Le Show; 2021-09-19

From deep inside your audio device of choice. Well ladies gentlemen, there was a time when those on the liberal side of the equation, politically speaking, were suspicious of the FBI. It had this history during the 1960s of running an intelligence program against anti-war people, program called Cohen Telepro, tracking them, tapping them, taping Martin Luther King's phone calls, calling up Martin Luther King and FBI agent calling up Martin Luther King suggesting that he'd kill himself because he's been screwing around and the FBI has proof and they'll release it. That FBI and, and yet a miraculous transformation happened, long about 2016, followed by the name

of Donald Trump, started whaling on the FBI and all of a sudden, you, you couldn't think more highly of the FBI if you were Ronald Reagan. They were the goodest of the good guys. This was the week that all came tumbling down. So thanks to Donald Trump or Ronald Reagan. More about that coming up, hello, welcome to the show. From everything I've heard, there's only one cause it can be.

That's my lot, also love I hear, leaves you weak, love I hear, makes you blush and turns your action. You try to speak with passion and speak I hear, love they say, makes you pine away, but you pine away with an idiotic grin, I pine, I blush, I squeak, I squawk, today I walk, too weak to walk, what's love I hear, I feel I fear, I mean.

Love they say, makes you pine away, but you pine away with an idiotic grin, I'm afraid, I'm sick, I'm sore, I've never felt so well before, what's love I hear, I feel I fear, I know I am from sure, I mean, I hope I trust, I pray I must be. Forgive me if I shout, forgive me if I crawl, I've only just found out and well, I thought

you ought to know. From the home of the homeless, I'm Harry Scherer, welcoming you to this edition of the show, the good news, yes, there's good news. You know, there's going to be the Winter Olympics coming up right away, next February, in Beijing, China, this week, they announced their slogan for the Winter Olympics, did the Chinese, quote, together for a shared future, unquote, to be fair, it sounds better in Mandarin. Now, news of bad banks. Well there's no bigger bank than the World Bank, I guess, maybe the baddest, maybe not,

who we report has found that Chris Talina, George Ava, former chief executive of the World Bank, directed staff to alter data to play K-China. She's now at the International Monetary Fund, against that's her punishment, the findings and the investigation conducted by a law firm at the request of a bank's ethics committee, who knew? She raised questions about the judgment of Ms. George Ava, since the New York Times, during her time at the World Bank, underscored the pressure the bank has under to accommodate its third largest shareholder. China, the investigation focused on accusations top bank officials pressured the team that conducts the doing business survey every year, pressured them to inflate China's standing in its 2018 report, the role to accusations that the 2020 report, the doing business survey, two years later, was manipulated to artificially bolster the raking of Saudi Arabia.

There's a whole lot of monkey business going on at the bank, or was? The doing business report assesses the business climate in countries around the world, developing countries in particular care deeply about their rankings, they use them to lure foreign investment. We're number 17, come on. At the time of the report, a manipulation world bank officials were under pressure not to anger China. It was ranked 78th on the list of countries in 2017 was about to decline in the 2018 report. According to the investigation, the staff of Jim Young Kim, then the president of the bank held meetings to find ways to improve China's ranking. Well, the food, Miss George Eva also got involved working with the top aide to develop a way to make China look better without affecting the rankings of other countries. Yes, there's a trick.

There's a thing. The investigation found she was directly involved with efforts to improve China's ranking, and at one point chastised the bank's China director for mismanaging the bank's relationship with the country. In her statement, Miss George Eva denied accusations. She'd acted inappropriately. A world bank spokesman said the report spoke for itself, silently, I guess. The bank said Thursday of this week, it's discontinuing its annual doing business survey. So that should fix that. Now everybody's number one. Now some news for her friend, the Adam. Here comes that old problem of what do you do with the nuclear waste.

But companies want a federal approval to build an expensive nuclear waste site in Texas. But residents, state lawmakers, environmentalists and the governor of Texas are all against it. The nuclear regulatory commission should license for interim storage partners to store as much as 5,000 metric tons of radioactive waste. One of two proposed storage sites, the other in the southeastern New Mexico, under agency review for several years, according to Washington Post. It's of course a dead cage-long battle to find a home for 85,000 tons of nuclear waste accumulating at dozens of nuclear plants across the country. 85,000 tons is all. Fears about the dangers of the material, which scientists say remains hazardous to humans for hundreds, maybe thousands of years.

