0:00:00.055,0:00:02.285 Helen Walters: So, Chris, who's up first? 0:00:03.159,0:00:06.357 Chris Anderson: Well, we have a man[br]who's worried about pandemics 0:00:06.381,0:00:08.181 pretty much his whole life. 0:00:08.738,0:00:11.474 He played an absolutely key role,[br]more than 40 years ago, 0:00:11.498,0:00:15.458 in helping the world get rid[br]of the scourge of smallpox. 0:00:15.966,0:00:17.474 And in 2006, 0:00:17.498,0:00:20.831 he came to TED to warn the world 0:00:20.855,0:00:24.871 of the dire risk of a global pandemic, 0:00:24.895,0:00:26.440 and what we might do about it. 0:00:26.464,0:00:29.265 So please welcome here[br]Dr. Larry Brilliant. 0:00:30.236,0:00:31.838 Larry, so good to see you. 0:00:31.862,0:00:34.037 Larry Brilliant: Thank you,[br]nice to see you. 0:00:34.863,0:00:37.092 CA: Larry, in that talk, 0:00:37.116,0:00:39.863 you showed a video clip[br]that was a simulation 0:00:39.887,0:00:42.578 of what a pandemic might look like. 0:00:42.926,0:00:45.902 I would like to play it --[br]this gave me chills. 0:00:45.926,0:00:49.728 Larry Brilliant (TED2006):[br]Let me show you a simulation 0:00:49.752,0:00:52.493 of what a pandemic looks like, 0:00:52.517,0:00:54.496 so we know what we're talking about. 0:00:55.167,0:00:58.838 Let's assume, for example,[br]that the first case occurs in South Asia. 0:01:00.120,0:01:02.501 It initially goes quite slowly, 0:01:02.525,0:01:05.192 you get two or three discrete locations. 0:01:06.903,0:01:09.426 Then there will be secondary outbreaks. 0:01:09.942,0:01:13.450 And the disease will spread[br]from country to country so fast 0:01:13.474,0:01:15.674 that you won't know what hit you. 0:01:16.228,0:01:19.635 Within three weeks,[br]it will be everywhere in the world. 0:01:20.533,0:01:22.969 Now if we had an undo button, 0:01:22.993,0:01:24.937 and we could go back 0:01:24.961,0:01:27.866 and isolate it and grab it[br]when it first started, 0:01:27.890,0:01:30.484 if we could find it early[br]and we had early detection 0:01:30.508,0:01:31.713 and early response, 0:01:31.737,0:01:35.426 and we could put each one[br]of those viruses in jail, 0:01:35.450,0:01:40.479 that's the only way to deal[br]with something like a pandemic. 0:01:42.083,0:01:44.297 CA: Larry, that phrase[br]you mentioned there, 0:01:44.321,0:01:46.273 "early detection," "early response," 0:01:46.297,0:01:48.283 that was a key theme of that talk, 0:01:48.307,0:01:51.630 you made us all repeat it several times. 0:01:51.654,0:01:55.402 Is that still the key[br]to preventing a pandemic? 0:01:56.573,0:01:58.851 LB: Oh, surely. 0:01:58.875,0:02:00.740 You know, when you have a pandemic, 0:02:00.764,0:02:04.851 something moving at exponential speed, 0:02:04.875,0:02:08.077 if you miss the first two weeks,[br]if you're late the first two weeks, 0:02:08.101,0:02:11.553 it's not the deaths and the illness[br]from the first two weeks you lose, 0:02:11.577,0:02:13.577 it's the two weeks at the peak. 0:02:13.919,0:02:17.593 Those are prevented if you act early. 0:02:17.617,0:02:20.220 Early response is critical, 0:02:20.244,0:02:22.822 early detection is a condition precedent. 0:02:24.013,0:02:25.840 CA: And how would you grade the world 0:02:25.864,0:02:29.543 on its early detection,[br]early response to COVID-19? 