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Helen Walters: So, Chris, who's up first?
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Chris Anderson: Well, we have a man
who's worried about pandemics
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pretty much his whole life.
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He played an absolutely key role,
more than 40 years ago,
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in helping the world get rid
of the scourge of smallpox.
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And in 2006,
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he came to TED to warn the world
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of the dire risk of a global pandemic,
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and what we might do about it.
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So please welcome here
Dr. Larry Brilliant.
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Larry, so good to see you.
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Larry Brilliant: Thank you,
nice to see you.
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CA: Larry, in that talk,
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you showed a video clip
that was a simulation
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of what a pandemic might look like.
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I would like to play it --
this gave me chills.
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Larry Brilliant (TED2006):
Let me show you a simulation
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of what a pandemic looks like,
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so we know what we're talking about.
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Let's assume, for example,
that the first case occurs in South Asia.
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It initially goes quite slowly,
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you get two or three discrete locations.
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Then there will be secondary outbreaks.
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And the disease will spread
from country to country so fast
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that you won't know what hit you.
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Within three weeks,
it will be everywhere in the world.
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Now if we had an undo button,
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and we could go back
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and isolate it and grab it
when it first started,
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if we could find it early
and we had early detection
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and early response,
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and we could put each one
of those viruses in jail,
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that's the only way to deal
with something like a pandemic.
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CA: Larry, that phrase
you mentioned there,
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"early detection," "early response,"
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that was a key theme of that talk,
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you made us all repeat it several times.
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Is that still the key
to preventing a pandemic?
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LB: Oh, surely.
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You know, when you have a pandemic,
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something moving at exponential speed,
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if you miss the first two weeks,
if you're late the first two weeks,
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it's not the deaths and the illness
from the first two weeks you lose,
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it's the two weeks at the peak.
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Those are prevented if you act early.
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Early response is critical,
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early detection is a condition precedent.
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CA: And how would you grade the world
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on its early detection,
early response to COVID-19?
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LB: Of course, you gave me
this question earlier,
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so I've been thinking a lot about it.
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I think I would go through the countries,
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and I've actually made a list.
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I think the island republics of Taiwan,
Iceland, and certainly New Zealand
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would get an A.
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The island republic of the UK
and the United States --
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which is not an island,
no matter how much we may think we are --
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would get a failing grade.
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I'd give a B to South Korea
and to Germany.
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And in between ...
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So it's a very heterogeneous
response, I think.
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The world as a whole is faltering.
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We shouldn't be proud
of what's happening right now.
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CA: I mean, we got
the detection pretty early,
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or at least some doctors in China
got the detection pretty early.
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LB: Earlier than the 2002 SARS,
which took six months.
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This took about six weeks.
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And detection means not only finding it,
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but knowing what it is.
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So I would give us
a pretty good score on that.
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The transparency, the communication --
those are other issues.
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CA: So what was the key mistake
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that you think the countries
you gave an F to made?
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LB: I think fear,
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political incompetence, interference,
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not taking it seriously soon enough --
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it's pretty human.
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I think throughout history,
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pretty much every pandemic
is first viewed with denial and doubt.
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But those countries that acted quickly,
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and even those who started slow,
like South Korea,
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they could still make up for it,
and they did really well.
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We've had two months that we've lost.
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We've given a virus
that moves exponentially
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a two-month head start.
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That's not a good idea, Chris.
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CA: No, indeed.
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I mean, there's so much
puzzling information still out there
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about this virus.
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What do you think the scientific consensus
is going to likely end up being
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on, like, the two key numbers
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of its infectiousness
and its fatality rate?
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LB: So I think the kind of
equation to keep in mind
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is that the virus moves
dependent on three major issues.
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One is the R0,
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the first number of secondary cases
that there are when the virus emerges.
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In this case,
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people talk about it being 2.2, 2.4.
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But a really important paper
three weeks ago,
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in the "Emerging Infectious
Diseases" journal came out,
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suggesting that looking back
on the Wuhan data,
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it's really 5.7.
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So for argument's sake,
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let's say that the virus is moving
at exponential speed
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and the exponent
is somewhere between 2.2 and 5.7.
