 Covid cases are still falling across Britain, and with 88% of adults at least partially vaccinated, even if there is a resurgence of the virus, for most people in the UK at least, it should be a relatively mild disease. That's the optimistic take on the future of the pandemic in Britain. So what about the pessimistic take? Well, in that scenario, the government allowing the virus to circulate among a partially vaccinated population allows a vaccine-resistant mutation to develop, potentially taking us back to square one. If we want to be really fatalistic, we can imagine that we end up in a situation even worse than spring 2020, as the virus by this point has evolved to become more transmissible and more deadly. This is all incredibly speculative, but it's a very relevant topic for tonight's show because it featured in a SAGE document released last Friday, which has created some pretty scary headlines. We'll be speaking to an expert on viruses and vaccines. I'm also joined tonight throughout the show, of course, by Ash Sarkar. How are you doing, Ash? I'm good, feeling like a mutant variant over here, but all good. This is one of those shows where I'm not precisely sure what our expert's going to say, so I don't know if it's going to be incredibly scary or somewhat reassuring. So we're all going to, you can see the emotional journey on my face as the show develops. Also tonight, we'll be talking about Pfizer and Moderna jacking up vaccine prices and the athletes speaking out about mental health at the Tokyo Olympics. That's a long, well, a continuing story there. As ever, if you're new to the show, please do hit that subscribe button, on the hashtag Tiskey Sour, and in the comments under the video, if you're rewatching the show. In the recent tranche of documents released by the Scientific Advisory Group on Emergencies, better known as SAGE, there was one particular report which has caused a great deal of concerns. It covers the possibility of new variants of COVID-19 emerging, including those which are more transmissible, more deadly, or more resistant to vaccines than the current dominant Delta strain. The document lays out a number of scenarios to which it assigns probabilities, all quite speculative, but they're saying these things could happen and it's this likely or this unlikely that they will. We'll take you through some of the key ones now. They lay out four. Scenario one is a variant that causes severe disease in a greater proportion of the population than has occurred to date. For example, with similar morbidity, mortality to other zoonotic coronaviruses, such as the original SARS, which had a 10% case fatality, or MERS, which had a 35% case fatality. So that very scary possibility to be assigned a realistic possibility. That's the likelihood according to SAGE. Scenario two is a variant that evades current vaccines. Now, when it comes to how possible, how likely SAGE thinks this is, that gets a bit more complicated. So we're going to go to a couple of different hypothetical mechanisms they suggest by which this vaccine resistance might emerge. They cite two possible routes among others. In fact, they are antigenic shift and antigenic drift. We'll start with antigenic shift. Sorry, these are quite technical terms, but this is, I think, very important for us all to understand. Antigenic shift means the virus recombining with other coronaviruses which are currently circulating in the population. So some of them are common colds, for example. As for what this would mean for me and you, they write, the consequence could be a virus that causes disease at a level similar to COVID-19 when it first emerged, but against which our current battery of spike-based vaccines would not work. To that, they assign a realistic possibility. So that's sending us back to square one, a realistic possibility. Another option they suggest is antigenic drift. So drift instead of shift, this would mean a gradual accumulation of variations that eventually leads to what they call current vaccine failure. Now, current vaccine failure also sounds quite scary. And what's particularly worrying about this part of the SAGE document is for this one, the likelihood is almost certain, almost certain that we will end up with current vaccine failure according to SAGE. The other three scenarios, the other two scenarios, sorry, to make up the four is the emergence of a drug-resistant variant after antiviral strategies. They say that is likely unless drugs are used correctly. And scenario four is the good one. SARS-CoV-2 follows an evolutionary trajectory with decreased virulence. Unfortunately, they say that's unlikely in the short term and a realistic possibility in the long term. So we'll have to wait for that to happen. It is, as I say, a pretty scary document. I read it quite late on Friday night and struggled to sleep afterwards. It's also led to some pretty scary headlines, including this from the Daily Mail. So their headline reads, the next COVID variant could kill up to one in three people. SAGE warns, doomsday scenario is realistic possibility and UK's vaccine rollout may even speed up mutant strains emergence. Now, this headline is a classic, you know, you look at a Daily Mail headline, you think that's a classic scare story from a tabloid newspaper that loves to scare its readers. They gain audience. It's not actually that far off from what was in the SAGE document, though I wasn't reassured by looking at the original thing. So how seriously should we take speculation like this? How likely is a vaccine-resistant COVID variant? And if one emerges, could it be even deadlier than the version of coronavirus we faced last year? To find out, I'm joined by Deanan Pillay, who is Professor of Virology at UCL and a member of Independent SAGE. Welcome back to the show, Deanan. How scared should we be about those scenarios laid out by the official SAGE? Well, it clearly is an array of options. And we've got to place this document in the context, is that a bunch of virologists, experts and immunologists were asked, what are the potential trajectories that could happen following