News & Events Videos of COVID Conversations: Thinking Through the Pandemic

Biddy Martin (00:00:10):
Good evening, everyone. Thank you for joining us for this third in our series of programs designed to help us think through COVID-19. I'm delighted tonight that we will feature Arthur C. Brooks, who is Professor of the Practice in Public Leadership at the Harvard Kennedy School where he is also the Arthur C. Patterson Faculty Fellow at the business school. Before joining the Harvard faculty, Arthur Brooks, as many of you know, served for 10 years as President of the American Enterprise Institute based in Washington DC. He's the author of 11 books, several of which are best sellers: Love Your Enemies, published in 2019; The Conservative Heart, 2015; and the Road to Freedom, 2012. Arthur writes a regular column for the Atlantic called How to Build a Life, and he has recently launched a podcast called the Art of Happiness with Arthur Brooks. He started his career, interestingly enough, as a classical French hornist.

Biddy Martin (00:01:22):
Along the way has acquired degrees in economics and public policy analysis. Arthur, we're delighted to have you here. Thank you for coming. Our own Phil Jackson is an Amherst College Trustee, and a graduate of the College in the class of '85. Phil Jackson is priest-in-charge and vicar of Trinity Church Wall Street in New York City where he leads ministry programs that touch on every conceivable aspect of parish life, including liturgies, music, educational programs, membership and stewardship of Trinity Church Wall Street. Prior to being ordained, Phil had an early career as an attorney. In addition to a bachelor's degree in history from Amherst, he holds a J.D. in law from Yale Law School and a master of divinity from the Church Divinity School of the Pacific. We're delighted to have Phil here. We're delighted to have Phil on our Board of Trustees. Thank you both so much. We're looking forward to your conversation. Phil, take it away.

Phil Jackson (00:02:40):
Thank you, Biddy. Welcome, Arthur. Good to see you again.

Phil Jackson (00:02:46):
Nice to you too, Phil. How are you?

Phil Jackson (00:02:47):
I'm good. I don't know if you can hear it, but I'm here in our apartment in New York and it's seven o'clock and people are banging pots and pans and celebrating our first responders and healthcare workers. I can see them right outside people outside their windows clapping and celebrating.

Phil Jackson (00:03:07):
That's fantastic. You know, I'm in Brookline, Massachusetts and I can't hear that where I am, but I'm feeling the same sentiments. I'm cheering for the frontline responders. It just goes to show you when you're in a terrible situation, when you have discomfort, when you have challenge, it's always an opportunity to celebrate the great courage, the valor of other people who are stepping up in a crisis. Now it's a perfect time to show what we're made of. Right, Phil?

Phil Jackson (00:03:35):
Yes, it absolutely is. Let me ask you, Arthur, what are you doing? How are you faring during the lockdown and what are you up to?

Arthur Brooks (00:03:42):
Well, like everybody else, I'm staying at home. I'm abiding by the rules, which is as we're supposed to do. It's interesting. I just finished teaching a class at the Harvard business school called Leadership and Happiness. One of the things I teach my MBA students is that if you want to be an entrepreneur in life, if you want to treat your life like a startup. This is the big opportunity to treat your life like an enterprise. You have to look at what everybody else would say is not just a challenge but maybe even a tragedy and see it an opportunity for personal growth. I teach this. I teach this, and now I've got to live it. I have to practice what I preach. I have to say it's been tough, but it's been very beautiful. At the same time I'm finishing a book. I was very behind on a new book that I'm writing for Penguin and I had an editor that was getting a little bit stressed out and now I'm ahead in that. But more to the point, I'm reading more, I'm praying more, I'm spending more time with my family, and I'm trying to make this challenge into really a moment of personal growth. What are you up to, Phil?

Phil Jackson (00:04:44):
Pretty much the same. I feel like my life has been dominated by Zoom meetings at various times. Reading a little bit more. I miss exercising. I mean we get out and walk and whatnot, but I miss my exercise routine. I'm staying in touch with family and friends on the phone as much as I can. We just kind of hunkered down too, you know, Our head of security today--we have a daily security briefing--he announced to us today that this was the beginning of week eight, day 51, I think is today. And it looks like we've got a little bit more to go.

Arthur Brooks (00:05:37):
I was just going to say it's worth pointing out, it's not permanent. You know, people are starting to talk as if this were a permanent way of life and it isn't. I mean this is going to end. There's all kinds of reasons to be optimistic about when and what's going to happen when it does. So it's important for us to remember for ourselves and to remind all of the people watching and not to lose hope.

Phil Jackson (00:05:59):
Well, absolutely. Let's come back to that, but let me ask you, because this new column that you started in the Atlantic, I just love it. You've done two columns thus far. I guess it's going to be biweekly.

Arthur Brooks (00:06:14):
Yeah. Every two weeks.

Phil Jackson (00:06:16):
Your thing is talking about happiness and how to build a life. I wonder if you can tell us something about why happiness?

Arthur Brooks (00:06:29):
I had planned to do this column for a long time. I'd been working with Jeff Goldberg, who's the editor-in-chief of the Atlantic and Julie Beck, who's my editor. We weren't anticipating launching this column during the coronavirus epidemic, and we thought about putting it off. And we thought, what better time. People are thinking about their lives, they're thinking about their happiness as a matter of fact. It gave me, gave us, an opportunity to say, look, while you're in the stillness of your apartment, your house, think about these big issues in your life. Think about the things that you actually want to improve. Would you like to come out of the coronavirus epidemic with greater skills to be happier than you went in? I would say so. We launched it and I have to say it's gone really well. I mean, there's a lot of people who've been reading it. A lot of people have been reaching out. We started a podcast also called the Art of Happiness that goes along with the column and it's really fun. It's really gratifying. It turns out to be almost the perfect time.

Phil Jackson (00:07:24):
How is happiness, how do you see happiness as being an art?

Phil Jackson (00:07:30):
Well, in truth, I talk about it like science. I'm a social scientist by background. My Ph.D. Is in public policy analysis, but I've been working across the social sciences my entire career. And one of the things that I've found is that when you use the science of happiness, you have to use each element that you've got, almost like paints in a palette on the canvas of your life. So it's a little bit art, a little bit science, but I like the art part a little bit better. This whole idea, Phil, that you're in my life, is something that we're constructing, that we're responsible for making it beautiful. We can't leave it up to chance. And there's all sorts of ways to think about it too. Sloshing the paint on only goes so far. Sometimes you need to chip away the jade to find the sculpture that's inside that boulder as well. A lot of artistic metaphors that I use to actually find the happiest person that we can possibly find and therefore share that happiness with others to lift people up and bring them together.

Phil Jackson (00:08:28):
That's lovely. Let me ask you this about the three equations. This is from the first week's column, the three equations for enriching our lives. I thought that was wonderful. Could you say something about that?

