 Hi, I'm Emily Schneider, and I'm here with Dr. Lina Wen. Dr. Wen, thank you so much for joining us today. Since our time is so limited, I'm going to jump right in with my first question. As someone who doesn't have a medical background, but has been closely following the news since the beginning of the pandemic, I've noticed that both scientists and the media have used numerous and sometimes different methods for tracking the spread of the virus and also our battle to contain it. And at the beginning of the pandemic, it was all about the number of infections, and then that changed to the number of hospitalizations and deaths. Once vaccines became available, that number became really important, how many doses were administered, and what percentage of the population has been vaccinated. Now in some countries, the UK, for example, it seems that the focus is shifting a bit, and officials are more concerned with the number of hospitalizations or severe cases of infection instead of just pure positive cases. So my question for you is, how do you think these metrics will evolve going forward, and how do we continue to track the virus in a way that gives an accurate depiction of the danger it poses? And then a follow-up question to that would be, do you think that these metrics will affect public health policy in the US going forward? Well, Emily, it's a pleasure to join you and to join all of you today. I will say that you're asking a very good question, and one that's that there really isn't an answer to. And here's why, because the types of tracking that's done by different countries and that are prioritized in different countries actually isn't about differences in science. We have the same tests. We have the same measures for hospitalizations, certainly counting deaths. I mean, we all know how to do that. We're using the same measures to do that. It's not about the science that's different. It's that our values are different, and in fact are evolving over time. And I don't think that there is any agreement in the US or between countries or really among people about what are the measures that we should really be looking for at this point. There are some countries, for example, New Zealand, Australia, some Asian countries that have from the very beginning been aiming for a zero COVID strategy. And for them, it was all about not having any cases or having very few cases. And so there were things that were triggered, restrictions that were triggered, even with a handful of cases. For them, tracking infection is everything. There are other countries that arguably the US is one of them, where certainly in many parts of the country, the infection rates are skyrocketing and what people are really responding to and what elected officials are responding to is hospitalizations. That when hospitals became overwhelmed and cared for not only COVID patients but all patients begin to suffer, then that begins to trigger some level of restrictions. I think moving forward, we have not to find this. I mean, Dr. Anthony Fauci has just said, success means less than 10,000 new infections every day because that gets to a level where we can do containment. But I don't know that we as a country have said, that's our end game. I hope that our end game isn't where we are now, which is well over 1,000 deaths every day from COVID. I mean, that is at least, that's about what, 365,000 deaths every year. I mean, I don't think any of us could find that to be acceptable, but would it be acceptable if we get to the level of the flu and we're having about 44,000 deaths from COVID every year? I mean, that feels very high to me, but I think at this point, we need to have this honest conversation that weighs the risk of severe illness and death and even infection in the first place versus what is the price that we're willing to pay to get there? That's fairly interesting what you said about the values that we have as a society. I think that's very important. And as someone who lives abroad right now, so I live in Germany, it's interesting seeing the pandemic through that lens where here they have very kind of strict or hard guidelines in terms of numbers. So, and that also brings me to my next question about public health policy in different locations. So in your new book, one of the things that you talk about is how location and circumstances can contribute to access to quality health care and even life expectancy. And this seems like an especially timely topic now with vaccine inequality around the world being such a big part of the problem in ending the pandemic. So I think it's clear at this point that wealthier nations have won the race for vaccines and many of the world's poor countries have been unable to secure doses. How do you think this vaccine inequality will contribute to the pandemic going forward, especially in terms of the variants that we're seeing? It brings up the larger point that COVID did not create health disparities, but certainly has amplified them. You mentioned my book Lifelines where I talk a lot about by experience leading Baltimore's health department and how it's not even healthcare that there is differential access, right? I mean, health care certainly contributes to overall health but there are so many other factors including the air that we breathe, the education that we have access to, housing as a health issue as well, the social determinants of health, that's one issue. And there's a domestic and a policy issue that we need to be wrestling with too as we're looking beyond COVID to see how can we now pay attention to the social determinants of health? But then you bring up this other point about global vaccine equity and there is a point of self-interest for Americans and for other wealthy countries that as long as there is virus that is mutating and replicating out there, we're going to get new variants and these new variants could very well set back our progress as the Delta variant has. So there is a self-interest component and as well as of course the humanitarian reason, I think that where I get concerned is when somehow things are framed as an either or as then there have been some people who