uncomfortable Conversations with Josh Szeps

• 0:00
  G'day humans! Welcome to the safe space for dangerous conversations to show where the
• 0:05
  chitty chat may be comfortable, but the ideas and the topics and the perspectives that we
• 0:10
  address are confronting to one or both political parties, or ideally to all rigid cultural
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  world views. This is not a show where we shout slogans at one another or get hostile,
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  it's where we come together to jointly understand things, even things that might make everybody
• 0:27
  else uncomfortable.
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  This week on the show Science! Microbiology, viruses, vaccines, tiny, wily microorganisms that
• 0:47
  can crash economies in prison entire populations, grind global travel to a halt, demolish our
• 0:53
  normal social customs, wipe out industries and human lungs with blind but ingenious power.
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  This might just be the most uncomfortable conversation we can have right now, because
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  of where Australia currently sits. If you're outside of Australia, then you're dealing
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  with your own coronavirus maelstrom, but let me reflect a little bit about what's going
• 1:14
  on here. Australia had basically eliminated community transmission of coronavirus using
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  all of the scientific principles that all experts and epidemiologists knew that we should
• 1:30
  undertake. Stay home, shut down, don't go to school and work, don't shake people's
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  hands, social distancing, all of that. That was highly effective. The other column,
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  the other pillar, the other strategy, the other component was to completely seal the borders
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  and prevent any new cases from coming in from outside. This is a massive undertaking
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  for a country like Australia, which is so reliant on foreign travel, on inbound tourism,
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  on international students coming to study at our universities. I've spoken to a lot of
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  Americans who say, oh, you couldn't possibly do that here, we're too big, but really
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  in some respects, it's a more difficult thing to do in a country like Australia, because
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  the connections with the rest of the world for a nation that is essentially stranded in
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  the wrong part of the globe for what it actually is doing, what it actually is up to are even
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  more important. But Australia took the step of essentially banning anyone who's not an
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  Australian from coming into Australia and simultaneously imprisoning all returning Australians
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  in hotels, I mean, they're four star hotels, they're not prisons, but nonetheless, it's
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  a prison if you're not allowed to leave it for two weeks upon return. And that way you
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  would ensure that no coronavirus entered the country while you are trying to get your
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  arms around the pandemic here at home. And throughout March, April and May, that was
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  basically successful. And Australia really looked like it was on track to becoming a New Zealand,
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  which did essentially the same thing, but with an even harsher lockdown. Although to be fair to
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  Australia, New Zealand's lockdown in the moment didn't seem to work any better than Australia's
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  did. Australia's was a bit looser, you could still sort of go to the beach, you weren't allowed
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  to lull around on the beach and have picnics, but you're allowed to walk directly across the beach
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  into the water and go for a surf, you're allowed to jog along the beach, you're allowed to use
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  do things for exercise, you were still able to go to coffee shops and restaurants and get takeaway
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  even though you couldn't sit in them. Whereas in New Zealand, it was full on lockdown,
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  nothing, you couldn't even go for takeaway. You couldn't, you know, go outside without getting
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  a fine. And effectively, I'll get complaints about saying, well, actually, if you've got a permit
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  and you downloaded it from the internet, then you were able to go outside without a fine, as long
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  as you filled out subsection 14c, you know what I mean, it was a lot harsher. And Australia was
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  successful without going full crazy lockdown just by relying on the epidemiology, ramping up
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  testing, massive contact tracing, really throwing everything at the problem. And many people,
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  myself included, thought that we'd sort of done it and at the end was inside. And then
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  the quarantine hotel arrangement in the state of Victoria, the second most popular state,
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  where Melbourne, the second most popular city is located, a fellow part, turned out that instead
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  of employing the police and the army to manage the quarantine hotels, organizations and institutions
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  that have experience in such things, the Victorians had decided to outsource it to private firms,
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  including some firms that would, for example, send WhatsApp messages to under trained former
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  bounces of nightclubs who would just get a message saying, hey, you want to part-time casual gig
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  at one of these quarantine hotels? Inadequate training about how to seal off a pandemic.
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  Staff is going between quarantine hotels, spreading pathogens between them, without the proper
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  protective equipment, returning home to families, seeding coronavirus back into the community.
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  And all of that was going on without the authorities catching it.
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  In one of the more colorful examples of a quarantine breach, there were allegations,
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  unsubstantiated, but hey, they come from the Murdoch tabloids, so you can take that to the bank
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  that one of the staffers was having sex with the inbound visitors, prompting me on the ABC
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  afternoon show that I was presenting last week to put together this little sketch. It's a quarantine
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  safety training ad for the new staffers who are going to be working at Victoria's quarantine
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  hotels. When greeting new arrivals from abroad, be sure to always wear personal protective equipment
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  and avoid touching, kissing and licking the guests. Do not welcome new arrivals with hot stone
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  massages or fondue parties. As a temporary precaution, the nightly staff versus guest jelly-wrestling
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  tournament will only be held on Sunday nights. And a reminder, please keep the licking of
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  door knobs to a minimum, because we're committed to keeping Victoria as safe as is compatible with
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  us not doing anything that might remotely inconvenience our normal lives. That is my whimsy about
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  the situation, but I am feeling currently pretty depressed because the Victorian case load
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  has been all over the joint this week, but very high. It looks like today, I'm recording on
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  Sunday, the 2nd of August, the Victorian Premier is about to announce a case load of 650 new cases
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  today. There were over 300 yesterday and there were over 700 on Thursday. Just to put that in
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  context, the nation of Germany this week is bouncing between average new cases of
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  300, 400, 600. It jumped up to 900, which alarmed everybody, but in that sort of vicinity.
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  The state of Victoria, which has one-twelfth the population of Germany, has been recording about
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  the same number of new daily cases. So it's gotten out of control. More than a quarter of all the
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  deaths in Australia from COVID have taken place in the past seven days.
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  So we thought we were out of the woods. Of course, it's nowhere near as bad as it is abroad,
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  and I made some gentle fun of that of the US and the UK on my ABC afternoon show as well.
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  I took a crack at doing a Trump, but what do you reckon?
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  When my chief of staff comes to me, I say, what ranking is at the United States, they say,
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  Mr. President number one. As in number one, now Obama never got a number one. Obama never got a
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  number one in coronavirus. It's sad in hospitals all over America. They say Mr. President is
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  unbelievable. The hospital has never looked like this so full, so great. So many people coming out
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  to hospitals. They say, Mr. President, how did you do it? I don't know. I don't know. I guess I just
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  got a nap. That's my gentle rubbing of Donald Trump. And just to be an equal opportunity offender,
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  I also poked fun at the UK and Boris Johnson, which I'll play you in just a moment. But before I
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  play that, I just want to relate a positive story from this morning, which is that I was going to
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  take the little kids. I've got two twin toddlers who are two years old. I wanted to take them out to
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  a play center. And I felt a little bit anxious because of the increase in coronavirus. I thought,
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  all right, let's take them somewhere outdoors. It is the middle of winter, but it's beautiful
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  whether it's a sunny day. It's not too chilly. And so I find this huge outdoor kind of play area
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  that was built as part of the Sydney Olympic redevelopment when Sydney had the Olympics in the
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  year 2000. A lot of stuff was built on around around the Olympic site to revitalize that area
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  where around where the stadiums were being built. And there's this fantastic park with huge slides
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  and flying foxes. What do they call those in the States? Ziplines. And you know, all kinds of
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  things, everything that a child would love. So I get out there. It's a beautiful sunny Sunday.
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  And it's in Western Sydney, which is demographically more multi-ethnic and a lower socioeconomic,
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  God, that's horrible jargon isn't it? Why do I use turns like that? I mean, I've got to stop
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  doing that. It's a poor, it's a poor, it's a poor, non-white area that was socioeconomic background
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  sounds so pretentious. So there are a lot of, there are a lot of poorer people and a lot of
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  non-white people there. I'm probably the widest person out of about a thousand people. It's a huge
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  park. There's probably a thousand people there. There are families having picnics. Some people
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  have pitched a little tense so they can, you know, don't get sunburnt during the day. I'd say
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  five to 10% of the people there are white. About a half of all the women have, have head scarves
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  on. They're either, they're either of South Asian extraction or they're Arabic.
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  And yeah, basically some combination of mostly, I'd say they're probably about a third Asian,
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  probably about half Arab or Indian and probably, you know, the rest miscellaneous mungols like me.
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  And it's strange to me that I can say that. In other words, it's strange to me that I would
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  notice the ethnic breakdown because a year ago, I wouldn't have noticed at all. Like I wouldn't,
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  I just wouldn't have been able to tell you. I remember in his American friend of mine coming to visit
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  and as we walked past some people in the street, he said, so would they have been like aborigines
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  or were they like Pacific Islanders? Why exactly? And I was like, oh, I didn't, I mean, I literally
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  didn't see it at all. I didn't notice. I didn't pay any attention to it. I'd have to go back and
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  look, but his eye was trained to see it. He was sort of inculcated in a culture where noticing that
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  was important. And I thought we'd grown out of that. One thing that I loved about Australia was the
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  fact that I wouldn't notice it. Maybe that sounds naive. Of course, the white guy doesn't have to
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  notice it because he's dripping with white privilege. But I really think that part of the ethos of
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  intentionally not noticing it is something that has kept Australia together as a great multi-ethnic
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  success story. And I stood on top of this hill where the slippery dips, the slides went down the
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  side. It's slippery dips. That's a wonderful Australian term, isn't it? Yes, that's actually what we
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  call them, Americans slippery dips. That's what we call slides. When I go down the side of the hill,
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  I'm standing up on the top of the hill with my kids and looking out at this vista of all these
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  people from all over the world with all these different religious faiths and customs and tastes
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  and ways of cooking and ways of thinking and ways of doing things. The different ways they choose
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  to have breakfast, the different ways they pray. And everybody having no issue with each other,
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  no sense of a chip on anyone's shoulder as far as I could tell, no animosity, big smiles all
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  around, incredibly warm and friendly atmosphere. It made me proud. It made me realize how small and
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  petty so many of the arguments and debates that I see online, especially on sites like Twitter.
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  It made me feel like there is hope and something to be treasured in the experiment that Australia
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  and hopefully most of America is still committed to, an experiment where people can actually
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  try to make where they come from and their historical grievances and the disadvantages that they've
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  had or the advantages that they've had, the components of their tribe, less important than
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  the mission of living a happy life and breaking bread with each other and being part of a
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  national communal mission to live well, to get along, to not fight over little bits and pieces.
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  A sense I suppose that there's more than enough, that the pie is more than big enough for all of us
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  and we don't need to be squabbling over a zero sum interpretation of things. One person's
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  advantage is not another person's disadvantage. We can all get along. It sort of made me realize
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  when I said that I wouldn't have noticed the ethnicities of the people a year ago, what I mean is
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  that the past year has been so traumatizing, so brutalizing, to so many of us,
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  that it's left me with more of a sensitivity, and I don't mean that in necessarily a good way.
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  More of a sensitivity towards difference, more of a hardness towards the other. I certainly
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  receive a lot more hate than I did before. The massively important and overdue conversation that's
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  happening in the United States about police violence and the massively important social unrest
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  that happened after the murder of George Floyd have since somewhat devolved into a kind of
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  calcified, doctrinaire orthodox war in which you have to basically pick sides and you're not
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  able to, and the kind of comedy that I'm talking about, the kind of communal sense of
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  ignoring one's culture and it race in the interests of just going down a slippery dip or a slide with
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  your kids and another person's kids. That has somehow been condemned as being naive.
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  The sunny optimism of the stupid person who thinks that we can all just get along.
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  I hope we can regain it. I hope we can retain it. I hope it's still part of our.
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  I hope it's still woven into the fabric of who we are, especially as Australians, and I have to
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  believe that it still is as Americans as well, that we don't have to devolve into camps, into
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  warring camps, where one group is condemned to their own white privilege while another group is
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  condemned to always being oppressed, where there's a kind of oppression, a limpix where each
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  identity group that you belong to either ratchets you up or down a hierarchy of oppression.
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  It was so lovely just being out in the sunshine with people who weren't treating each other
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  as their histories, as their skin colors, as their head scarves. Anyway, that was my little
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  bit of whimsy for today. It made me optimistic and hopeful and I hope that we can refocus on those
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  things that bind us all together instead of the things that corrode us and divide us, even if those
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  things are couched in terms like justice and social justice, and anti-racism and anti-fascism.
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  Let's take a listen at my hopelessly ambitious attempt at doing a Boris Johnson impression.
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  At the first voice you'll hear is my newscaster, a voice.
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  Meanwhile in Britain, Prime Minister Boggers Jumbleson has lashed out at critics of his government's
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  coronavirus response. Alistair Molsky reports from London,
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  it was supposed to be a publicity stunt promoting Britain's success in combating coronavirus.
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  The Prime Minister, wearing a leather aviator helmet and goggles, had planned to fly around
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  Parliament House on a jetpack, skywriting the words, winning against Covid from a flare stuck
• 17:49
  in his bottom. But he crashed into Big Ben and spent three hours dangling from the big hand of
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  the clock, 230 feet above the Palace of Westminster. After he was winched to safety, he insisted
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  his government's messaging on masks, lockdowns and coronavirus has been crystal clear.
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  Crystal clear, crystal clear, wear a mask on your face if you don't have a mask,
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  just wear your face on your face and if you don't have a face where the mask on your foot or
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  don't or do, and I'm terribly sorry I just disappeared up my own anus. Oh look, there's the flare.