the emergence of SARS-CoV-2? And the document reads almost as a standard virology module in an undergraduate degree course, which have been taught for many, many years. That's not to belittle it or trivialize this at all, but the scenarios they lay out are based on what we know from other viruses. And that is why when it comes to probabilities, as you've mentioned, there are some situations where the probabilities are high. What this means is that we can learn lessons from other viruses where, in fact, these processes have indeed happened. Example being for, as you quite correctly point out, and you're becoming an expert virologist yourself, is when you're talking about antigenic drift and shift. The shift being when you get recombination of different viruses together to create a new virus, and drift is the sort of mutation, the gradual evolution of viruses, then with regard to shift, this happens regularly with influenza, and we have to deal each season, each winter, with the potential for a shift in influenza requiring new vaccines. With regard to the drift that you mentioned, the drift is very, very highly possible, because in fact, we've witnessed this through the emergence of different variants with SARS-CoV-2, but equally with many other viruses. So placing all this into context, I think this is, yes, these are possible ways in which the virus can develop, but all of these things that it identifies, we have to live with, and we have lived with, and we're still living with the same situations with other viruses. I think, for instance, the drug-resistant viruses that emerge, we have to deal with this with HIV, for which there are 25 drugs available, and the virus is continually evolving to evade them with hepatitis C as well. So these are scenarios which we have learned how to deal with, but nevertheless, I think it's a realistic set of options and scenarios and feasibilities that the document has come up with. Are probabilities possible at all to assign to these types of things? Because as I say, I do think that Daily Mail headline probably was scaremongering, but it does say in the Sage document that this recombining to form a virus which is as deadly as MERS and so kills one in three people, they say that's a realistic possibility. But by realistic possibility, does that mean a 0.1% chance? You know, is it theoretically possible, or is it a 10% chance, that we let this keep growing and growing and growing and don't get it under control? It's almost inevitable that we'll get some sort of disaster mutant being generated. How do we assign probabilities to these things? Well, of course, it's highly speculative, but we can make some broad generalizations that the more that the virus is circulating amongst the population of the world, the more likely all of these scenarios will become true. Now, it doesn't mean that the risks are very high. So for instance, there's a big speculation, big discussion now as the degree to which the Delta variant that we're now living with has sort of come almost to the near the maximum degree to which the virus as it stands can replicate and can transmit, and we know that these Delta viruses are of course very infectious. But of course, with the potential for what we call recombination or what you've talked about is shift, then with other coronaviruses, then clearly that would allow a step change of the virus and it can lead to a whole range of scenarios, both more pathogenic but equally less pathogenic. So it depends on a whole range of circumstances and this is really back of the envelope stuff when it comes to predictions. As I mentioned, all these scientists and all we can be guided by is what has happened before with other viruses as well as coronaviruses and you mentioned the 30% mortality. Well, of course, we've witnessed that with a MERS virus which was 10 years ago, which transmitted really a coronavirus from camels to humans, then very high mortality, fortuitously, this was a less transmissible virus so it didn't transmit around the world. But we've witnessed this already. This is not sort of scaremongering. We witnessed these sort of viruses and so we've got to be mindful of that but the most important thing I think is that all of these scenarios are more likely with a greater degree of replication and transmission. And that is why, for instance, within Independence Sage, we've really been banging on that we've got to reduce ongoing transmission despite the success of vaccines because of course as there's more transmission happens, more countries that don't have access to vaccines then the potential for these things to happen happens increases. But that doesn't mean it's likely. Let's talk about some of the potential solutions or responses to this to try and make them more likely. The Sage document also had a couple. I suppose I want to start with one that reading it I thought was maybe inconsistent because they're very keen on giving booster shots to vulnerable groups in the UK if a variant develops which has a bit more vaccine resistance. If you've got a recently updated booster you're more likely to be able to fight that off. At the same time they're incredibly keen that we vaccinate the world as quickly as possible because it is going to be in places with very few people vaccinated where variants are quite likely to emerge just because you've got lots of people getting seriously ill. Do you see those as inconsistent? And from the position of we really don't want a more deadly vaccine resistant virus to emerge where should we be sending our vaccines which currently are I mean ideally they wouldn't be but they currently are in short supply. Yeah this is a really this is a political question really rather than a scientific question and it is about the economic model for manufacturing vaccines about patent protection that may be limiting the degree to which outsourcing to generics companies can be undertaken and I think it's a false dichotomy to be that either we immunise or we vaccinate adolescents in the UK or we send our vaccines abroad. I think we need to nail this down as to this is about