Listen: Epidemiologist Dr. Larry Brilliant, whose work helped eliminate Smallpox forever, explains the steps necessary to eradicate the COVID-19 virus from the world. Brilliant methodically details a three-tiered approach to combating this health threat: Vaccination and herd immunity, proper protection to prevent spread including masks and gloves, and the technology tools that can track illness and infection.
TRANSCRIPT: Dr. Larry Brilliant Explains How to End the COVID-19 Pandemic
Ian Bremmer:
Hello and welcome to the GZERO World Podcast. Here, you'll find extended versions of the interviews from my show on public television. I'm Ian Bremmer, and today I'll sit down with a doctor who helped defeat smallpox and actually observed the very last case of it. Dr. Larry Brilliant is among the world's leading epidemiologists, and we'll talk about how the past informs the present and what can be done to stop the spread of COVID-19. Let's get to it.
Compare what's happening now with the way the world has responded to previous pandemics, recent pandemics.
Dr. Larry Brilliant:
Well, there's no real comparable since 1918, but the way the world has responded to SARS and MERS and Ebola, let's call those regional epidemics, just to be a little technical.
Ian Bremmer:
Yeah.
Dr. Larry Brilliant:
That was the derivative benefit of the post-World War II and a new global order. And you and I have talked about this before, but after World War II, when we all collectively, with never talking to each other, we saw the skeletons come out of Auschwitz, we saw the firebombing of Dresden and the mushroom clouds over Hiroshima. It was as if a silent vow was taken that everyone agreed to give up a little bit of our sovereignty, our national sovereignty, even our personal sovereignty. And we created that alphabet soup of acronyms, from the Security Council, to the UN General Assembly, to the World Bank, to the IMF, to FAO and WHO, UNESCO, UNICEF. We can go on.
And while that patchwork quilt seemed cumbersome and clearly is now long in the tooth, it held us together. And at times of periodic challenge, like the Cold War, like earthquakes and catastrophes, it got strengthened enough that we were able to come together, and for me personally, in smallpox eradication, to see Muslims and Christians and Jews and Hindus and Buddhists and Shinto from every part of the world, 60 countries, every color of the rainbow and facial tones all work together to defeat a common enemy was proof that that worked.
I don't know how we could do those things today in this environment. We're obviously not doing a very good job on the pandemic, and I think that's one of the reasons.
Ian Bremmer:
You had your very famous TED Talk back almost 15 years ago now, warning the world about the next great pandemic. And at that point you said the numbers were pretty startling, a billion people could be infected, 165 million potential deaths. Could this have been the big one? If it could have been, could it still be the big one given what we know now?
Dr. Larry Brilliant:
Well, it could have been a lot worse. We could have had a couple more unlucky roles of the genomic reassortment, genetic shift, genetic drift craps table or the roulette wheel. I think there's no question that a billion people will be sickened by this. I wouldn't be surprised if it was three billion, but certainly more than one billion.
Ian Bremmer:
Sickened meaning symptomatic?
Dr. Larry Brilliant:
Well, I'm going to hedge on that for a second.
Ian Bremmer:
Okay, so say cases.
Dr. Larry Brilliant:
The ratio of asymptomatic, to presymptomatic, to clinical, especially since every day, Ian, we're learning more about this virus. For example, a higher percentage than we ever thought of patients have blood in their urine showing that they have kidney disease. A higher percentage of people than we ever thought are having heart failure, showing that the ACE2 area of the heart is being invaded by the virus. We know now about the loss of smell and taste, which means the olfactory nerve is being attacked. Of course, the lungs are being attacked.
The question is, is there any part of the body that is not attacked by this virus? We're just early into it. We don't know that it's going to be a round one, round two, round three like it was in 1918 where the second round was the most devilish. We don't know the answer to that question. Is it the big one? It's big enough. I can't imagine that the death rate, which is now 5%, that death rate of course is artifact because deaths are reported earlier. The epidemiologists have an awful but quaint term, we say that death is a hard endpoint.
Ian Bremmer:
Right. And we don't know how many cases there really are, right?
Dr. Larry Brilliant:
No, we don't know how many cases. And until we get over this ridiculous government failure of not having sufficient test kits, they should be free, they should be ubiquitous. There should be hundreds of millions. You should be able to get both the virological and immunological tests at home with a finger stick for free when you want it without a physician's prescription. This is a pandemic. If government exists, if the federalists permitted there to be a government in Washington, a federal government, it's for this purpose.
