Pandemic: Coronavirus Edition

The big FDA announcement and Pfizer vaccines for the little ones...

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 86

Share episode

Can you Rate and Give us a Review in Apple Podcasts?

Please consider financially supporting us for the monthly upkeep and helping hand off some of the editing responsibilities. You can give a one-time donation or become a Patreon member for as little as $5 a month. See the links below. Thank you!

  • Give a one-time gift through Venmo at @mattboettger
  • Give a one-time gift through PayPal here.
  • Give monthly (as little as $5 a month) on our Patreon Page.

Things Discussed on Episode:

Support the show

Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face today's crisis. My name is Matt Boettger and I'm joined with my one good friend, Stephen Kissler, an epidemiologist at the Harvard school of public health. How are you doing buddy?

Stephen Kissler:

I'm doing all right. How are

Matt Boettger:

you? It's good. You know, it's, you know, doing this two week thing, it feels like it feels a little bit longer, you know? So, it's good to see you again. It's great to see ya. And suddenly we got some stuff to chat about. It's, it's kind of nice, you know, to do every two weeks. I know some of our listeners probably would like to every week, It gets a little more time to breathe and kind of see what's going on in the whole COVID spectrum, because now somethings, sometimes things change really quickly and it's in a week, but other times it takes a couple of weeks to kind of really see what's the w what's really, really making headlines and what really needs to be talked about. I think these two weeks have helped to frame a couple of things that I want to share. With you to see what's going on, but first, just to hear what in your neck of the woods, you know, now that you were saying a couple of things, what you've been doing and the past two weeks, what you've been working on over there at at home.

Stephen Kissler:

Well, yeah, so we've been doing some you know, a lot more modeling, so, you know, different organizations are really interested in just sort of how to keep their clientele safe. As we're going into the winter, as we're starting to think about, you know, Yeah, just what sorts of testing do we need? It's, it's really interesting because I think that a lot of these questions have become a lot more nuanced. Both as the technologies have advanced as our understanding of the virus has advanced. And I think a lot of the questions have shifted from is this safer? Is it not? Or Do we need to test or do we need to not, and now it's more like, so we have this many people who are vaccinated and this many who aren't, but they were vaccinated this many days ago. And these are the vaccines that they were vaccinated with. And some people we know, and some people we don't and there the different types of tests that we have available, and we can do it this frequently with this type of test. But it, it, it keeps me. Well employed for one and that's good. And on my toes so it's been sort of fielding a lot of those kinds of questions on different levels. So it's been good, challenging man, busy, the

Matt Boettger:

same good, the same epidemiologists.

Stephen Kissler:

And so I'm pretty excited to be less famous, but

Matt Boettger:

I I'm sure. I know. Well, you know, you mentioned winter and so let's start with this. It's a bit on my mind. Maybe only like may seven days really, because I think my wife brought it, brought it up to me. I'm like, oh yeah. Like she was like, what do you expect to winter to be, you know, you know, she's asking me as if I'm a qualified person, but she just says, I have, I have the gateway to asking these questions to you and mark. So, you know, so I'm gonna throw my scenario and then I want the actual informed person you to actually talk about. What you might expect about the upcoming months. I know we've done all these caveats of you are not a magician. You can't see the future. And when it comes to viruses is way unknown. But given what we know, so this is what I'm thinking, Stephen I'm. Okay. All right. A couple of things have been happy in my mind. I follow the news about every couple of days or maybe about every day, at least for five or 10 minutes and clips some articles, and I've seen a pattern. I haven't seen a lot of information on headlines about other variants. Whereas say a month, six weeks ago, eight weeks ago, there was a number of headlines talking about other variants other than. So I'm thinking, huh? I wonder what that is. We've talked about how Delta is just way more intense it's, you know, at least two times more contagious. And so it seems to be a strong force among variants. So, so I'm thinking, you know, is there going to be another variance like, or, or as Delta going to keep things abate? I have no clue, but it seems to be right now holding strong, which for me is a great news. I mean, for a number of reasons, Yes, because there's not new new variants, but because Delta is incredibly more contagious, but not necessarily that proportionate in how worse it is. Right. It's so I would rather have a super, highly contagious one, roughly the same kind of worseness whatever, you know what I mean? And so keeping those maybe more traumatic mutations at bay, right? So the. We're also seeing now in the U S that cases are starting to level out to decline overall. Right now we're seeing hot pockets here and there. Someone at, oh my gosh, is this winter going to be like, just like, as really slow burn anticlimactic in a good way. Right. As long as there's no variance. So what are you thinking about what this winter might look like in light of what we've seen so far in the past two or three weeks?