the model of production of medicines and this vaccine is not this is not an exception of course almost all medicines that have been developed start with being targeted those countries that can afford them so I think that's a dangerous argument to get into and of course we need to roll out vaccines across the world and have affordable vaccines across the world and of course availability of those vaccines but yes again coming back to the scientific question here which is the hypothesis that in a partially vaccinated population then whilst there's ongoing transmission then that transmission will fuel the virus to evolve to better infect those people who already vaccinated in other words the virus evolves to escape vaccine it's not clear that that is happening at the moment many of the emerging viruses that had apparent resistance to vaccines developed in the absence of vaccines so for instance the beta variant that was previously called the South African variant that may be less susceptible to immunity induced by vaccines this developed probably in the absence of any vaccines selective pressure so these things may be stochastic or random and I would be up towards feeling more confident that the more vaccines are available around the world some level of immunity develops and that will protect against the extreme disease that even variants will generate and is that partly because when you get the worst variants so for example the Kent variant as I understand it that came from someone who was or developed within a host who was seriously ill for a very long time so they were fighting Covid for weeks that meant there was ample opportunity for the virus to keep replicating and replicating and if we got lots of people who were vaccinated then there's less serious disease and so there's less opportunity for that extreme replication to happen is that why maybe we aren't seeing these vaccine resistant variants in vaccinated populations it may be I should say Michael that's one theory that's just one my hypothesis and there's no direct evidence that that particular variant the alpha variant came from an immunocompromised person who was infected for a long period of time and in whom this developed there's been separate demonstration of such instances in individuals but the linking between the two remains speculative so it's unclear really whether that is the case but you're right is that the more vaccine that there is then the less likely people are going to become infected and the less opportunity there is for these sorts of mutants to evolve but I just want to stress that what is really unique about what we've experienced as well as a pandemic and a huge impact around the world and unfortunate deaths as well as severe illness is that this was a virus that we have documented to have jumped species barrier sometime in late 2019 and there's never been a situation where we've had the technology to be able to describe what's happening within such a short period of time pretty much all other viruses have at some point across the species barrier so this is the way viruses infect humans and adapt to humans and given that our human population was completely naive to this virus no remnant immunity from previous similar viruses then of course it's retavoc but once vaccines have started then as well as the infections that develop that lead to some sort of immunity then of course as variants develop there remains some level of protection the same way with influenza that the fact that many of us have either been immunized or have had unfortunately influenza in the past leads to a level of immunity which does attenuate the disease even with new variants of influenza so I do I am much more hopeful to be honest and I think this document whilst being absolutely correct in terms of virological and immunological speak could be misinterpreted to make us feel we're completely vulnerable whereas in fact we've dealt with vaccines are a major step forward and of course we need to make sure the world has access to them so that's to say we are the one where the vaccines that we currently have are just completely useless it's going to be a question of a spectrum where they become less effective as opposed to just being like injecting orange squash in your arm absolutely and as in fact this document says one of the mitigations to this potential emergence of new variants is of course for vaccines to be updated as time goes on and again that's not new we do that with influenza so every time that every time there's new variants that are circulating that's then reflected in the vaccines that are available for the next season for those individuals who are at high risk so again this is not new and the fact that we've got these new technologies for producing vaccines for COVID I think sets the scene for a much more rapid response in terms of developing new variant vaccines which can build on the immunity that we already have so again I'm not as I'm not as despondent as you inferred yourself I want to bring in Ash because I know Ash has got a question that you've been waiting to answer and you can jump it we're on a more optimistic stage now I don't know if your question is going to throw us back into the doom is about to arrive or come in Ash it's not a deem me question it's a question from a public health angle so as variants develop there are sometimes different symptoms or the order in which the symptoms come can be different and one of the things that lots of people have been reporting particularly with the Delta variant and particularly if they've had either one or both vaccines and they've been part of the unfortunate minority to get the Delta variant anyway is that the symptoms are just different it's a bit more like a hangover of being run down there's you know less coughing potentially not even a fever and so one is that people presume that they don't have COVID and they don't self isolate and then two is that they are less likely to get a PCR test when when they don't have those symptoms so what I was wondering all today is what possible justification is there for the government