Arthur Brooks (00:08:40):
The first column that I launched was called the Three Equations for a Happier Life. It sounds really wonky, I know, but basically it follows a lot of common sense. The first equation is that your happiness is made up of three things, your genes, your circumstances and your habits. And one of the really shocking things that people don't know about human happiness is that about half of your happiness depends on your genes. Now that's only half. But for a lot of people that sounds like an awful lot. And the way that the scientists, that psychologists have figured that out is through studies of identical twins that were separated at birth and adopted to separate families and then voluntarily have been reunited to do personality tests as adults. It's uncanny how much, using statistical methods, they can figure out, how much of their personalities are genetic. Sure enough, about 48% of happiness, depending on who does the analysis is genetics. So, Phil, your mother really did make you unhappy.

Arthur Brooks (00:09:44):
I know, I'm kidding man, is she watching? But there are other parts--that still leaves half, and the two parts of the other half are your circumstances and your habits. Everybody's obsessed with their circumstances. Like if I only get that raise, if I can only get that person to marry me, then I'll finally be happy forever. And no. I mean we have an uncanny ability to go back to our baseline happiness levels because that's a process. I'll just call it homeostasis. It's the inability to stay above your zone because you wouldn't be able to live otherwise. If somebody broke up with you and broke your heart and you stayed unhappy forever, which you think you're going to be in the first couple of weeks, you'd die because you wouldn't be able to actually participate in life.

Arthur Brooks (00:10:28):
So you'd go back and very, very quickly. There's studies that show that lottery winners and paraplegics both go back to their old happiness levels after about six months, which is extraordinary when you think about it. That's the part that you think is going to matter a lot, but you should kind of disregard it because you're going to be fine. Or even if you're happy, it's not going to last. A part to pay attention to is habits and the habits basically are sort of the accounts, the accounts in which you need to make deposits every day. And there are four habits that you need to pay attention to. And that's the second equation.

Phil Jackson (00:11:10):
I really liked your discussion of habits. Please, please go on.

Arthur Brooks (00:11:15):
The habits, and this is really important, this is the part that we can control. It's somewhere between 15 and 40% of our happiness is under our direct control. But you got to pay attention to four things every day and you can't be undiversified. It's like you have to put the deposit in each one of these accounts, through your faith, your family, your friendship, and your work. Now, it's worth a little bit of a explanation here. Faith does not mean my faith. I mean I offer it up to everybody, Phil, I know you offer your faith up to everybody too. I mean you and I are both Christians, but that's not what the data say. The data say that any life philosophy that's transcendent of ourselves and focuses us on other people and serving others, that works, but we have to practice it every day. Spend time in prayer, meditation. Actually make sure that you're in communion with others, et cetera. Family is pretty self-explanatory. You define family the way you want. Friendship as well. Friendship is one that's neglected, especially by men. A lot of people, we find that the loneliest people in America are 60 year old men. You'll love this, Phil, the average 60 year old man, 60% of 60 year old men say their best friend is their wives, 30% of their wives said their best friend is their husband.

Arthur Brooks (00:12:26):
So I told that to my wife, she's like, huh, no kidding. It's very important that we've maintained our friendship chops. The last is work and I don't care what the work is because I've been studying work my whole career as an economist and I'm telling you, I've looked at above and below average income. I've looked at college educated, non-college educated. That does not actually affect happiness. What affects happiness is two things. If you can earn your success and you're serving others. Accomplishment and service are the two secrets to a happy job. So faith, family, friends and satisfying work through service and earning your success. If you could put a deposit in each one of those four accounts, you're well on your way to living your happiest life.

Phil Jackson (00:13:06):
Wow. I think that is so true. I could comment on all four of those. I would say just my observation as being a parish priest for 27 years, the one we least deposit in is our faith, and the one we over deposit in is our work.

Arthur Brooks (00:13:26):
That's right. And we focus on the wrong things in our work too. You know, when people [inaudible]

Phil Jackson (00:13:33):
[inaudible] work as identity rather than work as a locus of meaning or service, which I want to come to. Sorry I didn't mean to cut you off.

Arthur Brooks (00:13:40):
No, exactly right. Your own career is a perfect example of that. I mean, you were a high-flying lawyer, at Yale Law, the number one law school in the world and at 27 you gave it up to become a priest. Obviously being a lawyer wasn't cutting it. That's really important for all of us to figure out. Think about it now, your work is all about saving people, helping people, lifting people up. It's sort of the epitome of exactly what should bring satisfaction from work as opposed to what people usually do with their work, which is money, power, prestige. Those are the things that Saint Thomas Aquinas said are substitutes for the true happiness that we want. They're counterfeits as a matter of fact. So the key thing is that you should take what you think you want, which is money, power, pleasure and fame and substitute for that faith, family, friends, and work. So you've got the bad four, the vicious four, and you got the virtuous four. And that's really a good way to actually start trying to conduct your substitutions in life.

Phil Jackson (00:14:44):
What is it about service that all religious tradictions, certainly ours does, it's at the root and heart of our tradition, serving others, what is it about that that's so universal?

Arthur Brooks (00:15:04):
It's interesting. This is one of the many areas in which theologians and psychologists agree. They agree that other-focused, other-serving behavior is really at the secret of happiness, is at the heart of happiness. But they don't exactly agree as to why. And so psychologists will talk about it with respect to simply thinking about something besides ourselves to the extent that you can, we're wired to think about ourselves because frankly we wouldn't survive if we didn't think about ourselves. But the problem is that, how do you say, it's just boring? I mean, it's just so boring all the time. And you actually find that people who are suffering a lot from different forms of clinical depression, they'll often say the worst part about it is the boredom of thinking about myself a lot.

Arthur Brooks (00:15:51):
This is why in Dante's Inferno he talks about the devil at the bottom of the mountain, half-frozen, a block of ice up to his waist. All of our Amherst students, of course, they've read Dante's Inferno. It's a great college and classical education. And he's twisting around in agony, not even aware of what's going on around him. In other words, it's just an agonizing, boring life of pride, and that's really the big problem. And so other-focused behavior is just more interesting and it allows us to have a more fulfilling life according to psychologists. Now, on the other side, theologians think about this in a slightly different way. Theologians have quite correctly figured out that love is the nuclear fuel of happiness.

Arthur Brooks (00:16:39):
Remember, work is one, but work that lifts people up, faith, family and friends, which are based on love. Now what is love? According to Saint Thomas Aquinas once again, to love is to will the good of the other. There's nothing sentimental about it. It's not a feeling, it's nothing squishy and soft. It's super hard-edged. It's work. To love is to will the good of the other. If that's love and love brings us happiness and it's other-focused, that's why service really matters according to theologians. It's a little bit of the beatific vision, isn't it?

Phil Jackson (00:17:14):
Would you say there's a difference between happiness and joy?