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  That's my Boris Johnson from last week on ABC Radio Sydney. So while we make fun of where the
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  US and the UK are at and while we breathe, of course the sigh of relief that Australia is not in
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  that position, there is also a sense that we need to know where this is going to go now.
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  So I wanted to have a conversation with someone who understands the science of developing a vaccine
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  and what makes viruses so cool from an evolutionary point of view, so resilient, so hearty and
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  capable and wily and evasive, there's such simple little strands of brainless RNA that you would
• 19:09
  think that they should be easier to counter. But because of their simplicity, they find these
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  ingenious, shape-shifting ways to bring us to our knees. Peter Colchinsky is, he got a PhD
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  in virology from Harvard University and he's now a biotech investor, he's a scientist but he works
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  as an investor where he identifies biotech companies and he invests in the ones that he see
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  regardless of being the most promising, which means that he has the he wears the hat not only
• 19:45
  of somebody who understands the science but somebody who thinks forward about the most fruitful ways
• 19:50
  in which that science is going to be applied to real life. If you are an Australian listener, it's worth
• 19:55
  bearing in mind for this conversation that when he talks about Medicare, when we talk about Medicare
• 19:59
  in the American context, that's the program for old people and only kicks in at age 65. So if there's
• 20:05
  a bit of ambiguity or you don't quite understand why we're talking about only old people for Medicare,
• 20:08
  Medicare also happens to be the name of Australia's public health system that applies to everybody,
• 20:15
  not just the elderly. And I know it's boring, but leave a rating or a review on an app where you can
• 20:21
  do so. A lot of us use apps like I use Overcast, which is a great app for listening to podcasts.
• 20:26
  Unfortunately, it has no functionality to actually leave a rating or a review. So if I want to do
• 20:32
  the right thing by podcasts I love, I also have to have my conventional old tacky Apple podcast
• 20:40
  app that I don't even like, which is just sitting there on my phone exclusively so that I can be a
• 20:44
  good citizen and leave ratings and reviews. Because that's the way that a lot of people discover
• 20:49
  podcasts, they're just surfing around looking for things in the store and something pops up and it
• 20:54
  only pops up if a lot of people are talking about it or rating it, please do it. I know it's boring,
• 20:58
  but right now just pull out your phone and either on the Google Android app or the Apple app,
• 21:03
  leave a rating or a review, the system then understands that you like this show and that you're
• 21:07
  engaging with it. Follow Peter Colchinski and enjoy this conversation.
• 21:19
  Can you tell us what you do?
• 21:21
  Yeah, so I invest in biotechnology companies, companies that make new drugs, diagnostics, medical
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  devices, I'm a scientist by training and I'm always trying to figure out how we're going to solve
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  these new problems. Usually these are things that matter to certain small subset of people,
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  you know, breast cancer, let's say our Parkinson's, but now COVID matters to the entire world and so
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  my team's studying all the ways that we're going to crack that nut.
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  When you say your team is studying how to crack that nut, does that mean they're studying who
• 21:54
  do invest in, who's going to crack that nut or they're trying to crack that nut themselves?
• 21:58
  Yeah, well, you know, it's actually like a lot of people I feel on the one hand are doing
• 22:02
  their jobs and the other hand they feel like they're contributing to, you know, this great global
• 22:07
  effort, you know, to solve a common problem. So on the one hand, yes, we are trying to figure out
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  are there investments we should make that take COVID into account, you know, and we have made some
• 22:19
  investments in companies making vaccines, companies making drugs, but at the same time, you know,
• 22:25
  we don't, for example, publish our research. We created this giant map of all the different
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  technologies of vaccines and development for COVID and we put it online for the entire world to see
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  because we thought that it was important to help coordinate the global effort and not just
• 22:43
  use that knowledge in order to make our own investment decisions. Are you investing in small
• 22:48
  companies that would otherwise have resources or are you investing a sort of piggybacking on
• 22:53
  larger companies that have resources? It's across, it's across the spectrum. So my firm
• 22:58
  are a capital we've been around now for 18 years. I've been an investor and we've got about 90
• 23:08
  people and we invest across basically all markets. We'll invest in public companies, we'll invest in
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  private companies and we'll even form companies of our own. We just follow the science wherever it
• 23:20
  takes us and sometimes we're collaborating with a lot of other investors to, you know,
• 23:27
  provide a ton of funding to a company doing some advanced work, you know, phase three clinical
• 23:32
  studies or something. And sometimes we're alone cutting a small check to, you know, a group in a
• 23:38
  laboratory just, you know, planting the seed of an idea. But we're really focused on new things.
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  So we don't invest in very many companies that are already out there selling a product. We're
• 23:49
  always on the cutting edge. Right. And this might be a stupid question, Peter, but how do you start
• 23:54
  as an investor? Like, how did you make the money in the first place or did you start
• 23:57
  for yourself in this same industry? By accident. So I did not indeed, you know, think that I was
• 24:03
  going to become an investor. I went into science because my dad told me when I remember as a
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  young teenager, you know, I think we were on a beach somewhere and my dad, you know, was having a
• 24:16
  deep conversation with me because really those were the only conversations you knew how to have
• 24:21
  with me, you know, in a little time that we had together, he was working a lot. That's a good
• 24:26
  dad. That's a good dad who I know is how to have deep conversations. Yeah. Yeah. My dad is great,
• 24:30
  you know, and he's looking to connect with his son and he decides to have a deep conversation
• 24:34
  about the future and your career. And he said, you know, my career has been in computers and it's
• 24:40
  served me well. And I've written the computer wave. But I think that that wave, you know, is
• 24:46
  cresting. And I think that there's a new way for you, you know, biotechnology. So basically,
• 24:52
  my dad totally missed, you know, Google and Facebook and all that stuff, right? You know,
• 24:57
  he was leapfrogs from one revolution to the next. Yeah. You know, I'm not complaining.
• 25:03
  Biotechnology has been an amazing field, you know, just blossoming so much knowledge.
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  And I was like, all right, right dad, I'm, I'm going to study biology. And so from that moment
• 25:17
  forward, I read about biology, I studied biology, I took all the biology classes I could, all the
• 25:23
  laboratory work that I could in college. And in college, I actually saw the movie Outbreak with
• 25:28
  Dustin Hoffman, right? You know, trying to save the world from in a bowl of like virus.
• 25:34
  Wearing a space suit doing it. I just thought that it's super cool. I want to wear a space suit
• 25:39
  and work with viruses. I have vague recollections, Peter, of like helicopters, like naparming whole
• 25:44
  towns or something in that movie. It's been like 20 years since I saw it. But is that, is that right?
• 25:50
  It's really important to, you know, beat the virus. You got to get rid of the virus. Yeah.
• 25:54
  Because otherwise the army will, you know, napalm the citizens. If a little bit of napalm is what it
• 25:58
  takes, then so be it. Yeah. So, you know, I feel like today, my job is to protect the world from
• 26:03
  basically global obliteration by the army with napalms. There will be a movie in the future,
• 26:08
  in which you'll be played by Timothy Shalamay or some creature as yet unborn on your, your quest
• 26:14
  to save the globe. We'll, we'll see about that, you know, see if we can bring Dustin Hoffman back.
• 26:18
  Yeah. So, so I thought it was a cool movie and I was like, that's it. I want to be a
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  virologist, right? And, and I was a Cornell School in upstate New York that really has a
• 26:31
  lot of like agriculture and animal husbandry research. And when I want to do, you know, virus
• 26:37
  research there in, in college, the only virus that they really had to work on was this canine
• 26:43
  paro virus, which was widely known among all veterinarians as the virus that made dogs
• 26:50
  shit in their office in 1977. It basically swept the globe and all veterinarians are shell shot
• 26:57
  by how much diarrhea they were, you know, a wash in from all the dogs in the world getting this virus
• 27:02
  that just popped into existence. It evolved from a cat virus. So cats basically gave dogs the runs.
• 27:10
  Right. And so this was the virus that I studied. And, you know, then I want to go to grad school
• 27:16
  and get my PhD in virus research. And I went to grad school at Harvard and they had 40
• 27:24
  virology labs. You know, it's the leading, you know, school for doing virus research, but they
• 27:29
  were basically two viruses. Herpes in HIV. And neither of them were going to get you a date,
• 27:34
  right? You know, so you can choose which one you want to work on. And, and I dabbled in each
• 27:43
  and decided I was going to work on HIV at the time from what I recall had 11 genes and herpes
• 27:50
  had nearly like 200, right? So in terms of which one is going to be easier to understand, you know,
• 27:55
  HIV is far, far simpler. But it's a, you know, really cool virus with a whole lot of tricks
• 28:00
  up its sleeve and it's really tough, tough virus to beat. And I was learning actually about some
• 28:10
  of the virus's tricks, how it manages to evade our immune system, you know, and keep the immune
• 28:15
  system from neutralizing it. And I realized I actually wasn't likely to invent anything great
• 28:22
  myself. And my dad had invented technologies that he'd formed his own company around and he
• 28:27
  was a CEO and I really looked up to him, you know, for having started a business and I thought
• 28:32
  that's what I want to be. I want to be a CEO of a biotech company. But I realized I wasn't going
• 28:36
  to invent my own technology and I should instead learn something about the business of biotechnology
• 28:41
  so I could help those people who can invent something great, right? And it takes a lot of dedication
• 28:47
  to invent something in really any field, but especially in biotechnology, you got to be ready to,
• 28:52
  you know, dig, dig, dig for 20 years, you know, try to find a nugget of something and you may
• 28:59
  find nothing, right? Like what a tremendous risk to take with your career. And, you know,
• 29:04
  there are people that have invented cures for certain cancers. But for every one of those,
• 29:09
  there's thousands of scientists, you know, that just dug, dug, dug, dug and found, you know,
• 29:16
  very little that the public would take interest in. I mean, they learn all kinds of things like
• 29:22
  they learn where other people should not waste their time digging, right? It's a fruitless area
• 29:26
  of research. And that's a contribution of its own kind. So I did not want to make that,
• 29:31
  that kind of a commitment to science. I really wanted to be closer to the action and that
• 29:36
  meant helping other people that were discovering things. And that meant learning something about
• 29:41
  the business of biotech. So as I went out into, after getting my PhD and I went out into
• 29:47
  the industry looking for a job, I got a really great job offer from a gentleman whose initials
• 29:53
  are R and A to he had been a businessman and a founder of a biotech company.
• 30:00
  Am I supposed to know who that person is?
• 30:02
  Well, you can, but sure, Rich Aldridge, but what's relevant is that the firm that I now run,
• 30:08
  R-A Capital, right? Sorry to mention that. The firm is called up.
• 30:15
  It's named for my mentor. He gave me my start. And, you know, R-A Capital exists because, you know,
• 30:21
  Rich was, you know, pretty trusting. And it was like, oh, I've got an account here with $4
• 30:27
  million. Here's the username and password to log into it. I want you to recommend what I should
• 30:33
  be buying and selling in it, you know, which biotech stocks. And that was just a small part of my job.
• 30:39
  I thought I would help him evaluate private companies that he might join as a board member,
• 30:43
  maybe get involved in things where we might start a company, you know, really learn about the
• 30:47
  business. And picking stocks was like, it wasn't what my mother or father raised me to do. You know,
• 30:52
  not what I thought I would end up doing. And it struck me as kind of soulless, right? Because
• 30:58
  basically, you know, as public companies, you can research them. But at the end of the day,
• 31:02
  there's a limited amount of information that they'll give you. You know, you're not allowed to go
• 31:08
  behind the wall, you know, and, you know, you make an investment. And then this, you know,
• 31:14
  herd of investors decides whether you can be right or wrong, you know, making the stock go up
• 31:18
  down. And it's, it takes you far from the science, or at least that's what I thought.
• 31:22
  But it turned out over the next couple of years that I was a little bit good and a lot lucky.
• 31:27
  And I did really well with my mentors money and I caught the bug. And I was like, oh, I think I
• 31:32
  actually want to be an investor. And how many dead ends can you afford when you're catching that bug?
• 31:39
  Well, let me put it this way. Let's just say that there are hundreds of parallel universes out
• 31:44
  there. In every other parallel universe, I'm not a biotech investor. This is just the one where
• 31:50
  things worked out. What I meant that was when you're investing, like, how many, how much do you need
• 31:55
  to get right and how much, how much is it a game of your, you can get nine, nine bits wrong as
• 32:00
  long as the one pays off? Yeah. Well, it is very much like that. So, you know, I certainly would like
• 32:07
  to get more than 10% of my investments right. But biotech is a pretty risky field. I would not
• 32:13
  recommend anybody investing in biotech. You know, it's make it your profession or don't bother.