not to add these new symptom appearances to its official guidance because it seems to me that wouldn't you just want people to get tested as early as possible in terms of when they suspect that there might be something wrong with them so I agree Ash I mean it's absolutely the case that there has for some time there's been a much wider spectrum of symptoms being proposed the ZoE app that you may have heard of which gets self reporting of symptoms of as long been reporting a much wider range of symptoms and you're absolutely right with this delta variant there seems to be an array of different symptoms and possibly the you know whether this is symptoms in those who are completely naive and not being vaccinated or whether you know partial vaccination partial immunity is attenuating is changing the nature of those symptoms but in the end this is if we go back to how the viruses replicate viruses this virus like other respiratory viruses replicates in the back of the throat in the nose in the cells of the nose and then you know if it progresses if you don't clear it at that stage it progresses to lung disease and damage and then the immune system kicks in with all the consequences of that of the very severe lung damage and other organ damage and it's not surprising that the infections of the nose and the throat give rise to a whole range of different symptoms such as runny nose of course sore throat things that you're right were not within the original the original triad of symptoms such as cough and I do think this needs to be this needs to now be reflected in the guidance and again you're also right to infer the variants which may have and these variants for instance delta is far more infectious why is it more infectious it's infectious because someone is infected with the delta virus will have more replication of the virus going on within their upper what we call the upper respiratory tract the nose and the throat because that is how then those people infect other people that's what more infectivity means there may be some nuances to that surprising that a virus or a variant that is replicating in a different way will then lead to damage to the cells of the body which will give rise to these various symptoms so I would fully agree with you that there needs to be a wider spectrum of symptoms now the only caveat to that strategy of more testing is that of course as we move into winter in fact we're already seeing other respiratory viruses circulating and that's interesting because viruses such as respiratory syncytial virus which cause particularly in newborn or infants can lead to severe symptoms but these viruses also infect adults these are also coming up at the same time and what's being discussed at the moment is where the testing can start to include testing at the same time as for COVID respiratory syncytial virus influenza and so on so in fact we have a much better sense of which viruses are circulating as we come to winter that's a slightly different issue to that you mentioned but it is an implication of being we're less able to distinguish between these viruses purely by symptoms because of the wider array of symptoms Danine before we let you go I want to put a comment from the audience to you this is from Taddu's Cantwell who's kindly given us 10 euros they write there is a universal COVID vaccine in development so there is hope a couple of years down the line is that I've read the same thing how confident are you that we could have a universal COVID vaccine within a couple of years well it's I mean I've seen that there's a lot of work going on on this and it is really important a sort of coronavirus vaccine which will also act on the coronaviruses that do circulate regularly which cause mild disease as well as COVID but of course the important thing as well is not only for COVID and the variance of COVID but you know we've got to remember that the best predictor of future is what's happened in the past and we've now had three of these really serious cross species transmissions of coronaviruses SARS-1 which was in 2000 MERS which was in 2010 and now SARS-CoV-2 in 2020 so it is almost inevitable that we're going to continue to have these novel coronaviruses jumping from animals into humans and that's a real advantage then for a cross coronavirus vaccine it would be fantastic and I'm pleased that the investment is going into that Dean and Pillay thank you so much for joining us again this evening very insightful and I have to say somewhat reassuring I'm more reassured than I was reading that sage document on my own so for that I do thank you thank you we'll have you back soon let's go to some comments Dave Lee with a big donation thank you very much 50 quid just something in solidarity with the Navarra media team thank you so much we really appreciate that Joshua Youngman with a fiver will Ash be using Pfizer Superpower her vaccine using Pfizer Superpower vaccine passport to go to the Emirates to see Arsenal beat Tottenham stay safe everyone and get jammed will you be Ash? I will not be using a vaccine passport to see Arsenal beat Tottenham because Arsenal will not be beating Tottenham especially if Daniel Levy continues to keep Harry Kane in contract bondage and we don't have to let him go brave weight bone spurs Quackabush the fourth great name with a five dollar donation says we are all doomed live for only today not tomorrow sleep with that married next door neighbour you have always loved her I have to even though I've read that out that is not official advice that Navarra media endorses my married next door neighbour is like a retired Filipino woman in like her early 70s I'm going to leave her alone she doesn't need problems like that in her life she's worked hard all her life she doesn't need me chasing after her even if even if we are all doomed let's go to a video break we are going to be talking about big pharma and vaccine prices first of all we have this message for you let me ask you a question what were you doing ten years ago here's what I 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everyone but one sector of