What have we learnt from Covid?

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Hello, we're back for a brand new series of the Infinite Monkey Cage and still aiming to solve some of science's greatest mysteries.

I don't think we're going to solve science's greatest mysteries on the radio.

Nobel Prize, if we do one of our 28-minute episodes and actually get the answers to some of these things, I don't think we're going to be.

You don't think it's going to happen?

It's not going to happen.

But if you're in the UK and can't wait to hear the finest minds we've assembled this time around, the whole series is available available right now, first on BBC Sounds.

Hello, I'm Robin Ince.

And I'm Brian Cox, and this is The Infinite Monkey Cage.

And welcome to a special show.

We don't normally do this, but it's going to be a kind of show of nostalgia, like an advert for a butterscotch sweet or an album that contains 180 different songs from the 1950s that is not available in the shops.

And the reason that it's nostalgic is we've made a really terrible error.

Every now and again,

we do a show where we're actually recording it quite a few months in advance.

So, what we do is we pick something that hopefully won't change that much in the interim.

So, for instance, the science of black holes or monkey behavior.

But for some reason, we've decided five months in advance to record a show about COVID.

Yeah, that's right!

The thing that has never varied at all.

I'm sure you've all noticed in the press how little COVID has varied.

So, basically, what we're doing is when you're listening to this show at home, see how many things have remained the same scientifically as they were back in July.

Enjoy.

General, this is the thing that worries me is because our Christmas special that we recorded last week is the scientific theories behind the longevity of Boris Johnson's prime ministership.

I mean he's sincere secure today.

Today we're discussing the COVID pandemic.

How has our scientific understanding changed?

How will that understanding change the way that we approach infectious disease prevention and treatment in the future?

And how will the experience of seeing science being done in real time affect the way the public perceive science?

We're joined by a professor of immunology, a professor of vaccinology, and the presenter of Operation Ouch.

And they are.

Hi, my name's Dan Davis.

I'm a professor of immunology at Imperial College London.

I've written books about the immune system, most recently The Secret Body.

The most fascinating and awesome thing about COVID-19 for me is that Sarah Gilbert and her team made up how a vaccine might work in January 2020, and by November 2020, they had formal proof that it really worked.

And we now know, of course, that her and others who made vaccines have saved something like 20 million lives.

I'm Sarah Gilbert.

Just so you know, Sarah, you're now under tremendous pressure to say something about Dan.

So, I'm Sarah Gilbert, Professor of Vaccinology at the University of Oxford.

And what I find fascinating about COVID is the number of different effects it has on the human body, which people like Dan on the immunology side and Chris on the medical side and are still trying to understand how something that's really tiny and can't even fulfil all of the functions of life on its its own can do so many different things to people.

I'm Chris Van Tulliken.

No applause.

Thank you.

I was fishing.

I'm Chris Van Tulliken.

I'm merely an associate professor at UCL of Infection and I'm an infectious diseases doctor.

And I do present children's television, as some of you may know.

And I think the most interesting thing about COVID is the clinical side of those molecular effects that Dan and Sarah study, that massive variety that we see in the way that patients respond to the infection, where some people are hardly affected and other people have the very worst outcomes.

And COVID is teaching us about that variety, not just with COVID, but with other diseases as well.

And this is our panel.

So, Dan, I'm going to ask everyone on the panel this as a simple question really, but perhaps with a complex answer, which is, so you're an immunologist.

So in terms of immunology, how has COVID affected your field?

Well, I mean, it's almost like how hasn't it affected?

I mean, there's so many different ways.

For me, what it's really highlighted is so many important things that actually we don't really know yet.

For example,

you know, roughly speaking, we know how a vaccine works in some rough way, that you're exposed to something alien to your body, that's some component of the real virus.

And then, when you see the real virus,

you're ready to react to that very quickly.

But given that rough thing works, there's so much we don't know.

We don't really understand why that varies between each person.

And crucially, most crucially of all, we really don't know what determines how long that immune memory lasts.

So, it couldn't be more important to understand the differences between people, how long immune memory lasts, lasts, and many other aspects of the immune response.

So, for me, it's highlighted the gaps.

Sarah, could I ask you the same question?

So, in terms of vaccine development, how has that field changed, accelerated during the COVID pandemic?