Those fears of stifled plans to build repositories. As in Texas, where environmental activists have forged a rare alliance with oil interests and powerful state republicans to prevent the site from moving forward, they worry that transporting and storing high-level nuclear waste, including contaminated fuel rods exposes the state to the threat of an incident or potential for groundwater contamination. Our consider is that the waste will sit there, the cement around it will crack, leaks will develop and radioactive contamination will result, said the executive director of an Austin-based advocacy group, the governor of Texas, Governor Greg Abbott, signed legislation just last week preventing federally-approved waste facilities from obtaining local construction and wastewater permits. The governor has framed the license as an unwelcome incursion by the Biden administration. He accused it of, quote, trying to dump highly radioactive waste, unquote, in Texas oil

fields. He continued, quote, Texas will not become America's nuclear waste dumping ground, unquote. The idea of a temporary storage facility for nuclear waste came about after the Obama administration shut down the notion of a permanent storage facility in Yucca Mountain, Nevada, the then head of the Senate, Democratic head of the Senate, was from Nevada and opposed that plan. The recommendations of the panel reporting to President Obama in 2012 were, quote, consolidated interim storage facilities, where spent fuel, unquote, where they spent fuel could be stored while a permanent repository was being developed. The Texas site would, one of the, be one of those, would store nuclear waste for up to 40 years, say, though there is no plan for what to do with the material after the 40

years expires. The company involved, waste control specialists, said it would seek amendments to allow it to store as much as 40,000 metric tons of spent fuel, nearly half the country's current inventory, and it could seek approval to extend the license for longer than 40 years, like until we all forget about it, fall asleep. The proposed site in the oil-rich Permian Basin of Texas would be adjacent to an existing facility for low-level radioactive items, such as contaminated gloves and medical tubes, that the license to accept low-level waste was approved in 2007 and 2008, despite an opposition from local environmental groups, engineers and geologists from the Texas Commission on environmental quality resigned over the issuance of those licenses, because they consider

that site geologically unfit for even low-level radioactive waste disposal, according to local news reports at the time. There's a federal law that holds the federal government responsible for storing nuclear waste. Did you know? So the Energy Department makes annual payments to the companies that do the temporary storage. A few years ago, a Congressional Budget Office report said the department had already paid more than $5 billion to utility companies for storing waste, and estimated such payments could eventually total $29 billion, cheap, clean, two cheap to meter, or friend the atom. All right, it's one of those weeks where I have to mention the T-word, or as he's known now, the former guy. Another Trump book has come out. I'm kind of, my guilty pleasure is reading all of them, so you don't have to. But the latest one got a, a boatload of attention when CNN obtained an advanced copy. Gee, how did that happen?

It, it's by Bob Woodward, again, this time with Bob Costa, also a reporter for the Washington post. The book is called peril. It's a, kind of a typical Bob Woodward book in which there are quotes, exact quotes that you think, how, how did he, how could he possibly, but there they are inside quotation marks. It's a conversation between Donald Trump and his vice president, Mike Pence, the vice former guy in early January, just before the demonstration riot, insurrection, whatever you want to call it, at the, at the Capitol, and Trump suggested that, well, more than suggested that Mike Pence refused to certify the electoral college results when he presided over the Congress on January 6th.

Pence responded that he tried everything to figure out a way to do that, done everything he said to find a way around this, but it was, quote, simply not possible. And he added, I wouldn't want any one person to have that power. Trump replied, but wouldn't it be almost cool to have that power? And when Pence, Pence had even asked Dan Quail, if there was any way for the vice president to stand on the way of the certification of the electoral college results, Dan Quail said, no, he said, no. And then the former guy told Pence, well, then I don't want to be friends with you anymore. I picked the wrong man four years ago, unsupposedly. When I chose you for my running mate, I gave you such a gift.

We were in like perfect sync until one day I sent a shift the very time I need you most is when I know I'm stiffed. I don't want to be your friend anymore. I don't want to be your friend anymore. I get you into Mar-a-Lago at half the normal rate, introduce you to my big time friends, tell them that you're great, then I need one solid, not only am I not first class, but

I'm great. I don't want to be your friend anymore, I don't want to be your friend anymore. I don't want to be your friend anymore. Friendship is more special than the biggest precious jewel. It's a presidential suite with an infinity pool. It's the best, it's the greatest, it's really cool. It's like the huge super yacht on the deep blue sea. That's what friendship means to me, me.