society who definitely made the best of it a big farmer this is an industry which was famous for price gouging during the AIDS crisis and getting millions of Americans hooked on opioids it's now associated with the one tool capable of getting us out of the worst public health crisis in a century Covid 19 vaccines companies like Pfizer and Moderna are not only doing this for PR to be associated with vaccines that rescue us from this pandemic they're also making tidy profits from the sale of them and it looks as if those profits are only going to keep on rising that's because as the FT report both firms have this summer jacked up their prices so the paper reports that Pfizer raised the price of its Covid 19 vaccine by more than a quarter and Moderna by more than a tenth in the latest EU supply contracts as Europe battled supply disruptions and concerns about side effects from rival products the groups are set to generate tens of billions of dollars in revenue this year as they sign new deals with countries anxious to secure supplies for potential booster shots in the face of the spread of the highly infectious delta coronavirus they go on to write the new prize for a Pfizer shot was 1550 previously according to portions of the contracts seen by the Financial Times the price of a Moderna jab was $25.50 a dose the contract show up from what people familiar with the matter said was about 19 euros which is $22.60 in the first procurement deal but lower than a previously agreed $28.50 because the order had grown according to one official close to negotiation so it's that Moderna vaccine which is the most expensive but Pfizer well still expensive and only getting more so the companies are able to command such high prices because they are the only two mRNA vaccines currently on the market and it's those mRNA vaccines that have proven to be the most desirable technology for the countries that can afford them in a few experiments or a few studies they've been shown to be more effective than the other vaccines on the market and having fewer side effects you'll know all about AstraZeneca and that problem with blood clots for younger recipients of it obviously very very rare we can see here the effect of that desirability of the mRNA vaccine in terms of revenue forecast for 2022 the FT is suggesting that those mRNA vaccines are expected to have a revenue of $85 billion of course they're more expensive so that doesn't necessarily mean more vaccines in total in contrast the viral vector vaccine so that includes AstraZeneca Johnson and Johnson and Sputnik are expected to generate $30 billion in revenue during 2022 of course when it comes to countries like the UK when it comes to regions such as the EU or the USA governments are more than happy to pay these prices basically because lockdowns cost a hell of a lot more than $85 billion that's a big problem here I shouldn't say that's not a big problem because we did fund them through public investment we are paying twice for them that's kind of annoying but it's manageable it's a much bigger problem for poor nations who can't afford them they're not getting them they can't afford those prices what Pfizer say in response is they say look these high prices we charge these are actually only for those rich countries that afford them in fact because we charge these high prices in the west we charge these high prices in the developing world and the chief executive of Pfizer told the FT that they would be providing jabs to middle income countries at half price and to the developing world or to poorer countries low income countries at cost that might sound good that might sound reassuring until you realise they aren't selling any vaccines to those low income countries or not very many at all again we've got another graphic from the Financial Times you can see here the high income countries where they're selling vaccines at full price Pfizer have sold over 2 billion and to low income countries see Pfizer here is that sort of royal blue to low income countries Pfizer have sold less than 200 million they say oh it's so generous we'll sell them at cost to the developing world we'll sell them at full price to the rich world but then they only sell them to the rich world so they only sell them at full price I say only obviously they are selling some to low income countries but not very many Ash this is a pretty neat trick isn't it you say don't worry we're going to charge low prices to poor people and then you don't sell any to poor people I mean look it's a way of managing some of the political fallout particularly around this issue of intent try that again particularly around this issue of intellectual property rights whilst also not having to do very much which is going to at the end of the day harm your profit margin what this is resulting in is in some areas of the world dangerously low levels of vaccine coverage so when you look at the amount of vaccine brought up by North America by wealthy European countries you've got enough to cover the population you know not just once over but one and a bit times over so it's like 114% for Europe and I think maybe even 120% for North America you start comparing that to poorer countries to certain regions in Africa and it's as low as 2, 3, 4, 5, 6% right so you have this huge difference in available vaccine for those populations and look one the argument against that is that it's just inhumane profit shouldn't be put above people's lives the fact that intellectual property rights have been maintained at the expense of countries being able to manufacture generic versions of this vaccine technology is of course a complete abomination it is offensive to the notion of human dignity and that there are some things which are more important than making money but two if you have unvaccinated spots in the world well you increase the likelihood of the emergence of variants which ultimately danger the efforts to lift lockdown restrictions over here in a rich country like ours so no matter what way you look at it even if it's from a purely selfish and self-centred perspective this is stupid it's