have said, well, don't do booster shots or don't vaccinate children in wealthier countries, instead let's focus on vaccinating the world. That should not be a choice. We should both do booster shots and vaccinate children and scale up manufacturing and distribution in other countries and I think that is ultimately what's going to get us out of this pandemic. Yes, that's a very good point. So do you think moving forward once this initial hurdle of getting over mass infections like we're seeing now, moving to a place where it's more manageable, do you see COVID vaccines kind of being included in public health policies just in terms of administering them like they do with polio vaccines or measles and things like that, how do you think countries are going to go about and incorporating that into their existing kind of vaccination schemes? Do you think we'll ever get to that point? And if so, do you see it happening anytime soon? I think part of it depends on what direction COVID is going to go in. And I think if it's anything that we've learned in the pandemic, it's that we really can't prognosticate anyone that tries to predict, well, there's so many other factors that determine where things are going to go. I think of the short term, I would love to see the COVID-19 vaccine understood as we do all other vaccines. Part of the reason why COVID has become so polarized and divisive and politicized is that it's seen as somehow different from other diseases that we wrestle with all the time. And the vaccine is somehow not understood the same way that we understand routine childhood immunizations that are required in all 50 states. And so I think there is a reckoning that needs to occur and that reckoning needs to be to place the COVID vaccine in the same light as we do all other vaccines. Yeah, and I think that kind of political or politicization is especially apparent in the US. And so my next, and I think final question for you would be, you know, in the US, it was one of the first countries to offer vaccinations to most of its population, you know, even without sort of age restrictions or job requirements or anything like that. And the rest of the world was kind of watching and hoping that they could catch up. Now it seems that the US vaccination rate is kind of hovered below 60%. And it seems that everyone who was wanted to get vaccinated has. Do you think Biden's new plans go far enough in addressing this group of people who are vaccine hesitant or just playing against getting vaccinated full stop? Or what could the US do from a health policy perspective to increase vaccination rates moving forward? Do you think that the mandates go far enough or there needs to be kind of stricter requirements? I don't think that the mandates go far enough, but I do think that they are a major step in the right direction because previously the Biden administration was quite hesitant to embrace the vaccine requirements. But you know what? All the things that we've been doing before, the incentives, the education, the cajoling, the pleading people to do the patriotic thing, it's not working. And we need to look at what other countries have done. I mean, I think what France has done is what we should be doing here. Basically saying that if you want access to public spaces, if you want to, look, if you wanna be unvaccinated, that's your choice. But if you want to go to bars, restaurants, gyms, be on a plane train, if you want to be around other people, you need to get vaccinated because you do not have a right to infect others with a potentially deadly disease. And right now the vaccinated have been paying the price for the unvaccinated. I don't think that we should be held hostage any longer. And it's not fair for the vaccinated to fear going to these settings. Why should the vaccinated be the ones who have to isolate themselves and stay out of public settings out of fear for coronavirus when the problem is the unvaccinated? And so I think that the president definitely did some things that were in the right direction requiring federal workers to be vaccinated. I think what he's doing, especially around employers, asking for employers with over a hundred people to either mandate vaccines or weekly testing, I think that will also help to push some employers over the edge. As in many employers might have already wanted to do vaccine mandates, but didn't want to take the fall for it. And so by now being able to say, hey, we didn't wanna do this, but the federal government is making us do it. That provides cover for employers. And there are some employers too that may have feared losing their employees to the competition if they did this. Well, if everyone is under the same rules, they're not going to have that fear. It levels the playing field. And so I think those were the good things about the Biden plan, but I wish he had gone much further to mandate vaccines on planes, on trains, and to do what France has done. I don't think we can legally do that, but look at what San Francisco and New York have done, at least support the cities or give substantial incentives to entities and jurisdictions that are implementing that type of no vaccine, no service requirement. Do you see that sort of being implemented with a green pass situation, like it's common in Europe? Or do you think that the US would ever be able to institute sort of a federal tracking system of vaccinations? I think we need it. Do I think that we are there? Obviously we're not there yet. And the Biden administration has said that they do not want to do that, but I frankly find it shameful. I wrote a Washington Post article about how it's shameful that we are relying on a paper card. I mean, that is so easy to counterfeit and to forge and to fake. Why are we letting people have this loophole? By the way, we also have this big loophole of religious and medical exemptions. And I think that people are going to absolutely abuse those as a way, as a reason to say why they're not getting vaccinated. We should not have those exemptions in place. Okay. Thank you so much, Dr. Wen. I think that's all we have time for. All right, thank you. I'm great to join you today.