Ian Bremmer:
But when you talk about one to three billion people that are going to be sickened or in some way contract this disease, of course, that says that almost no matter what the United States does... Those aren't US numbers, those are big, gaudy, every corner of the globe numbers, most of which has nowhere near the capacity to respond that the Americans do. Explain. What do you think the parameters of that looks like?
Dr. Larry Brilliant:
But see, that's exactly right, and that's why the failures in most of the developed world, let's put the UK and Sweden in that same pot, that's why they are so disappointing because what's the slums in Mumbai with the highest density people per acre in the world? How are they going to fare? What about Kibera in Kenya? But look, we haven't even started talking about Zimbabwe and Venezuela and Syria, Afghanistan, failed states or states on the brink of collapse with virtually no public health system. Yeah, the deaths are going to come from there as well in higher proportions, certainly.
Ian Bremmer:
When you talk about one to three billion people, give me a sense of likely timeframe. Give me a sense of sort of likely mortality. Give me a sense of who is really going to face the greatest pain as a consequence of this. Because I can see the emerging market numbers be high, but I also know that in those same countries, those slums, the age rates are really skewed towards much younger.
Dr. Larry Brilliant:
Yeah, yeah.
Ian Bremmer:
Do they get through with it? All of that stuff.
Dr. Larry Brilliant:
I think we should be making three-year plans. On a global level, I think that there should be a coming together of WHO and Gavi and The Global Fund and the funders. And in a way, we thought of the Gates Miracle Commission about five years ago. I was on that commission. We met in Berlin and advised and then G8, what should trigger a meeting of this organ inside of WHO called GOARN, the Global Outbreak Response Network. I still believe that should happen, but there should be national plans as well. And I think three years is the right timeframe.
Look, if it's going to take us 12 to 18 months to get a vaccine. Yes, I know, there's good news coming out of the Moderna and NIH vaccine. Good news coming out of the Oxford program. Good news coming out of J and J. Let's say that we have a vaccine in 10 months and let's say it's in the field in trials now, and that it's in the arms of first responders this fall, and it's available next year. That's one year. It's going to take us six months to have the food fight as we figure out where the vaccine gets distributed. Will Bill Gates' generous offer to stand up six vaccine factories in the United States, will that be developed in time to help? Will we be able to get India and China to develop vaccine in the formidable vaccine production facilities? In Africa will we be able to stand one up?
Let's say now you're talking about the full 18 months. What happens after 18 months? It doesn't end with a bang, Ian. It ends with a vaccination program. And then you've got to go and deliver vaccine to 215 countries. And not to the capital cities, we need to deliver it, as we just talked about, to the poorest and most vulnerable people, in the most outlying areas, in the most remote parts of those countries.
And what does that look like to you? To me, it looks like the polio eradication program or the smallpox eradication.
Ian Bremmer:
Which you were a part of.
Dr. Larry Brilliant:
Yes. Both of them, and I'm proud of them, but that's what we need to have again. We need to have a global, and we should be thinking about it now, we should be today thinking about what is that program going to look like that delivers two different kinds of vaccination waves. One, the kind of mass vaccination that increases herd immunity. I love when people talk about herd immunity now, talking about people who are sick and seroconverted. That's great. It's true. Herd immunity is both the injected and the infected who have become immune, but we should raise the level of herd immunity and then we should go after individual clusters that are resistant, communities that are having a hard time with it.
But all of that should be done in a coordinated way or you're going to have countries that are so behind, lagging, that the virus continues to form a Wuhan or a Northern Italy and Zimbabwe. I don't mean to pick on Zimbabwe or Africa, but Venezuela, Syria, the places that we all know are going to be unable to mount their own vaccination campaign without a lot of international help.
We should be thinking about that now. We should be fighting about it now, adjudicating it now, bringing it to the security council now. Nada. Crickets. Three years, a concerted effort to flatten the curve. And the curve is not Mount Fuji. This is not Mount Shasta. It's not Lone Mountain that has the same slope up as down. It's a tidal wave followed by rogue waves and echo waves and swells. The height of which depends upon how well we work and how good we are.
We want that. We have a tool that works. Actually, we have two tools that work right now. We have convalescent serum, which really does work as a treatment and perhaps as a prophylactic. And we have... I'm going to call it physical distancing. I don't want social distancing, I want us to be physically distant, but we've got two great tools. Let's not forget about those. But the third tool that we have theoretically, which is surveillance, containment, early detection, early response, finding every case, finding every active case, doing intense contact tracing backwards and forwards, finding those people, testing them, and then quarantining active cases. Not this Swiss cheese, social distancing-light.