not something which has got a long term or even medium term view in mind but ultimately companies like Pfizer are able to behave in this way because of the relative weakness of governments if we wanted Pfizer to behave differently it would make it much more difficult for them to price gouge and restrict sales to poorer countries but we don't I think what's become really apparent over the past few months especially at the beginning of the year when lots of people were saying we need to release the patents I think you should release the patents anyway but there was an argument to say that wouldn't solve the problem because the problem is actually the capacity that the world currently has which are currently going idle and so even if you release the patents there wouldn't necessarily be the capacity to make that many more vaccines on a very short time frame I think what the last few months have shown is that even if opening the patents wouldn't allow that many new vaccines to be created on a really short time frame even if it was in an 18 month time frame like there are many countries given the amount of boosters we're having given the amount of problems that different vaccine production outlets are having what this has shown once and for all is that telling developing countries to rely on the goodwill of the west and to rely on the goodwill of big pharma is completely for the birds Africa has been told we're going to provide you this many millions of vaccines via covax and none of them have arrived some of them have arrived but very few of them have arrived and that's because the factory which is in India understandably they've said we're going to use all of those vaccines in India because we've got such a big problem and then Pfizer only want to sell their vaccines to the countries where they can charge super high prices and AstraZeneca have had its own problems but basically what you need is you need to have an infrastructure in these countries so that they can rely on themselves because relying on the west is just not it's not working at this point in time obviously that takes a while we should be giving billions and billions of vaccines to all the countries in the world but this idea that the liberal ruling class will save sub-Saharan Africa is even false in this situation absolutely so you're completely right and not only is it a load of bollocks it also I think shows the model of crisis management that we're going to see as the climate emergency deepens so what we're seeing is that there is a thin veneer of western philanthropy which fits with our idea of what our place in the world is of oh look at you, you poor, abject melanated people we'll give you some scraps off of our table and our huge big pharma conglomerates our governments can feel really good about themselves and say we're doing enough to help these poor, unfortunate souls whereas actually what's going on is that the reason why we're so relatively well insulated when it comes to vaccines is because it's built on a model of exploitation, price gouging and also moving intellectual property and advances in technology which were developed in the public sector into private hands so actually you can't separate off the relative level of privilege though that also does mean a certain amount of vulnerability to predatory pricing mechanisms imposed by private companies but you can't really separate that from what's going on in the rest of the world now if countries like ours were to push forward with socialising lots of this technology and saying we're obviously going to put distribution and manufacturing over and above the ability to generate a profit while not only would it be cheaper for our governments it would also be better for the rest of the world but there's an ideological opposition to doing that so what we're seeing is a form of vaccine nationalism of you know buy up all the stuff for richer countries and then we'll just give the crumbs off the table to the poorer ones and it is precisely this kind of model I think that we're going to see with the climate emergency which is we insulate ourselves through technology through our ability to fund infrastructure very quickly and for the rest of the world not only will we neglect our duty in terms of our contribution to emissions through outsourcing emissions right through buying from countries which aren't decarbonising at the same rate as countries but when dealing and looking at the kind of human cost of that particular kind of emergency we'll go well there's not much we can do to help you beyond this kind of quite you know flimsy and insulting level of philanthropy so what we'll do is we'll put our borders up and I think that it's you know we've talked a lot about borders on the show Michael and I'm with you I don't think that it's reasonable to have a full open borders approach to pandemic management you have to restrict some levels of travel from hotspots to populations which have got low case rates however I think that looking at it also as a way of dealing with an inequality that a rich country has had a hand in shaping that's obviously not the politics that either of us would subscribe to but also it's immoral and it's deeply wrong but I think it is also something we're going to see as the climate emergency deepens we cause the problem we make it harder for poor countries to fix the problem and then our solution to the movements of people human suffering is to put the borders up no I mean I absolutely agree with that point I mean as we've talked about in the show I think in a pandemic situation lots of movement across borders isn't particularly a good idea we want to contain the virus as much as possible stop the spread of variants but the real danger of it is that it means that rich countries can say oh it's not a problem now because we've essentially stopped travel from sub-Saharan Africa if they have a huge out of control epidemic so what it's not going to get here anyway I mean that's not true it will get here anyway but also that would be a terrible way to think and we do need political pressure to make sure that this