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The other two factors that matter
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are the incubation period
or the generation time.
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The longer that is,
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the slower the pandemic appears to us.
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When it's really short,
like six days, it moves like lightning.
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And then the last,
and the most important --
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and it's often overlooked --
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is the density of susceptibles.
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This is a novel virus,
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so we want to know how many customers
could it potentially have.
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And as it's novel,
that's eight billion of us.
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The world is facing a virus
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that looks at all of us
like equally susceptible.
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Doesn't matter our color, our race,
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or how wealthy we are.
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CA: I mean, none of the numbers
that you've mentioned so far
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are in themselves different
from any other infections in recent years.
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What is the combination
that has made this so deadly?
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LB: Well, it is exactly the combination
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of the short incubation period
and the high transmissibility.
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But you know, everybody on this call
has known somebody who has the disease.
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Sadly, many have lost a loved one.
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This is a terrible disease
when it is serious.
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And I get calls from doctors
in emergency rooms
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and treating people in ICUs
all over the world,
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and they all say the same thing:
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"How do I choose who is going to live
and who is going to die?
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I have so few tools to deal with."
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It's a terrifying disease,
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to die alone with a ventilator
in your lungs,
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and it's a disease
that affects all of our organs.
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It's a respiratory disease --
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perhaps misleading.
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Makes you think of a flu.
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But so many of the patients
have blood in their urine
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from kidney disease,
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they have gastroenteritis,
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they certainly have
heart failure very often,
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we know that it affects taste and smell,
the olfactory nerves,
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we know, of course, about the lung.
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The question I have:
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is there any organ
that it does not affect?
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And in that sense,
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it reminds me all too much of smallpox.
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CA: So we're in a mess.
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What's the way forward from here?
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LB: Well, the way forward
is still the same.
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Rapid detection,
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rapid response.
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Finding every case,
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and then figuring out all the contacts.
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We've got great new technology
for contact tracing,
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we've got amazing scientists
working at the speed of light
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to give us test kits
and antivirals and vaccines.
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We need to slow down,
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the Buddhists say slow down time
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so that you can put your heart,
your soul, into that space.
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We need to slow down
the speed of this virus,
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which is why we do social distancing.
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Just to be clear --
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flattening the curve, social distancing,
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it doesn't change
the absolute number of cases,
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but it changes what could be
a mount Fuji-like peak
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into a pulse,
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and then we won't also lose people
because of competition for hospital beds,
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people who have heart attacks,
need chemotherapy, difficult births,
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can get into the hospital,
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and we can use the scarce
resources we have,
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especially in the developing world,
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to treat people.
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So slow down,
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slow down the speed of the epidemic,
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and then in the troughs, in between waves,
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jump on, double down, step on it,
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and find every case,
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trace every contact,
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test every case,
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and then only quarantine
the ones who need to be quarantined,
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and do that until we have a vaccine.
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CA: So it sounds like we have to get
past the stage of just mitigation,
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where we're just trying
to take a general shutdown,
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to the point where we can start
identifying individual cases again
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and contact-trace for them
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and treat them separately.
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I mean, to do that,
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that seems like it's going to take
a step up of coordination,
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ambition, organization, investment,
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that we're not really seeing
the signs of yet in some countries.
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Can we do this, how can we do this?
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LB: Oh, of course we can do this.
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I mean, Taiwan did it so beautifully,
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Iceland did it so beautifully, Germany,
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all with different strategies,
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South Korea.
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It really requires competent governance,
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a sense of seriousness,
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and listening to the scientists,
not the politicians following the virus.
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Of course we can do this.
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Let me remind everybody --
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this is not the zombie apocalypse,
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it's not a mass extinction event.
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You know, 98, 99 percent of us
are going to get out of this alive.
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We need to deal with it
the way we know we can
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and we need to be
the best version of ourselves.
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Both sitting at home
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as well as in science,
and certainly in leadership.
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CA: And might there be even
worse pathogens out there
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in the future?
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Like, can you picture or describe
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an even worse combination of those numbers
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that we should start to get ready for?