Well, there have been so many developments since the beginning of the pandemic.

I've been working for more than 10 years now on developing vaccines against viruses that can cause outbreaks and pandemics, and thinking how we do this well, and then starting to think about how we could do it really quickly if we needed to.

And so, one of the ways that we can go quickly is to do as much advanced preparation as possible.

So, if you're thinking about maybe cooking a dinner party, you probably don't want to wait until two hours before your guests are coming round and then have to go to the shops and then buy all the ingredients and then come back and look at the recipes and do all the cooking.

And you're exhausted by the time your guests get there, and you've probably got to get it.

I'm going to write this down.

Something to remember.

So, how much in vaccine development, how much can we do in advance?

Well, what we can do is use what we call platform technologies, and that's a way of making a vaccine that we can adapt to lots of different situations.

So, we have our Adenavirus platform technology, Chadox1.

It's derived from a virus that normally gives chimpanzees a cold, and it's very similar to a virus that normally gives us a cold.

But we haven't been infected with it before, so we're not already immune to it.

So, that helps when we want to use it to make a vaccine.

But, what we can do is do all the preparation of how are we going to create this vaccine, how are we going to manufacture it, how are we going to test it in clinical trials.

These are

the same for any of the different vaccines that we want to make using this technology.

And it's only the last bit when we decide that we're going to make a vaccine against a coronavirus or an Ebola virus.

And that means we have to add a specific piece of genetic instructions into our platform technology.

And then we start the testing.

So 90% or maybe more of the work's already been done, and we just need to do the last bit.

So, we're well prepared, and that means we can go quickly.

And that's what we did in 2020.

And we've been thinking about this, but actually, we haven't been doing it quickly.

We've been doing it very, very slowly, one piece at a time, because that's how scientific funding normally works.

So, we'd do

a very small experiment and show that that gave us the expected result.

And then we'd say, Can we have some more money, please, to do the next bit?

And maybe a year later, we'd get that money and we'd move on and we'd do the next bit.

But we'd also started to think about if there is an outbreak and we need a vaccine quickly, and it's an outbreak of a virus that we don't know about, we've never seen before,

how are we going to put all these pieces together so we can go as fast as possible?

And I wrote a grant application to say, can we have some money, please, to prepare for going as quickly as possible?

And I was told, no.

So we hadn't done that preparation, but we had at least thought it through, and that was important because at the beginning of 2020, when we were starting to see the news about

what seemed to be a new virus circulating, new information coming through every day in the first 10 days of January, I was able to go back to those plans and get my team together and say, look, I think we have to try to do this.

We might not need this vaccine, we don't know yet, but if we do need it, we have to go as fast as possible, so we have to start now.

And we had a little bit of money that we could use to get started, and then the big problem became bringing in the money to enable us to keep going fast.

But while I was trying to bring the money in, we were also working through all the different steps and showing that actually, because we knew how to do all the individual parts of the process and we'd done it before slowly, we now were able to put it together and do it quickly.

We didn't miss anything out.

We just worked out what the shortest time between achieving the first part and achieving the second part was, all the way through to showing that the vaccine actually worked.

That little bit of history is interesting, actually, because we'll all remember, I suppose, in January, wasn't it, you see these news reports and no one pays any attention.

And in February, there's a bit more.

When was it that funding agencies and governments really took it seriously to your lab and said, Right, you now have unlimited money,

basically, do this?

Well, during February, we did get a little bit more money, and then there was a rapid response call from one of the UK funding councils, which took their normal process and really trimmed it back and speeded it up.

And so, we got an answer in three weeks, which is remarkably fast for a grant application.

But by the time we'd actually got confirmation that money was coming in, we'd already spent it.

And so we were still then, you know, still running standstill, really.

And it was not until April of 2020 when the UK Vaccines Task Force had formed.

And what they were doing was looking at lots of different vaccine developers, seeing what they were doing, and investing in them.

And what was really important was that they deliberately invested in many different things because nobody knew what was going to work.

We hadn't done this before, and there were some new technologies out there that were untried.

There were some old ones that had been used before but were a bit slow.

So the task force, very deliberately, knowing that these weren't all going to work, spread their bets, invested in lots of different ones, and we got money through that mechanism that enabled us to carry on with our clinical trials all the way through to November.