Arthur Brooks (00:17:19):
That's a great question. That actually gets into this notion, because once again, that's the difference between theologians and psychologists. Psychologists, they're a little bit dismissive of joy. Joy is a fleeting thing. Basically the way that psychologists have defined happiness, there's the emotion of positive effect, which you can actually get from pleasure. You can get it in a bottle, you can get it from smoking dope. But that's just pleasure. It's extremely fleeting, not something you can base your life on. Then there's a psychological happiness, which is kind of taking accounts, all things considered, good and bad things happen. I'm a relatively happy person and there's this kind of good life, well lived. Psychologist sort of dismiss joy as being in that first category of fleeting feelings. Theologians, no, no, no. Theologians talk about joy as being the ultimate thing that we want. Christian theologians will talk about, and Muslims will talk about joy in the sense of being in heaven. So it's that euphoria that you finally get when that window opens up and you see something that's really good. The problem is t closes, right? People of serious religious faith will say, well, guess what? If you do things right, that window stays open.

Arthur Brooks (00:18:35):
That's the offer, right?

Phil Jackson (00:18:39):
Let's go back to how to build a life. Let's look at the second column. I want to ask you, you described the column as being about how to find what matters and how to hold onto it at any age, at any age to build a life that feels whole. Can you define for us what matters and what are the things that make us feel whole?

Arthur Brooks (00:19:09):
One of the things that I talk an awful lot about with my class, or in my writing is finding the why in life. You know, we're encouraged in modern society, and for that matter in any society, to only think about the what of life. You know, when you go to a party, Phil, and people say, Hey Phil, hey, what do you do? They're saying, what do you do for a living? Basically it's the what of your life. Nobody ever says, why do you do what you do? But you know, we need an answer. You have one. Biddy mentioned in the introduction that I used to be a French horn player, and I did that all the way through until I was 31 years old. I finished college right about that age because it was sort of a wayward youth.

Arthur Brooks (00:19:53):
The reason I left music and actually became [inaudible] I was on the road. I was actually in the Barcelona Symphony. And when I was playing in Barcelona, I remember reading a biography of Johann Sebastian Bach, who is my favorite composer. And he was asked why he wrote music. And it's an extraordinary question, right? I mean, why. Not what's your writing process or all the dumb stuff they would ask composers and artists today, But why? Why do you do it? And his answer just blew my mind. It actually changed my life. He said that the aim and final end of all music is the refreshment of the soul and the glorification of God. And I thought to myself, can I say that? And I actually went on a vision quest to actually find a way to be able to say that.

Arthur Brooks (00:20:43):
Again, for all the people were watching us, we're not religious. Don't be stymied by that. What Bach was saying is that the purpose of your work, the why of your work is to serve, to lift other people up. You must find a way to do that. And I thought, I'm not serving anybody playing in this orchestra. I'm not even serving myself. And actually I went to to find a way that I could study what I was really interested in, quite frankly, was solutions on how to lift people out of poverty. That's what I studied. That's what I did my Ph.D. Work in that. And it was extraordinary. I have to say that I have good days and bad days, Phil, but my why is Bach's why, the refreshment of the soul of others and the glorification of God as I can see fit. I can tell you I don't sleep poorly because of my work, when I really think I'm living up to that mission. And that's the point. That's purpose. And that's meaning. I encourage everybody who's watching us to give some deep thought during this coronavirus lockdown. What's my why? Not what's my what. What's my deep why. Am I serving it, am I fighting for it? Am I sharing it? If I'm not, what do I need to do to change?

Phil Jackson (00:21:49):
Let me ask you how, what would you say to some of our young people at Amherst who might be watching us today who have, if you've gotten to Amherst College, you've done all the right things and moved up the food chain and gotten good grades and activities and scores and sports.What would you say to a young person who this evening is thinking for the first time, "What is my why? Is my why just to do that?"

Arthur Brooks (00:22:25):
It's very easy to, to think that, to believe that when you finally meet your destination that you will finally be happy. And one of the great consolations of getting older, Phil, I mean you and I are almost exactly the same age and it's extraordinary. The data show that people, they tend to bottom out between their mid-forties to their mid-fifties but from their mid-fifties to their early seventies, that turns out to be the happiest period in most people's lives. And if they play their cards right, they can continue getting happier all the way to the end. Why is that? And it's in no small part because you realize that the journey is the destination, that the key to the treasure is the treasure. That in actually creating the good and doing what you're doing,

Arthur Brooks (00:23:11):
there's an intense amount of, or there can be an intense amount of intrinsic satisfaction. That's something that you can get a head start on actually learning. When I'm on college campuses, which I am a lot, and I was supposed to be in person at Amherst College this spring, but we'll do it again. We'll find another way because it's just a couple hours away. And it's such a beautiful place. I've been there. I love it there. What a wonderful place to study. What a great college too. But when I'm talking to students and they say, what should I be focused on, there are two things that are really suggest that it's worth focusing on during the student years. The first is the sacredness of sadness. One of the things that we do, I think we do wrong today in talking to young people, is that we pathologize all discomfort and sadness.

Arthur Brooks (00:24:00):
We say that if you have a lot of what psychologists called negative affect. Negative affect, bad emotions, negative emotions and positive emotions are processed in different hemispheres of the brain. You can be a very high positive emotion, a very high negative emotion person as a matter of fact, but when you're experiencing high levels of negative emotion because of anxiety, because of sadness, because of events, because of a bad turn in a class or in love or with your parents or whatever, there's a tendency to pathologize that, to say any of that is bad, but it's actually quite sacred in a lot of ways. Now we don't want it to get out of control. It hurt us. But at the same time, it's very important to remember that it's not just inevitable, it's super necessary.

Arthur Brooks (00:24:44):
We find that that negative experiences tend to be the times of greatest growth, which is why I hope a lot of people watching us are going to come out of the coronavirus experience and three years from now say I didn't want it to happen, but I learned so much. It's also important to recognize that bad feelings per se have an enormous amount of benefits. They can connect you to other people. They tend to be correlated with high levels of creativity. Lucid thinking, that's quite accurate. You find that leaders who have a certain amount of sadness tend to be better and more accurate and better decision making leaders. It's also quite worth pointing out that a lot of bad feelings that we feel from fear and sadness and even anger, they can keep us alive because they alert us to threats. So that's the first thing is to recognize that sadness is a part of life and to embrace it.

Arthur Brooks (00:25:32):
Embrace your poet. The second thing is another little equation that I talked about with a lot of young people. Everybody wants satisfaction in life. And satisfaction is a hard thing to get because we have this treadmill that we're on. Is that homeostasis? I talked about it a little bit earlier, but satisfaction basically is made up of haves and wants. And here's the relationship. Your hands are in the numerator of your satisfaction equation and your wants are in the dominator. Haves divided by wants. Everybody needs to be satisfied, get more stuff, get better grades, get into a better college, graduate and get a better job, make more money, et cetera, et cetera. And that's managing the H. That's fine as far as it goes. But you're W in the new denominator, f you don't pay attention to that, it's going to run out of control.