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LB: Well, smallpox
had an R0 of 3.5 to 4.5,
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so that's probably about what I think
this COVID will be.
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But it killed a third of the people.
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But we had a vaccine.
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So those are the different
sets that you have.
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But what I'm mostly worried about,
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and the reason that we made "Contagion"
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and that was a fictional virus --
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I repeat, for those of you watching,
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that's fiction.
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We created a virus that killed
a lot more than this one did.
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CA: You're talking
about the movie "Contagion"
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that's been trending on Netflix.
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And you were an advisor for.
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LB: Absolutely, that's right.
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But we made that movie deliberately
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to show what a real pandemic looked like,
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but we did choose a pretty awful virus.
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And the reason we showed it like that,
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going from a bat to an apple,
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to a pig, to a cook, to Gwyneth Paltrow,
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was because that is in nature
what we call spillover,
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as zoonotic diseases,
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diseases of animals,
spill over to human beings.
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And if I look backwards three decades
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or forward three decades --
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looking backward three decades,
Ebola, SARS, Zika,
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swine flu, bird flu, West Nile,
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we can begin almost a catechism
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and listen to all the cacophony
of these names.
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But there were 30 to 50 novel viruses
that jumped into human beings.
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And I'm afraid, looking forward,
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we are in the age of pandemics,
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we have to behave like that,
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we need to practice One Health,
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we need to understand
that we're living in the same world
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as animals, the environment, and us,
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and we get rid of this fiction
that we are some kind of special species.
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To the virus, we're not.
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CA: Mmm.
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You mentioned vaccines, though.
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Do you see any accelerated
path to a vaccine?
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LB: I do.
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I'm actually excited to see
that we're doing something
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that we only get to think of
in computer science,
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which is we're changing
what should have always been,
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or has always been, rather,
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multiple sequential processes.
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Do safety testing,
then you test for effectiveness,
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then for efficiency.
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And then you manufacture.
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We're doing all three
or four of those steps,
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instead of doing it in sequence,
we're doing in parallel.
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Bill Gates has said he's going to build
seven vaccine production lines
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in the United States,
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and start preparing for production,
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not knowing what the end vaccine
is going to be.
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We're simultaneously doing
safety tests and efficacy tests.
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I think the NIH has jumped up.
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I'm very thrilled to see that.
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CA: And how does that translate
into a likely time line, do you think?
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A year, 18 months, is that possible?
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LB: You know, Tony Fauci
is our guru in this,
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and he said 12 to 18 months.
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I think that we will do faster
than that in the initial vaccine.
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But you may have heard that this virus
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may not give us the long-term immunity --
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that's something that smallpox would do.
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So we're trying to make vaccines
where we add adjuvants
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that actually make the vaccine
create better immunity
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than the disease,
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so that we can confer immunity
for many years.
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That's going to take a little longer.
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CA: Last question, Larry.
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Back in 2006,
as a winner of the TED Prize,
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we granted you a wish,
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and you wished the world would create
this pandemic preparedness system
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that would prevent
something like this happening.
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I feel like we, the world, let you down.
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If you were to make another wish now,
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what would it be?
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LB: Well, I don't think we're let down
in terms of speed of detection.
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I'm actually pretty pleased.
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When we met in 2006,
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the average one of these viruses
leaping from an animal to a human,
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it took us six months to find that --
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like the first Ebola, for example.
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We're now finding
the first cases in two weeks.
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I'm not unhappy about that,
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I'd like to push it down
to a single incubation period.
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It's a bigger issue for me.
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What I found is that in
the Smallpox Eradication Programme
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people of all colors,
all religions, all races,
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so many countries,
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came together.
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And it took working as a global community
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to conquer a global pandemic.
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Now, I feel that we have become victims
of centrifugal forces.
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We're in our nationalistic
kind of barricades.
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We will not be able to conquer a pandemic
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unless we believe
we're all in it together.
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This is not some Age of Aquarius,
or Kumbaya statement,
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this is what a pandemic
forces us to realize.
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We are all in it together,
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we need a global solution
to a global problem.
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Anything less than that is unthinkable.
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CA: Larry Brilliant,
thank you so very much.
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LB: Thank you, Chris.