Stephen Kissler:

No, I'm, I'm glad you bring all of this up because I think that You know, last year, last year, around this time, or even a little bit earlier when we were talking about the winter, you know, I was, I was pretty certain that we were going to have a major winter search which we did end up having. And you know, that was based off of experience with previous respiratory pandemics and some of the modeling that we had done at the number of susceptible people who were still in the population. We of course didn't have vaccines at that point. And so, yeah, I, you know, the, the, the playing field has changed. And I am a lot less, I'm a lot less certain about what this winter is going to look like as a result. So one of the things and there was a, there was a paper on this by by some colleagues. So I really highly respect last year. But it also matches up with just sort of my own epidemiological intuition, which is that the. Sort of this, this seasonal variation and transmission that we see where we see these real spikes in the winter and troughs in the summer. Is, it depends a lot on really just sort of the baseline infectiousness of the virus itself. W which is basically the, you know, if you have this virus that sort of just on the knife surge of, of transmissibility, where the reproduction number, once you factor in behavior and immunity, and all of these things is right around. Then these subtle changes in the weather and how frequently people spend time indoors and so on is really enough to sort of shift the virus on one side or the other of that threshold. And that's what gives us this seasonal change in transmission, but for something that's a lot more infectious, you know, we have this Delta. Variant where you know, we think the reproduction number is like on the order of six to eight in a, you know, in a you know, in a population with no immunity and where everybody's mixing at a normal rate, but that's, you know, that's, that's quite a bit more infectious than, than we think flu is. And the result of that can sometimes be that these seasonal variation in transit. Sort of gets damped out. It's sort of overwhelmed by just the inherent contagiousness of the virus. And, and I think that's, that's part of why we saw so much spread this summer because the seasonal damping effect that we normally see in the summer just wasn't strong enough to. Really do much to suppress transmission of this, of this highly infectious variant. And so then I think, you know, the question becomes, you know, what do we expect to see this winter? And it could very well be that with high vaccination rates with lots of spread over the course of this. That we might actually not see as much of a winter surge as we might've expected with previous variants. I think that's possible now. I, I do still expect to see a bit of a surge, especially in places that have colder weather, where people are going to spend a lot more time indoors. I do think that keeping control of the virus this winter, especially, you know, up here in the Northeast is going to be a lot harder this winter. And I do expect to see spikes in cases up here. But I am hopeful that it's not going to be. As disruptive as last winter's search was in large part due to vaccination and due to exposure and all of these different factors playing into it. So I don't think that we'll able to be able to totally avoid this kind of wintertime surge, but but I, I know it's strange for me, but I'm a little bit hopeful. You know, it the, that it might It might be a lot less disruptive than it could have been otherwise. So

Matt Boettger:

great. You know? Yeah. Again, I mean, not that I want to be thankful for the amount of transmission in the summer and cases, that seems to be potentially to our advantage that Delta raised locally head around, you know, April, may, June kind of, you know, again, allowing it to be not quite as intense, right. I, even though hospitals were overwhelmed still, if I'm not trying to make light of some really particular hard states. Yes, but I could have only imagined if that was December or January. Now I get it. Florida's a little bit different if you were saying how you know, they're kind of more in the inside during the summer months because it's so just crazy hot and humid and maybe in the winter they're more outside. So that could, it could cause it, so, before we continue on, I forgot to mention this because we always say a couple intro things that love reviews. We've got two that came in this week. I'll read this. This is from will 6, 1 9 6 happened on Thursday. Love the podcast. Great way to stay up to date on the, on the latest pandemic info. I'm an RT in this podcast is a great way to keep up with the newest variants treatment in vaccine. Thank you. Will the 61 96 and then September 12th, squids 1, 1 12. I love these. Helpful and quick knowledge, love this podcast to get instant info on the pandemic as we learn more together, super helpful and straight to the point. Thank you. All of you for leaving reviews helps us and inspire. Keeps us going. So I want to do that. If you wanna support us in any way as little as$5 a month, patrion.com/pandemic podcasts, or just a one-time gift PayPal, then Mo all in the show notes. Okay. I got the other way we can continue to move forward as I get back to my screen, it went away. Okay. So the next thing I want to talk about is let's just go straight to the vaccines. Cause there's a lot of information when talking about I want to get to the boosts. For sure. And let's talk about, you said there's some news that dropped to this morning that I wasn't aware of speaking of vaccine with. We want to share that. Yeah.