0:02:30.950,0:02:33.236 LB: Of course, you gave me[br]this question earlier, 0:02:33.260,0:02:35.029 so I've been thinking a lot about it. 0:02:35.053,0:02:37.014 I think I would go through the countries, 0:02:37.038,0:02:38.911 and I've actually made a list. 0:02:38.935,0:02:44.641 I think the island republics of Taiwan,[br]Iceland and certainly New Zealand 0:02:44.665,0:02:45.815 would get an A. 0:02:46.284,0:02:49.807 The island republic of the UK[br]and the United States -- 0:02:49.831,0:02:53.545 which is not an island,[br]no matter how much we may think we are -- 0:02:53.569,0:02:55.022 would get a failing grade. 0:02:55.046,0:03:00.220 I'd give a B to South Korea[br]and to Germany. 0:03:00.244,0:03:01.394 And in between ... 0:03:01.792,0:03:05.085 So it's a very heterogeneous[br]response, I think. 0:03:05.109,0:03:07.974 The world as a whole is faltering. 0:03:07.998,0:03:11.960 We shouldn't be proud[br]of what's happening right now. 0:03:12.974,0:03:15.752 CA: I mean, we got[br]the detection pretty early, 0:03:15.776,0:03:19.873 or at least some doctors in China[br]got the detection pretty early. 0:03:21.048,0:03:24.493 LB: Earlier than the 2002 SARS,[br]which took six months. 0:03:24.517,0:03:27.164 This took about six weeks. 0:03:27.188,0:03:29.410 And detection means not only finding it, 0:03:29.434,0:03:30.664 but knowing what it is. 0:03:30.688,0:03:34.204 So I would give us[br]a pretty good score on that. 0:03:34.228,0:03:37.170 The transparency, the communication --[br]those are other issues. 0:03:39.709,0:03:42.607 CA: So what was the key mistake 0:03:42.631,0:03:45.868 that you think the countries[br]you gave an F to made? 0:03:46.919,0:03:48.521 LB: I think fear, 0:03:48.545,0:03:52.656 political incompetence, interference, 0:03:52.680,0:03:55.014 not taking it seriously soon enough -- 0:03:55.038,0:03:57.260 it's pretty human. 0:03:57.284,0:03:58.706 I think throughout history, 0:03:58.730,0:04:03.933 pretty much every pandemic[br]is first viewed with denial and doubt. 0:04:03.957,0:04:05.823 But those countries that acted quickly, 0:04:05.847,0:04:08.471 and even those who started slow,[br]like South Korea, 0:04:08.495,0:04:11.709 they could still make up for it,[br]and they did really well. 0:04:12.204,0:04:15.029 We've had two months that we've lost. 0:04:15.053,0:04:18.989 We've given a virus[br]that moves exponentially 0:04:19.013,0:04:20.918 a two-month head start. 0:04:20.942,0:04:22.942 That's not a good idea, Chris. 0:04:23.387,0:04:24.609 CA: No, indeed. 0:04:24.633,0:04:27.490 I mean, there's so much[br]puzzling information still out there 0:04:27.514,0:04:29.618 about this virus. 0:04:29.642,0:04:33.921 What do you think the scientific consensus[br]is going to likely end up being 0:04:33.945,0:04:35.553 on, like, the two key numbers 0:04:35.577,0:04:39.579 of its infectiousness[br]and its fatality rate? 0:04:40.939,0:04:44.422 LB: So I think the kind of[br]equation to keep in mind 0:04:44.446,0:04:48.260 is that the virus moves[br]dependent on three major issues. 0:04:48.284,0:04:50.156 One is the R0, 0:04:50.180,0:04:54.728 the first number of secondary cases[br]that there are when the virus emerges. 0:04:54.752,0:04:56.736 In this case, 0:04:56.760,0:05:00.073 people talk about it being 2.2, 2.4. 0:05:00.097,0:05:02.819 But a really important paper[br]three weeks ago, 0:05:02.843,0:05:07.946 in the "Emerging Infectious[br]Diseases" journal came out, 0:05:07.970,0:05:10.406 suggesting that looking back[br]on the Wuhan data, 0:05:10.430,0:05:12.136 it's really 5.7. 0:05:12.160,0:05:13.359 So for argument's sake, 0:05:13.383,0:05:16.437 let's say that the virus is moving[br]at exponential speed 0:05:16.461,0:05:20.279 and the exponent[br]is somewhere between 2.2 and 5.7. 