Ian Bremmer:
I want to get into all of that, but let me first, because you brought up the vaccine and the three-year plan, listening to you and watching you, I will say you came across, the assumption seemed pretty confident that within a year to 18 months, it's not just that we could get a vaccine distributed. We are going to have a successful vaccine. And the question is just will it be coordinated? Will it be a big food fight between countries or not? Is that an acceptable level of confidence to have? Is it reasonably possible that we fail on the vaccine front?
Dr. Larry Brilliant:
I am pretty confident that we'll have multiple vaccines. I think we have 60 right now that are in various stage of thinking about and doing. We have five that are in phase one trials.
Ian Bremmer:
Yep.
Dr. Larry Brilliant:
It's hard for me to believe that we won't have a vaccine. Or said another way, we will have a vaccine, whether it'll be as good as the smallpox vaccination or the polio vaccination, no, I don't think so. That took, in one case, hundreds of years. Will it be better than BCG or the seasonal flu vaccine? Yes.
Ian Bremmer:
The seasonal flu vaccine, a lot of people get that vaccine and end up getting the flu, right?
Dr. Larry Brilliant:
Well, it depends on the year.
Ian Bremmer:
Right. Because different flues every year. Yeah.
Dr. Larry Brilliant:
Some years it's at 80 or 90% effective, in some years it's 10%.
Ian Bremmer:
What does does that look like? If we have a 50%? If we have a vaccine...
Dr. Larry Brilliant:
It's not the function of the vaccine so much as the bad guess that's made six months earlier.
Ian Bremmer:
Yeah.
Dr. Larry Brilliant:
What antigen would survive? And you need to make the flu vaccine.
Ian Bremmer:
What I'm trying to ask you, Larry, is what is the plausible, the kind of base case, bad scenario for we have a vaccine for coronavirus, but it's not great. Is that 50%? And if that's true, what does that then mean for the three-year plan?
Dr. Larry Brilliant:
I find it hard to believe that we won't have a vaccine that is not 70 or 80% effective. Now, let's be clear, that doesn't mean it's lifetime immunity. I also think that almost certainly we will have a vaccine that produces more immunity than the disease does, which is a very kind of tepid immunity and looks a lot like the previous coronaviruses. But if you add adjuvants, the way we're able to do, if you use CRISPR, we have all these great new tools, I'm highly confident that we will wind up with a vaccine that produces more antigenicity and more immunity than the virus itself at a 70 or 80% or higher rate and does so for at least the period of observation, which is one or two years.
Ian Bremmer:
And that allows you to really bring the economies back to functioning, right?
Dr. Larry Brilliant:
Yeah.
Ian Bremmer:
Okay.
Dr. Larry Brilliant:
Yeah, yeah.
Ian Bremmer:
Okay. That feels good.
Then let's go to these other questions. You talked about the other tools that we have right now, and one thing that, and I maybe it's part of physical distancing for you, but I personally have been surprised that there hasn't been more proactive discussion of mask wearing here in the United States. And we're now seeing a little bit of it in New York, you just had the announcement that everyone should wear them, though homemade, you don't have N95 mask for folks. If we had production of N95 masks for everyone and the ability to sterilize them, would you be telling everybody to wear those?
Dr. Larry Brilliant:
Yeah. Or KN95, the Chinese mask which the CDC reluctantly approved has just been tested in the 3M labs.
Ian Bremmer:
Yeah.
Dr. Larry Brilliant:
On the parameters that they checked, the KN95 is as good as the N95, and there's a lot more production of the KN95. Yeah, this is another example of a failure to have a national plan where you have a national testing lab. Since when does CDC cave in to political power and approve drugs that don't work and tests that are questionable and have a strange view of masks? Why wouldn't we have masks? I just wrote about the 1918 flu in San Francisco where the city fathers, and they were only fathers in 1918, in October, thinking that the virus had ended its round in San Francisco, decided to have a mass celebration in downtown San Francisco, Union Square. And the idea was that everybody would come together and do what? Remove their masks. This is 1918. Well, they removed their masks, they had a big party, and then exactly two incubation periods later, the virus came back worse than ever. Two lessons there. One, even then they had masks. Two, taking them off was a bad idea.
Ian Bremmer:
When I think about what we're doing now as we think about reopening the economy, relaxing the lockdown measures, give us the Larry Brilliant plan in the United States, in the Bay Area, in New York, the places that are hard hit, what would you like? We've got the phase one, phase two, phase three from Dr. Burkes and Fauci. What would the Brilliant plan look like?