• 32:19
  Okay. I'm just gonna make a note here. Do not invest. Do not become biotech investor in second half
• 32:25
  of my life. Yes. If you want, if you want to sleep well at night, do not dabble in biotech
• 32:30
  investing. It's crazy risky. But what I discovered was that while you can't go very deep with any one
• 32:36
  company, when you talk to every diabetes company out there and they allow you to go a few inches
• 32:42
  deep, you start to get a really good sense for what's going on below the surface, right? If you
• 32:48
  can't, can't go deep with anyone, go broad and get to know all of them. And then you start to see
• 32:53
  certain emergent phenomenon field, like, you get a sense for where it's going. And that actually
• 32:59
  became the, the way that RE Capital blossomed in our team grew. We, you know, wanted to know everything
• 33:06
  that's going on. All the companies working on breast cancer, all the companies working on Parkinson's
• 33:10
  disease. And, you know, we eventually would, you know, get to really know private companies and
• 33:17
  there you can sign a confidentiality agreement and you can learn a lot more about their science and
• 33:21
  you can go deep with them. And so when you get to know all the companies doing everything,
• 33:27
  you start to see the chess board of human activity in, you know, as it tackles a given problem,
• 33:35
  right? Like everything that's going on. And sometimes these companies don't even know about one
• 33:38
  another, right? Can you imagine somebody's like building a bishop over here and somebody else is
• 33:43
  building a knight over there and some people are working on pawns? And you can see the strategy
• 33:48
  that's emerging or at least the potential for the strategy for how you could move those different
• 33:53
  pieces around. But the pieces themselves don't understand where they are or how they can be combined
• 33:58
  because they're so focused on just developing their one drug. So it was, it turned into a really great
• 34:03
  vantage point for the emergence of this absolutely stunning vibrant industry that over the last 20
• 34:10
  years has just blown up. I mean, it's like your neighborhood electronic store has turned into this
• 34:19
  giant home depot. I don't know if you guys have home depots in Australia. We have an equivalent
• 34:25
  called bunnings. There you go. So, you know, your neighborhood tool shop where you could maybe get
• 34:31
  one hammer, one saw and a screwdriver is now turned into a bunnings, right? There's no problem. You
• 34:37
  can't solve. If you walk through the aisles of your bunnings and pick the right tools from the
• 34:43
  shelf, that's what biotech has become. And that's what the world's seeing now as the whole industry turns
• 34:49
  all of its resources and ingenuity on this one problem that's plaguing us all. Are you confident
• 34:55
  that they're adequately coordinated in that mission when you talk about one person making a
• 34:59
  bishop and another person making a night? That sounds wasteful. Yeah. Yeah, it's, well, I mean,
• 35:07
  what's a little wasteful is when there's 15 bishops, you know, a bishop, right? Okay, it's
• 35:12
  pretty good, right? But what I would say that the global effort to beat COVID is
• 35:20
  reasonably better coordinated than, for example, the effort to
• 35:25
  cure pancreatic cancer or something like that. And that's because there's a concerted effort to
• 35:33
  share data and to collaborate, but it's definitely not as coordinated as it could be. But groups
• 35:40
  like CEPI that's backed by the Gates Foundation, you know, they are definitely helping to,
• 35:46
  you know, sort of aggregate all the data and to centralize some funding and to make sure that
• 35:52
  the best bishops that are getting the funding because, you know, chess is played with really solid
• 35:58
  little pieces, right? But I need you to think about chess as it's being played by people that are
• 36:05
  building each piece. And there's a chance that as you reach for a bishop, it's going to disintegrate
• 36:10
  as the clinical trial fails. And oh, I thought I had a bishop there to work with, but I guess I don't.
• 36:16
  Yeah. Right. And so you're really playing this game of like probabilistic chess. What's your
• 36:20
  strategy if maybe you have a bishop on C3, right? And so a group like CEPI has that perspective.
• 36:28
  And we put out our COVID map, which if people want to go to our website, racap.com, they can click on
• 36:35
  the COVID link in the menu. And they can download this massive PDF with all the different technologies
• 36:42
  that we were able to find anyway. And the thing is out of date, like within a day of us putting it out
• 36:47
  because there's new programs being announced, you know, and we're hoping that all these different
• 36:51
  groups that are, you know, trying to coordinate the global effort will take a look at that map and
• 36:55
  maybe it'll help them do an even better job, right? Now, when it comes to pancreatic cancer,
• 37:00
  I can understand why companies don't, you know, collaborate like that. They're competing.
• 37:05
  They want to create the best one or two chess pieces to try to really like knock back pancreatic
• 37:10
  cancer. You know, and so, you know, they end up collaborating more once their drugs are FDA approved
• 37:17
  and now doctors can start to mix and match the different drugs and figure out how they work together.
• 37:22
  So eventually you get collaboration. But today with COVID, we're seeing collaboration,
• 37:28
  you know, at an earlier point in development that you'd normally see.
• 37:32
  Hmm, let's let's talk about dogs diarrhea for a moment. I don't want to leave that behind
• 37:38
  because I want to ask you a professional opinion about something that happened to me.
• 37:45
  While I was living in New York, it was my partner and I, now my husband, before we got married,
• 37:50
  he was here and I thought we would take a little weekend away because we were very stressed out
• 37:54
  about a new dog that we'd gotten from the pound. We got a rescue dog. She was wonderful but very
• 38:01
  rambunctious and hard to control and she wasn't really toilet trained and she wasn't really like
• 38:09
  trained in any way whatsoever. But we wanted to get out of the city because it'd been so difficult
• 38:13
  in the apartment and it was freezing cold. It was one of those brutal New York winters and we found
• 38:19
  a little place up in the up the Hudson River. You know, it was a bed and breakfast. But one of these,
• 38:25
  when we get there, it's one of these bed and breakfasts that is basically just an old lady's home
• 38:31
  and you're just sleeping in one of her rooms, right? And it's a beautiful, it's a beautiful,
• 38:35
  beautiful place. But we've got this rambunctious dog with us and it was a dog-friendly place so she
• 38:41
  knew the dog was coming but you feel a little bit awkward about the fact that she's just sleeping
• 38:45
  across the hallway and there's this dog in your bedroom with you. So anyway, whatever, we're
• 38:51
  going to roll with this thing anyway. We go on a walk out in the freezing cold and there's a large
• 38:58
  pond that is half frozen over but not but very shallow but also watery and the dog starts playing
• 39:05
  and frolicing in the water and drinking the water and I'm like, should she be drinking that water?
• 39:10
  It seems like it's kind of muddy still water. I don't know, we don't have frozen water in Australia.
• 39:14
  What do I know about the bugs that might be in a frozen pond or not? So we go back inside and about
• 39:22
  four or five hours later as the sun is setting, she erupts in explosive diarrhea all over the bedroom
• 39:30
  of this kindly ladies cottage and for the rest of the night she was basically, her anus was just
• 39:39
  exploding on a regular basis every 90 minutes or so and we ended up leaving early the next morning
• 39:46
  with just the most horrendous stains. I mean, I was on hands and knees doing my best to get out of
• 39:51
  the carpet and out of the rug but the I mean, it was almost like we were just walking away from a blazing
• 39:58
  inferno that we'd left behind us of dog shit. Could that have been that virus?
• 40:02
  I doubt it because odds are your dog was vaccinated against that virus.
• 40:07
  Right. Yeah. We don't really have vaccines against
• 40:10
  Giardia and the algae and tons of other bacteria. I mean, your dog could have been drinking a
• 40:15
  veritable sewer. So yeah. Yeah. Yeah. You know, dogs should do less of that. Dogs should do less
• 40:21
  of the eating shit. I think a dog should social distance from some of that stuff. Definitely.
• 40:27
  I think that'd be good. Peter, let's start going through what is cool about viruses because
• 40:32
  this is where you first came to my attention basically listing your 10 favorite things about
• 40:38
  viruses. And I'd like you to explain them to us. You say that your favorite viruses are HIV
• 40:43
  rabies and herpes. There's a pickup line for you. Yeah. I sort of said there. We said they're
• 40:50
  the cleverest. Yeah, the cleverest virus. Yeah. So I'm going to give them that.
• 40:54
  Explain the ways in which they're cleverest. Let's start with signal jamming. What does that mean?
• 40:59
  When a cell gets infected by virus and a virus, it's basically just a bit of code wrapped
• 41:10
  in a protein and fatty sugar shell that protects the genetic code inside. And it can't make copies
• 41:19
  of itself because it's not really alive. It doesn't have all the machinery needed to ingest
• 41:24
  some kind of food and nutrients and make copies of itself. What it needs to do is it needs to
• 41:29
  infect a cell, get in there and hijack all of its production machinery. In order to then have
• 41:36
  the cell make copies of the virus and then the virus pops out of that cell, maybe killing it in
• 41:41
  the process and infects new cells. It's not unlike a computer virus. You remember back when we had
• 41:48
  floppy disks. If you had a computer virus on a floppy disk and you put that floppy disk into your
• 41:53
  computer, think of that like a virus infecting your computer. Now there's no visual there because
• 41:59
  virus has just sort of come in over the internet. Well, or a USB, a USB's dongle a stick,
• 42:05
  right? Perfect. I think that's how the Americans and the Israelis screwed up the Iranian nuclear
• 42:12
  reactors back in. When was that? Like 20, I want to say 2009 or 2010 or something. They created
• 42:19
  this piece of software and they had a spy drop a USB dongle somewhere near the Iranian nuclear
• 42:25
  reactor and someone picked it up and plugged it in and the whole thing went crazy and nobody,
• 42:29
  the Iranians couldn't figure out why. That's exactly it. You absolutely should not use
• 42:35
  some random thumb drive that you find somewhere. It was probably dropped by somebody in order to
• 42:41
  infect your computer and steal all your knowledge. And the same thing with condoms. Don't
• 42:48
  use those if you see them lying around. That's how infections spread. So a virus infects a cell
• 42:56
  and the cell has a ton of defenses. A single cell in our body actually doesn't care all of that
• 43:02
  much about its own survival. It cares about the survival of the whole, the host, the person.
• 43:08
  And so that virus is going to do so many things to try to stop the infection. It'll certainly try
• 43:14
  to stop that virus right there and then. It's got ways of doing that, like cutting up the virus
• 43:20
  genome. It's going to try to keep that virus from being able to make copies of itself. But it's
• 43:25
  also going to send out alert signals to the immune system and to other cells saying, hey, there's
• 43:30
  an infection going on, which allows surrounding cells to raise their own alarms, their own defenses,
• 43:36
  right? Activate their own booby traps and brings immune cells over that will detect which cell is
• 43:41
  infected and destroy it, right? And so what the virus does is says, oh no, I know your
• 43:49
  game plan here. You know, you're going to secrete this little protein called IL-18.
• 43:54
  You know, well, I've got a protein that attaches to IL-18 and keeps it from, you know, going out
• 44:01
  and alerting everybody else that I'm in here, right? So, you know, that's an example of signal
• 44:08
  jamming, right? And so, yeah, right. And so just to clarify, when a cell in my body receives this
• 44:16
  protein, it goes, oh, shit, that's a red flag that's been raised by one of my buddy cells.
• 44:23
  And I need to do what to protect myself. Well, you know, a cell will produce all kinds of these
• 44:30
  signaling molecules to basically, you know, say, hey, send in the cops, the national guard,
• 44:36
  you know, send in a priest, whatever, you know, just like everybody, come help. Right. And
• 44:41
  so it's a flare essentially for, to, to corral the truth. And there are multiple different kinds of
• 44:48
  signals that the cell will send out and different viruses are clever enough to have jamming
• 44:53
  mechanisms for multiple members of these things, right? So, you know, the fact that we're still here
• 45:00
  that we haven't all been murdered by viruses tells you that whatever tricks the viruses have to
• 45:06
  get around our defenses, we're still pretty good. Like, we still have more tricks up our sleeve,
• 45:10
  and eventually we beat the virus, right? And so I judge a virus's cleverness by how many tricks it's
• 45:17
  got for beating our defenses, but we haven't really come across a virus that can beat them all,
• 45:23
  nor interestingly, does a virus really want to overcome all of our defenses and just kill us?
• 45:29
  Yeah. That is no good for the virus. So I'd say the best virus, you know, of all would be a virus
• 45:35
  that causes pretty mild infection can overcome a bunch of our defenses, maybe allows the immune system
• 45:42
  to corner it, to quarantine it in certain cells, but has a sort of stalemate there, you know,
• 45:49
  where it doesn't get wiped out. Basically, herpes. Herpes is, you know, a really great virus.
• 45:55
  It's got tons of tricks up its sleeve, and it will go dormant in your neurons, you know,
• 46:02
  just sits there for years and years, and occasionally will erupt. And if we're talking HSV1,
• 46:09
  Herpes Simplex1, then that's what causes, you know, sores on your lips. And if it's HSV2, it,
• 46:17
  you know, causes sores on your junk. So, you know, those are different variants, but they can also
• 46:23
  pop out at times and cause pretty severe pain. In parts of your body, we call that shingles. So
• 46:31
  that's unfortunate, but these are viruses that can spread through contact, skin to skin contact.
• 46:37
  So kissing or sharing a drink, you know, can spread them. And they don't really kill you,
• 46:44
  right? You know, they don't want to kill you. I mean, the vast majority of people have Herpes Simplex1
• 46:50
  may not even know it. And is the point of the war to transmit itself between between people?
• 46:56
  You know, you're most contagious when you've got a sore, you're potentially still contagious,
• 47:03
  even when you don't have a sore. It's one of those sort of myths that you're totally fine
• 47:09
  if you don't have a sore. You could still be what's called shedding virus. You know,
• 47:14
  virus could still be popping off your body, even without a sore, at a lower level. So you're
• 47:18
  less contagious, but, you know, there is some transmission. So it's kind of like a symptomatic
• 47:24
  COVID, right? You know, you could be infected with a virus, you could be spreading it, but you
• 47:28
  may not be showing symptoms, may not know it. The better a virus actually can spread without
• 47:34
  showing any symptoms, the, you know, more likely it is to go undetected.