When, as Dan said, we got the result that showed it works.

See, that's what we're going back to that when you just mentioned that, it seems like such a strange time.

At that period where we were seeing, you know, on kind of continental Europe where in Italy and places like that, somehow there was this mass delusion amongst, I think, a lot of us that, oh, it's okay here because a virus can't get across the channel.

They can't do the crawl.

There's no way.

And it seemed like, and now looking back, how on earth did we ever fall for, you know, so many people?

Not, I don't mean in your world, but I mean in the

newspapers and all those other things, we somehow fell for this delusion that everything will be fine.

Robin, I think.

I think your point's so good, but you're almost making it to be one of the very few people who in early 2020, as soon as you got that sequence of the virus,

you were one of the few people who was good at futurology.

Sarah did predict that this would be important and get to work on the vaccine.

But I remember meetings in the hospital with colleagues from Italy, from Lombardy, who were desperately trying to explain to us what was going to happen.

I remember one of them was almost in tears on this video call.

And the sense among the clinicians that while we intellectually understood this, we couldn't possibly get its emotional heft.

We didn't appreciate what was really going to happen.

It didn't feel real because it couldn't, even though we were all infection clinicians.

And so we prepared, but there was a sense of unreality about it.

And I wonder if that notionally in the back of our minds there was a kind of liquid barrier that prevented us engaging with it.

I don't know.

And with that's a really sorry, I'm going to mention something that's got human interest, so you won't like it because it involves humans.

But

just when you were saying that, it made me think about things like climate change as well.

That bet that somehow, I mean, this, which was much more immediate and much closer, but somehow the idea of a pandemic still felt that such an alien thing in terms of our possible experience for the majority of people alive now that you would just go, no.

And that seems to play into that little bit of kind of cognitive dissonance of many other possibilities.

I think the pandemic's maybe, maybe kind of one of the main thing it seems to have revealed is how bad at futurology we are when it comes to that kind of microforecasting.

That most virologists I think would have been able to give you the 10 or 20 years of what was going to happen.

I think most people thought, well, the minute this is left China, it is clearly spreading in the community, and we're not going to get on top of this.

But then the detailed predictions about waves proved really, really challenging, even for the mathematical modelers early on.

One thing that Robin said that I thought was that I just wanted to come back to as well was: you know,

that thing that it was a bit weird at the initial early stages, it looked like something was happening, and we couldn't get that that was going to come here inevitably.

I think that one of the really important things about that was that in the early days, we got our messaging from

not experts, essentially, not immunologists, or

medical doctors, or vaccinologists, or virologists.

And so, one of the really important things that have also come out from COVID is that suddenly there's a whole world of scientific experts that have hit the media spotlight.

And I really hope that it stays like that because we definitely need messaging on these complicated scientific issues.

We need to go to experts.

Journalists are fantastic in what they do, but they also have to get information from the experts.

So in the early days, we didn't have that culture of

on

Andrew Marr's TV program that there would be a virologist on there.

That wasn't happening.

But now that does happen.

And so we need to keep that.

So I think it would be great to have more experts speaking more broadly, and I and I've tried to do that.

But what I find is it's we then get treated as the the way the politicians would be on a panel show.

So I'm asked to talk initially to talk about something that I know about, and I'm happy to do that, and I will try to make it accessible, but then the interviewer will drift into something else, and then they'll start to say, Oh, but you must have an opinion about some other thing.

And it's so I'm a scientist, it's not about opinions, it's about finding the facts, interpreting the facts, and also being very honest about fact when we don't know yet.

As Dan was saying, there's a lot we don't know about the immune system.

We can put our theories together, we can discuss them, we can try and test them and see what's really right.

But we shouldn't, as scientists, be saying, Well, I think this is the way we should do everything because I'm a scientist and I know what's really right.

So, we have to be careful to stick to what we do know and be honest about the fact when we're being asked astray into an area that we actually don't know anything about.

Did you find it difficult that you and many others were being asked to communicate science in real time?

So the rate of acquisition of knowledge about this virus was such that the health advice would change very quickly.

And that's a real challenge, isn't it?

Because then people start saying, well,

people aren't used to seeing science done in real time.