Arthur Brooks (00:26:19):
It's going to sprawl like the suburbs of Atlanta. It is going to grow and grow. And if you're not paying attention, that thing is going to be so huge that your satisfaction is going to fall even as you make more money and have a better job and get better grades and you're going to wonder why is my life so unsatisfying? And so the key thing I talked about young people is make a strategy for managing your wants, for circumscribing your wants. And what I mean is write them down. What is all that stuff that I want? What are all the things that I want? What are the relationships that I want? What are the jobs? What is the prestige that I'm looking for? Write it down and then talk about managing it. So it doesn't sprawl saying that doesn't make sense. I'm getting rid of that. Throw it away. Empower yourself by managing your denominator and your satisfaction will grow. It's like magic. Actually. This one of the great hacks to happiness. So those are the two things I tell young people.

Phil Jackson (00:27:08):
Well, that's terrific. As a parish priest, it sometimes feels like, even though we know the absolute truth of what you just said, there's literally a whole giant behemoth of a machine out there convinced whose job it is to convince us all that our wants are in fact our needs.

Arthur Brooks (00:27:36):
That's a conspiracy, I think. I think you're absolutely right on. It's amazing to convince us of this. I thought about this for a while, but I thought if I listened to Madison Avenue or just take my values from Netflix, I'm going to be convinced that the formula for a happy life is use people and love things and worship myself. That seems like the formula for the happiest possible life. That's what everybody's telling me to do. But the truth is that all the verbs and nouns are wrong in that. It's amazing when you think about it. Every religious tradition, every philosophical, every secular ethical tradition tells us that the real formula is use things and love people. And if you're religious, love God, that's it. Worship God. That's it. You should never ever use anything but things, and only within moderation. And you should never love any things. You should only ever love people. People are made for love and the love is the will the good of the other. And so if we basically remember use things and love people as opposed to vice versa, we're really off onto the right trail, I think.

Arthur Brooks (00:28:51):
I definitely see that sort of flip flop made every day and hoow hard it is to break away from that mindset. Let me you this. You talk about, in the April 23rd column... Actually I'm going to break. I want to go back to something you said about the sacred because that is such a rich and beautiful point. I know our listeners or watchers, may think that that in sadness there can be the sacred, but I think of the comment of one of my mentors, Father Richard Rohr, the Franciscan friar who told me once, he said, Phil, I never learned anything important after the age of 35 by any success I had.

Phil Jackson (00:29:51):
He said it all came from failure. It all came from sadnesses. It all came, the real learning, the real depth of learning. He also talks about how, in what he calls the second half of our life, the aim is to learn to then give self away. To your point that we learn to give ourselves away. And that the goal of that, the end of that, from a psychological standpoint, a secular standpoint is this funny thing called wisdom. That by giving ourselves away we can actually acquire wisdom. What do you think about wisdom?

Phil Jackson (00:30:33):
I appreciate that. And I've read Richard Rohr's work and I recommend that everybody read it. It's excellent, it's wise. It's very moving. I'll address that because you've already addressed it from a theological standpoint more eloquently than I could. So I'll talk about it as a social scientist. There are two kinds of intelligence as defined by a famous British social psychologist named Raymond Cattell in the early 1970s, he talks about fluid intelligence and crystallized intelligence. Fluid intelligence is what you've got just to the max when you're in your twenties and early thirties. I mean this stuff is just coursing through...your ability to analyze, to multitask, to get jobs done, to learn the answers to new problems, to come up with solutions very quickly. That's fluid intelligence. Young people have it in a big way.

Arthur Brooks (00:31:24):
It's one of the reasons they're coming up with new solutions to old problems is generally speaking, what's going on with people in the twenties and thirties. It's also the reason that physicists and chemists generally speaking, do their Nobel Prize winning work, usually by around the age of 32 or 33, as a matter of fact. It used to be in the twenties. Quantum mechanics was actually developed by Paul Dirac, who is a physicist in the early 20th century who invented the whole idea when he's 26, won the Nobel prize at 30, said that as a physicist is better off dead before he's reached his 30th year as a result. But that's all fluid intelligence. Here's the good news. That's only one kind of intelligence. There's another intelligence curve that starts increasing through your thirties and forties and fifties and can stay high through your sixties and seventies, even your eighties which is your crystallized intelligence.

Arthur Brooks (00:32:18):
And that's your ability to synthesize ideas and bring them into new ways of thinking. It's extraordinary when you get into your fifties, particularly when you teach. You're a teacher. I mean you're a priest, but you're a teacher. You're helping people understand the messages that come from Holy scripture and synthesizing different ideas and bringing them to the pulpit. And I'm sure as sure as I'm sitting here, even though we've never talked about this, that you're a better preacher at 56 than you were at 36 because you have more crystallized intelligence. And that's another way of saying wisdom. Wisdom is bringing ideas together. That's the reason that people need to think about their careers in a very integrated way. All the young people watching us today, you're going to make your bones in your career with your fluid intelligence. But by the time you're in your thirties and forties, you've got to start thinking about ways that you can pass on your ideas. You can share what you know, that you can synthesize things that you can teach, that you can be a mentor and crafting a full life is one in which you invent earlier and you instruct later. That's actually what Richard was talking about because instruction, teaching is that the essence of giving of yourself, giving what you know, helping people to be better on the basis of what you can share.

Phil Jackson (00:33:31):
I love that. By the way, your column on just that, on aging, I thought was brilliant. At least at my age, it really hit me, and touched me deeply. Let's switch to the American educational system for just a second. We know that, as we were talking earlier that obviously this year, this coming academic year or the next one is kind of up in the air as to schools closing, classes moving online, students and families unsure whether schools will reopen. We don't just learn academic things as part of the experience. We learn how to socialize with one another. We learn interaction, we learn, hopefully, broadening of our minds. We might say in a way that part of what happens at a place like Amherst over your four years, you should be maturing. Do you think what we're going through now with the pandemic and having to go online, do you see any effects that might touch that area of growth and learning?

Arthur Brooks (00:34:55):
Yeah, I do. And obviously I can see the costs, but I'm also seeing some benefits too. To begin with maybe some people are watching us thinking about should I defer, should I wait a semester? And the answer is no. Why? Because next fall is probably going start weird and end well. That's what the data say. That's most likely a semester where you're half online and half in person or something. That will be an ancient memory and there's a lot that we can actually learn from that because we're getting better and better alternative teaching methods and students will be part of the experiment in doing that. So I'm recommending to people that they they not defer. They take an opportunity for actually learning in a new way. It's completely temporary. The gist of your question is a little bit different.

Arthur Brooks (00:35:44):
Are we sacrificing the socialization that is an important part of higher education? Answer is obviously yes. I mean when you went to college, I think you went to college in 1981 at Amherst and you grew up. I mean 18 to 22, these were formative years. [laughter] I know you're still working on it. We all are. I know the dirty secret of being in your mid-fifties is you realize that you're never really grown up. You socialize, you grow up because you're exposed to difficult things. You're exposed to risky ideas, different ways of thinking, things that maybe threaten your old paradigms. That's part of growing up that comes from socialization, learning together as a matter of fact. Now here's a problem in higher ed today that's actually different than in the early 1980s when you went to college successfully and I went to college unsuccessfully and almost immediately dropped out.