If I saw you lying in the street, I'd call 9-1-1-1. If I saw you with a naked frankfurter, I'd go get you a bun, you saw them rob me blind, you threw away your gun. I don't want to be your friend anymore. Don't try to call me, I'll throw the phone on the floor. I don't want to be your friend anymore. I don't want to be your friend anymore. The COVID pandemic is rarely out of the news last year and a half or so, but it hit the

front page the end of the week when a panel of the Food and Drug Administration here in the United States did not, as it was expected to do, approve the idea of a vaccine booster for everybody. It did approve the notion of a vaccine booster for people over 65, so if you'll excuse me, I'll end for people with compromised immune systems. It's long enough into the pandemic that books are starting to come out on the subject and one that's just out, fairly sprawling history of the pandemic and our reaction to it here in the States is by Scott Gottlieb. He was head of the Food and Drug Administration for a couple of years, 2017 to 2019. He's at the American Enterprise Institute as a resident fellow for here.

He's a resident fellow and he's a member of the Board of Directors of one of the companies that makes the coronavirus vaccine Pfizer and he's with me today here on the show to talk to you. Thank you for doing this. Thanks for having me. So, uncontrolled spread is the name of the book, which sounds kind of dire. Are we in a dire situation? Well we are in a dire situation with respect to the impact that the pandemic's had on the US and the globe and I think that we're in a precarious situation with respect to our overall posture going forward whether or not we're adequately protected against the future pandemic and the book really wasn't attempt to try to lay out how we can change our preparedness and our posture so that we're not so excessively vulnerable to these kinds of risks going forward. So you lay out some history here.

We had a couple of coronavirus attacks, SARS-1 and MERS and we dealt with those or we successfully got through those, they didn't turn into pandemics. Was that just dumb luck? It was by virtue of the nature of the viruses themselves. I mean, SARS and MERS were very deadly but not very contagious. It was direct human human transmission was more difficult. You needed to have close contact. So most of the spread or a lot of the spread was within health care institutions where healthcare workers predominantly got infected because they were in close contact with patients. So once we learned how to do better infection control and how to get people diagnosed adequately, we were able to control those infections. So we caught a break in so far as they just weren't very contagious viruses but we should have, it should have been a harbinger or a future risk that we should have understood that the coronaviruses as a category of viruses were on the march and they were developing

features that can make them more menacing to people and that it was a matter of time before some variant came along that combined the sort of lethality or the pathogenicity of SARS or MERS with the easy spread of a virus like influenza and that's in fact with SARS-CoV-2 was. It was a SARS-like virus that was able to spread much more efficiently between people. So how do we understand our inability to see that coming? We were preoccupied with influenza as the pandemic risk and I think we just couldn't get out of that paradigm. There were various people who started to worry about coronaviruses that was a group created inside CDC to focus on coronaviruses as a pathogen that had pandemic potential but I think we weren't expansive enough and not thinking about these risks and we were just so focused our paradigm around pandemic preparedness was so focused on flu that we were never really able to break out of that thinking and the way you would combat a flu pandemic is very different in the way you would deal with coronavirus pandemic.

So for example, diagnostic testing wouldn't be as important in the setting of a flu pandemic because the incubation period is much shorter. People are contagious for a much shorter period of time and they're typically contagious after symptoms come on but in the setting of a coronavirus pandemic, diagnostic testing could be very important because the incubation period is longer so you have a longer interval to intervene to prevent transmission and people could be infectious even when they're asymptomatic and they're maximally infectious before symptoms come on. So having a widely deployable diagnostic test becomes very important. So our planning never really allowed for that, the importance of diagnostic testing. That's just one example. What we really should have been focused on was the category broadly of viruses that replicate through RNA and that are respiratory pathogens. The reason why we should be worried about viruses that replicate through RNA is because that gives them the potential to mutate quickly because by virtue of the fact that they replicate through RNA, you have more opportunity for mutations and in a virus that spreads through respiratory droplets or aerosols has the potential to spread very widely, very quickly.