Dr. Larry Brilliant:
I would follow the virus. First of all, I would try to get the hyperbole on both sides out of it. You saw the hyperbole in Michigan and Ohio the last couple of days. People protesting, without regard pretty much, reopen the economy. And you see people who they may never leave their apartment again, don't open anything. I think there's a prudent middle ground. I do find it a bit of an overreaction that the beaches and the wild areas of the country that we've worked so hard to keep wild, that those are prohibited from solitary walkers or a couple walking eight feet apart, 10 feet apart. There is another way that we could be using the great outdoors that we're not using. In my mind, that's an overreaction born of fear that if you let up anywhere, you'll let up everywhere.
I think that there's a real definition of essential industries, not one that is lobbied for, but one that you would agree to. Let's say the Ian Bremmer choice of what are essential industries. And certainly it'll be the food industry, but it would also include agriculture. The governor of Michigan who wanted to ban getting seeds and planting seeds for a home veggie garden, well, that's wrong. That's clearly an overreaction. People should be able to do those things. They are pretty solitary occupations.
If we start adding in masks, I would add glasses and hats and gloves because the virus can enter through the eyes. It's part of the pattern that you see people with red eye first. It's because the virus enters through the eye. And I'd certainly add hats because whether it is six feet or 12 feet, when you sneeze, the virus settles on fomites, on inanimate objects, and one of those inanimate objects is your hat, which is better than on your head. That's why I recommend my friends have two hats. One that they leave outside, and when they go out, they put it on, and they take it off, they leave it there in the sun, it'll kill the virus. And then another hat that you can wear the next time. I think if you wear glasses and hats and masks and gloves and you stay six feet away, you've done a pretty good job. I don't recommend that for the rest of our lives, but for now, if we agree to that, then you can start opening up other things.
Ian Bremmer:
And is that behavior, is that something we kind of need to do until we have a vaccine, from your perspective? Or not necessarily?
Dr. Larry Brilliant:
Yeah.
Ian Bremmer:
And if it's not necessarily, then what is it?
Dr. Larry Brilliant:
Well, I don't think Coachella is going to be held the next year because when you bring that many people from that many places together, TED had to be canceled this year.
Ian Bremmer:
Yeah, but I'm talking about the mask wearing, the glove wearing, the hat wearing, for the personal behavior, is that...?
Dr. Larry Brilliant:
These are reciprocal.
Ian Bremmer:
Yeah.
Dr. Larry Brilliant:
See, that's my point. If you follow the virus, you would get the result that if everybody was protected all the time, hermetically sealed, then you can open up more places. If nobody is protected or if a particular group, whether it's right wing or left wing or young or old, if they disregard those norms, then it's harder to open those places up for anyone. That reciprocal nature of personal behavior and public policy has not been taken into account as we think about opening up.
Ian Bremmer:
Let's move to the tech side. We haven't talked about that yet, which is on the... We have this dynamic between individual behavior and public policy, what you can, what you can't open up. How much is this going to be affected by the technology, by the contact tracing?
Dr. Larry Brilliant:
Yeah.
Ian Bremmer:
If we have to publicly opt in, if it's not forced like it would be in China, for example, or Singapore, how effective is that going to be? What do you think about how our lives will or won't change with the technology interventions?
Dr. Larry Brilliant:
It's almost the same as what we talked about before. Personal behavior dictates a larger range of public policies. Let's start off with what we have right now. We have three or four bidirectional opt-in systems. The one that I like is COVID Near You. It's been running as Flu Near You for about 10 years. It's out of Harvard. John Brownstein at Harvard and Mark Smolinski from Ending Pandemics run that. They've got about three quarters of a million people who opt in and every week report their symptoms. And from that, we're able to get a very good spot map of the country and predict where flu and now COVID will be a couple of weeks before CDC will. If we can get 100 million people voluntarily opting in, even though it's not a stochastic random probability sample, we will have some wonderful tools. There's also COVID Tracking and How Do You Feel. These are also very good opt-in bidirectional systems.
Ian Bremmer:
Apple and Google, two companies we don't think of as working hand in glove usually, a big announcement that they're planning on working together to help create a technological tool to fight coronavirus. What do you make of this? What do you think about what they're doing together?