So they say, well, you said this last week.

Now you're you're saying something different.

So, we did, we had to try to, we're developing our ideas, we're working out what's going on and trying to communicate that in real time, as you say.

And sometimes

we change our opinion because a new piece of data becomes available.

And then you'd, oh, you don't know what you're talking about because you said this before, and now you're saying that.

Well, actually, well, that was what we thought last week based on the available information, but now we've got more information, so we're going to go with a different answer.

There's been a lot of real, we need data.

Scientists need data.

We can't just work through ideas.

We have to test our ideas.

And what's been really great in the UK response to the pandemic is the amount of data that's come out of the public health services and the NHS that really allows us to look into what is truly going on.

When we're vaccinating people, is it actually protecting them?

Is it keeping them out of hospital?

Is it stopping people dying?

Is it stopping them getting infected?

And because we've had so much data on that, we've been able to tell people what the answers to those questions are.

And, Chris, as you were saying, you were making shows at this time, you were making shows about COVID.

So, I wonder, you know, how different that was to what you've done before in terms of going, right, how the clearness of the message.

And you had suddenly have, I mean, I know you always have responsibility making shows about medicine, but this one I would imagine had a different sense of burden to it.

I thought you were going to accuse me of being part of the problem of putting the.

No, I do that in about

me through the second section to add an element of drama.

It's coming.

For the time being, we're still friends, but then we fall out.

I don't know if you read many Mills and Boone medical novels, but it follows a very similar argument.

The ending of that, yeah.

Oh, it's amazing.

The ending is, frankly, torrid.

I was going to say, I have been, and maybe Brian may relate to this.

I've been both interviewed as an expert, as a virologist and as a clinician, but I've also been the interviewer, interviewing, I mean, I've interviewed Dan, I've interviewed people like Sarah, and there is always, as the interviewee, I want to extract every little

thing I can from you because it's a rare opportunity and the

viewers are, or the listeners, are hanging on the opinion of the expert.

And so if you can extend that opinion, it's very valuable.

But it does put the scientist in a really uncomfortable position.

So I have some sympathy with why journalists do it, but I think it's really important that good scientists always respond with, I don't know.

That point that you make about science playing out in real time was really, really important.

And I think that's another hugely important thing that came out of the whole pandemic thing, that the public got to see that.

And for me, there were...

there's at least, well, there was two really good examples of that.

So the masks was a really good example of that, where should you wear a mask?

And it's not, what I like about that example is it's not obvious what the answer is.

Because if you remember, there were those sort of graphics of, well, obviously, viruses in droplets can go under the mask.

So what is the point of wearing the mask?

And so, and the fact is that it wasn't, as a as a scientist, actually just thinking about it, I didn't know what the answer was, right?

I don't know.

So you, and the messaging in the beginning was a bit unclear, if you remember.

So we might want to wear masks just as a precaution because why not?

But does it really help?

I don't know.

And then it really came much clearer when there was actual data, when you would just look at the, you know,

people did calculations over people, populations of people that are wearing masks, not wearing masks, and what's the likelihood of the things spreading around.

And so then it became clear that the masks do help.

So that was, that really unfolded in real time.

And it was really good because everyone could have an opinion on it, but then you had to come down to the data.

Another good example of that was: should we mix up the vaccines?

Would it be okay to have this vaccine followed by that vaccine?

And again,

actually, I remember, you know, as an immunologist, think, well, yeah, actually, hold on a minute, I don't know.

Well, let me think about that.

I don't know.

So you have to wait for the data.

You have to wait to see what happens when they did trials.

That's the only way.

And then you can have a clear messaging.

I think that unfolding of how science works, it just couldn't be more important because we need that.

We are so deeply affected by this science and all kinds of other science, especially perhaps science about the human body and about vaccines and germs.

And so understanding that process and realizing that experts can tell you what they know, but there will be gaps and they just have to acknowledge that there are gaps and going with that,

it's really important.

It couldn't be more pivotal to the whole of medicine, I think.

You know, it's not just the vaccines.

It's also like when you get genetic information about your risk or susceptibility to this or that disease.

The bottom line is it gets fuzzy very quickly.

Very, very quickly.

You can get information about, you know, you might have a one in five chance of getting cancer in the next five or ten years.