And if you're taking that few, if that's your orientation, that's your governing framework, the universe of pathogens you worry about is much broader than influenza. Influenza certainly falls within that universe but so do coronaviruses, so does NIPA viruses, a lot of other pathogens to start to fall within that framework. As I understand the history that you're telling, it took us a long time to realize that this particular virus was prone to asymptomatic spread. Right. There was a presumption that Dr. Fauci and others said this, there hasn't been an example where an epidemic has been instigated by asymptomatic transmission and so there was a presumption early that this wasn't spreading that widely through asymptomatic transmission. We didn't detect that early enough to change our overall posture, the overall tenor of our response. And part of the reason we didn't pick up the asymptomatic transmission was because we

didn't have a diagnostic test and so we actually overestimated the role of contaminated surfaces, what we call fomites, early on we thought there must be a lot of transmission from contaminated surfaces and that's why we were all wiping down our groceries and getting recommendations to clean surfaces and you saw people spraying in subway cars because what was happening was CDC was seeing situation settings where there would be 30 people infected coming out of some gathering but there was no one who went into the gathering who was sick and so and CDC had no capacity to test people. So they said, wow, 30 people got sick and no one was symptomatic. There must have been some contaminated surface that they all came in contact with but really what happened was there was someone who is infected and asymptomatic who ended up infecting that those 30 people. So because we didn't have the test, we couldn't really fully understand those patterns of spread so we underestimated the role of asymptomatic transmission overestimated the role of contaminated surfaces.

So we were spraying when we should have been doing something else, masking I guess. Was the United States unique in not understanding the or not having a test weren't other countries doing more in the in the matter of testing than we were and have been? That's right. We were unique in our struggle to deploy a diagnostic test at scale. I mean, one of the things that South Korea did very effectively early in the epidemic and why they were able to get control over their initial outbreak while we weren't was that they were able to pivot very quickly to a widely deployable diagnostic test and use testing and tracing and tracking and quarantining sick individuals as a way to control the initial cases. In the United States, we became heavily seated with a virus. By the time we had a widely deployable diagnostic test, there were literally hundreds of thousands of cases. We were already so heavily seated that we couldn't use testing and tracing as a way to contain the spread at that point.

We had to turn to population wide mitigation. And even as we applied the population wide mitigation, the absence of a diagnostic test that could be widely deployed forced us to apply the mitigation much more broadly across the country rather than target it to those regions that where the spread was was actually occurring. If you look back at the pandemic planning that had been put in place back in 2005 in preparation for a pandemic flu, it envisioned population wide mitigation, but it never envisioned a national shutdown. What it envisioned was that you would have regional steps that you would take as the virus spread across the country, you would take actions on a regional basis to try to mitigate spread because the virus wasn't going to simultaneously, at least initially, wasn't going to simultaneously infect the whole country. It was going to spread in a regionalized fashion as flu epidemics each year do. They start off from one part of the country and then eventually I'm confluent. But in this case, we didn't have a diagnostic test that we could deploy to actually target our interventions. So the inability of field diagnostic early on really was at the root of a lot of our early challenges.

Are we testing enough now? We have enough testing available now. I mean, we finally reached a steady state where there is enough testing available to keep up with the epidemic in the U.S. and what's good about our current postures, we have different kinds of testing platforms that are deployed. We have the PCR-based tests which are widely accessible. We have a lot of at-home tests and antigen-based tests that people can use at home. There's still spot shortages of testing. There's still shortages of the tests that people prefer, but there's ample testing in the marketplace. And we're not even tracking all the testing that's going on because a lot of testing is taking place using point-of-care-based diagnostics that don't necessarily get reported. So might say we're doing X number of tests, but it's probably like 10X, what's actually being done once you factor in all the point-of-care diagnostics. My wife just returned from England where people are on the street passing out at-home tests for free.

And my first reaction is, as an American, how would you trust those people? But apparently the Brits see things differently. So their national health service has deployed people on the streets of London and other cities actually passing out the at-home tests. Is that something that we just were unable to do because of the way we're structured? Well, that's something we should have done. I mean, we should have made testing the tests much more available to consumers and should have subsidized the purchase of tests for people who couldn't afford tests. I think we made at-home tests much more widely accessible to people and helped subsidize the acquisition of tests. We would be in a better position. We would be getting more people diagnosed. We'd be making testing sort of a routine part of life. You don't feel well.

You expose to someone you should test yourself on a serial basis. So in that regard, we still don't have enough testing. I mean, we don't have enough of the tests we need to do that. And from a public health standpoint, I think that could be highly effective. Now, you look at the tests, they're not exorbitant. You can buy the buy-necks now to test for $25. But that's still expensive enough that it's out of reach of many people to either acquire it or certainly use it on a serial basis. And so that's where the government could come in and help subsidize the acquisition of tests for people who are insured on to Medicaid or Medicare, and it's something we should have done. But at this point, we don't necessarily have the supply to really enable that kind of broad access. One of the things I'm struck by in reading your book is history doesn't repeat itself, but it rhymes. I'm seeing this rivalry that you sketch out between the CDC and the FDA, and I'm thinking of, oh, there was siloing going on before 9-11, but one agency wasn't talking to the