0:05:20.649,0:05:22.268 The other two factors that matter 0:05:22.292,0:05:25.347 are the incubation period[br]or the generation time. 0:05:25.371,0:05:26.530 The longer that is, 0:05:26.554,0:05:29.918 the slower the pandemic appears to us. 0:05:29.942,0:05:33.037 When it's really short,[br]like six days, it moves like lightning. 0:05:33.061,0:05:35.110 And then the last,[br]and the most important -- 0:05:35.134,0:05:36.546 and it's often overlooked -- 0:05:36.570,0:05:38.712 is the density of susceptibles. 0:05:38.736,0:05:40.434 This is a novel virus, 0:05:40.458,0:05:44.069 so we want to know how many customers[br]could it potentially have. 0:05:44.093,0:05:47.244 And as it's novel,[br]that's eight billion of us. 0:05:47.268,0:05:49.037 The world is facing a virus 0:05:49.061,0:05:52.093 that looks at all of us[br]like equally susceptible. 0:05:52.117,0:05:54.149 Doesn't matter our color, our race, 0:05:54.173,0:05:55.640 or how wealthy we are. 0:05:57.459,0:06:00.270 CA: I mean, none of the numbers[br]that you've mentioned so far 0:06:00.294,0:06:05.277 are in themselves different[br]from any other infections in recent years. 0:06:05.301,0:06:08.441 What is the combination[br]that has made this so deadly? 0:06:09.464,0:06:11.380 LB: Well, it is exactly the combination 0:06:11.404,0:06:15.337 of the short incubation period[br]and the high transmissibility. 0:06:15.648,0:06:21.585 But you know, everybody on this call[br]has known somebody who has the disease. 0:06:21.609,0:06:24.982 Sadly, many have lost a loved one. 0:06:25.006,0:06:28.602 This is a terrible disease[br]when it is serious. 0:06:28.626,0:06:31.891 And I get calls from doctors[br]in emergency rooms 0:06:31.915,0:06:35.848 and treating people in ICUs[br]all over the world, 0:06:35.872,0:06:37.410 and they all say the same thing: 0:06:37.434,0:06:41.442 "How do I choose who is going to live[br]and who is going to die? 0:06:41.466,0:06:44.925 I have so few tools to deal with." 0:06:44.949,0:06:46.913 It's a terrifying disease, 0:06:46.937,0:06:50.132 to die alone with a ventilator[br]in your lungs, 0:06:50.156,0:06:53.211 and it's a disease[br]that affects all of our organs. 0:06:53.235,0:06:55.283 It's a respiratory disease -- 0:06:55.307,0:06:56.680 perhaps misleading. 0:06:56.704,0:06:58.300 Makes you think of a flu. 0:06:58.324,0:07:00.855 But so many of the patients[br]have blood in their urine 0:07:00.879,0:07:02.045 from kidney disease, 0:07:02.069,0:07:03.911 they have gastroenteritis, 0:07:03.935,0:07:06.847 they certainly have[br]heart failure very often, 0:07:06.871,0:07:10.864 we know that it affects taste and smell,[br]the olfactory nerves, 0:07:10.888,0:07:13.283 we know, of course, about the lung. 0:07:13.307,0:07:14.514 The question I have: 0:07:14.538,0:07:17.537 is there any organ[br]that it does not affect? 0:07:17.887,0:07:19.363 And in that sense, 0:07:19.387,0:07:22.053 it reminds me all too much of smallpox. 0:07:25.061,0:07:26.442 CA: So we're in a mess. 0:07:26.466,0:07:28.666 What's the way forward from here? 0:07:29.625,0:07:31.846 LB: Well, the way forward[br]is still the same. 0:07:31.870,0:07:33.125 Rapid detection, 0:07:33.149,0:07:34.768 rapid response. 0:07:34.792,0:07:36.260 Finding every case, 0:07:36.284,0:07:39.434 and then figuring out all the contacts. 0:07:39.458,0:07:41.840 We've got great new technology[br]for contact tracing, 0:07:41.864,0:07:45.315 we've got amazing scientists[br]working at the speed of light 0:07:45.339,0:07:48.974 to give us test kits[br]and antivirals and vaccines. 