And you've got to weigh up very complicated information with a lot of fuzziness to it.

Chris, I was wondering, in talking about messaging, and you obviously were in in terms of information, one of the things I think sometimes with pseudoscience, with misinformation and disinformation, is they can have an emotional impact, a much easier emotional impact sometimes sometimes than facts and evidence.

But you were making a documentary at the time with your brother, and there was an experience of that which had an incredible emotional impact.

I don't know if you want to talk about it or whether I should just mention it briefly.

Well, I'm happy to talk about it.

I mean, I was on the ward and I was wearing these three hats because I was presenting this documentary.

I was also working as a clinician, and then I got a call from my brother saying he was coming in, he had a heart arrhythmia, he'd just recovered from quite a bad COVID infection.

He's a lot heavier than me,

He's very public about that.

And that may be one of the factors about why, although we're genetically identical, he had a worse infection.

So he called me and said, I've got an arrhythmia, I'm coming into hospital because my heart's beating abnormally.

And my first thought was, this is going to be an incredible sequence for the documentary.

And

it did indeed lead to a Grierson Award nomination.

But I was also, then we went downstairs to ANY and we had to watch him be shocked.

His heart had to be stopped and then restarted.

And so then I was wearing these three hats of sick relative, documentary presenter, and

it was my team that was looking after him.

And

it was a powerful moment, I think, because he was a young, ostensibly

healthy person who people sort of can relate to.

He's taught their kids about medicine.

And I think it did make it real for people that this was a virus that damaged people's hearts.

It also was illustrating very real physical damage

to an important organ that you could see a very real effect of.

So I think that was useful.

I'm very sympathetic to the people who do emotionally connect with the pseudoscience and the misinformation.

I think

over the years we have, as a community maybe of scientists, not been the best at communicating

about how

that that information spreads.

So, for example,

there are groups of people in this country who are mistrustful of the government and of the pharmaceutical industry, and they are mistrustful of those two entities for good reasons historically.

And I think when those people are suspicious of having vaccines, rather than labelling them as anti-vaxes or as stupid or as uninformed, I think treating them with some dignity and seeking to understand their beliefs, because most people have

some rational reason for their fear.

And there is a small number of cynical people who we would all, I think, agree on who are deliberately exploiting it, often for political or financial gain.

But most people who are hesitating about vaccines have well-founded fears.

They're often making other good health decisions.

And we need to be really good at engaging with them empathetically and kind of bringing them on board.

They're mostly swing voters.

And I think Sarah and Dan have been incredible at not alienating those people who've been hesitating.

Because I know, Sarah, I was going to ask you just about, I think one of the popular kind of t-shirts that I saw was, I don't need a vaccine, I've got an immune system.

And, you know, I'd see that on kind of marches in the Trafalgar Square and things like that.

And so, you know, can you explain that and just how accurate it is in the middle of the state?

Well, I think that statement shows a lack of understanding of both vaccines and the immune system.

If you didn't have an immune system, there'd be no point in having a vaccine.

And there are some people who don't have a functioning immune system, and we can give them monoclonal antibodies now.

So we can give them antibodies by infusion that cuts out the middleman of the immune system having to make them.

It's a small number of people, and it's a bit of a complicated thing to do, so it's not going to be very widely used.

But that's the answer if you don't have an immune system to get the antibodies given to you.

And there are now long-acting ones that can hang around in the body for about six months, which is really great, so you don't have to keep being re-injected.

But if you do have an immune system, you want to have the vaccine because the vaccine is going to teach your immune system how to respond and how to protect you quickly when you encounter the infection.

And that means that you have a much better chance of a really good outcome.

Even if you get infected, it's probably not going to be such a serious infection.

And so your immune system without the vaccine is going to have to go into the battle completely unprepared, having not seen this virus.

trying to work out what to do, make the immune response at the same time as trying to fight off the invader in other ways.

And it's much easier for your body to respond if you've already had the vaccine and the immune system's, oh, it's this one again.

We know what we've got the memory for this, we can respond to this, we'll deal with it.

So I think that statement just shows that whoever's wearing the t-shirt doesn't really understand the immunology.

It's worse than those people who wear Ramones t-shirts and can't name any Ramon songs.