• 47:38
  Shedding virus is a great word, by the way. I think shedding, it's so like it's just visually,
• 47:43
  it's evocative. I just imagine people walking around like with just shedding little
• 47:47
  micro particles of virus all over the joint. Look, I'm going to make up all kinds of like
• 47:52
  fun analogies or whatever, but that's actually a technical term. Yeah, no, I know. Whenever I hear
• 47:56
  doctors talking or epidemiologists talking about like when you might be at, be maximally shedding
• 48:02
  coronavirus, I just, it makes my skin crawl as you're supposed to. So let's, so okay, that's great.
• 48:07
  So we've got the, we've got the signal jamming where the, the, your cell sends up a flare to call
• 48:12
  in the troops, but the, the virus sends in an intercept and puts an invisibility cloak over the,
• 48:17
  over the flare. So the backup doesn't, so the cavalry doesn't arrive. And what about this,
• 48:22
  this other point, about the ability of a cell to basically hide who, the ability of a virus that
• 48:29
  is to hide who it is so that you can't really see what proteins it's made of. What cells will try to
• 48:34
  do? And I, and I use the analogy of like a factory that has been infiltrated, you know, and,
• 48:41
  and that the virus is like this robot with code, you know, that for how to make more copies of
• 48:48
  itself, and it breaks into your factory into the cell and it wants to use all the machinery in
• 48:52
  there to make more copies of itself. And then it's going to pop out of that factory and leave it
• 48:56
  and rubble and go on and affect more factories, right? So first order of business, you get in there,
• 49:01
  the factories, you know, alarms are about to go off to alert, you know, the world, hey, I've
• 49:07
  been infiltrated and the virus cuts the wire and make sure that the factories stay silent. But,
• 49:14
  you know, these factories are cells are smart and what they'll do is they constantly put
• 49:20
  pieces of whatever's being made inside of them on display right there at the window so that
• 49:26
  anybody walking by can see, oh, look, there's a bit of this protein being made and that protein being
• 49:31
  made. And our immune cells are constantly going by all of our cells and kind of feeling around for
• 49:39
  are all the things that are being made in this factory part of us. Are they self, right? Or is
• 49:46
  it something weird, non-self that I haven't seen before? If it's non-self, then let's kill it.
• 49:52
  Let's destroy, let's burn the factory to the ground, right? And so this is part of our
• 49:59
  cell-based immune defenses rather than antibodies and we can talk about antibodies later.
• 50:04
  Well, in order to put things on display, there's kind of like a pedestal protein, it's called
• 50:09
  MHC, major, major histocompatibility complex. But you just need to think of it as MHC. And what the
• 50:18
  virus, some viruses will do is they will basically prevent the production of the pedestal or
• 50:23
  prevent it from getting to the window, right? And so nothing in that factory can be displayed in the
• 50:29
  window. So anybody walking by cannot see that there are bits of virus protein being made in that
• 50:35
  factory. Now, our immune system still clever and knows that, you know, there are some viruses that
• 50:42
  will do that. In fact, not just viruses, but cancers will do that too, right? The thread I haven't
• 50:48
  written, but you know, someday when I find some time, I'll, you know, show you the analogies
• 50:56
  of sort of similarities between the tricks that viruses use and the tricks that cancer cells use
• 51:01
  in order to, you know, survive in our bodies. Because our immune systems are constantly trying to
• 51:05
  kill off any cells that turn cancerous. And so what our immune system has figured out is that
• 51:13
  if I don't see pedestals in the window of a factory, I know something's up. It's either a cancer
• 51:20
  cell that doesn't want me to know that it's making all kinds of cancer favorable proteins
• 51:26
  in there or it's a virus infected cell. And I don't care, you know, I'm going to kill it.
• 51:31
  And the cells that do that, they're called natural killer cells, right? And it's one of the coolest
• 51:37
  cell types. I always think is that a natural, is that a technical term like, like shading a natural
• 51:42
  killer cell? It's a natural killer cell. It's an NK cell, right? This is the Woody, Woody house
• 51:48
  and a netable killer's poster. That's right. Yeah. But, you know, as I point out, these are actually
• 51:54
  good cells that are constantly looking to kill only bad cells, right? So it's like if Woody
• 52:01
  Harrelson played Dexter, right? So, you know, these cells are going around. And if they see that a
• 52:08
  cell does not have pedestals on display, then they destroy it. And so there are some viruses that will
• 52:17
  make a fake pedestal their own, right? And put it into the display. So, you know, this is like
• 52:24
  it's like counter espionage. So hang on, let me, let me just get my head around this. So the
• 52:30
  in a normal cell, you can see what's going on because the immune system can walk by and it can
• 52:35
  see it can just check that everything is is okay. But in order for it to to see that, all of the
• 52:41
  things need to be displayed on these little pedestals called MHC. And then the virus
• 52:47
  can essentially remove those pedestals, can it so that the so that there's nothing to see in the
• 52:53
  window. But then your immune system goes, aha, because there's nothing to see, something fishy is
• 52:57
  going on. But then some viruses like herpes can go, actually, I'm going to manufacture my own
• 53:04
  fake rinky dink pedestal and just put it in the window so that the immune system will walk on by
• 53:09
  thinking that everything's kosher. That is it. That's it. You, you get a PhD from Harvard and
• 53:13
  amazing. That's great. That was a lot easier than I thought a little PhD from Harvard would be.
• 53:17
  That's excellent. Yeah, it's actually not that hard. It's a myth that you got to do in real
• 53:22
  real work. So let's talk about HIV. What is what makes HIV special? HIV infects our immune cells.
• 53:30
  So in the thread, I describe it as a cop killer, right? Our immune system is designed to catch viruses
• 53:38
  that infect sort of other cells, right? You know, you kind of assume that the immune system itself
• 53:45
  is not going to come under attack, but HIV attacks the very cells that are coming after it, right?
• 53:51
  So imagine a cop is coming for this killer robot and the robot's like, oh, it's so good to see you
• 53:59
  and comes right at the cop and then takes over his body and destroys it while making copies of
• 54:04
  itself. So it's a brilliant tactic. The more the immune system revs up and launches, you know,
• 54:15
  T cells, you know, the type of immune cells that the HIV likes to infect at the virus. The more
• 54:22
  the virus says, oh, this is great. No, please more, more, you know, keep, keep sending. I can't get
• 54:27
  enough, right? And so our bodies don't really have a defense against HIV, but there are some people
• 54:37
  by the way. It sounds like Jiu Jitsu where you use the force of your opponent and then you swing
• 54:43
  them around and it's actually their attack that benefits you. That's yeah, I mean, it very much
• 54:50
  is like that. And there are some people who can basically not get infected with HIV, no matter
• 54:59
  how much HIV they're exposed to, right? And they have a mutation. They have a mutation in a protein
• 55:07
  called CCR5. And CCR5, and I talk about this in COVID, you know, I talk about how the robot,
• 55:17
  you know, the criminal clone robot that infects your body, it will reach out and it has to grab
• 55:24
  a doorknob on every cell in order to get in. And that doorknob, if people have been reading about
• 55:29
  SARS, SARS-2, is a protein called ACE-2, right? That's the protein on the surface of our cells
• 55:38
  that the virus attaches to and uses to get into cells. And we've got ACE-2 expressed in our
• 55:44
  lung cells and our throat cells and our nose cells. And that's one of the reasons why the virus
• 55:49
  likes to replicate in those kinds of tissues, right? Well, in HIV's case, the doorknob that it
• 55:54
  reaches out and grabs and turns in order to get into cells is called CCR5. Well, there are some
• 56:00
  people that have a mutation in CCR5 so that basically they don't put CCR5 doorknobs on their T-cells.
• 56:09
  And it's not that big a deal to not have CCR5. They're normal people. We can't seem to see any
• 56:16
  kind of real problem. It seems to tamp down their immune system a little bit. So you might think of
• 56:20
  it as a slightly weaker immune system, but not in any way that's harmful. And it probably keeps
• 56:26
  the immune system from overreacting to stuff if anything. And those people basically, you know,
• 56:32
  well, frankly, can have unprotected sex with HIV positive people and not worry about getting HIV.
• 56:38
  Not something I would recommend because they're still herpes, right? So, you know, lots of other
• 56:44
  reasons to... Well, I mean, this is part of the problem that a lot of health experts have with
• 56:50
  the rise of prep and these things that people can take now to essentially make it impossible,
• 56:56
  well, not impossible, almost impossible for them to catch HIV because there are these increases
• 57:00
  in gonorrhea and syphilis and all these other diseases now that young gay guys can pop a pill
• 57:05
  and go and have sex with impunity. Yes. And thankfully, there are antibiotics for those,
• 57:11
  but not for herpes. We are starting to see some antibiotic-resistant strains of gonorrhea,
• 57:18
  for example. You don't want to get that. If you go back into his books and you read about what
• 57:23
  like advanced gonorrhea and syphilis are, like... Oh, syphilis is absolutely horrendous. I had no
• 57:28
  idea. I mean, thank God we've got... Thank God for antibiotics because you look at some of the images
• 57:33
  of some of the drawings of people who had syphilis in like the 19th century and it's just like
• 57:37
  the half of their faces fallen off. You have a really interesting audience if they're really
• 57:43
  dig listening to this while drinking their coffee. We should talk more often. They could be drinking vodka.
• 57:49
  They could be drinking vodka. So, yeah. So, if CCR5, this gene, essentially makes it impossible for
• 57:56
  you to get HIV, would there be an alternative therapy that would be a gene therapy possibly
• 58:03
  to give to tweak with people's DNA and give them that gene? But first, let me tell you
• 58:09
  why it is that there are even as many people as there are that have this mutation because
• 58:16
  it's actually rare. I shouldn't say that it's common, but it's more common than it should be
• 58:23
  if it's really a mutation that sort of does nothing good, nothing bad. Like, it's clearly
• 58:28
  been enriched. Something historically has happened that has caused people who have that mutation
• 58:35
  to be more likely to survive. And one of the coolest theories that I read about this as to why
• 58:43
  is that during the Black Death, what is that? In the 1400s or something like that, this bacteria,
• 58:53
  your sinneapestus swept through Europe, and it was just carnage. I don't know what fraction,
• 59:00
  like some huge fraction was like it was like a third or something. It was something insane.
• 59:06
  Yeah, the people who died. And the theory is that people who had that mutation,
• 59:12
  you know, the very slim number, they were much more likely to survive. And so, they became a larger
• 59:18
  fraction of the people who survived the Black Death, right? And the plague. And so now centuries
• 59:27
  later, HIV comes along and they are protected against HIV infection. So it's just such a cool
• 59:35
  thing to see, you know, these connections, you know, between horrors across the centuries.
• 59:42
  So yeah, sounds like a good gene. I want that gene. I want a CCF5. Can you give me a CCF5?
• 59:47
  Can you hit a brother up? Well, you want me to destroy your CCF5. You want me to take it out.
• 59:52
  Oh, is that the one? So I don't want to have it? Yeah, you don't want to have it.
• 59:56
  Okay, got it. Yeah, take it out. So one company actually developed a drug to inhibit CCF5.
• 1:00:03
  It's not a very good drug. It doesn't work all that well, not use much. And it's okay,
• 1:00:09
  because we've got other really great drugs for managing HIV at this point. But, you know,
• 1:00:13
  there is a push to try to cure HIV. And there's been one case, and I can't remember if I heard
• 1:00:20
  about a second one, but in any case, the first person ever to be cured of HIV, this man is called
• 1:00:27
  the Berlin patient. And he had a, he was HIV positive. And he had a leukemia, I think,
• 1:00:37
  or a lymphoma, or something. And he needed a transplant. And the doctors decided they were going
• 1:00:42
  to find a donor that had this CCF5 mutation. And so when they destroyed this patient's immune system,
• 1:00:52
  completely wiped it out, killed all the T cells, all the bone marrow stem cells, just wiped out
• 1:00:57
  his bone marrow, which is what you need to do to treat a leukemia like that. And then they gave
• 1:01:03
  him back the immune system of one of these CCF5 mutant donors, then whatever little HIV there
• 1:01:12
  might have been in his body after the procedure had no cells to replicate in. And it just vanished.
• 1:01:20
  And that person was cured. Now it was hell for him, right? And it's not. I don't want to do that.
• 1:01:27
  I don't want you to do that to me. Look, anybody who is HIV positive has been
• 1:01:33
  basically restored to need or normal health by cocktails of modern drugs. They inhibit
• 1:01:42
  multiple points of the virus's machinery. And basically, you have to take a pill every day.
• 1:01:50
  But other than that, you can live a normal life, right? No, it is a terrible idea to put yourself
• 1:01:56
  through what's called chemoablation, wiping out your bone marrow, which has a pretty high
• 1:02:01
  chance of killing you in order to consider yourself, if you don't die, cured of HIV.
• 1:02:06
  Okay, so what few moments ago, I said, can you get rid of my CCF5? I would like to retract
• 1:02:14
  that request. No, no, no, don't, don't retract it. Okay, not yet.