other. Is that the kind of situation we had? Was this a siloing problem? Was this a turf problem? What was the problem between the CDC and the FDA, or what is the problem? Yeah, the early problem, there's different problems at different levels, I think. But I don't think that this was the sort of main shortcoming in our response. But the problem that I talk about in a book was around the diagnostic test where CDC really tried to maintain tight control over the deployment of a diagnostic test for COVID, and was resistant to turning the private industry, was resistant to helping facilitate private companies from developing their own tests for a very long time. And FDA was pushing in that direction while CDC was resisting. And so it was FDA, ultimately, that turned to a contract manufacturer and helped stand them up to develop a diagnostic test that could be mass deployed. People think that the testing shortage was resolved when CDC eventually got their tests working.

It was actually resolved when a private contractor entered the market through the work of FDA, which was working with that contractor to get them into the market. But the issue is less about it at rivalry or challenges between FDA and CDC, and more an issue of CDC's sort of cultural orientation with respect to testing in the same crisis where they wanted to maintain tight control over it, where they sort of envisioned themselves as designing the test, developing it, manufacturing it, deploying it, and didn't see a role for turning to private industries scale that response early on. That's what needs to change. You know, it sounds like it's a bad news book, but you do cite a couple of pieces of good news, one, the very ability to get a vaccine up and available within a very abbreviated based on history timeframe, possibly because it's a new form of vaccine. And the other is the ability to do genomic sequencing of occurrences to be able to track

the mutational history of the virus going forward. Talk a little bit about both of those pieces of good news if you would. Well, look, we were at a point in technology where we were able to develop vaccine constructs using fully synthetic tools that allowed us to pivot to the development of a vaccine very quickly based just off the sequence data of this virus. So if this was three years ago, five years ago, we would have made a vaccine by growing up, taking the virus, putting it in the cell culture, growing it in massive quantities, inactivating it, cleaving off its surface proteins, and using those proteins and putting them in a syringe. That would be the vaccine. And that's how we make flu vaccine. We grow the virus in chicken eggs, and we isolate the virus. We inactivate it, and we use its proteins as part of the vaccine. What we were able to do here was take the genetic sequence of that protein, the spike protein

that sits on the surface of the coronavirus, put it in a strip of mRNA that just codes for production of that protein and use that as the vaccine construct. And that allowed us to pivot to a vaccine construct very quickly and get it into clinical development. Now, the clinical development was the traditional approach to clinical trials. These were the largest clinical trials ever run really in modern history, but we were able to get that vaccine construct very quickly. And that owed to a technological inflection point we were at with these kinds of approaches were becoming available and about to be mainstreamed. If this was five years from now, this synthetic approach would have been commonplace. If this was five years ago, we would never have been able to do this. We were just straddling that line where these tools were becoming available and allowed us to pivot very quickly. And then from a sort of policy standpoint, I think we recognize the shortcomings in our early response where we couldn't really marry the high science aptitude of CDC with an operational capacity to mobilize a national response because we didn't have the right kind

of agency and construct to do that. And when it came to the vaccine, we said, you know what, we're going to need to marry the high science aptitude of NIH, National Institute of Health with the regulatory prowess of FDA with the operational capacity of the Department of Defense to actually mobilize the manufacturing and distribution of a vaccine. And that was Operation Warp Speed. Operation Warp Speed was a new entity created that married the Department of Defense with the Department of Health and Human Services. So we finally realized it took something different when it came to the vaccines. And I think it was part of recognition that we lacked that kind of alignment early on. And we needed it if we were going to accelerate a vaccine to the market. We're talking on a day when the FDA is meeting, despite some technical difficulties that I saw, to decide whether to advise the onset of booster shots for those who've already been vaccinated.

And both the WHO and some folks inside the FDA have expressed an opinion that it's a little premature to be boosterizing Americans when there are so many people around the world who've not yet had their first dose. How do you come down on that? Look, I think that the debate, the issue of the boosting people here or in Western countries, obviously the UK is boosting their population, their older population, the French have decided to do it, the Israelis have already deployed it. I think the issue of is this zero-sum game and a vaccine used here isn't a vaccine used abroad. I don't think that that's the case. The reality is that we are going to soon have much more supply than we can distribute. Over the next 12 months, they'll probably will be 15 billion doses of vaccine manufactured. If you aggregate Pfizer, they'll make $4 billion. I'm on a board of Pfizer, as you know, Moderna said they'll make $3 billion AstraZeneca's going to make $1 billion, J&J will make $1 billion, Snoopy's going to enter the market,