Arthur Brooks (00:36:41):
The difference is that we've actually taken a lot of the socialization experiences that lead to a lot of benefit out of higher ed. And I know a lot of us are really quite worried about that. You find, for example, that the in loco parentis experience is sort of making sure that a lot of people are exposed to less risky ideas. It's extraordinary to me the extent to which, on college campuses, people are protected from hearing things they disagree with. That's a big problem because that's actually cutting down on the resiliency of our students and we're not serving them very well. So I wonder to the extent to which we've been actually living up to our socialization function to begin with. Either way, come back to my first point, which is this is a highly temporary situation and we need to look for the best that we can get out of it. Recognizing that by the spring of 2021, things are going to be normal and we're going to go on with our lives.

Arthur Brooks (00:37:38):
Okay. We heard it here. Thank you, sir. I love hearing that. Let me, if you don't mind, I'd like to open up a a more personal dialogue if we can. We talked a little bit earlier about how in calling the spiritual masters tradition, certainly in the Christian tradition, I know in the Buddhist tradition, in the Islamic tradition, that there's always been this group called mystics.

Phil Jackson (00:38:14):
The mystics bring us to a description of what they call experiences with the divine. In those variances with the divine, they almost uniformly, universally describe those experiences as being what they call unitive, or that is that they somehow, when they encounter the divine, they walk away with a sense that all things are one, where all things are in unity. All things are of the same creator. I was thinking, as I mentioned earlier, about Thomas Merton's fourth and walnut experience. And I know you've described an experience you had with our lady of Guadalupe when you were young, when you were 15. Can you talk about that a little bit?

Arthur Brooks (00:39:10):
When I was 15 years old, I had the opportunity to visit the shrine of Guadalupe in Mexico City. I was not Catholic. I was raised in a Christian home. I was raised in a Protestant Christian home and I didn't know any Catholics, but I remember sitting contemplating the tilma ofJuan Diego in Guadalupe and I remember it's a rather extraordinary thing by the way. The image of the Virgin Mary and the tilma of Juan Diego. And this is at a time in the 16th century when the Spaniards were brutally suppressing the indigenous people trying to convert them to Catholicism with complete lack of success. And what happened, this appearance, believed still today by most Catholics, that the appearance, the apparition of our Lady of Guadalupe to an indigenous peasant Juan Diego, she appeared as a woman of mixed race. Now sounds normal to us today.

Arthur Brooks (00:40:12):
That is super radical at the time, the idea of somebody of mixed race and what that did, and it was imprinted on his tilma, which, and again, some people believe in it, some people don't. But in point of fact, this image of a woman of mixed race saying, you are my beloved son had this incredible catalytic impact on people. There were 9 million conversions in the next decade. That's how radical unity works. That's when we come together as people and we can believe something bigger than ourselves. When we recognize the what the Buddhist call the emptiness, the illusion that we are somehow separate. I realized that they feel that you and I are different beings, but in point of fact, I don't fully exist without the existence of Phil. I mean that's what that is really saying.

Arthur Brooks (00:41:00):
Whether it's the Buddhist tradition of the Catholic tradition and that had such a big impact on me. I didn't know how big an impact that had on me until many years later. I converted to Catholicism when I was 16 because of that, which is not nothing, but now I look back on it and I recognize that the true moral and mystical importance of that was happening without me knowing. And this is an important thing for all of us to recognize that the mystical moments, the hinge moments in our spiritual lives, they might be happening right now and we don't know until later. Most experiences are only recognized as such retrospectively, and that's why we have to be so careful about the sacred. That's why we have to remember that every moment of our lives is potentially the moment of our mystical transformation. This might be the epiphany right now. There might be somebody watching us right now and then who thinks about it and she thinks about it. And in a few weeks she says, something's changed for me because retrospectively it turns out, I mean, probably not, but that's a really important thing to keep in mind. All of my most mystical experiences in my life, they've shown themselves to me. They've revealed themselves to me after the fact. That's how mysticism works. That's an incredible gift.

Phil Jackson (00:42:18):
It really is. You made me think when you said that you said it so beautifully, but I was thinking of one of our professors at Amherst College. There was a guy named Bob Thurman taught Buddhist studies back in the eighties, seventies, eighties, and maybe into the nineties. Ended up going to Columbia. But I took a class on Buddhism with him and he had us read this text, a Mahayana texts that he had translated himself. It ended, the high point of the text was when the bodhisattva who is the central figure of this text was able through silence to declare that the nature of non-duality was in fact, the answer to the question, what is non-duality with silence. I was 19 or 20 when I read that and had no idea what that meant. And it wasn't until about six years ago after being a priest for over 20 years, that one day out of the blue that came, that moment came back to me and I understood what that concept meant. It came back years later, and I was able to understand the mystical truth at the heart of the obliteration of non-duality.

Arthur Brooks (00:43:38):
That doctrine of emptiness and the non-duality, the illusion of individuality is something that takes many, many years too. I had a very similar experience. As a matter of fact, I remember when I was 20 years old reading Zen and the Art of Archery by Eugen Herrigel, which is a great book and everybody should read it. It's not to be mistaken with Zen in the Art of Motorcycle Maintenance, which is a kind of a pseudo Buddhist book and I don't recommend it, but Zen and the Art of Archery is really a very profound book. And it introduces this concept, this sort of mystical question of what is the sound of one hand clapping? I contemplated it. And of course nothing came to me. And then when I was many, many years later, when I was studying in Dharamsala and the Himalayan foothills with the Tibetan Buddhists, I was learning to meditate with the Tibetan Buddhist monks.

Arthur Brooks (00:44:27):
And I was studying this concept of the illusion of the individual. In other words, we all have common roots and we're simply different manifestations of the same common roots. And I realized that the question, what is the sound of one hand clapping, is not a question. It's an answer. So who is Arthur, me, in the absence of Phil? And the answer is it's the sound of one hand clapping. It doesn't exist and it took me three decades to figure that one out. Right. But it's important because those are the mystical questions that if we actually can focus on them, can contemplate them, they can actually help to help us, that can help us understand our deep why or deep purpose or deep meaning. And that's really a nutritious thing to do. That's worth contemplating during our coronavirus lockdown.

Phil Jackson (00:45:20):
Exactly. I'm getting messages that I've got to stop asking you questions, although I feel like I could ask you questions for hours.

Arthur Brooks (00:45:32):
Yeah, I know we're just getting started and I'm looking forward to our lunch together in New York coming up.

Phil Jackson (00:45:37):
Let, me just quickly ask you before I go to these, I'm going to pick some, but I'm going to ask you, we talked earlier this afternoon about...you made Camino de Santiago. Could you, say what that experience is like for you?