Stephen Kissler:

So it seems like, what Pfizer has just announced this morning is that they now have safety and efficacy data for, I believe it's five to 11 year olds. So this is sort of the next age group down from who the vaccine is currently approved for. I believe it's a smaller. Then what's normally given to adults, which is pretty standard for pediatric vaccines. And yeah. I haven't seen the data yet. I don't think that they've actually released those data yet, but they say that it looks good. So I'm looking forward to reviewing it. And and I imagine, you know, if, if it does bear out, then, then we, we could start to see some regulatory changes relatively quickly. I wouldn't be surprised if we start to see vaccine approvals for those age groups. And the coming month or so, so

Matt Boettger:

great. That's awesome. And then let's just continue on the heels of this. You said there was a piece of information as well. New news that may drop later on today or tomorrow it's related to kind of the vaccines, it's all about safety and, and, and reduce the level of mortality. But you said there's kind of a interesting statistic that might be making headlines soon.

Stephen Kissler:

Yeah. So, I was speaking with some journalists over the weekend and sort of talking about. What's going to be coming up. And there's, there's a really significant threshold. Unfortunately that we're about to cross. And that is that the the number of deaths in the United States is about to pass 675,000. The number of recorded deaths from COVID-19. And that's significant because that is the same as the best estimate of the number of deaths that we suffered in the U S during the 1918 flu pandemic. So that's, you know, even just from a cultural and social significance point of view, you know, that's, that's, that's a big deal. Now of course, in in my conversations this weekend, I was talking about a lot of these things too. There are, there are a ton of reasons why. We need to interpret these numbers in context first and foremost, of course, is that the United States is over three times as big as it was in 1918. So on a per capita basis the COVID-19 pandemic still has not been as deadly as the 1918 flu pandemic. And you know, furthermore, as we've talked about in a number of episodes since the question of mortality data is, can be a really sticky one in the sense that you know, what, which, which deaths do you actually attribute to COVID? So there, there may be some undercounting, you know, or there may be some over counting in some contexts, but there's almost definitely a lot of undercounting as well, because we've seen these huge spikes in excess mortality. But really surpassed the official counselor COVID 19, but also, you know, that was probably in play even more so during the 1918 flu pandemic, because there really weren't these national robust crosschecked data streams for mortality data. Then either a lot of our estimates come from sort of these rough estimates that we're extrapolating from certain populations. And certainly. Minority populations at the time were not counted in any sort of rigorous way in the mortality counts either. And we're doing better at that now, but still not perfect. And you know, so, so there they're all of these issues, but but nevertheless, I think that it's, it's a significant threshold to cross. And I think that we're probably going to be hearing a lot more about that.

Matt Boettger:

Yeah. Now, if you're new to our show, how do you know which episode this was? We've talked about a couple of times mark and Stephen, when they were both on that, it was new to me. Early on there was all of this kind of misinformation about like conspiracy is about over counting deaths. As COVID. Now I'm not saying there's not abuse. I w I'm sure there could be a, you know, I'm sure there's some abuse in some level on COVID deaths, but in general, It just really positing the difficulty in, you know, the nature of our show. It's okay. It's, it's complicated. The complexity of actually determining the cause of death. And this is not just strictly a COVID issue. You bring mark back on here and he'll definitely tell you about how it's just not straight or it's not like a little like know algorithm you just put in and it just tells you, there's just, you know, there's narrative and there's context. And, and so it's a complicated reality that, that, that this makes things harder. Not conspiracy, just part of humanity. So the complexity of humanity, now let's get into this vaccine and I'm trying to find a way to how I could maybe weave this into one discussion because we have vaccine to discuss in general, right? Just Medina it's, you know, you know, just hitting the topics like its efficacy being stronger than Pfizer. We can talk about that, but maybe the context, and then we talked about immunity. And how that works and the waning immunity in light of when you might need a booster and these kinds of things. So let's maybe let's make the anchor point, this Israel study. So that might be a revolving way for us to see it everything. So if you're not familiar, there was a study done in Israel. Credible about really suggesting that there is a significant Wayne and ethicacy in particularly the Pfizer. What kind of thing that dominated Israel? I mean, that's the one they used the Pfizer vaccine you know, down to maybe even like 40 to 50% effective when it comes to I think hospitalization or the I forgot what that was, but something you can correct me on all these stats. I'm just general. But pretty significantly low 40, 50, 60% on, on, on those kinds of things. So. This has been circulating, suggesting that, oh, we should really advance a cause of a booster, right? Because if that's that dramatic now, you know, Biden and the administration advance for a booster for everyone, FDA just came out, you know, kind of countering and say, no, that's more nuanced. Let's do that for 65 or older. Those who are at severe risk. And I heard, they just released a third tier that's basically health workers that are like that, that are in constant contact. Those kinds of three, three groups. So we're seeing this kind of fight of what should we do? Should we get a booster? Is Pfizer really not effective? Now we've got to pull in immunity and waning and these kinds of factors in this great article I've put in the show notes, please, please, please read it as body Atlantic waning immunity is not a crisis right now. And to put it in there about how fi you know, Pfizer also had. Really suggesting that there's waning immunity, there's antibody reduction significantly within the Pfizer vaccine, maybe after six months, eight months, these kinds of things. And maybe you can help us sort all this out when it comes to, again, like last week, antibodies are not the sole reason that w the sole measurement of whether we have strong immunity. And, and really kind of helped us go through the T-cells B cells antibodies in what you think in the end, let them all this craziness. What is your suggestion when it comes to. Efficacy

and

Stephen Kissler:

boosters. Yeah. Yeah. So let's let's try to break this down. You know, and this is something that that's you know, as, as this introduction or the eldest is complex and it's something that, you know, even we, epidemiologists are trying to wrap our heads around in there's a lot of disagreement or at least, you know, very vigorous discussion about, you know, sort of what, what the right path forward is because it does play into, you know, there are these. Biological physiological, epidemiological considerations, but also social considerations considerations to justice considerations to equity safety, all of these things are really factoring into this and that this is a pretty sticky situation. So right. So we have the vaccines, we, you know, some of the story that's starting to emerge is all right. So it seems like the efficacy of the modern vaccine seems to be holding up a little bit more strongly than. Both of them seem to be holding up more strongly than the AstraZeneca and the Johnson and Johnson. And so now there are a lot of questions as to what do we do in this context. So as you mentioned, this study from Israel is one of the best that we have to date on, you know, clear. Numbers regarding the sustained efficacy of these vaccines in a real setting, which is really, really what we're after. You know, we can measure antibodies, we can measure sort of, you know, levels of immunity in the blood. But all of those things are really just proxies for what we care about, which is, am I protected from infection? Am I protected from symptoms? Am I protected from hospitalization? And am I protected from dying? Given vaccinations. And the study from Israel really did see a pretty clear evidence of waning immunity. The biggest declines in immunity you know, looking at these different tiers it was of course in symptomatic disease of any sort of showing any sort of symptoms. And I think that's where we saw the sharpest declines. Efficacy against hospitalization and deaths remained high, but was definitely lower. I think, I don't know if it quite reached down to that 40%, but I, I think it was still, you know, probably on the 60 to 80 level, which is, which is lower, you know, definitely lower than we were seeing with early on in, in as these vaccines were first being rolled out. And so that's, you know, that's the first thing that sort of perks up your ears and it makes you want to learn more. So what's going on here? Well, you know, first of all, we waning immunity whether to natural infection or to a vaccine is totally natural, happens all the time. Really? The outlier is things that we get permanently immunized to. So things like measles and to some extent like varicella, which causes chickenpox, you know, Viruses in particular that basically you get exposed to them and by, cause you know, they give us lifelong immunity. Yeah, that's pretty rare. You know, you can think about all sorts of other infections, whether it be RSV or flu or tetanus you know, not naturally, hopefully you're not being naturally infected with tetanus, but, but we have to get boosters every 10 years, right. To keep up our immunity, to tetanus for the same reason that our immunity wanes it declines over time. And it seems like for the coronavirus vaccine and for natural infection, that seems to be the case here as well. As you mentioned this Atlantic article really you know, describes this in a good way. You know, w we can ask the question, like, why does our immunity weigh in? And part of that is because if we, if we kept these really high levels of immunity to everything all at once, there's just not enough space in the body for all of those cells to keep circulating. And so, so it has to decline. And so really what our body has is this memory that allows us to Mount a good response quickly. But that response gets better and better. The more we get exposed to a virus. And so, so the question that we're trying to answer now is how many exposures do you need and how does that depend on the vaccine that you've gotten and really critically on how old you are, so that it brings in an extra layer of complexity into this study from Israel, which is that the they really focused on vaccinating the oldest members of their society first and sort of worked down the age group. The people we have the most information about right now on waning immunity as for the most elderly. Now in this study, they did break down by age group and they actually did show that in younger age groups, it seems like the immunity is better sustained than an older age groups. That's also a very well known phenomenon across epidemiology, which is that frequently. You know, we, we have just like, we have a physical age, we also have an immunological age. And that correlates with our ability to. Mount a good and effective and sustained response to things that we've been exposed to. So oftentimes when people are older, They need a higher dose flu vaccine, for example, or they need boosters more frequently against the pneumococcal bacteria. And so this is, this is also very consistent. And I think that what we're beginning to learn now is, you know, not only do we need boosters, but also who needs boosters and why and how frequently. And so all of that is sort of what the study from Israel is starting to inform. That then brings us to some of the FDA decisions that that we heard over this past week. So for a while the white house has been saying, you know, we want to approve boosters across the population, basically, as soon as the FDA gives us the green light and seems to really have been pushing for that. So the FDA came back with really interesting decision, which was that? Well, actually, actually, no, we're not, we're not going to recommend boosters for. Because the the data just doesn't really suggest that for people under the age of 65 who are healthy and have no other comorbidities and aren't exposed to high levels of the virus that they're actually going to have much of a benefit right now from a booster relative to the protection that they already have no getting a booster will actually provide, you know, it will absolutely provide greater protection for those age groups. But we have to remember that those age groups are on average. Closer to their finishing their vaccine. So, so, people like me are more freshly vaccinated, you know, my I already have higher levels of antibodies in my system than people who were vaccinated earlier and I'm younger. I got walloped with the second dose, you know, and so I don't know if that actually correlates to the level of protection that I have, but I can guarantee you something happened and I, you know, there's and so. So I think that this, this decision is actually interesting and based off of the data we have available makes it makes a lot of sense because those older age groups are more likely to be further away from their vaccine. And they're more likely to suffer the severe effects from COVID-19 anyway, and they're more likely to have less durable immunity in the first place. And so vaccinating those age groups with a third dose makes an awful lot of sense. And I do think that we will probably approve a third dose for everyone at some point, but. Necessarily think that the time is now. And I think it still makes sense. You know, we, we have a huge abundance of vaccines in this country, but. The other thing that we've talked about in the last episode, I think, and that has been factoring into a lot of these decisions is that, you know, how do we balance giving third doses to our own country versus trying to provide vaccines for the rest of the world? And I think that's really critically important too, because. Vaccination rates in a generally more wealthy countries are much, much, much higher than in other countries who aren't able to afford the doses or who weren't as quick to the, you know, securing the doses or whatever, where distribution is more difficult. And so I think that there's, you know, we have to put in a really big effort to make sure that we're providing doses to those countries as well. And that's even in our national interests, you know, we, we really. Prevent the spread of COVID across the world because that's, what's going to keep new variants from emerging. And that's, what's going to keep infection from spilling back over into the United States. So from a humanitarian perspective, from a nationalist perspective, from all of these perspectives, that makes a lot of sense to raise vaccination rates around the world. And so I think it's actually a very good choice to still protect the people who we know to be most vulnerable, but for right now, to really focus on distributing vaccines around the world and to do those things simultaneously to really throw our weight behind both. And I think that's a really interesting and seems to me like a very good way forward to that. Both the scientific data, but then also sort of the social responsibility and this long view forward for where do we want to be in this pandemic in the next six months? It seems to really integrate all of those things in a good way. So I was, I was pleasantly surprised.