• 1:02:17
  All right, okay. There are some technology companies, including one that I had invested in years
• 1:02:23
  ago and subsequently been acquired and I doubt their technology is going to succeed, you know,
• 1:02:29
  probably has failed by now. But there are still others that will probably pick this up and
• 1:02:33
  experiment with it over time. What they do is they take your own immune cells out
• 1:02:39
  if you're HIV positive. And they will gene edit, you know, the CCF5. They will use whether it's
• 1:02:48
  CRISPR or something else, they will change the CCF5, or they'll put in some sort of a blocking
• 1:02:53
  agent in there. And while they're at it, they might, you know, put in something that eliminates
• 1:02:59
  the other door knob that the virus grabs onto CD4. And they will, well, actually, no, I don't
• 1:03:08
  think they would really do that. I can't remember now. In any case, they will basically make those
• 1:03:13
  cells like the mutant, you know, HIV impervious cells. And then they'll put them back into you.
• 1:03:20
  Now, the thing is is when they do that, it doesn't require wiping out your bone marrow,
• 1:03:28
  you know, completely. It gives you at least a portion of your immune system that is
• 1:03:34
  impervious to HIV. And so it may not matter as much after that, whether the HIV is still replicating
• 1:03:43
  in other of your non-modified immune cells, because you will always have these Kevlar protected
• 1:03:51
  cops that can both attack the HIV. Oh, that's right. The company actually armed those Kevlar
• 1:03:58
  cops with, you know, basically targeting mechanism to go after HIV infected cells. So, you know,
• 1:04:06
  the hope is that they'll wipe out any HIV infected cells. But in any case, they are Kevlar protected
• 1:04:10
  against HIV. And they are able to also protect you against all the other infections that are out
• 1:04:16
  there. And how do I get these Kevlar protected cops? Well, enrolling a clinical study
• 1:04:23
  and cross your fingers. And this will be by tweaking my DNA.
• 1:04:30
  Tweaking your bone marrow cells DNA. Yes, it's done outside your body. The cells are taken out of
• 1:04:36
  you. They're modified and laboratory and then they're put back into you. So, I think you're just
• 1:04:43
  starting to point to something that I don't really understand about CRISPR and this sort of stuff.
• 1:04:48
  And you might want to give the listener a brief rundown of what CRISPR is. But my confusion around
• 1:04:54
  it is, I mean, if my DNA is in every cell in my body, how you tweaking my DNA out and altering
• 1:05:04
  it and then putting it back in in a way that is significant enough to have an impact on my entire
• 1:05:10
  body? Yeah. Well, so in this case, and you're absolutely right, by the way, there are some diseases
• 1:05:15
  where you have to modify the DNA in a whole lot of the cells in your body and we have no mechanism
• 1:05:20
  for getting, you know, these smart scissors. That's what you can think of CRISPR as, smart
• 1:05:25
  scissors to go into every cell and modify them in just the right way. So, that is still way far
• 1:05:31
  out. But as it happens, we really just need to modify your immune system in the case of HIV,
• 1:05:36
  right? And that means we just need to take your bone marrow out. And so, you'll go in there,
• 1:05:40
  you two. The word just is doing a lot of heavy lifting in that sentence. We just need to take
• 1:05:45
  your bone marrow. That's all we need to do. Just take your bone marrow out of your bone.
• 1:05:50
  It's painful. That's true. They sedate you. So, that helps. It might give you a drink. I don't
• 1:05:57
  know. And I'd want to be out. I'd want to be out. And they take a thick needle and they go into a
• 1:06:03
  big bone and they punch through it and they extract the bone marrow. Next time, you eat some
• 1:06:08
  fried chicken, crack open a bone and look at what's in there. You know, when that chicken was alive,
• 1:06:13
  there's, you know, immune cells, stem cells that were making all kinds of stuff. That's what makes
• 1:06:19
  the bone marrow so delicious, Peter. Yes, I'm pretty sure the doctors don't eat the patient's
• 1:06:24
  bone marrow. I would hope not. I'm not saying mine would be delicious. But, you know, you've got
• 1:06:29
  a fancy farm to table, nose to tail restaurant. They bring out a big piece of bone marrow, the bones
• 1:06:34
  all. There'll be some salt. I thought you might be getting all, you kind of are getting
• 1:06:38
  Hannibal electron. So, I like it. But so the doctors, you know, they reach in there, they extract
• 1:06:46
  some of the bone marrow cells out. And then in the laboratory, they have a number of tricks for
• 1:06:53
  how to get the CRISPR protein or gene into the cells. So all of that modification of the DNA
• 1:06:59
  is actually happening inside the cells, right? And one of the methods, for example, is you
• 1:07:04
  electrocute the cells. And it causes their membranes to open up and allow stuff to come in. It
• 1:07:13
  really is, you know, various forms of torture. But once you modify the DNA in those cells,
• 1:07:19
  you take a sample of some of them, you check, you sequence the DNA, you make sure you got the
• 1:07:22
  changes that you want. And then the other cells, you can put back in the patient. And, you know,
• 1:07:29
  the cells, you can just infuse them into the patient's blood. And the cells will naturally say,
• 1:07:34
  oh, I so want to go home. And they will migrate back into the bone marrow. Wow. Really? Yeah.
• 1:07:41
  So you can inject, you can inject bone marrow cells in a needle into my bloodstream. And they'll
• 1:07:45
  make their way into my bone. Basically, yeah. These are stem cells. And they don't
• 1:07:52
  traffic their way back into the bone marrow. Now, it helps to use some chemotherapy to kill off some
• 1:07:58
  of the cells that are in your bone marrow to make room. So you kill them off. And then the bone
• 1:08:04
  marrow is kind of like, I'm feeling rather hollow and empty here. I would love some stem cells to come
• 1:08:08
  in and, you know, occupy my spaces. And so if that's the point where you infuse the stem cells,
• 1:08:14
  they will happily go in there and take up residence. Right? So these are all cool tricks that we
• 1:08:19
  have learned over time. Like I said, it's like a bunnings, right? You know, there's so many tricks,
• 1:08:24
  so many tools that we can use to tackle so many diseases. And we're using these now. I mean,
• 1:08:29
  I just described a process that maybe someday possibly might, you know, allow us to cure HIV.
• 1:08:35
  But it actually is curing genetic disorders that kids have. You know, there are some kids with
• 1:08:42
  sickle cell anemia that have been functionally cured with a process like this. And in fact, in those
• 1:08:50
  cases, there's a company that has taken HIV itself, the HIV virus and gutted it. You know,
• 1:08:59
  completely appropriated its genetic material and stuck the gene in to that kids with sickle cell
• 1:09:08
  anemia. They have a bad copy of this hemoglobin gene. And they stick a good copy of it into this
• 1:09:16
  HIV that we've, I'm one of my tweets I call domesticated, we've tamed this HIV. And you use that
• 1:09:22
  HIV to infect the kids bone marrow cells. And then you stick the bone marrow in. So we have basically
• 1:09:32
  flipped HIV, you know, to be an agent on our behalf. So you rip out the bad, you rip out the bad
• 1:09:39
  components of the HIV virus and you insert something that is going to cure sickle cell anemia and
• 1:09:46
  then you put it back in them. And what role at that point is the HIV shell playing? What's it
• 1:09:51
  doing for us? Well, the shell that it's in, you know, it just is the delivery mechanism. It's
• 1:09:57
  like the disk drive, right? And is HIV, is HIV uniquely efficient at that? No, no, anytime you hear
• 1:10:06
  gene therapy or viral vector, those are terms that describe the way that we've used viruses now
• 1:10:16
  as delivery mechanisms for the code that we want to put into people. So it didn't have to be HIV.
• 1:10:23
  That's just an example. It could have been any virus. No, there's there's adno associated virus,
• 1:10:29
  AAV. And that was recently approved for the treatment of kids with spinal muscular atrophy.
• 1:10:36
  Now that virus you can just inject into babies and it will restore a missing protein in their
• 1:10:45
  spinal column and, you know, basically allow them to grow and walk. I mean, it just
• 1:10:53
  restores your muscle. It's just a clarify for people. In case, in case people are a bit confused
• 1:10:57
  about the difference between the treatments that we're talking about, what we're talking about
• 1:11:01
  here is basically CRISPR, correct? All of these are some, some variant of that. No, no, no, no, no.
• 1:11:07
  No, CRISPR, it's like a brand of scissors, right? You know, everyone's just talking about that
• 1:11:14
  brand of scissors. There are other types of scissors that we've used, zinc finger nucleases and
• 1:11:18
  mega nucleases. And, you know, those of us on the inside of the field have long known about,
• 1:11:23
  you know, all these different kinds of scissors. But for some reason, the CRISPR brand
• 1:11:27
  became the most famous. It's a great name, right? It's a great name. It's like that movie about
• 1:11:32
  about the founding of McDonald's. And at the very end, they're like, the only reason we wanted to,
• 1:11:36
  it's a quite a good movie that's called the founder. And he's like, the only reason why I've
• 1:11:40
  wanted the rights to McDonald's was because it's a great name. Like, it's a McDonald's sounds,
• 1:11:43
  sounds good. CRISPR, CRISPR, I know exactly what CRISPR does. So, hang on. So, let me just,
• 1:11:49
  but just so that people don't get lost. If you, we're all, we're all, we're all made up essentially
• 1:11:56
  of our genome, right? I am me genetically because of my genome. It's like a big book. It's a book
• 1:12:01
  of letters that are the code that instruct my body to be what my body is. And what we're talking
• 1:12:09
  about, what I'm calling, what I'm incorrectly calling CRISPR because I'm an idiot, but you can,
• 1:12:13
  you can correct me on it, is a, is the ability to quite precisely go to page 347 of the book,
• 1:12:20
  line 14 and just cut out a little bit that's not doing me any good and insert if we want to
• 1:12:27
  another bit that is going to be better for me. Is that basically it? Yes, that is what people
• 1:12:34
  tried to use CRISPR for. They also use another brand of scissors called zinc finger nucleases
• 1:12:40
  to do the same thing, but that's not a catchy name. So, nobody knows about that. I'm sticking with
• 1:12:45
  CRISPR. It's called gene editing, right? What you describe is called gene editing. And there's
• 1:12:50
  other ways of doing gene editing. And one of the problems with CRISPR is that it involves a
• 1:12:55
  foreign protein. Like, it's not, CRISPR itself is not a human protein. It's a foreign protein
• 1:13:02
  that you'll find in like bacteria, right? And so, when, remember how I told you, like,
• 1:13:07
  immune cells go around and they look in the windows of all of our factories, all of our cells,
• 1:13:12
  look for little bits of stuff that's being made in there. Well, if you use CRISPR in the human
• 1:13:18
  body to get stuff into cells and there's still some of that CRISPR protein in those cells,
• 1:13:24
  then the immune system is going to see it. There's a foreign protein in those cells. And going to
• 1:13:29
  think, huh, maybe I should kill this one. So, it still remains, you know, a problem for us to solve,
• 1:13:36
  how do you use CRISPR in the human body? We do use CRISPR when we take out bone marrow cells,
• 1:13:44
  and we want to modify them, right? And we, you know, are basically performing like open
• 1:13:48
  heart surgery on these cells. And you can do whatever you want, because later when you put those
• 1:13:52
  cells in there, they're not going to have the CRISPR in them. So, that's fine. But actually injecting
• 1:13:58
  CRISPR proteins into people that's still, you know, sort of buck Rogers plus Battlestar Galactic
• 1:14:06
  are piled on top of each other in terms of risk. Right. So, let's just talk about gene editing
• 1:14:12
  more broadly then. Is it going to save us all? No, I mean, save us off from what? Everything?
• 1:14:17
  Everything. Because like the people who are boosters of it are like, this is the game changer.
• 1:14:22
  This is where just going to be able to take out your cells. We're going to do a little editing,
• 1:14:26
  a little bit of, like, we'll do some magic and we'll put it back in here and then you'll be a
• 1:14:30
  superhuman. You've dragged me halfway down aisle 12 in Bunnings and said that thing. Is that going
• 1:14:35
  to fix everything in our in our house? Is that the only thing we need? No. It's for that at Bunnings.
• 1:14:42
  And they're like, we don't have a magic. We don't have a magic device that will solve all your
• 1:14:45
  problems. So get out of here while you're wearing an upturned ice cream container on your head.
• 1:14:49
  Yeah. Yeah. There's a tinfoil hat over there. So, you know, it's a useful tool for certain things,
• 1:14:55
  and it will have its role, right? But there's so many other cool things we can do. You know,
• 1:14:59
  we do not need to edit, you know, our genome in order to pass it to like, fix the problems that
• 1:15:06
  our kids are going to have. We don't have to edit or sperm in our eggs, you know, and create, you
• 1:15:10
  know, these genetically engineered babies in order to solve diseases. Like today, if two people
• 1:15:15
  want to have kids and it turns out that they, they both have the mutation for cystic fibrosis,
• 1:15:21
  they themselves are happy, I'm sorry, healthy, hopefully also happy, because, you know, you just
• 1:15:27
  need one good copy of your cystic fibrosis, what's called your CFTR gene. You need one good copy,
• 1:15:33
  and if you have a bad one, it's okay. The trouble is when two people that each carry one bad
• 1:15:38
  copy get together, there's a one in four chance that their child will inherit the bad copy for each
• 1:15:44
  of them, right? Well, we have technology now that's widely available, where you go to an IVF
• 1:15:50
  clinic, you do in vitro fertilization to create a bunch of embryos from the mother and the father,
• 1:15:56
  and then they can basically do a genetic test on the embryos to see which ones have one or two good
• 1:16:04
  copies of the CFTR gene and implant only those embryos. And then the child that you have has
• 1:16:10
  basically side-stepped cystic fibrosis. But that's not fixing the problem, that's just killing
• 1:16:17
  the embryos that are bad. Well, no, that's fixing the problem. If the child you have has only two,
• 1:16:23
  has two good copies of the CFTR gene, that's it. There's no more cystic fibrosis. No, no, I understand.