Arthur Brooks (00:45:52):
So the Camino de Santiago is an ancient pilgrimage, is a 1000 year old Catholic pilgrimage that walks across the North of Spain. So it's somewhere, depending on how much of it you do, between 160 and 800 kilometers. It's on foot, it's hot, it's blisters, it's staying in not very nice hostels. It's terrible. And it's the most beautiful thing ever. And so pilgrims have been walking the Camino de Santiago to help understand the nature of their belief for these last thousand years, to the cathedral of Santiago, which is the site of the remains of Saint James the Great, who is the brother of Saint John, one of the apostles of Jesus. Spanish believers particularly believe that that his remains showed up in Santiago. He buried there. It's an incredible experience.

Arthur Brooks (00:46:45):
Now, pilgrimages are nothing new. The Hindus have been doing pilgrimages for 6,000 years. The Catholics and the Christians have been doing it only for the last 2000 for the obvious reasons. But pilgrimage is a very important thing because one of the things that we need to understand is that one of the barriers to our spiritual development is that we think of it as a task. We think of our religiosity, our faith, our getting in touch with ourselves spiritually. It's just, it's a bunch of work. And who's got the time, I mean, reading ancient texts, sitting in meditation, praying, you know, being in communion with other believers. What a hassle. Right? And the truth of the matter is that only when you can cross the concept from task to opportunity, from responsibility to adventure. Can you actually understand the deep import of this for our lives and a pilgrimage brings this to life.

Arthur Brooks (00:47:39):
So everything is a metaphor. There's a pebble in your shoe. Well, that's your next problem at work. You've got a blister. Somebody broke up with you. One foot in front of the other because you're getting to Santiago and Santiago is a certain point of your life that's not more important than any other, and yet is the place you're going to go and just understanding yourself. I'm telling you, Phil, I'm never going to be the same. I recommend it to everybody, that we think about pilgrimage because you'll understand your life that much better.

Phil Jackson (00:48:09):
Absolutely. You know, wow. Sorry. I'm about to start talking with you.[

Arthur Brooks (00:48:18):
Let's go more. [laughter] Let's keep going man.

Phil Jackson (00:48:19):
I just wanted to tell you about the pilgrimage that I took with some kids from my parish in Detroit. We made the pilgrimage to Croagh Patrick, which is the Holy Mountain of Saint Patrick and on the West coast of Ireland. And it was quite an experience. I'll tell you later. Let me ask you this question. I like this one. How could new graduates prioritize building happiness when planning for their future?

Arthur Brooks (00:48:49):
It's imperative that they do exactly that. And one of the ways that we do that is by remembering some of the basics that we talked about before. So remember that the challenge and the opportunity in life is not money, power, pleasure and prestige. It's not. It's faith, family, friends, and work where you can serve others, lift other people up. Now the first thing that people are thinking about, that graduates are thinking about when they're going out into the labor market is what's the best job for me, right? I mean, those are the lucky ones, by the way. I teach graduates. I teach MBA students at the Harvard business school and they're all working like crazy. There's no problem with that, but it's a tough labor market. So I'm sympathetic to that. But in the best of times it's what's the best job for me.

Arthur Brooks (00:49:32):
And the answer is that in which you can serve others, in which you can earn your success or you can sense your own accomplishment. Thank God we live more or less than a time and place where people can make a living, where we have opportunities, where we have options, where we have labor markets, where we can make that so. But even when we don't, it's the opportunity of our lifetime to surround ourselves with work, with worthy endeavor that we can sanctify, that we can offer up because we're serving other people. And because there is a sense of actually doing something meaningful, doing something that creates value. And I don't care if you're folding laundry, you're taking care of children, you're volunteering or working for an investment bank or your professor at Amherst College. It's really all the same. Earn success and serving others. That's the most important criteria to be thinking about. And the sooner that we get that straight in our heads, the sooner that we can do, the sooner that we can be able to manage our unhappiness and managing ecosystem of happiness that we can bring to other people, which is really beautiful and sacred thing to do.

Phil Jackson (00:50:38):
Is there nothing sadder than the thought of going through a life at the end of which we can discern no meaning.

Arthur Brooks (00:50:49):
A lot of people do this. A lot of people find this., One of the things I'm writing about, you referred to an article I wrote in the Atlantic last summer about professional decline and I'm actually writing it up into a book right now that'll be coming out next year. It will be out with Penguin and I'm just learning so much. I worked on it all day today and I'm learning so much. I'm talking to people who, the biggest problem with the midlife crisis that people have with their work is that they're really good, they're really accomplished, but they don't have purpose. They don't have meaning. And the only source of meaning is not going to come ever, ever from the money or the power or the prestige or the fame that actually comes from it.

Arthur Brooks (00:51:31):
Those are false idols. It's interesting. There's a party game. You know that when we talk about this, and again, this comes from the ancient Dominicans who talk about the substitutes for joy. And the substitutes for God. Money, power, pleasure, honor, which means prestige and fame. And I'll ask people, what's your idol? And put them in order. So money, power, pleasure, fame, easy to remember. What's the one that you're least attracted to, right? What's the one that doesn't attract you at all? For me, it's power, right? You know, I was president of a think tank in DC for 11 years. It was a chore to have power other over other people. And I hate it when people have power over me. So it's easy for me to pat myself on the back, you know, Hey, I'm super virtuous.

Arthur Brooks (00:52:12):
I don't care about power, but let's move up the line a little bit, right? And it turns out that all of us can recognize this idol that we fought, that we're in thrall of. And it's an interesting, it's a dangerous thing. Don't fall prey to the idols. Remember that your true bliss is going to come from the four virtuous goals: faith, family, friendship, and work. In other words, love. Different manifestations of love. Work is love. Family is love. Friendship is this platonic love. That's at the heart of really what brings meaning. And faith is love of God and God's love for us. Or if you're a secularist, even if you're an atheist, it's love for all of your surroundings so that you can bring more good to others. It's such a beautiful thing to remember that. Again, I'm saying, I've fallen prey to the idols many, many times. I'm just struggling, struggling like everybody else to get my priorities in order.

Phil Jackson (00:53:09):
What...oh, sorry, I keep being tempted to ask you my questions. Let's see. How about this question? Someone writes the effects of COVID-19 are

Phil Jackson (00:53:26):
so overwhelmingly negative for so many. How can they find happiness in the midst of it?

Arthur Brooks (00:53:33):
So one of the greatest...well there are basically three complaints for people who are not in harm's way. In other words, they're unlikely to suffer grave danger from the disease--death--or lose their jobs. Thankfully most people are not in the situation of dying or being permanently unemployed or even temporarily unemployed. Many people will, and this is a different situation, but I'm talking about most people who are suffering despite that, the reason their sufferings cause basically three things: disappointment, uncertainty and loneliness. So disappointment is basically, and again, we probably have some seniors at Amherst who are watching us, and my son is a senior in college. My oldest son is a senior in college, graduating from Princeton and you know, he's home like everybody else.