I thought we were doing really well, by the way.

I've just been looking because we always just come up with the questions beforehand, Sash and Brian and I.

And I just looked down and went, We've actually nearly done all of them today.

Now we're getting close to the end.

And then I've turned the page and went, Oh, that was part one of three.

So

let's see how far we can get.

Yeah,

if we could talk about the future, because there's been this, it's also an almost an Apollo program, I suppose, that was launched in terms of developing vaccine technologies and that understanding.

Where were you going now in terms of the possibilities for these new vaccines, these new vaccine technologies, and our understanding understanding of the way the immune system behaves?

I think what's powerful to think about is in terms of what's important to do next: is when Sarah was giving that description of how the vaccines work, she and I and Chris will know that that actually builds on about 300 years of quite basic curiosity-driven research, actually.

So, you know, in the very beginning, when we started this whole thing, I said we roughly know how a vaccine works, that you'll just see your body sees something that's alien to itself and then you make an immune response.

And then if you think about it, that doesn't quite make sense because you're taking in food that's not part of you.

There's stuff, there's particles in the air, so it's now it sort of makes sense.

There's something else that the immune system has to seed before it knows it should make a response.

And that really came from right back to like 1926, someone did an experiment where you put a...

a protein molecule from a germ into a mouse, it does not make an immune response.

But if you put the whole whole bacteria that that protein molecule is from, it would make an immune response.

So something alien to the mouse would not make an immune response.

You had to see the whole actual germ.

And then it just sat there as curious as something a bit strange.

And then it was, it was actually a guy called Charlie Janeway in 1989 had a bit of epiphany that the reason that it that an isolated protein component from a germ would not trigger an immune reaction was it didn't see it as a dangerous thing.

There had to be

your body has to have something that recognizes things that are telltale signs of a dangerous germ, right?

And so

this understanding evolved to get to the point where Sarah can then say, I've got a really good idea for making a vaccine in January 2020.

So I would say, and the answer to that question, what's really important is spend all the money on the science, the really basic science.

Because

you don't know.

You don't know.

Like we said in the beginning, there's big gaps.

How long is this memory going to last for?

And I don't know the killer experiment.

But what I do know is that if we fund loads of science around that area,

it will emerge to be, we'll get the answers.

So I think

my answer, which isn't quite what you asked for the specific future of vaccines, is that we need to get loads of loads of people engaged in doing the really basic curiosity driven research.

Because

taxpayers' money does go into that, and I think people would now see that that's vitally important.

It's an extremely important point.

Yeah, I was just going to echo that.

It's an extremely important point, isn't it?

That no one's smart enough to know.

If we knew exactly where to target the research funding, then we would know the answer.

We'd know the answer before we knew the answer.

There's millions, loads of examples of that.

The latest cancer medicines all came from basic curiosity-driven research.

And, you know, yeah, it's really important that we have to do that.

HIV drugs, the understanding of HIV started in, you know, the early 20th century with a guy called Peyton Rouse trying to see if he could transmit cancers between different chickens.

Could he take a filtrate from a cancer, which proved to be a retrovirus, and transmit it between different chickens.

So that laid the foundations for understanding retroviruses and then understanding HIV.

And that's why we had functional cures for HIV within

20 years of discovery of the virus, 25 years.

Sarah, in terms of the, as Dan mentioned, the vaccine technologies themselves,

what are we looking to do over the next few years and decades with those new technologies?

So one really area, one area where I think we're going to see a lot of growth is working out how to get the immune system in the right place in the body in the first instance.

So, at the moment, we're trying to immunize against a respiratory pathogen that infects us through the respiratory tract and infects the nose and the throat and the lungs, and that's where it has its infects.

And we're giving vaccines into the muscle.

So, actually, what we're doing to our immune system is saying, Here's something that you might see in a muscle.

We need you to make a response to this and be ready for when you see it again.

And then, the virus doesn't turn up in the muscle, the virus turns up in the nose, and the throat, throat, and the lungs.

So the immune system is going, Oh, I thought we were going to have this here in the muscle, and now we've got to go somewhere else.

And so the immune system cells that are patrolling the body say, No, it's not in the muscle, in the arm, it's in the nose, we've got to get over there.

And actually, that takes a bit of time.