Matt Boettger:

Great. Yeah. Can you help make sense? You know, you know, I was thinking about, okay, the Biden administration. They advance boosters for everyone, you know, to me, I could, I could logically think through why Biden would want to, and this administration wants to advance the cause of that. Right. There's I won't get into that. Right. That's the gets into the politics. Sure. But what I want. Fast adviser as Fowchee kind of backing Biden. Who's he's, he's the science guy, right? So he seems to be at odds with the FDA. And he still seems to be like, kind of answering the cause of he still wants this to happen. Can you help make sense of this in light of it? You know, it may be, it just reveals the fact that. The data really is complicated, you know? Cause I, you know, I see in that Atlantic article, they read about how we know one reason why not to advance boosters for everyone is because of a particular demographic age demographic. Because when you look at the teenage people who, who they're in very rare circumstances can suffer from what like myocarditus. Here's pericarditis, which I didn't know about. I don't know the difference. Maybe you can, if you know the difference, you can talk about those two. I have no idea, but this to exist. Yeah. We need mark desperately. So these, these two things exist. So they're like, well, it may not actually be worth the costs given how little they're susceptible already and they've already been vaccinated twice. So there is these kinds of situations. So is that's where FDS reserved, but then here's Fowchee is still really advancing. Is there, what's the science behind staying in that direction. Yeah. So

Stephen Kissler:

I think in my mind, a lot of what's going on here is really just a question of time. So I think the, you know, the again, I, I imagine that probably within the next six months to a year, that third doses will probably be approved. Across age groups, because at that point, you know, we'll have had more time for those age groups in their immunity to weigh in and we'll have more data and information. We'll just have more information available to make a really sound decision about that. I know that with Dr. Fowchee, a lot of his sort of, Well, it seems like the reason why he is throwing his weight behind this idea of boosters for all is because it really, the question there comes down to you know, resources, like what, what are the resources we have available? And he's very convinced that this both and approach of. Providing third doses for people in the United States and providing doses for people around the world is feasible. That, that we could enter into this false narrative of scarcity. When in fact there is none and that, you know, we can, we can argue about, well, do we do one or the other, you know, are we, you know, stealing doses away from the rest of the world? If we vaccinate people here And you know, who better to know what these numbers are then him, you know? And he, he seems to believe that like, well, no, there's, there, there is actually no narrative of scarcity here that and, and we can do, we can easily do both at the same time. We can throw our weight behind. And I think that's a really compelling argument, you know? But it also makes sense to me that an organization like the FDA who is ultimately, you know, they're the ones with whom the buck stops with these decisions. They're ultimately responsible and it would make sense to me that they would want to tread slowly. I think it's true that for those who are under 65 and don't have co-morbidities and are not frequently exposed to COVID-19 and already have, are fully vaccinated against COVID-19 that the risk of hospitalization and death from COVID is now. Not that much different from many other risks that we bear in our day-to-day life. And that's really what they're trying to evaluate is like, how does this risk stack up in other risks that we accept every day? Yeah. And so that seems sound to me. And again, I think that there will come a time when it makes sense, you know, of course the risks that we face in our day to day life compound. So, you know, we might have. Risk from flu and a risk from COVID on a risk from tetanus and a risk from all these other things. And we don't want those to add up too much. So it makes sense to introduce a third dose at some point to reduce that risk. But right now I think that it's a totally sensible choice to say, like we've got plenty of data to know for sure that a third dose for people over the age of 65 makes a lot of sense. Absolutely. I think we can wait a little bit on, on, on approving it. It's sort of, you know, just pushing the decision down the road a little bit. And again, I really want to emphasize that there is a lot of room for reasonable disagreements, amongst people who are very well-informed on this. This is even putting me at odds with some of my own very well-respected colleagues who have been really pushing for either a third dose or who had been pushing for it and not giving third doses to anyone until everyone in the world. So. So I'm sort of threading this middle ground, which it seems like the FDA has chosen to as well. But I just also want to emphasize that this is, you know, this is just one young epidemiologists perspective and there's a lot of there's a lot of room for discussion out there.