I believe. They'll be able to manufacture billions, the serum institute in India is going to be able to manufacture billions of Chinese, are making billions of doses of their vaccine as other Russians. So there's going to be 10 to 20 billion doses of vaccine available. We've already distributed 5.8 billion around the world. There's only 7.8 billion people in the world. So it's going to become an issue of getting vaccine into the austere, hard to reach settings. That's not going to be a supply question, it's going to be a distribution question. The idea that we might use 50 million doses here in the US to give a boost to our population over the age of 60, and that's somehow going to straighten the global supply, I just don't see that being the case. And the reality is that the doses that the US has already bought, so the Biden administration has already bought 200 million extra doses from Pfizer, 200 million extra doses from Moderna. Those doses aren't going to be distributed globally. The Biden administration is going to hold on to enough vaccine to re-vaccine the entire population as a matter of national security, because you don't know what you don't know

and should some new variant come along. We have to quickly re-annoculate the population. They're going to want to have the vaccine available to do that. So these doses aren't going to go anywhere. They're going to be used in the US or just stockpiled in the US. So I don't think it's a zero-sum game. Now where there's another debate going on is among the public health crowd, which is, are the vaccine, is a booster necessary? And that turns on a question for some people of, is the vaccine still fulfilling its original premise in terms of protecting against hospitalization and severe disease? Or do we see a decline in its ability to fulfill that promise? We know there's a decline in the protection against infection. We see that and people accept that. But is it still protecting people against severe disease and hospitalization? And should we re-vaccinate the population just to boost their protection against asymptomatic transmission or mild infection? And that's kind of where the public health debate is. Now I think where I come out on that is when you look at the data, you do see a decline in protection among older individuals who were vaccinated a long interval ago, not just

in protection against infection and not just protection against mild infection, but also symptomatic disease. And if you look at the Israeli data, there are some data sets that show a decline in protection against severe disease. And that's what's more concerning and points in the direction of maybe we should be providing an additional dose to some portion of the population based on their risk. And that might include people above the age of 60 who were vaccinated more than six months ago. I think that that may be an appropriate place for us to come out here, even if some people maintain and feel that the evidence isn't there to support giving a booster to everyone. I think the evidence is more convincing when you're starting to look at older individuals who were vaccinated a long interval ago. Certainly the Israeli data set points in that direction. The problem is we don't have our own data set. And the CDC isn't systematically collecting this data. So we could say that we don't fully trust the Israeli data, the Israeli data doesn't fully

inform the experience in the US, but we don't have our own data to say that it's wrong. And it is being collected pretty rigorously. But I ask why we don't have our own data? Well, because the CDC isn't collecting it, the CDC made a decision not to collect data on breakthrough infections except when people are hospitalized and the data set that they're relying on are these cohort studies that they have where they're following tens of thousands of patients, but not hundreds of thousands from defined groups. So for example, they have a cohort study of grocery store workers, they have a cohort study of healthcare providers and what they do is they follow these people in perpetuity over time. And they're examining whether they're seeing breakthrough infections, breakthrough hospitalizations. But the problem is that these aren't representative groups. First of all, they're not geographically diverse. So you have an epidemic in Florida and your cohort study might over and roll people in New York where there's very low incidence of Delta right now. And the other problem is that you're following groups that have a high prevalence of prior

infections. So grocery store workers, we know had a higher incidence of early infections. So then if you take a group that had COVID, then you vaccinate them, suddenly they have more immunity than the average person who might have just been vaccinated and never had the infection. So that's no longer a representative sample to derive conclusions for the broad population. So we're not collecting the right data to answer this question because when CDC started doing this, they never envisioned having to answer this question. So they never collect the data in a systematic way to really be in a position to do it. Two things I have to ask you about because any time the subject of COVID comes up, they come up. And one you do cover in the book in some detail is China and the role of China and the behavior of China. We at this point, do we know how this pandemic originated and where? We don't and we might never know, you know, this might be a battle of competing narratives

over time. There's a group that thinks it's more likely that this came out of nature that this was a sort of zoonotic source, some animal was in the wrong place at the wrong time transferred this virus to people and that triggered a global pandemic. And there's people who believe this more likely came out of a laboratory where there was an accident in the laboratory in China that was working with this virus and it ended up escaping from a lab. And there's certainly past precedent for viruses escaping out of laboratories, even triggering global epidemics. SARS-1 escaped out of laboratories six different times. The last known outbreaks of SARS-1 were all laboratory accidents, four of which were in China. I think that the challenges that over time, the side of the ledger that says that this came out of nature hasn't really expanded and you can argue as diminished because we've disproven the food market that was originally implicated as the source of the initial outbreak.