And there's a lag phase when the immune system is, oh, this isn't quite right, we need to be somewhere else.

And that gives the virus time to spread because the immune system is not quite where we want it at the point where we get infected.

And by the time the immune systems get to the right place, the virus has been having a great time doing its own thing without anything to stop it.

And then it's a bigger task for the immune system to get in there and kill it, and there'll be a bit of collateral damage caused as that immune system's responding and clearing everything up.

So we want to be able to give vaccines into the place where we want the immune response.

But that's actually not so straightforward because if you put a vaccine into somebody's nose, the nose is quite good at keeping things out.

That's part of the body's defence.

And to get past the defences in the nose is difficult.

And if you put something in somebody's mouth, well, they tend to just digest it instead of making an immune response to it.

So we've got to find ways where we can give a vaccine to people where we then get the immune memory in the right place in the body, but we're not quite there yet.

Chris, I wanted to ask you as well, in terms of we're very close to him, but I still, this

talking there, for instance, about HIV drugs, et cetera, are we looking at a world where what we've seen in the last two years is an incredible reaction to a virus?

That actually there are many things out there now, which, if a similar situation arose,

we would be if it became a pandemic situation,

the wherewithal the abilities, the knowledge would be able to come together and eradicate things which are in the world now?

I'd love to say yes to that.

I think I said in the green room that I'm a natural pessimist, and I'm often wrong to be a pessimist.

But

I think we've seen in the last

40 years of the say, I don't know, two, three thousand new drugs that have been developed, we've seen around 1% or maybe slightly less have been developed for infectious disease in general and for particularly the infections of poverty.

So the diseases that affect so-called neglected tropical diseases, diseases that affect the poorest 3 billion people in the world.

And I wondered for a while if this pandemic would be this incredible wake-up where we'd go, we need to stop destroying the biosphere, we need to stop creating these interfaces that allow viruses to leap into the human population and cause pandemics, and we need to reduce all the sources of pandemic disease.

And I'm not really sure that we are seeing that happen.

I think we are going to see increased funding to people like Sarah working on.

I mean, I know you're working on vaccines for diseases like MERS and other coronaviruses.

So we are going to see a bit of that.

But I feel like the revolution that I might have wanted hasn't quite happened.

And so we are seeing monkeypox.

We're seeing vaccine-derived polio in our sewers.

There is an ever-present threat of pandemic avian influenza, which could well make,

and I'm conscious I'm the company I'm speaking in, but a pandemic avian flu could make this coronavirus pandemic look pretty trivial.

And MERS as a threat coming out of North Africa and the Middle East, this is a coronavirus that the reservoirs, we think in camels, maybe bats.

This again could be catastrophic.

And this kind of viral chatter where there is an exchange between

the natural world or the wild world and the human world continues, and it may be continuing at an ever-accelerating pace as we destroy our wild places.

It's a question to everyone, actually.

Do you think that our memory, our political memory, let's say, of this pandemic is going to wane quickly?

Because I remember, you know, we've done programmes in the past.

I think you're older than Dan.

I think the last thing you said was it's the bats that are going to get us.

And you said it about four years ago.

And we talked about

great threats.

And we talked about asteroid impact and these things and super volcanoes and always in there was pandemic disease.

And then everybody laughed and clapped and we went away and

nothing happened, of course.

We did this program in 2018 on the immune system and I think

people might have thought it was a bit of an esoteric topic.

And right now, I think people might think it's quite a good topic.

Some conspiracy theorists believe you've created this entire situation merely for the benefit of your ego, Dan.

So,

do you have a comment on that?

Given what you know now, is that memory waning?

It's already dropping off the political agenda, unfortunately, because there are so many other crises in the world, and people really just tend to focus on one thing at a time.

But we can't let this drop because there's so much we could do to be better prepared for the future.

There are things that we know we should be doing better, and then we will discover more of them as we do more research.

So, we have to keep doing this.

And it is coming, isn't it?

Another pandemic is coming.

Yeah, we always expected the next pandemic would be flu.

So, it was a slight surprise that it was a coronavirus, but actually, some people have been saying it could have been a coronavirus because we've had the original SARS virus in 2003, which we now call SARS-1,

and the MERS, which was also a coronavirus.