Matt Boettger:

Yeah. This is an insensitive probably kind of way to say things because of when I was a child, when you mentioned Fowchee saying maybe it's not necessarily either or, but both hand, it kind of reminds me of like when I was a child, And yeah, I definitely heard from my grandma when I was eating dinner and I didn't finish my plate and she would always use the flame. Well, they're starving people in Africa. Right. And so somehow that's supposed to make me eat my plate because you know, some of that, there's a relationship between the two and it's and it's really, it's not a relationship directly between whether I eat my peas and whether the somebody who's fed, you know, it's just kind of a way to, like, I think that's a similar kind of reality with with, without you saying, like it's not necessarily. By taking a mercy in an article by this, by take, by receiving the vaccine in the U S doesn't deprive someone in somebody it's, it's much more complicated scenario that you have to work with in policy that actually needs to be addressed to be able to provide these. So, you know, one thing I wanted to drop on. Unless you have anything else that you want to share, that that peaks your interest. We didn't talk about this, but I figured this might be an interesting topic if you know anything about this, because since right now, I feel as if the variants are kind of at bay right now, there's not like, at least, at least in the mainstream. We're not talking about, I'm sure all you scientists are studying all these little variants on a small level and seeing where they're going and how they're. But I remember seeing this article about three months ago, maybe two months ago about us, isn't prepared to track COVID variants as Delta mutation spreads. Right? So now it's all over this. This was back in probably may. Have you heard anything talked about your colleagues about what the us has done or been trying to cultivate to be maybe like a front runner, kind of like the UK on really being able to see a variance in the context of the us and, and it starts kind of scoping them out before they get too large.

Stephen Kissler:

Yes, we're, we're making progress on it. Slow and steady progress, but progress, you know, that's I, in many ways, you know, especially early in the pandemic, you know, frankly, the UK has run circles around us in terms of their genomic surveillance for this epidemic and, you know, kudos to them for that they've and a big part of that is just you know, there were some very clear policy and funding decisions where. They're public health regulatory agencies decided that that was actually an important thing to do. And here, you know, some similar proposals were advanced and ultimately decided, well, we don't actually need those as much. And so now that led us to the situation that we're in, where we're kind of trying to catch up. Now a lot of the sequencing and a lot of the genetic surveillance that is being done is still being done. At universities and in local public health agencies. So like for example, the New York city department of health and different universities are sort of acting as the sequencing hubs for their regions currently in doing a lot of the sequencing and analysis and epidemiology to try to figure out what's circulating and where and that That's fine, but definitely having an integrated platform and, you know, agreement about, you know, who's doing what a little bit better distribution of labor there makes a lot of sense. And so that's something that we're moving towards. So that is going to be one of the key. Goals. I believe of this new national center for outbreak analytics that's being started and is actually going to be led by mark Who's one of my very close colleagues and mentors here at the school of public health at Harvard. And so I think that's going to be one of their first and central efforts is, is trying to figure out how they're going to make a national responsive platform for Genetic outbreak analytics in the United States. So, but that's, you know, we still have some time it's going to take a while to build that infrastructure, to build the sort of organization that we need for that kind of thing. So it may still be some time before we build up that capacity, but it's, it's moving in the right direction. It's something that. Just about every epidemiologist is thinking about right now. And so, yeah, so we're, we're, we're racing to to get it to get that sort of thing put together. It'll come, it'll take some time, but it'll, it'll get there.

Matt Boettger:

Yeah. And I didn't even know this existed, so I don't know if you have any information you could put in the show notes or links to this new research or whatever with mark at the head of it. And just, if he wants to follow up, see what's going on, see their first kind of seeds of movement. I'll try to put in the show notes if Stephen can share. Great. I think that's it for, for today. We're good. I hope. You guys have a wonderful week. We'll see you guys yet. Our Dar normal every two weeks until things change, you want to leave a review, please do apple podcasts. We love to see them. It inspires us to want to support us patrion.com/pandemic podcast for monthly donations or just a one-time gift PayPal, then know all you can find in the show notes, as well as some of the articles we discussed for your reading. Pleasure. Have a wonderful time. We'll see you guys in two weeks. Take care and.