Arthur Brooks (00:54:25):
He's doing his precepts and his lectures online, he's writing his senior thesis and he's super disappointed. He won't admit it because he thinks you know, graduation. Who cares? That's just a piece of paper. He's super disappointed and everybody's disappointed. Look, I'm disappointed. I travel. I do. I do 175 speeches a year. I live to get on stage and talk to people and meet people. I'm at the 99th percentile of extroversion. Everybody, I'm looking at a camera right now, but I'm thinking of you and I love you. It's pathological practically. So I'm really disappointed at the stuff that I'm not doing. People are missing...they missed Easter, Passover, their weddings. The problem is that they're thinking about it in the wrong way because disappointment is not the same thing as regret. Regret is something that we'll ruminate on so that we can learn from it and behave differently.

Arthur Brooks (00:55:18):
Disappointment is a very similar cognition, but it doesn't involve your agency. There's nobody watching me here who's responsible for the COVID-19 epidemic unless you were patient zero and even then you didn't do it on purpose. So ruminating on what you're missing, all of this is reinforces disappointment. So I recommend that people start the day with an empowering reminder. I am disappointed. It is true, but I didn't do anything. So therefore I should not face regret. And as a result of this, I choose to move forward. Uncertainty is the same kind of thing. We have a tendency to mistake the uncertainty around this. We don't know what's going to happen with risk. Something we can manage. How do we try to treat it like risk? We binge on news. We watch three or four hours a day of CNN or look at the Johns Hopkins coronavirus website. But that's a mistake because you can't do it. And the same thing with loneliness. We can manage loneliness by understanding the social, psychological basis of it, by understanding that we need more contact with the people that are touchable and more eye contact by using Zoom and getting off of social media. But a little knowledge goes a long way.

Phil Jackson (00:56:26):
Wow. That's good stuff. That's good stuff. What about this one? What trends do you see in the changes of college students' want list during this pandemic?

Arthur Brooks (00:56:41):
I'm doing my office hours on Zoom every day. I've learned to use it, we've all learned to use Zoom. I'll set up my, I'll be sitting here at my desk and, and I'll have a queue and every 20 minutes I say goodbye to a student and I let another student in from the waiting room. And actually it's good as far as it goes, but I'm hearing a lot of the same lament and that really is a lot about, about seeing people. And they're sorry they didn't appreciate the value of cohort enough, they don't appreciate what it meant to be in community quite enough. And now it's gone. They've said, you know, my graduating MBA students, they're leaving. They're going to go off to their jobs.

Arthur Brooks (00:57:28):
They're not going to see most of their class again until they come back for their reunions. And they're really, really sad about that. And they're also suffering because they're in quarantine. Some of them alone, most of them are not alone. So I wind up giving a lot of the same advice and it's something we just touched on a minute ago. Not to be too technical about it, but there's a neurotransmitter that functions as a hormone called oxytocin produced by the human brain. And you get it in response to touch and with eye contact. And when you don't get it, you physically suffer, you feel lousy. And so people will say, I wake up and my back hurts and I don't feel rested. And the reason is because you're not getting enough oxytocin. So one of the things that I'm telling students, I'm telling everybody, is that you actually need a 22 second hug therapeutically every two hours to maximize your oxytocin levels.

Arthur Brooks (00:58:18):
So if somebody is touchable in your environment, go touch. I've got a 17 year old daughter here and she's like, get away from me, but my wife fortunately is not shunning me. This is what it's like to live with a social scientist. We've got to hug now. The other thing is to get more eye contact. And that means using this technology. I talked a minute ago about social media. Social media is social junk food. To get the oxytocin that we want is like empty calories because you don't get very much with social media. No eye contact, no touch. So people will binge on social media because their brains hurt and they wind up feeling actually lonelier. So everybody watching us, you should limit your social media consumption to a total of 30 minutes a day and then therapeutically used Skype, FaceTime and Zoom and other eye-based technologies for one to two hours a day. And in doing that and with your 22-second hugs on the two hour intervals, you're going to start feeling a lot better.

Phil Jackson (00:59:12):
Wow. That's good stuff. I think we have time for one or two more questions. Let me ask this. One of the qualities you mentioned aren't evident in our national leaders. Do you think they are making a bad situation worse?

Arthur Brooks (00:59:32):
So it's a good question. I contemplate this a lot. I moved from Washington D C last summer. I kind of got out of Dodge and I'm liking it. I've got to tell you, the problem is that we tend to get leaders that reflect us. I don't want it to be true. I'm a professor of Public Leadership at Harvard. I want leaders to be so visionary, and so inflecting, and so entrepreneurial that they bring society along with them for the better. But that's not the way it works generally. Just like in market economies, companies give us what we want more or less. And sometimes it's bad. You know, private markets give us poison gas and pornography stuff that shouldn't exist. Why? Because it's profitable. Why do we have leaders that are antisocial, dysfunctional that reflect our worst characteristics?

Arthur Brooks (01:00:24):
It's because we reward it, you know? Again, we're in a moment of polarization. I understand. We're at a unique time, a really tough time, but it's in our hands. My last book is called Love Your Enemies. Why? Because I'm completely convinced that we can re-inflate our culture. How? By reaching out to people who disagree with us, who challenge us, who maybe even offend us and treating them with love. It's interesting. When I say love, I'm remembering, is to will the good of the other. It's nothing sentimental about that. Dr. King in 1957 he said, in Matthew 541, Jesus said, love your enemies. He didn't say like your enemies because like is a sentimental something. It's a hard thing. But to love them, that's what actually will create the market signals, can create a new social movement during this coronavirus epidemic locked down. By the way, we can change society by demanding something better, by looking within ourselves, by coming out of it better than we went in. And, you know, will it be overnight? Will it be magic like that? No, but I'm actually kind of convinced that--I'm hopeful at least--that good times are going to come, but we're not going to be talking so much about leaders who bring out ou worst angels forever.

Phil Jackson (01:01:38):
The last question. I'm going to stay with that book. Could you tell the story that you tell about the Black Lives Matter gentleman, and the gentleman from the, I forget who the group was, but they're on the National Mall and I think it was maybe the second amendment group or something. Could you remember that story?

Arthur Brooks (01:02:05):
Yeah, I do. It was in September of 2016. No, September of 2017. It was a Trump rally. It was called the Mother of all Trump Rallies with a whole bunch of very pro-conservative and Trump groups, bikers for Trump, voters for Trump, et cetera. And a Black Lives Matter group showed up. Black Lives Matter in greater New York as a matter of fact, which is run by a guy named Hawk Newsome, the guy who's become a great friend of mine since then. He comes with his group and this is going to be trouble. He's got his fist raised in the air, and the bikers for Trump, I mean this is combustible. So the people who were there did what you always do when you want to make things better.