0:07:48.998,0:07:51.879 We need to slow down, 0:07:51.903,0:07:54.966 the Buddhists say slow down time 0:07:54.990,0:07:58.337 so that you can put your heart,[br]your soul, into that space. 0:07:58.361,0:08:01.273 We need to slow down[br]the speed of this virus, 0:08:01.297,0:08:03.480 which is why we do social distancing. 0:08:03.504,0:08:04.654 Just to be clear -- 0:08:04.678,0:08:06.997 flattening the curve, social distancing, 0:08:07.021,0:08:10.791 it doesn't change[br]the absolute number of cases, 0:08:10.815,0:08:14.688 but it changes what could be[br]a Mount Fuji-like peak 0:08:14.712,0:08:16.165 into a pulse, 0:08:16.189,0:08:20.885 and then we won't also lose people[br]because of competition for hospital beds, 0:08:20.909,0:08:24.823 people who have heart attacks,[br]need chemotherapy, difficult births, 0:08:24.847,0:08:26.792 can get into the hospital, 0:08:26.816,0:08:29.522 and we can use the scarce[br]resources we have, 0:08:29.546,0:08:31.514 especially in the developing world, 0:08:31.538,0:08:32.713 to treat people. 0:08:32.737,0:08:34.728 So slow down, 0:08:34.752,0:08:37.141 slow down the speed of the epidemic, 0:08:37.165,0:08:40.720 and then in the troughs, in between waves, 0:08:40.744,0:08:43.766 jump on, double down, step on it, 0:08:43.790,0:08:45.639 and find every case, 0:08:45.663,0:08:46.989 trace every contact, 0:08:47.013,0:08:48.251 test every case, 0:08:48.275,0:08:51.902 and then only quarantine[br]the ones who need to be quarantined, 0:08:51.926,0:08:54.622 and do that until we have a vaccine. 0:08:56.232,0:08:59.859 CA: So it sounds like we have to get[br]past the stage of just mitigation, 0:08:59.883,0:09:03.144 where we're just trying[br]to take a general shutdown, 0:09:03.168,0:09:06.565 to the point where we can start[br]identifying individual cases again 0:09:06.589,0:09:08.581 and contact-trace for them 0:09:08.605,0:09:10.313 and treat them separately. 0:09:10.337,0:09:11.703 I mean, to do that, 0:09:11.727,0:09:16.020 that seems like it's going to take[br]a step up of coordination, 0:09:16.044,0:09:19.671 ambition, organization, investment, 0:09:19.695,0:09:23.537 that we're not really seeing[br]the signs of yet in some countries. 0:09:23.561,0:09:25.918 Can we do this, how can we do this? 0:09:25.942,0:09:27.522 LB: Oh, of course we can do this. 0:09:27.546,0:09:31.053 I mean, Taiwan did it so beautifully, 0:09:31.077,0:09:33.149 Iceland did it so beautifully, Germany, 0:09:33.173,0:09:34.649 all with different strategies, 0:09:34.673,0:09:36.109 South Korea. 0:09:36.133,0:09:39.672 It really requires competent governance, 0:09:39.696,0:09:42.100 a sense of seriousness, 0:09:42.124,0:09:46.671 and listening to the scientists,[br]not the politicians following the virus. 0:09:46.695,0:09:48.712 Of course we can do this. 0:09:48.736,0:09:49.998 Let me remind everybody -- 0:09:50.022,0:09:51.998 this is not the zombie apocalypse, 0:09:52.022,0:09:54.760 it's not a mass extinction event. 0:09:54.784,0:10:00.820 You know, 98, 99 percent of us[br]are going to get out of this alive. 0:10:00.844,0:10:04.167 We need to deal with it[br]the way we know we can, 0:10:04.191,0:10:07.085 and we need to be[br]the best version of ourselves. 0:10:07.109,0:10:09.180 Both sitting at home 0:10:09.204,0:10:12.442 as well as in science,[br]and certainly in leadership. 0:10:14.236,0:10:17.577 CA: And might there be even[br]worse pathogens out there 0:10:17.601,0:10:18.752 in the future? 