• 1:16:29
  Yeah, I understand that, but it's, assume you only get to produce one viable embryo out of that,
• 1:16:34
  and it has cystic fibrosis. You're not talking about a mechanism by which you can cure it.
• 1:16:39
  You're just saying, well, if you had several and one of them didn't, then you would just pick the
• 1:16:42
  ones that don't have it. So what I would tell you is go through another round of IVF and make
• 1:16:47
  another embryo, right? I mean, it's a pretty edgy case there to say, yes, but what if they only make
• 1:16:54
  one and it has, all right, fine, then you have to make a choice. Are you going to give birth
• 1:16:59
  to a child with cystic fibrosis? No, I'm not saying it's not useful. I'm not saying it's not
• 1:17:03
  useful. I'm just saying it's not really medicine, right? I mean, we're talking about
• 1:17:07
  using gene editing. No, no, no, hang on. If the embryo, if the embryo, think of the embryo as a tiny
• 1:17:13
  little person, and you've got, so you're saying if you've got a bunch of them, then you can use
• 1:17:17
  pre-implantation genetic diagnosis to figure out which ones are bad and which ones are good genetically,
• 1:17:23
  and then you can discard the bad ones. That's different from taking the tiny little person and
• 1:17:28
  fixing that tiny little person. You know, that is different, but what I'm saying is if the tools
• 1:17:38
  you use to fix, you know, oh, let's genetically engineer that embryo, you know, involve taking
• 1:17:43
  a pair of scissors so that tiny little embryo is genome, and you know, for all you know are making
• 1:17:49
  lots of little nips and cuts throughout the rest of the genome, and while maybe you cure the
• 1:17:54
  cystic fibrosis, you have no idea what else you did and might have condemned that kid, you know,
• 1:17:59
  to cancer when he turns 12. I don't think that that's a great risk to take, right? And so that's
• 1:18:05
  the problem with these technologies. You know, we're still five-year-olds with a pair of blunt
• 1:18:09
  scissors, you know, going at this, and the public is saying, oh, we'll just gene edit every problem
• 1:18:14
  in our genome out. You know, look, there's an analogous controversy with genetically engineered
• 1:18:22
  foods, genetically modified foods, right? Where people say, oh my god, you're creating like
• 1:18:28
  franken foods, right? And it's like, you understand, for thousands of years, farmers have been taking
• 1:18:34
  their best kernels of corn and, you know, planting those and then looking for the traits they wanted
• 1:18:41
  and then planting those and then hybridizing plants and mixing, you know, various, you know, strains
• 1:18:46
  of a given plant in order to try to get the best traits. So it's akin to the difference between
• 1:18:53
  using diagnostic tests to, you know, select embryo that doesn't have a disease, right? So it's less
• 1:19:00
  fancy, I get it, but it's still, you know, messing with nature to try to get a better outcome,
• 1:19:08
  right? And side-stepping a disease right now using those techniques is way better than trying to
• 1:19:15
  go in there and say, well, show me the most cutting-edge shelf and bunnings and I'm going to try like
• 1:19:19
  all these cutting-edge technologies on my embryo. I want cutting-edge, Peter. No, I'm just, I'm,
• 1:19:24
  I'm, I take your point, I'm just trying to keep the category, I'm not trying not to make a category
• 1:19:29
  error in our conversations about what is, what is medicine, what is gene editing and what is sort of
• 1:19:38
  just public policy. Like there are, you know, Denmark claim, I think it's Denmark claims to have
• 1:19:42
  basically eradicated Down syndrome. This is another analogous controversy, right? But that's, but
• 1:19:49
  you can't eradicate Down syndrome because Down syndrome is something that happens by chance. Yeah,
• 1:19:53
  but what they, what they, what they mean is that they basically have a policy where, if,
• 1:19:57
  if, where they, they test all, all women and if the, if the baby has Down syndrome, then they
• 1:20:02
  abort it and they try again. That's not, that is not a medical, it's a woman's role. It is,
• 1:20:08
  it is medical, man. Like I, it's not a medical triumph to say that, that we vanquish Down syndrome
• 1:20:14
  just because we kill all the tiny babies who have Down syndrome. I, I'm going to guess that maybe
• 1:20:19
  you and I might be on opposite sides of some sort of divide out there, but maybe we ought to back off
• 1:20:24
  and explore something else. Really? Talk about dog diarrhea. I, you know, I mean, that's cool.
• 1:20:32
  I mean, I'm, I'm pro-choice. I'm just, I'm just going on the edgy like ethics angle here,
• 1:20:36
  which is that there's a, there's a, there's a difference between fixing something and just noticing
• 1:20:41
  that it's there. And so, flushing it down the toilet. So just to be clear, you're saying there's
• 1:20:48
  a difference between fixing something and preventing something. And I think that that is not a
• 1:20:52
  significant distinction. So, the end result is a healthy child. If that's your goal, there's
• 1:20:58
  multiple ways of doing it. One of them involves setting five year olds with scissors on your
• 1:21:03
  future kids DNA. And the other one just involves side stepping the problem entirely with a simple
• 1:21:09
  test. So, I'm just saying that if you think out of the box a little bit and don't just be like,
• 1:21:14
  no, I need a crisper solution. It's got to be crisper or nothing, you know, and just say, look,
• 1:21:20
  I want a healthy child. Then you'll discover that we have long had, well, long, I mean, you know,
• 1:21:25
  like a decade, you know, maybe 15 years we've had a solution that we could use. But it's not yet
• 1:21:31
  public policy to think that way. You know, IVF still remains the kind of thing that most people
• 1:21:35
  have to pay out of pocket for. But if they have a child with cystic fibrosis, well, there's a 300
• 1:21:42
  or $200,000 drug now that Vertex has created, that's an absolute miracle drug. And what's actually
• 1:21:47
  really amazing about our industry is Vertex's drug is going to be generic. Within like, you know,
• 1:21:53
  15 years, that's going to be a cheap generic pill that you'll be able to get. Wow. And it won't
• 1:21:59
  be one of these things where the world's up in arms about the cost of the drug. The same way there
• 1:22:03
  was once an outcry about how much statins cost. Oh my god. Lipitor. So expensive. Nobody talks
• 1:22:09
  about how much statins cost because of all generic drugs. Yeah. And drugs are the only part of
• 1:22:15
  healthcare that go generic, the only one. It's basically think of it as homes where we are paying
• 1:22:21
  off the mortgage. And then we own them as a society. We've now paid off the mortgage on all those
• 1:22:27
  statin houses and we own them. And what that's done is allowed us to get out from underpaying rent
• 1:22:34
  to hospitals that previously were treating a whole lot more people that were showing up with
• 1:22:39
  heart attacks. You know, those HIV drugs, they haven't yet gone generic, but in time they will.
• 1:22:44
  But if we hadn't invented those HIV drugs, you would have massive healthcare facilities that are
• 1:22:50
  just tending to HIV positive people that are constantly fighting off, you know, progressing to
• 1:22:56
  AIDS. How long does it take a drug to go generic beta? Typically 10 to 15 years. And I would say that
• 1:23:03
  the an emerging problem with our industry is that it has started to make drugs where we actually
• 1:23:12
  don't know how to copy them. And the process of a drug going generic conventionally involves
• 1:23:19
  the patent expiring. And then 20 other companies are freed and now make a copy of that drug.
• 1:23:24
  And they compete on price. And the price crashes down to close to the cost of production, right?
• 1:23:29
  So just good old school competition. The trouble is that while you can do that with a good cocktail,
• 1:23:36
  right, there's a recipe and, you know, good bartenders can figure out how to make a really high
• 1:23:40
  quality martini, you know, and it's theory the same. You use the same ingredients, you know,
• 1:23:47
  and you shouldn't be able to tell the difference. We're making drugs now that are called biologics,
• 1:23:52
  they're made in cells, they're proteins, antibodies, things like that that are more like wine.
• 1:23:58
  And it's really hard, arguably impossible to copy a wine. You can throw a label on there and,
• 1:24:04
  you know, I, for example, would not be able to tell the difference between two very similar lines
• 1:24:09
  on not that good, but there are people who can, right? And it's just it's much more of an art
• 1:24:15
  how you do it. And so the FDA and the EMA, you know, these regulatory agencies,
• 1:24:20
  what they really look at is not the composition of the biologic drug itself,
• 1:24:24
  but they study the process by which it's made. And even the same company when it makes a drug,
• 1:24:30
  you know, Amgen or Abdi or some of these companies when they make a biologic drug,
• 1:24:35
  it's not always identical from batch to batch to batch. So there's some variability just in the
• 1:24:40
  that expert companies production, right? And so when some other companies like, well,
• 1:24:45
  I'm just going to read your patent now that it's expired and I'm just going to copy this process.
• 1:24:49
  You know, it would be like going on a, I don't know, on a wine tour and drinking a bottle of wine
• 1:24:54
  and being like, I think I can wing it and reproduce your wine. You probably can't, right? And so
• 1:25:01
  one of the problems that's emerging is that we don't really have a process for generisizing
• 1:25:07
  biologic drugs. There's such a thing as biosimilars. They're almost like it. It's like, oh,
• 1:25:12
  well, I also got them more low. It's pretty close. But it's not the same. And sometimes a difference
• 1:25:16
  can matter a lot. Does that mean that the best drug, the best drugs coming down the pike are going
• 1:25:21
  to remain expensive? Exactly. Is that really what it means? And that's what I wrote my book about.
• 1:25:28
  And what I said is the, there has been a kind of unstated biotech social contract, right?
• 1:25:36
  That historically, whether we knew it or not, we were subscribed to it. We were, you know,
• 1:25:40
  we had signed on to it. This contract, what it basically says is the industry will make drugs
• 1:25:46
  that will go generic without undue delay, right? You collect your mortgage, you know, you collect your
• 1:25:52
  reward and then it ends. And you'd better build something new if you want to collect a new
• 1:25:56
  mortgage stream. You don't just sit back and collect rent. So we will make drugs and collect our
• 1:26:01
  reward for a finite period of time. Then they become generic and the world owns them. They're a
• 1:26:06
  public good. And in exchange, society is going to make all the appropriate drugs that a patient
• 1:26:13
  is prescribed by their physician affordable and accessible to the patient through proper insurance,
• 1:26:19
  which means low out of pocket costs. Everybody has to have insurance and that insurance plan
• 1:26:23
  has to have low out of pocket costs. And that contract has been unraveling on both sides,
• 1:26:29
  especially in America. I think in Australia, you guys have pretty decent healthcare system.
• 1:26:33
  Yeah, we have many care for everyone. Yeah. And so, you know, in America, we have a fantastic
• 1:26:41
  healthcare system for the like 80% of people who have good insurance and have jobs and can afford
• 1:26:46
  their out of pocket costs. And then it's absolutely abysmal. It's like third world for those people
• 1:26:52
  that are uninsured or have very poor insurance. And they can't afford anything in healthcare.
• 1:26:58
  I mean, anything I would just qualify even that by saying that the 80% of very good care
• 1:27:03
  is not very good value care. I mean, it's good at the point of use, but it's incredibly expensive.
• 1:27:10
  Here's a thing. It's more complicated than that. And I would urge you to read my book.
• 1:27:16
  I will to learn more. It's a whole separate interview if you want to have it. I might still be
• 1:27:22
  able to make it funny. It is a little bit more serious. Yeah, it's more serious than COVID,
• 1:27:27
  if you can believe. Wow. That's a heavy book. Yeah, I know. That's saying something. But basically,
• 1:27:32
  insurance plans have been increasingly reneging on their promise. You know, you sign up when you're
• 1:27:38
  healthy, you pay the premiums. And then when you actually get sick, they're like, oh, but actually
• 1:27:43
  first you got to pay like $6,000 out of pocket. It's like, but I can't afford that. It's like, well,
• 1:27:48
  you know, sorry. I guess you can't get the drug. Now, instead of in America, people realizing that
• 1:27:53
  their insurance plans have basically conned them and that they're not insured, they say, well,
• 1:27:57
  why can't I afford this drug? It's so expensive. Look, it only takes pennies to make that pill.
• 1:28:02
  And it, you know, it's like, well, wait a second. No, it costs billions of dollars to invent this.
• 1:28:09
  As they say, the second, the second pill costs a penny, the first pill costs $100 million.
• 1:28:15
  Well, like $2.5 billion or more, right? Like to invent this is an expensive business. And so,
• 1:28:21
  you know, you have to pay off that jackpot. It would be as if you looked at the lottery and it's like,
• 1:28:26
  I don't know why we have to pay a hundred million, you know, dollars to the winner here. I mean,
• 1:28:30
  he paid a dollar for the ticket. If we gave him like five bucks, that's pretty good. That's like
• 1:28:34
  five times more than he paid. Well, obviously, if you price control that lottery winnings down to
• 1:28:41
  five bucks, nobody would play the lottery. And it's like, but I don't understand. I'm offering to,
• 1:28:45
  you'll make $4 a profit. You know, and that's basically the problem that politicians,
• 1:28:49
  you know, reporters, members of the public, they don't get that yet. They play the lottery and
• 1:28:54
  they understand that they need a hundred million dollar jackpot to entice them to do it. Right?