moral catastrophe which is the fact that under 5% of people in most of Africa have been vaccinated against Covid-19 almost a year after we've had a working vaccine is disgusting just as we're about to go into a new wave as well where other countries get the delta variant as India did let's go to a comment Sean Hull with a fiverr says Solidarity from Scotland, great work Michael Ash and the rest of the Navarra media gang from Asperz van north of the Hadrian's wall hashtag come on mine and Sean the Tokyo Olympics will be remembered as the first one to happen without a live audience that's of course because they took place amid a global pandemic perhaps not unrelated to that pandemic they'll also be remembered as the first games where athletes frequently spoke about their mental health that pertains most famously to Simone Biles who's thought to be the greatest gymnast of all time pulled out of four events citing difficulties with her mental health she has since announced she will be competing in the final as we talked about on the show last week the decision to withdraw drew criticisms from the likes of Piers Morgan we won't go into that as we did that last week you can check that out on our YouTube channel in terms of opening up about mental health Biles has now been joined by Adam Petey Adam Petey is probably Britain's most high profile competitor at these games he's won two golds and a silver in Tokyo that includes gold and a 100 meter breaststroke which he also won at the Rio Olympics after the wins Petey announced he would be missing September's International Swimming League I haven't heard of it Eva to look after his mental health like Biles Petey also received some flack after announcing the decision sharing an article about that move he tweeted reading some of the comments in response to this is why we have such a stigma about being in sport it isn't a normal job there is a huge amount of pressure money does not buy happiness and then he goes on I'm taking a break because I've been going extremely hard for as long as I can remember I've averaged two weeks off a year for the last seven years unfortunately there are people out there who think they know you more than you know yourself I should probably add other jobs do have lots of pressure so while I completely back Adam to take a month off to focus on his mental health he probably shouldn't justify that by saying that being a sports person is not a normal job because I would like every work to be able to take a month off because all jobs tend to be fairly stressful but we'll put that to one side for one second finally and perhaps most dramatically we can go to Raven Saunders Saunders is an American shop putter who made Tokyo's first podium demonstration after winning silver in her competition Saunders said the X sign which you can see her making there represented the intersection of where all people who are oppressed meet Saunders who is 25 and gay has frequently spoken about mental health struggles including considering suicide in 2018 on doing the X gesture which is expected to fall foul of the international committee international Olympic committees ban on political demonstrations on the podium Saunders said I really think that my generation at the end of the day we really don't care shout out to all my black people shout out to all my LGBTQ community shout out to all my people dealing with mental health at the end of the day we understand it's bigger than us and it's bigger than the powers that be we understand that there's so many people that are looking up to us that are looking to see if we say something or if we speak up for them I should note in case it wasn't clear when she's saying we really don't care she's saying we really don't care if the IOC tell us we can't protest on the podium not I really don't care about all of these social issues because clearly she does we often talk about how responses to mental health problems in society can't be purely symbolic we need material solutions, good housing, good jobs good pay, etc etc these kind of messages from elite athletes do also matter they don't they it is quite refreshing to see these elite athletes who are heroes for so many people coming out and saying look I'm struggling too and I'm going to be open about that Well I think what's really important is for us to be able to look at both of those things at once that of course you need to address the material underlying causes which either make people much more vulnerable in terms of experiencing mental health issues factors which make the experience of mental health issues much more severe and then also the availability and the accessibility of proper mental health care I think we need to look at that as well as the fact that there is I think this quite profound cultural shift when it comes to destigmatising certain aspects of mental health issues and mental illnesses by young people in the public eye either in the field of the arts music entertainment or indeed sports these two things happening at once because I do think that what we're seeing is that you've got a generation of young people who in Britain and in America are in quite a profound way disempowered in the electoral process and both of those elected power structures tend to represent not only in their composition but also in the representation of interests older voters who tend to have more socially conserved to views but also are more likely to be financially secure looking at rates of home ownership savings all of that kind of thing I'm not saying that every single baby boomer is rich I'm saying that these things break down along generational lines so you have a generation of young people who are in a very profound way disempowered in terms of politics pop culture not only is that where young people are dominant because that's where young people have always been dominant I think the growth of social media has also shifted power within that realm because no longer does an athlete like Raven Saunders have to go well how do I impress these really nasty really reactionary editors and producers and the people who