0:10:18.776,0:10:20.388 Like, can you picture or describe 0:10:20.412,0:10:22.955 an even worse combination of those numbers 0:10:22.979,0:10:26.438 that we should start to get ready for? 0:10:27.625,0:10:31.466 LB: Well, smallpox[br]had an R0 of 3.5 to 4.5, 0:10:31.490,0:10:35.500 so that's probably about what I think[br]this COVID will be. 0:10:35.524,0:10:38.072 But it killed a third of the people. 0:10:38.096,0:10:39.445 But we had a vaccine. 0:10:39.469,0:10:43.190 So those are the different[br]sets that you have. 0:10:43.214,0:10:44.907 But what I'm mostly worried about, 0:10:44.931,0:10:46.796 and the reason that we made "Contagion" 0:10:46.820,0:10:48.868 and that was a fictional virus -- 0:10:48.892,0:10:51.125 I repeat, for those of you watching, 0:10:51.149,0:10:52.315 that's fiction. 0:10:52.339,0:10:56.172 We created a virus that killed[br]a lot more than this one did. 0:10:56.196,0:10:58.561 CA: You're talking[br]about the movie "Contagion" 0:10:58.585,0:11:00.863 that's been trending on Netflix. 0:11:00.887,0:11:02.308 And you were an advisor for. 0:11:02.332,0:11:04.239 LB: Absolutely, that's right. 0:11:04.263,0:11:06.270 But we made that movie deliberately 0:11:06.294,0:11:08.583 to show what a real pandemic looked like, 0:11:08.607,0:11:11.968 but we did choose a pretty awful virus. 0:11:12.536,0:11:14.347 And the reason we showed it like that, 0:11:14.371,0:11:16.599 going from a bat to an apple, 0:11:16.623,0:11:19.490 to a pig, to a cook, to Gwyneth Paltrow, 0:11:19.514,0:11:23.903 was because that is in nature[br]what we call spillover, 0:11:23.927,0:11:26.299 as zoonotic diseases, 0:11:26.323,0:11:29.650 diseases of animals,[br]spill over to human beings. 0:11:29.674,0:11:31.742 And if I look backwards three decades 0:11:31.766,0:11:33.706 or forward three decades -- 0:11:33.730,0:11:37.547 looking backward three decades,[br]Ebola, SARS, Zika, 0:11:37.571,0:11:39.736 swine flu, bird flu, West Nile, 0:11:39.760,0:11:42.161 we can begin almost a catechism 0:11:42.185,0:11:46.116 and listen to all the cacophony[br]of these names. 0:11:46.140,0:11:51.752 But there were 30 to 50 novel viruses[br]that jumped into human beings. 0:11:51.776,0:11:53.729 And I'm afraid, looking forward, 0:11:53.753,0:11:55.784 we are in the age of pandemics, 0:11:55.808,0:11:57.808 we have to behave like that, 0:11:57.832,0:12:00.231 we need to practice One Health, 0:12:00.255,0:12:02.951 we need to understand[br]that we're living in the same world 0:12:02.975,0:12:05.346 as animals, the environment, and us, 0:12:05.370,0:12:10.260 and we get rid of this fiction[br]that we are some kind of special species. 0:12:10.284,0:12:11.817 To the virus, we're not. 0:12:12.619,0:12:13.769 CA: Mmm. 0:12:13.793,0:12:15.522 You mentioned vaccines, though. 0:12:15.546,0:12:18.577 Do you see any accelerated[br]path to a vaccine? 0:12:19.054,0:12:20.218 LB: I do. 0:12:20.242,0:12:24.121 I'm actually excited to see[br]that we're doing something 0:12:24.145,0:12:27.497 that we only get to think of[br]in computer science, 0:12:27.521,0:12:30.260 which is we're changing[br]what should have always been, 0:12:30.284,0:12:32.017 or has always been, rather, 0:12:32.041,0:12:34.659 multiple sequential processes. 0:12:34.683,0:12:39.604 Do safety testing,[br]then you test for effectiveness, 0:12:39.628,0:12:41.080 then for efficiency. 0:12:41.104,0:12:42.791 And then you manufacture. 0:12:42.815,0:12:45.172 We're doing all three[br]or four of those steps, 0:12:45.196,0:12:48.199 instead of doing it in sequence,[br]we're doing in parallel. 