• 1:28:59
  And so, yeah, I mean, we don't need to get sidetracked by the, by the costliness of the US health
• 1:29:04
  system. But I think even people, people like me who think that it's, it's got major problems in
• 1:29:10
  terms of how it prices itself would concede that you want drug companies to make
• 1:29:16
  shit loads of money when they come up with a really, a really good drug.
• 1:29:19
  Especially if it's going to go generic because what you're doing is you're basically commissioning
• 1:29:24
  the creation of a, of a house. Something that's going to give us security. I would actually
• 1:29:28
  describe it more as a fire department, you know, a town needs a fire department. It's random
• 1:29:33
  homes are burning down. So they get together in the like, let's build a fire department. It's
• 1:29:36
  going to cost a boatload. But, you know, what you don't want to do is say, well, when somebody's
• 1:29:41
  house cash is fire, we're going to charge them a fat copay. And, you know, maybe eight out of 10 of
• 1:29:45
  them are going to be able to afford the copay, but two out of 10 won't. And we'll just stand by
• 1:29:48
  and let their house burn down. That's basically American health care system. Yeah, I mean, also,
• 1:29:52
  we publicly fund the fire departments. So, I mean, that would be the analogy they would be
• 1:29:56
  to public funding for a lot more public funding for research and development.
• 1:30:00
  Well, no, because you are even when insurance pays for drugs, the premiums, like it all comes
• 1:30:07
  out of our pockets, whether you call it taxes or you call insurance premiums, it's all money
• 1:30:11
  aggregated from society. So I wouldn't make that distinction. We simply need to make sure that
• 1:30:16
  insurance functions as insurance, which you guys are lucky and Australia does in the U.S.
• 1:30:20
  not so much. I mean, we had people who thought they had COVID going in following the CDC's orders
• 1:30:27
  and going in for testing as they were supposed to. And then they got hit with massive bills.
• 1:30:33
  That's going to dissuade people from going in to get testing. And, you know, there's no drug
• 1:30:37
  company to hate in there in that situation. That's just going and getting a, you know, a simple test,
• 1:30:42
  right? It's a hospital bills. And so what happened? Governors of various states and the federal
• 1:30:46
  government were like, that's outrageous. And insurance plans quickly changed. They patched up
• 1:30:51
  their holes. They covered it. And then we had all these people who have no insurance and they
• 1:30:55
  needed to go in. They had, you know, serious COVID and they would come out of the hospitals with
• 1:31:00
  massive bills that would basically bankrupt them. And the federal government stepped up and said,
• 1:31:04
  oh, we will pay for all of the medical bills, you know, of the uninsured. Really, it took COVID for
• 1:31:10
  you to do that. But when somebody's got cancer or Parkinson's or whatever, no, you just turn a blind
• 1:31:15
  eye, right? You let families go bankrupt. Right. So what's right for COVID is right for the future
• 1:31:20
  of American health care, global health care. But the thing is on the other side, you know,
• 1:31:25
  drugs have to be appropriately valued, right? Well, look at what COVID has cost just America.
• 1:31:32
  I think it's like trillions of dollars globally, you know, tens of trillions of dollars. You know,
• 1:31:38
  if you were to basically say we will pay a trillion dollars to whoever cures COVID, that would be
• 1:31:44
  like five times more than what all the branded drugs in America cost each year, right?
• 1:31:51
  It would be absurd and yet it would be a bargain. I mean, COVID must have cost hundreds of trillions
• 1:31:57
  of dollars, really, because I mean, even just the US government alone has already put a two trillion
• 1:32:01
  dollar stimulus in. And what's the value of the US economy? And if you add it up, the stimulus
• 1:32:06
  packages of all of the all of Western European countries, plus Australia, plus Canada, New Zealand,
• 1:32:10
  et cetera, then and then the economic devastation. I mean, it would, it's just unimaginable.
• 1:32:17
  You're going to have a generation of kids where you will be able to track their educational deficit.
• 1:32:21
  Right? You know, the lucky few that had parents that had the time to be able to sit down and
• 1:32:25
  actually homeschool them, great, they'll have an advantage. But everybody else has lost a year,
• 1:32:30
  right? And whatever psychological damage like the cost, we've only begun to calculate that,
• 1:32:34
  right? And you know, when health economists, which by the way, if you could see me now, I'm doing
• 1:32:40
  air quotes because they're, I don't actually think they're real economists. You know, when they do
• 1:32:45
  their math, do they take into account how reassured all of us would be if we knew that there were a drug
• 1:32:51
  or vaccine for COVID, right? Even if none of us were to get COVID, just knowing there's a drug that,
• 1:32:57
  in case we got it, we would not die would be reassuring. They never capture that. They just look at,
• 1:33:03
  oh, a person comes in sick with COVID. What is the value of their life? How much would it
• 1:33:07
  cost to take care of them? Otherwise, what did this drug, you know, save and health care costs and
• 1:33:11
  the value of their life? And you know, what's the right price? So for Remdesivir, the only drug that's
• 1:33:16
  been approved for emergency use for the treatment of COVID, they concluded it's worth $5,000.
• 1:33:22
  And yet, how reassured do all of us feel knowing that that drug even exists, that at the beginning
• 1:33:30
  of progress towards more drugs that maybe are like it, but better? Peter, when we talk about treatments,
• 1:33:35
  how do we make the, how do you approach treatments versus vaccine?
• 1:33:39
  The truth is a vaccine will probably never be 100% effective. I don't think it's going to eradicate
• 1:33:43
  COVID, but if you could just reduce the severity of COVID, the frequency of severe COVID and the
• 1:33:49
  severity of it when you get it by like 90% across the population, that will go a long ways towards
• 1:33:55
  making it less scary, right? And then if you have drugs that for those people that do get sick,
• 1:34:02
  don't worry, it keeps you from dying, you know, or it reduces your chance of death by another
• 1:34:06
  90%. You combine between those two things, you've just made COVID a hundred times less scary.
• 1:34:12
  So it's important to think about, remember, we started talking about chest pieces, right?
• 1:34:16
  Yeah. So there's a certain way in which we can combine the chest pieces, make sure that we're
• 1:34:21
  all getting the vaccine. And I mean like all people talk about, well, what's a critical
• 1:34:25
  mass that we need to achieve herd immunity? And you know, you maybe have heard like the number
• 1:34:30
  60%. Yeah. Sure. 60% is good. But you know, 80, 90 or 100% is better because when the virus has
• 1:34:37
  no quarter, there is no person that he can easily replicate in, then the benefits compound.
• 1:34:43
  Do you think that everyone will, I mean, I think in countries that have centralized public health
• 1:34:47
  systems, where it's free, mostly free to the end user, that it'll be pretty easy to vaccinate
• 1:34:53
  everybody in Australia. I think there might be your five, your five percent of anti-vaccins who
• 1:34:58
  don't want it, but I think everyone will get it. But in the States, what are your prognostitations
• 1:35:01
  about the vaccine? And then how will it actually be administered and will it be free?
• 1:35:06
  So here's the thing, as messed up as a US healthcare system is, it's not totally stupid.
• 1:35:11
  We do offer like free flu vaccinations to everybody, even the uninsured, right? So when it comes to a
• 1:35:17
  contagious agent, we understand that making sure that everybody, you know, gets a vaccine is good
• 1:35:23
  for everybody. Now, when it comes to cancer, if there's a poor person who has cancer,
• 1:35:28
  well, it's okay because that's not going to give me cancer. And that's a twisted mentality,
• 1:35:33
  but unfortunately, that's the kind of mentality you've got in the US. You guys are better about it.
• 1:35:38
  So I think a vaccine is going to be available for free widely and hopefully every country on Earth,
• 1:35:44
  but even the United States. I can't believe I just had to say that. And I think that vaccines
• 1:35:49
  are going to start to become available towards the end of this year. However, that doesn't mean
• 1:35:53
  that you and I should be like, oh, yeah, you know, we get to go club hopping towards the end of
• 1:35:59
  this year because it's going to take a while to get to the massive number of doses that will
• 1:36:04
  allow it to get to kind of ordinary people like us. The first doses of the vaccine are going to go
• 1:36:11
  to frontline workers, the most vulnerable people. And frankly, if our leaders are really strategic,
• 1:36:17
  if they really play chess well, they will map out, for example, a school system where you have
• 1:36:24
  kids that go home and everybody in their household is young and healthy, right? They've got young
• 1:36:30
  parents. And those families won't need the vaccine right away. They're not the most urgent.
• 1:36:36
  But you could open up the school and those kids are going to be able to start going to school.
• 1:36:40
  However, they will be, they will have classmates who will go home to a house that maybe has an
• 1:36:46
  older person in it. And so if you really want to restore the function of that school and allow all
• 1:36:52
  the kids to go in, you will find all the vulnerable members of those households and you will vaccinate
• 1:36:58
  them and the people they live with and those, and maybe even the kids, so the kids naturally seem to
• 1:37:03
  be sort of a little less likely to get infected and pass it on. And that will allow that whole school
• 1:37:08
  to feel, you know, maximally protected, both by the low risk status of some households and the
• 1:37:15
  vaccinated and now therefore low risk status of the other households. But if you just do it like,
• 1:37:20
  well, everybody whose name starts with A, get vaccinated. I mean, this is another, this is another
• 1:37:25
  gripe that I have. I mean, when I was living in the states, I had many concerns about the way
• 1:37:29
  that the health system is run there, which is not to take away from the great things that it also
• 1:37:33
  does. But this sort of centralized prioritization is also something that isn't very good because
• 1:37:38
  it's such a patchwork in the US. I mean, when when coronavirus testing was still scarce and that
• 1:37:44
  was being ramped up in, you know, February and March, the Australian government had had exactly what
• 1:37:50
  you're talking about, a kind of a list of who is able to get it. So it started off with have you been
• 1:37:56
  overseas in the last 14 days and you have a cough, then it was just have you been in overseas in the
• 1:38:00
  last 14 days or do you have a cough, then it was and gradually that ramped up to the situation where
• 1:38:06
  we're now in where anybody can get it for any reason if they just feel like it for free. And one
• 1:38:11
  of the concerns that I was speaking to an American colleague about that he had about the way the
• 1:38:15
  American testing was rolled out was this hodgepodge of labs and a hodgepodge of different health
• 1:38:20
  insurers meant that if you had great health insurance and you were paranoid, you could get a test.
• 1:38:25
  But if you were actually at risk, that didn't necessarily mean you were going to get a test.
• 1:38:28
  Yeah, you're right. The US system is pretty patchy. I mean, you've got the problem of, for example,
• 1:38:34
  in the case of hepatitis C, we developed a pill, you know, by we, I mean, the drug industry,
• 1:38:40
  humanity, we've got a pill that can cure hepatitis C and private insurance companies, you know,
• 1:38:45
  ensure people up to age 65 in the US. The trouble is that hepatitis C will destroy your liver and,
• 1:38:50
  you know, cause you to need a liver transplant typically after you're 65, right? And so
• 1:38:56
  technically speaking, private insurance companies were not really saving themselves any money,
• 1:39:00
  were not avoiding the cost of a liver transplant by spending money on these expensive hepatitis C
• 1:39:09
  and yet any kind of system that looked at the total cost would be like, it is such a bargain for
• 1:39:14
  us to just cure everybody of hepatitis C, you know, then to, you know, wait, a private insurance
• 1:39:22
  company that has a bunch of like 55 year olds that are hepatitis C positive. It's like,
• 1:39:27
  look, if I spent right now $50,000 on this cure for your hep C, you know, it'll cure you,
• 1:39:33
  but it'll save Medicare money because it'll prevent you from needing a liver transplant when
• 1:39:38
  you're 67, right? Right? Yeah. It's like, well, yeah, that's the right thing to do. And the
• 1:39:43
  private insurance company is like, yeah, but I'm not going to save any money economically as it makes
• 1:39:46
  sense. And it's like, you know, I'm pretty sure that I hired you to look after me and not your
• 1:39:51
  bottom line. So just pay for the damn drug. Let's stay on, um, on coronavirus vaccine. Your
• 1:39:57
  expectation is not that it would be like the measles where, where it would protect you essentially
• 1:40:01
  100 percent, but it would be a bit more like a flu shot. Um, sort of, the funny thing is about
• 1:40:06
  the measles is that it really only protects people about 50 percent, but because everybody got it.
• 1:40:12
  Oh, really? It basically acts all of us 100 percent. And the risk is when you've got anti-vaxxers
• 1:40:17
  that for whatever reason, you know, think that they're doing their kids a favor by not vaccinating
• 1:40:21
  them, they are not only putting their kids at risk, but they, these kids turn into these
• 1:40:27
  bio reactors that are spewing shedding, uh, measles virus and overcoming the infection, the immunity,
• 1:40:34
  even if some of the kids that have been vaccinated, right? So, you know, that's why any school that,
• 1:40:39
  you know, wants to say, look, we're just not letting kids in who have not been vaccinated from
• 1:40:43
  measles is, uh, you know, completely in the right from a public health standpoint, they are right.
• 1:40:48
  So what, which vaccines do provide basically 100 percent protection? You know, because vaccines
• 1:40:54
  should not be thought of as just protecting the person that they are infecting, they really are a
• 1:40:59
  public health measure. I don't know. I never really thought. Right? But, uh, you know, I don't,
• 1:41:06
  that is amazing, isn't it? I mean, I've just assumed that like polio and smallpox and things
• 1:41:11
  provide 100 percent protection, but you're right, I guess it's, if it's a public health thing,
• 1:41:14
  then it comes back a little bit to the conversation we were having earlier. There are a lot of ways
• 1:41:18
  to skin a cat. You don't actually have to have 100 percent protection if it's going to be widely
• 1:41:22
  adopted and you're going to get hurt immunity. That's right. And I'll show you through this.