Even the Chinese can see that wasn't the case, it was just to stop along the way. And we've conducted a pretty exhaustive search for a zoonotic source and haven't found it. So that has to tip in the direction of maybe this didn't come out of nature. The side of the ledger that says that this came out of a lab, that side of the ledger has expanded over time. First of all, we have some intelligence reporting that's been made public around some circumstances around that lab that created the conditions for spread. They were doing experiments with novel coronaviruses. They were infecting transgenic animals with fully human immune systems. That certainly creates risk. They were doing the research in what's called a BSL2 lab, a lab that didn't have high security. So those all create opportunities for risk. The Chinese government hasn't been forthcoming with information about this. And so that certainly has to tip in the direction of a laboratory source. Why are they more forthcoming, why haven't they been more open to a thorough investigation? So there's just things that have sort of accumulated on the side of the ledger that suggests

that this could have come out of a lab that I think is changing some minds over time around the relative merits of both arguments. But the bottom line is we might never have an answer to this question. It's either going to take finding the zoonotic source, finding the animal source, which we haven't done yet, or perhaps a whistleblower or someone who leaks out information from the China that clearly points in the direction of a lab. I think absent that, this may persist as one of those intrigues that carries on for some time. Good luck to that person. The other thing that comes to people's minds when we start digging into this subject is the structure that's known in this country as big pharma. And it did not escape my notice that the, and probably did not escape yours either, that the stock price of Moderna, one of the other companies manufacturing a vaccine, has gone up 360% in like the past year or so.

Is there profiteering going on and what's, I guess, a preliminary question is the difference between profiting and profiteering? Yeah. I mean, look, I don't know how to answer that question because I don't know what you would define as profiting versus profiteering. My definition might be different to someone else's definition, but I would look at what is the price being charged for the vaccines and do we think it's a fair price relative to the cost and risk of developing it and the benefits that it's delivering? And in Western markets, the vaccine has been priced sort of commensurate with the flu vaccine. And in developing markets, it's being priced much lower and in some markets it's being given away for a no-profit price. So different people are going to come to different conclusions. Some people will say, well, the COVID vaccine is delivering an immense amount of public

health value, pricing it on the level of the flu vaccine is appropriate. And some people will argue it should be given away free everywhere around the world. I mean, the reality is, I'm on the border Pfizer, so I'm close to this. The reality is the cost of goods are not trivial here. This isn't like it only costs a penny to make. So the cost of goods are substantial, even relative to the total price of the vaccine. And there's been a lot of reinvestment, every company is working on multiple new variant vaccines. Every company is investing billions of dollars in manufacturing. And so we want to continue to see those investments go forward because there's continued risk. And just anecdotally, from my experience, I'm on the border Pfizer, I remember the board meeting when we voted for about a half a billion dollars to spend about a half a billion dollars to purchase the machines that are used to make the vaccine. There's these mixing machines that are used that are custom made for Pfizer.

They cost $200 million each. And we voted to purchase, I think, four of them early on. This was probably in the spring time, or maybe the summer, before we even knew if the vaccine was going to work. So we made that investment early and there's been billions of dollars invested in just the purchase of those machines because as the company has been able to scale its manufacturing to make these four billion doses. So those kinds of investments, that's a lot of risk and there needs to be some return for taking that risk. Finally, the last chapters of your book bring up a subject that I think is probably the most controversial element that you discuss in the book, which is the need looking forward to prevent a similar experience with the next pandemic. And we all know that there's going to be an next pandemic. You recommend bringing in the intelligence community to participate in the detection of signs

of an incipient next pandemic. And the specter of mixing public health and intelligence can give people eight kinds of creeps. Yeah. I think that the public health community has historically not wanted the foreign intelligence assets anywhere near this mission, that they saw the mission of trying to find the next emerging virus that could create the next pandemic as something that was purely public health and that any involvement of our foreign intelligence agencies would erode the sort of multilateral work and the capacity building that needs to go on where public health officials need to be in these countries and have cooperation to get the information we need to protect ourselves. And the reality is that those multilateral commitments have failed time and time again. Every time there's been a major outbreak, we've seen most times, countries weren't forthcoming