Dr. Larry Brilliant:
Full disclosure, I was at Google for three years and ran google.org and I am a proud ex-Googler and Steve Jobs and I were friends from the time he was 19-years old. And I'm very close to Apple as well. I'm so happy to see these two tech giants engaged in a bit of a detente. Their rivalry has been hard and complicated, and it's really important that they've changed each of their operating systems to allow compatibility in one way, that using clever random digit generators, random numbers, you can have a short-term ID that tells you where your phone has been in contact with somebody who was in contact with a case of COVID without divulging your personal identity, your name, any of the demographics that would make it easy to find you.
I think that's wonderful. And this is one of the things that they did in China. It's one of the better ones that they did. We just need to understand that not everybody is lucky enough to have an Apple iPhone or an Android. Smartphone penetration in the world is, yes, around 50%, but it doesn't penetrate all sectors of society fairly or equally.
Homeless populations, which are a huge problem for them and for the rest of the world in the issue of the pandemic. Minority groups. African Americans in some places are 40% of the deaths when they're 15 or 20% of the population. We're not even just talking about equity and justice, it's the places that you will find the disease that you're less apt to find the wealth to buy a smartphone. The nursing home population, the elderly, people who are in convalescent homes. These are folks who are less likely to be the beneficiary of this new technology.
I think of it as a 30% solution in that it's the beginning of a lot of other technologies. I personally believe that the opt-in bidirectional systems are better right now because more people can use them. I'd love to see 100 million people using COVID Near You or COVID Tracker or one of these other systems right now.
Ian Bremmer:
Both in terms of some potential failings. We've talked about some of the countries that have gotten it right. You talked about some problems in the United States. When we look around the world right now, where would you point fingers and say, "These are governments that have really... they've made big mistakes, they're making big mistakes, and we need to do something about it."
Dr. Larry Brilliant:
There's different kinds of mistakes.
Ian Bremmer:
Right.
Dr. Larry Brilliant:
I think you can't make a bigger mistake than the UK made at the very beginning, somehow believing that you could stop the virus from attacking and killing a lot of people by letting the virus attack and kill a lot of people. I went to medical school for six months in London. I go to Oxford every year for the school work. I love that place. How could they, for a moment, believe something as silly as that? Now, to their credit, they've turned around.
Ian Bremmer:
Yeah.
Dr. Larry Brilliant:
I don't know whether it's Boris being in the hospital, but I think they're now on the right path.
Ian Bremmer:
No, they were turning around before Boris got in the hospital, actually. They just saw the numbers and realized that they were screwing up pretty badly. Yeah.
Dr. Larry Brilliant:
Well, but I think what you've just said is you've just said that the UK screwed up pretty badly, so I will quote you as saying that Ian Bremmer said the UK screwed up pretty badly as an exemplar of what your question asked.
And I think in the United States, we had three different levels of failures. Trump fired the Admiral, who was the only person on the National Security Council charged with looking around and worrying about bioterrorism, bio error and emerging communicable diseases. We defunded or threatened to defund or slow rolled the funding of AID and CDC funding, 37 countries that were in hotspots, that were likely to be accelerators of the virus. I think we've come back and we've started funding them again, but you don't get back the time that you lose.
And the best example of that is you don't get back the missing six weeks when nothing happened. When we had a flawed test kit because we didn't want to use the ...
Ian Bremmer:
The WHO test kit.
Dr. Larry Brilliant:
... designed, Chinese evaluated, WHO provided test kit that everybody else used. Well, we wanted to do something special, and we over-engineered it. We didn't understand how many reagents it would take. And then by downplaying and Mau-Mauing the severity of the disease, we set in motion a politicization of a pandemic, which is crazy. You now have people who still believe it's a hoax. They still believe that it's mild. They still believe it's like the flu. We have governors who believe that. We have governors to this day that have not issued social distancing orders. I don't want to make this into an anti-individual politician or anti-Trump thing.
Ian Bremmer:
No.
Dr. Larry Brilliant:
I stay in my lane. I'm only talking about the decisions that were made that endanger the lives of people from this pandemic. And we've made a lot of them. Now, we can still fix it. We've got some really good people. Harvey Fineberg's committee now of the National Academy of Sciences. I've got a lot of hope for it. It's got five or six or 10 of the smartest, most wonderful people in the world on it. It is specifically intended to advise the Pence committee and Trump, but Harvey Fineberg made it clear that every report they do is going to be released to the public simultaneously. And that's a great thing because only radical transparency will get us through this thing.
Ian Bremmer:
Larry Brilliant.
Dr. Larry Brilliant:
Ian Bremmer.
Ian Bremmer:
Thank you very much.
That's it for today's edition of the GZERO World podcast.
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