0:12:48.223,0:12:52.227 Bill Gates has said he's going to build[br]seven vaccine production lines 0:12:52.251,0:12:53.409 in the United States, 0:12:53.433,0:12:55.109 and start preparing for production, 0:12:55.133,0:12:58.227 not knowing what the end vaccine[br]is going to be. 0:12:58.251,0:13:03.576 We're simultaneously doing[br]safety tests and efficacy tests. 0:13:03.600,0:13:06.131 I think the NIH has jumped up. 0:13:06.155,0:13:08.608 I'm very thrilled to see that. 0:13:09.378,0:13:13.084 CA: And how does that translate[br]into a likely time line, do you think? 0:13:13.108,0:13:15.508 A year, 18 months, is that possible? 0:13:15.910,0:13:19.215 LB: You know, Tony Fauci[br]is our guru in this, 0:13:19.239,0:13:21.227 and he said 12 to 18 months. 0:13:21.251,0:13:25.440 I think that we will do faster[br]than that in the initial vaccine. 0:13:25.464,0:13:27.694 But you may have heard that this virus 0:13:27.718,0:13:30.988 may not give us the long-term immunity -- 0:13:31.012,0:13:32.948 that something like smallpox would do. 0:13:32.972,0:13:36.895 So we're trying to make vaccines[br]where we add adjuvants 0:13:36.919,0:13:42.355 that actually make the vaccine[br]create better immunity 0:13:42.379,0:13:43.585 than the disease, 0:13:43.609,0:13:46.680 so that we can confer immunity[br]for many years. 0:13:46.704,0:13:48.728 That's going to take a little longer. 0:13:49.141,0:13:50.514 CA: Last question, Larry. 0:13:50.538,0:13:55.517 Back in 2006,[br]as a winner of the TED Prize, 0:13:55.541,0:13:56.692 we granted you a wish, 0:13:56.716,0:14:00.398 and you wished the world would create[br]this pandemic preparedness system 0:14:00.422,0:14:02.740 that would prevent[br]something like this happening. 0:14:02.764,0:14:05.112 I feel like we, the world, let you down. 0:14:05.136,0:14:08.087 If you were to make another wish now, 0:14:08.111,0:14:09.261 what would it be? 0:14:10.698,0:14:14.040 LB: Well, I don't think we're let down[br]in terms of speed of detection. 0:14:14.064,0:14:15.437 I'm actually pretty pleased. 0:14:15.461,0:14:17.706 When we met in 2006, 0:14:17.730,0:14:21.371 the average one of these viruses[br]leaping from an animal to a human, 0:14:21.395,0:14:23.172 it took us six months to find that -- 0:14:23.196,0:14:25.141 like the first Ebola, for example. 0:14:25.165,0:14:28.482 We're now finding[br]the first cases in two weeks. 0:14:28.506,0:14:30.257 I'm not unhappy about that, 0:14:30.281,0:14:33.164 I'd like to push it down[br]to a single incubation period. 0:14:33.546,0:14:34.863 It's a bigger issue for me. 0:14:34.887,0:14:38.822 What I found is that in[br]the Smallpox Eradication Programme 0:14:38.846,0:14:42.441 people of all colors,[br]all religions, all races, 0:14:42.465,0:14:43.783 so many countries, 0:14:43.807,0:14:45.140 came together. 0:14:45.164,0:14:48.490 And it took working as a global community 0:14:48.514,0:14:51.458 to conquer a global pandemic. 0:14:51.482,0:14:57.441 Now, I feel that we have become victims[br]of centrifugal forces. 0:14:57.465,0:15:01.663 We're in our nationalistic[br]kind of barricades. 0:15:01.687,0:15:05.346 We will not be able to conquer a pandemic 0:15:05.370,0:15:07.752 unless we believe[br]we're all in it together. 0:15:07.776,0:15:11.903 This is not some Age of Aquarius,[br]or Kumbaya statement, 0:15:11.927,0:15:15.160 this is what a pandemic[br]forces us to realize. 0:15:15.184,0:15:16.938 We are all in it together, 0:15:16.962,0:15:20.391 we need a global solution[br]to a global problem. 0:15:20.415,0:15:23.015 Anything less than that is unthinkable. 0:15:24.153,0:15:26.293 CA: Larry Brilliant,[br]thank you so very much. 0:15:27.206,0:15:28.606 LB: Thank you, Chris.