with the information, including China with SARS-1, where it wasn't revealed that they were having an outbreak of a novel coronavirus and told people in Toronto, Canada to start to get infected and the Canadian sequenced the virus and realized it was a novel coronavirus and then the Chinese government conceded that it wasn't a fungal infection causing their outbreaks of pneumonia, which was their holding story up until that point, but actually a novel coronavirus. So I don't know that we have the luxury to just think that we could go to the World Health Assembly, the World Health Organization, sign some new binding agreements, hold hands and really mean it this time. I think we're going to need to build different capacities to gather this information overseas. And if anything, COVID condition countries would be even less forthcoming because it normalized trade and travel restrictions. At one time, it was taboo, the idea that you would isolate a country that had an emerging infection, it had an outbreak in an epidemic was taboo, it would be destabilizing, it would actually hurt the nation and hurt their ability to contain the epidemic. That certainly was the case when you had the Ebola outbreak in West Africa and there

was calls for isolating the West African nations and the Obama administration rightly resisted those calls. But if anything, COVID now normalizes practices. What's the first thing that happened when the British raised their hand and said, we have this concerning new variant called B117 that seems to be a lot more contagious? The French closed the channel. So if anything, we now, we should now expect countries, especially countries that aren't necessarily friendly to us, to be even less forthcoming and more likely to try to deal with it on their own quietly before they raise their hand and say, we have this problem here. And that's going to argue more in the direction of getting our foreign intelligence agencies engaged in this mission. So I think we need to come to a consensus around that and get comfort around it because I think it's sort of the bitter reality coming out of COVID. Aren't there people in the public health community who are afraid that that that means they're going to be fingered by those in other countries as probable CIA or NSA agents and make their jobs, if not their lives, a little harder?

Yes, that's absolutely the argument that everyone with a white coat will be perceived to be a spy. And that's why there's been resistance from the public health crowd. But I think that, you know, having sort of been in the government for a while. And I think that when Americans travel abroad, most foreign countries suspect that any American official traveling abroad might be working on behalf of our foreign intelligence agency. So I don't know that there's not already some suspicion just because countries are naturally suspicious of American official traveling abroad. So the well has been poisoned is what you're saying. Exactly. Dr. Scott Gottlieb, it's an amazing book and touches on so much that has been obsessing us in the last year and a half and clarifies a lot of it. Thank you so much for spending some time with us today. Thanks a lot. Thanks for having me.

And now the apologies of the week. Just here's Marine Corps General Frank Mackenzie, head of CENTCOM, about the drone attack in Afghanistan that killed 10 people. I have now convinced that as many as 10 civilians, including up to seven children, were tragically killed in that strike. Moreover, we now assess that it is unlikely that the vehicle and those who died were associated with ISIS-K or were a direct threat to US forces. I offer my profound condolences to the family and friends of those who were killed. This strike was taken in the earnest belief that it would prevent an imminent threat to our forces and the evacuees at the airport. But it was a mistake. And I offer my sincere apology. As the combatant commander, I am fully responsible for this strike and his tragic outcome. So then he'll be paying the compensation, right?

And here's the director of the FBI speaking to four of the gymnasts abused by US gymnastics, Dr. Larry Nasser, at a hearing visit. And profoundly sorry to each and every one of you. I'm sorry for what you and your families have been through. I'm sorry that so many different people let you down over and over again. And I'm especially sorry that there were people at the FBI who had their own chance to stop this monster back in 2015 and failed. And that is inexcusable. It never should have happened and we're doing everything in our power to make sure it never happens again. Chris Ray. And finally the organizers of the Brighton marathon in southern England have apologized after the course for last Sunday's race turned out to be 1,640 feet too long.

The apologies of the week, copyrighted feature of this broadcast. Thank you very much. Ladies and gentlemen, that's it for this edition of the show. There will be more, but different.

Next week, same time on these same radio stations and on your audio device of choice, whenever you want it, don't let anybody tell you otherwise. Or do, it's up to you. And it would be just like having the marathon course the right length if you'd agree to be with me. Then we do already. Thank you very much. A hundred tip of the show shop. Poe to the San Diego desk. The Pam Hall stood. The Thomas Wall should W-W-N-O in New Orleans. For help with today's broadcast, the email address for this program, your chance to get carsite talk t-shirts, man, there's a throwback, and the playlist of the music here, all at HarryShirt.com and a month Twitter at the HarryShirt. The show comes to you from century of progress, productions and originates through the facilities

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