• 1:41:27
  Like certainly the flu vaccine is a good example of that. Like it really helps for many people to
• 1:41:31
  get vaccinated. In the US, it's just under 50 percent of people get get vaccinated with the flu
• 1:41:35
  vaccine. You know, we would be so much more effective at saving ourselves and saving, you know,
• 1:41:41
  some people from dying. I think we've got like 60,000 people a year or so that, you know, die from
• 1:41:46
  from the flu, um, uh, maybe I'm honest. It's well, you know, in a very bad year, it's like 50 to
• 1:41:52
  60, but in, I think in most years, it's like 30 to 40. I mean, the fact that that number is so high
• 1:41:56
  has also been endlessly frustrating to me because it enables, uh, kind of coronavirus skeptics
• 1:42:01
  to be like, well, come on. I mean, that many people die of the flu to which I say, yes, and it's
• 1:42:06
  really bad. And it would be way, way worse if nobody got the, got flu shots and it was a brand new
• 1:42:11
  flu that nobody had any immunity against. That's, that's exactly it, you know, and we, and we don't
• 1:42:15
  need to accept that as a status quo, you know, we can actually combat that and there are companies that
• 1:42:20
  are making better flu vaccines. But really, if you make them and you still have the population that's
• 1:42:25
  like, nah, not feeling it, you know, then you're not using the product, right? Your, the product
• 1:42:30
  hasn't been actualized. The product is, we invent a vaccine and everybody gets it. Now, that's the
• 1:42:36
  product. What do you see? I'm going to keep that. Yeah. Because I partially answer your question. We'll
• 1:42:40
  get the first doses of vaccine, I believe by the end of this year. Um, and, uh, it'll go to
• 1:42:45
  frontline workers, maybe, you know, vulnerable people. And then you're going to start to really turn,
• 1:42:50
  up the production and start to get to the point where I believe we're going to see, you know,
• 1:42:55
  100, you know, 200, uh, million courses of vaccines produced per quarter. So in the first quarter
• 1:43:04
  of next year, you could plausibly see a couple hundred million courses of vaccine. Now, there'll be
• 1:43:09
  different kinds. There'll be maybe a nanoparticles, some mRNA, some adenoviral vector vaccines. We're
• 1:43:15
  going to see which vaccines are best. I think it'll be quite interesting when we're clamoring for
• 1:43:20
  vaccines, when countries are like, I want to open up, I want vaccines. And it's like, all right,
• 1:43:25
  well, actually the best one has been claimed by this country. You know, you can wait for more doses
• 1:43:30
  to be made, you know, you can wait three months or we've got second best. That will be interesting.
• 1:43:35
  So if you expect that there will be multiple vaccines, because I mean, Bob, yeah, you know,
• 1:43:42
  if you go on our website and you download that map that I told you about, you will see how many
• 1:43:47
  vaccines there are. It's amazing. The number of people working on all these vaccine chest pieces
• 1:43:52
  is, you know, tremendous dozens, dozens of companies that are working on this realistically,
• 1:43:57
  not that many credible efforts. But I would say that there are probably ten credible efforts out
• 1:44:02
  there. And so odds are, you know, we have lowered the bar for getting these vaccines to market,
• 1:44:09
  which mean, and we've provided a ton of funding from, you know, other sources like SEPI and Barda
• 1:44:14
  and other institutions into augment the private capital that's going into this. And so I think
• 1:44:20
  that you're going to see a decent handful, you know, maybe four or five across the finish line.
• 1:44:28
  And is it likely to be the kinds of things where you need to get boosters or where the vaccine
• 1:44:32
  needs to be tweaked from year to year, or you need a new version, or do you think it's a WAMBAM?
• 1:44:37
  So, yes and no. First of all, it's yet another thing that I tweeted about a while ago.
• 1:44:44
  I've written a lot of these science explainers. And one of them, I explained that
• 1:44:50
  flu mutates. It mutates, and therefore we're constantly chasing a criminal trying to get the
• 1:44:56
  latest mugshot of a criminal that keeps getting, you know, facial reconstruction surgery.
• 1:45:02
  It keeps getting a new nose job every year. Exactly. And sometimes the virus just totally
• 1:45:07
  changes its face. It's completely different from anything we've seen before. And that's when
• 1:45:11
  you get a pandemic flu. It's just too radically different, right? And flu, you know, it has its
• 1:45:17
  genetic code on eight separate pages, eight separate segments of RNA. And those swap, you know,
• 1:45:23
  if they're like Mr. Potato heads, two viruses infect the same cell and they'll swap body parts.
• 1:45:28
  And what comes out is like radically different looking viruses. Well, COVID SARS-2,
• 1:45:34
  it's genome like all coronaviruses is on just one page. So you might get typos, you know,
• 1:45:40
  as you copy it, you know, you get a little smudge, it changes the meaning of the code. And
• 1:45:45
  occasionally there's a much more rare kind of event that happens called recombination where essentially
• 1:45:50
  a page gets ripped in half and another page gets ripped in half and the top part of one gets
• 1:45:55
  combined with a bottom part of the other. But it's, you know, it's just a rare kind of event.
• 1:46:00
  And so essentially COVID doesn't mutate as radically or as quickly as flu does. It will mutate
• 1:46:08
  some and it's possible in the future we may have to modify our vaccine, but we're going to have a
• 1:46:12
  long lead time on that. And the vaccine that we invent to treat the SARS-2 that we see today
• 1:46:20
  is very likely to be the same one that we're going to be using in the future. However, I do think we're
• 1:46:25
  going to need booster shots, not in the same ways with flu, with flu every season you get a
• 1:46:30
  different shot. It's both boosting your immunity, but also sort of redirecting it to the latest
• 1:46:35
  snapshot, the criminal, you know, but in the case of COVID, it's simply a reminder. Hey,
• 1:46:41
  sales, hey, police, remember, this is what the criminal looks like because there's something about
• 1:46:46
  coronaviruses and really respiratory viruses where our immune system seems to be kind of forgetful.
• 1:46:52
  It remembers them for like a year, maybe two, but we've seen that even with the four coronaviruses
• 1:46:57
  that circulate normally every season and cause our common colds, people will be immune for,
• 1:47:03
  you know, a year and then you start to see that they can get reinfected after that. That doesn't
• 1:47:09
  mean that it's the same serious infection. I mean, colds are not serious infections to begin with,
• 1:47:13
  but I'm sure if you got re-exposed the same cold that you got over a year ago, it would be milder.
• 1:47:20
  And if you got exposed to it five years later, well, then it might be a little more serious,
• 1:47:25
  because your immune system is probably forgotten even more, right? And so in the case of SARS-2,
• 1:47:31
  there's a decent chance that our immune system is not going to remember the vaccine well,
• 1:47:35
  which is okay, because we're just going to combine the SARS-2 vaccine with the flu vaccine,
• 1:47:42
  and the flu vaccine is not even one vaccine, it's actually four vaccines against four strains of flu.
• 1:47:47
  It's basically not sure what the criminal is going to look like, so I've got four
• 1:47:51
  mug shots of four, you know, candidate criminals that I think might show up. That's pretty good,
• 1:47:55
  we used to have one, two, three, now we've got four mug shots. We'll just add a fifth mug shot
• 1:48:01
  of what coronavirus, of what SARS-2 looks like. So we're going to call it set of quadrivalent,
• 1:48:06
  you're going to hear about pentavalent vaccines. Now, some of the same companies that are in the lead
• 1:48:12
  for making the coronavirus, the SARS-2 vaccine, are actually not the best equipped to come out with
• 1:48:19
  a pentavalent combination flu and SARS-2 vaccine. Remember I was talking about chess, right? You know,
• 1:48:26
  you start to see the pieces have to come together. And so keep an eye on those companies that maybe
• 1:48:31
  are not the rabbits running ahead of the tortoise to win the race, but they are slower, more
• 1:48:41
  methodical, and better equipped to come out with the vaccine that we're likely to be getting for
• 1:48:46
  the long run. Yeah, right. I share one really cool feature about developing a SARS-2 vaccine.
• 1:48:52
  Yeah. SARS-2 is scarier than the flu. I hope we can all agree on that, right? And what I hope is
• 1:48:59
  that in the coming future, when you have pentavalent vaccines, people are going to rush to get them
• 1:49:05
  because they're scared of SARS-2, even if maybe they've been a little blase about the flu.
• 1:49:10
  And so they will get flu vaccine even though they didn't take the flu vaccine all that seriously
• 1:49:15
  in past years. Could it actually be that in the long run, we have a higher vaccination rate against
• 1:49:21
  the flu that then ends up saving a lot of lives from the flu. And over many years, maybe the number
• 1:49:28
  of lives saved because more people are getting flu vaccines will end up being greater than number
• 1:49:33
  of lives lost due to COVID. That's interesting. And not just a higher vaccination rate against the
• 1:49:39
  flu peter, but also a lower transmission rate because our behavior will be changed indefinitely,
• 1:49:44
  I think. I mean, I'm not going to go back to shaking people's hands. I'm going to always just
• 1:49:47
  feel like socially distancing anyway. Even once we are vaccinated, I think it's a new normal and
• 1:49:52
  will probably be less infectious. You're exactly right. You know, bless you for saying that.
• 1:49:57
  You know, as a virologist, I've been actually fighting for a number of years this hand-shaking
• 1:50:01
  thing. And I keep caving because it's just too awkward for people to stick. I'm like, no,
• 1:50:05
  I'm saying like, why do you want to shake hands with people? In any case, the point that means
• 1:50:12
  that if the world will end up with more lives saved as a result of this infection, then it's
• 1:50:20
  kind of like a vaccine. In fact, we used to give people a weakened form of smallpox in order to
• 1:50:28
  save them from smallpox, right? It did mean that some people died from exposure to that smallpox,
• 1:50:34
  but the end result was that many lives were saved. And so this is an old form of vaccination. We
• 1:50:43
  don't really do that anymore. But what this means is that if you think of the SARS-2 pandemic as a
• 1:50:50
  vaccine that trained us, that we learned from, that we said, oh, wow, this is a wake-up call. We've
• 1:50:57
  got a vaccine ourselves. Oh, and mind you, we should probably start developing drugs against all
• 1:51:02
  these other types of viruses that are out there that might lead to the next pandemic, right? You
• 1:51:08
  know, there's Dange and there's, you know, phyloviruses and there's flaviviruses, which is what
• 1:51:17
  Dange belongs to. But anyway, there's so many different types of viruses. We should develop drugs
• 1:51:20
  preemptively so that if one hits, we can be pulling the next remdesivir off, you know, the shell
• 1:51:27
  and quickly responding to that. In other words, we will build this fire department for ourselves
• 1:51:31
  in case our town catches fire and we will all sleep better tonight. So if you think of this as a
• 1:51:36
  wake-up call, then it's a vaccine, right? The trouble is that some people have really weak immune
• 1:51:42
  systems. You show them the mug shot, you show them a danger and they don't react. You know,
• 1:51:46
  their immune systems don't react. That's terrible, right? Except we're actually in control of whether
• 1:51:52
  or not we're going to learn from this, right? This isn't like some function, weird function of our
• 1:51:56
  immune system. This is our brains. Are we going to learn the right lessons from SARS and from COVID?
• 1:52:03
  And therefore protect ourselves much better from flu and everything else that's out there and
• 1:52:08
  save far more lives for the rest of human existence than COVID ever took. Yep. And there's a whole
• 1:52:15
  other conversation about not just on the medical side of things and the behavioral side of things,
• 1:52:19
  but like the agricultural side of things. And are we going to do what needs to be done to reform
• 1:52:24
  the way that we interface with wild animals? And you know, because if you continue to behave the
• 1:52:30
  way that we're behaving in industrialized agriculture and especially in the developing world,
• 1:52:36
  imagine that then you're just shuffling the the deck of cards and eventually you're going to
• 1:52:39
  pull another joker out, right? I'm with you. I mean, it's some of these artificial meat products,
• 1:52:46
  which I've tried them. Some of these like the impossible border is delicious, right? They're made
• 1:52:50
  from plants, not just plant-based stuff, but even actually producing lab-grown meat. You know,
• 1:52:55
  I've interviewed people like Paul Shapiro who's at the forefront of this and he really thinks that
• 1:53:00
  we're going to be able to manufacture actual meat, genuine actual meat without a sentient creature.
• 1:53:07
  In time, we will. And when we do that, if we can get away from having to have all these chickens,
• 1:53:13
  that's fewer animals for food to breed in, right? In close proximity humans. Yeah, there's all
• 1:53:19
  sorts of ways that these technologies come together on this chess board to ultimately make things
• 1:53:24
  better. But we got to keep investing in them, right? We got to have a healthy respect for what
• 1:53:31
  scientists can do. And I really hope this mission you and I had converted a few kids to wanting to
• 1:53:35
  become scientists. Yeah, absolutely. No, I'm super respectful of your ability to make these things
• 1:53:42
  sound cool and to describe them in ways that don't sound like they're abstract and wonky to people
• 1:53:46
  who don't understand the underlying science. So on this optimistic note, Peter, thanks so much for
• 1:53:51
  your time. It's great to talk to you. My pleasure. Thanks very much for the opportunity.