shape broadcast and print media direct line to your following and your fan base because of social media and you've also got I think a kind of shift of power away from broadcasts and print media outlets who now know that they've also got to follow the story as it unfolds on social media and that I think is really powerful when it comes to achieving cultural shifts, changes in norms, values and viewpoints so while I think we've got in many ways a deepening of all of these factors which have created a mental health crisis for young people the rise in precarious forms of employment, the decline in stable housing, the fact that we are in a very volatile political situation the climate emergency on the horizon, all of these things can really fuck with your mental health you I think also have this area in which people feel empowered to speak out and not have to kowtow to the kind of norms which dominated broadcast and print media and I've said this before that's why you have people like Piers Morgan ultimately trying to make a name for themselves by being a reactionary backlash against that shift in norms but it's the scream of the imminently defeated Piers Morgan knows that this isn't going to be something that he can win it's something he can in the short term capitalize on for notoriety but he can't win it because you've got your Raven Saunders you've got your As-and-Petis you've got your Simone Barsas and you've also got Tyrone Mings who today was speaking out about his experiences with mental health issues anxiety and having real trouble around the start of the Euros this is I think a generational shift in norms it might just take a while for it if it ever does to manifest in a change in politics proper I think that's really important especially that generational divides people sometimes find them controversial because they say I'm of an older generation I'm open about mental health and I'm actively anti-racist if what we're talking about is football players taking the knee and obviously that's absolutely true in many of these cases but I do think one thing that's interesting about sport and culture is in a way it does pick people out quite randomly it is genuinely meritocratic the Olympics is genuinely meritocratic at least the popular sports not those sports that actually probably only 10 people do in each country anyway but the popular sports sorry to anyone who does the poll sorry for the dressage enthusiast it's not a meritocracy how many people do it I assume it's quite easy to qualify for these things maybe I'm wrong in any case you get a horse Michael you get a horse and tell me how easy it is a genuinely meritocratic so it is interesting that you've taken this sort of random cross-section of society when it comes to the Olympic team or when it comes to the English football team and they are all people who are quite in tune with communicating anti-racist values quite in tune with sort of communicating their solidarity with people suffering from mental health struggles in a way that I'm not convinced would have been the case 40 years ago or even 20 years ago potentially it would have been a social media to make that communication but I do also think that probably social media has changed those norms within that generation I suppose in a way I'm sort of rephrasing what you've already said Ash but just to emphasise why I think generational analysis is important when it comes to issues like this yeah I mean I think like because one it allows you to express yourself more authentically I also think that in terms of how celebrities now use social media it had this big shift towards you know being handled by management and publicity and then the pendulum has swung back because actually what celebrities like is having a direct link to their audience and not having it being so managed and curated and then on top of that I think you've also got you know a huge extent to which power is now just no longer dominated in a public relations sense by you know the old gatekeepers of respectable discourse and I think that a generational analysis it doesn't explain everything but I think it explains an awful lot about why we are at this kind of tipping point when it comes to mental health advocacy one thing that I would like to add though is that I think it's important to acknowledge that this project of destigmatisation is very very partial because the kinds of discussions around mental health that it's seen as acceptable to have it tends to be around depression and anxiety rather than the kinds of you know very layered very complex presentations of mental illness which also involve things like substance abuse or schizophrenia the way in which one of these things can then overlap when there is an adequate care and support with homelessness and rough sleeping and all sorts of behaviours which can fall under the bracket of you know the deviant, the criminal or the dangerous so one of the things that I always say be wary of with celebrity mental health advocacy the insistence of it's okay not to be okay is that all of that is happening within certain constraints and certain limits so if what you want to do is have a conversation about how do you support people in their experiences of mental health crises thinking about what it is that's being asked for by celebrities which is a more hospitable and stigmatised environment that's only one part of what needs to be there there's this whole other realm of I think quite complicated institutions and support structures which need to be in place to catch those people who have those kinds of experiences with mental health which don't see reflected in celebrities that was very well put I'm not going to do the thing I did last time where I had to reformulate what you said because you did a great job of it there as you did before as Sarko it's been an absolute pleasure being joined by you on this Monday evening my mainest man any time awww it means the world thank you everyone for your super chats tonight we'll be back on Tuesday at 7pm so do make sure you hit the subscribe button you've been watching Tisgy Sour good night