So, you know, this is this keeps happening.

We should learn the lessons of what's happened in the the past.

It's going to happen again.

I think it's worth considering that it's not just merely inertia that means that the, I mean, Kate Jones, who you've had on this programme many times, a colleague at UCL, has shown that the rate of pandemic disease is increasing all the time.

And there are pandemics that we don't really think of as pandemics, like the rise of antimicrobial resistance or the new fungal strains that are increasing their ability to live in the human body because of climate, man-made climate change, global warming.

But we have to sort of think about what are the forces that are driving this, because it's not accidental, it's because we don't put the external costs of the risk of creating pandemics on essentially the corporations and the profits that drive them.

So if we think of destroying ecosystems, that doesn't happen by accident, it happens because there's a lot of money in doing it.

And there's never quite as much money in preventing a pandemic as there is in making money from the pandemic that happened.

So we see that

a huge number of corporations and individuals have made a huge amount of money, and we've increased global inequality.

So poor people have got poorer, but the rich have got incalculably richer over the course of this pandemic.

And so, until we understand that pandemics happen because forces drive them to happen, it's not accidental, we can arrest it, but it will require the exertion of political power over private interest.

I just wanted to ask you as a final question because obviously doing shows for children, I presume you get a lot of communication with children.

And I wondered what you were hearing, you know, from kids who were kind of asking, I presume they were asking questions about COVID and about the pandemic.

Did you find that they were kind of engaging and fascinating?

Because what a strange time for them?

Kids are always so curious about viruses.

And they always say, what's the worst thing you've ever seen?

What's the worst virus?

And then you say, well, we don't really want to open that box.

I'm not going to tell you about that today at work

I think the the operation out team and in fact children's BBC in general one of the the the institutional philosophies is to treat children more or less as as grown-ups who are very smart but don't have quite as much knowledge and so we very aggressively took the view that we would be truthful about coronavirus which was which was relatively easy to do.

I made a video at the beginning of the pandemic and I spoke about this with a lot of colleagues at work and I said

This is a virus that's very likely to spread around the world.

You may well get this, your relatives may.

This was, I think, in February 2020.

And the vast majority of people who get this infection will fully recover.

And it's a video that is really uneasy to watch now, but it remains true that the vast majority of people do fully recover.

And yet, when I made that, I couldn't quite imagine that whilst there is a vast majority, when everyone gets the virus, we see a huge tragedy.

So, but we've been truthful with kids, and I think that helps to reduce their anxiety enormously.

I don't think you can protect children from truth in the world anymore.

Brilliant.

Thank you very much.

We asked our audience as well, it's quite a hard one this one.

You might have noticed, in terms of this, probably been a lower gag ratio than normal for precisely the reason that you just said.

Our fun question about COVID.

We asked our audience, what is the best thing that came out of lockdown for you?

Listening to people trying to identify birdsong for the first time.

There's a lot of tits out there.

Thank you, Ruth.

Robin W.

said not wearing a mask at Halloween was more frightening than wearing a mask at Halloween.

I became a more rounded individual, literally.

So John said, there's two parts to this.

He said, I haven't worn shoes for two and a half years, which is kind of okay.

But it says I haven't worn shoes and trousers for two and a half years.

And you can just see them there.

So thank you very much to our panel.

Dames Sarah Gilbert, Dan Davis and Chris Van Tulliken.

Next week we are going to Hollywood.

This is really true.

We are going to Hollywood to discuss exoplanets and the search for life around distant stars.

If we passed our COVID test and they let us on the plane.

Well actually, when you hear this, we've already been to Hollywood because we recorded this ages ago.

So if we didn't, we'll have changed this ending.

So you won't be hearing this ending.

So, this is, I don't even know why we're recording this.

It's an absolute waste of time to record this, isn't it?

Well, we can just edit it out.

Well, has this been edited out or not?

You know, the block universe.

Check the block universe.

Have a look in your block universe, see if it's been edited out.

No, we did go, so it hasn't.

It hasn't happened.

It hasn't been edited out.

Well, that means we haven't edited it, and it's not even a very strong kind of ending either, is it?

Thank you very much, everyone, for coming down.

Thank you for our panel, and we'll see you next time.

Goodbye.

Goodbye.

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