Arthur Brooks (01:02:53):
You take out your cameras and start filming so you can put it on the internet. It's the worst of society. But so there's a million film clips of this. But what happened was not what anybody expected. What happened was the guy who was running the rally saw Hawk Newsome. I mean he's hard to miss. He's six foot five. He's a huge guy and he's decked out in Black Lives Matter gear, and he ended up, the guy running it, he sees him up on stage, says, why don't you come up here and tell the crowd what you're all about. This is America and I'm going to give you two minutes of our platform and see if you can make your case. Now Hawk Newsome, this guy is a really super serious Christian and he says to himself, it's in God's hands. Lord Jesus Christ,

Arthur Brooks (01:03:31):
Give me the words, put them into my mouth. And he walks up on stage and within two minutes he went from them booing to them cheering, Bikers for Trump, cheering for the head of Black Lives Matter of greater New York. How did he do it? He did it by saying, I love this country. I want what's better for this country. I'm an American, I'm a Christian. He made unity with this group that he didn't agree with. Nobody came away from this thing saying, Oh boy, you really convinced me. And Hawk Newsome didn't say, why those bikers for Trump, they're making a lot of sense. No. But they understood that they were brothers and sisters because of the unity that came from the things that from their shared, their common loves. He also made the case,

Arthur Brooks (01:04:14):
He explained the Black Lives Matter movement in a way where people were actually listening and not booing. And you know what's my point? You can say he did it wrong. You can say he's wrong. The bikers for Trump are wrong. The point is this, my friends, is possible. Loving your enemies is not a theoretical construct. It's not pie in the sky. It's not ridiculous. People laugh it a generation after generation, but look, it changed the world 2000 years ago and it can change your life and my life today. You've just got to do it. You got to be a little radical. You got to be like Hawk Newsome, go where you're not invited. Say the things that people don't expect and do it with warm heartedness, answer contempt with love and maybe magic is going to happen. It did that day. I think it can happen again and I think we should all be down with that. We should be trying to make that kind of our goal.

Phil Jackson (01:05:05):
Arthur, this has been a true joy for me. I cannot thank you enough. I hope I will get to see you at some point. Maybe in New York City.

Arthur Brooks (01:05:14):
We'll make a point of it, Phil. They're going to let us out. They're going to let us out sooner than later. And you and I are going to break bread and we're going to be friends for a long time and I appreciate it.

Phil Jackson (01:05:27):
Oh, well, thank you for being with us. I want to hand it back over to Madame Biddy. Would you take it from here?

Biddy Martin (01:05:36):
Thank you, Phil. Thank you both so much. What a wonderful conversation to listen to in on.Thank you so much for being here, Arthur. We really appreciate it.

Phil Jackson (01:05:50):
Thank you, Biddy.

Biddy Martin (01:05:52):
Phil, thank you. What a wonderful interlocutor you are. We have a final event for now on Thursday at five o'clock, I'll be asking questions of Zeke Emmanuel, Amherst class '79 and oncologist and bioethicist who is also Senior Fellow at the Center for American Progress and Vice Provost for Global Initiatives at University of Pennsylvania. So please join us, and everyon,e stay well

Zeke Emmanuel (00:00:11):
Hello, everyone. Thank you for joining us. We're in for a treat today. We have an hour with Dr. Zeke Emmanuel. Zeke is an oncologist and a bioethicist. He's also a Vice-Provost at the University of Pennsylvania. He's one of the best known and most sought after public health experts in the country. Many of you know that he was one of the architects of the affordable care act during the Obama administration. He is a Senior Fellow at the Center for American Progress. He has many more gigs for tonight, but we have him for an hour and we're delighted. Welcome, Zeke. Thank you so much for doing this.

Zeke Emmanuel (00:00:56):
You didn't say that I was an Amherst class grad of ’79.

Zeke Emmanuel (00:00:59):
Well, I'm getting to that. Not only were you a graduate of the class of ’79, you were a chemistry major and then you went on to get a medical degree and a Ph.D. In political theory from Harvard and it shows in your work, I think, all of that. Zeke, I just want to start for a few minutes on a personal note. I took the opportunity to read your memoir, Brothers Emmanuel, and I thought I would start there. It's an extraordinary account of extraordinary lives and extraordinary parents and families. You said you attribute the success of you and your brothers in part to your parents' art of jazz parenting. And I thought I would just start by asking you to explain to our audience what the art of jazz parenting is.

Zeke Emmanuel (00:01:57):
I think my parents were quite creative. I would say, I think I went on to say my mother was the sort of opposite of a helicopter parent. From a very young age, she would shoo us out of the house and make us find our own way and allow us to explore the neighborhood and do our own thing and have a set time to come back. We lived about a block and a half from the beach in Chicago and a large part of our summer, she would take us to the beach, plop us down, with a lot of food, towels, and tell us when to come back home. No cell phones. We had to occupy ourselves and figure out how to get on in the world.

Zeke Emmanuel (00:02:52):
And it was kind of a great arrangement. They did have a very high standards for what we should do. Expected us to take initiative. They instilled in us a very strong sense of social justice. My mom was very, very early on, involved in the civil rights movement and before the rest of the country and the anit-Vietnam war movement. She was very, very, sometimes I say violently against the war, but she was very militantly against the war. My father was very committed to getting rid of lead paint because he was a pediatrician and saw the ravages of lead paint and led a lot of efforts. He was also strongly committed to universal healthcare coverage. He did not understand the American system of denying coverage to many people and, and resigned the AMA over their opposition to Medicare and Medicaid expansion of coverage in this country.

Zeke Emmanuel (00:03:53):
That was a theme that we understood and were basically communicated that we had to do. The other great thing I think they did for us as part of this jazz parenting is for a lot of the time it was the three brothers together. We spent a lot of time together. We played together. They took us on summer vacations. It was us. We slept in the same bedroom for many, many years. We had to negotiate our complex relationship and the power dynamics. Anyone who's had siblings understands the complex power dynamics between kids for recognition, for attention, for time. But that was very, very important. And it's one of the reasons that my brothers and I remained extremely close. We talk multiple times a week all together. I think this sort of free form was very important. I will say one other thing and to all the people who are either--my mom was a, this was the early sixties, actually, I was born in the late fifties. She was a big believer in Dr. Spock before it became popular. Even when it was despised, and I think many of his philosophies of expressing love and affection to kid, and providing them support without providing the, heavy-handed directing what they would do, was very important to our growing up.

Zeke Emmanuel (00:05:30):
Zeke, just for the benefit of our students. You also write in the book that when you went to Amherst you discovered you were an Emmanual and you had a friend named Andy at Amherst to help you understand what that meant. It is a transition, isn't it? We all in a way learn what it meant to be in our families once we make that transition. Are you still in touch with Andy?

Zeke Emmanuel (00:05:58):
I spoke to him yesterday.

Zeke Emmanuel (00:06:01):
Okay. So he's still helping out with the transition?

Zeke Emmanuel (00:06:04):
Very much so actually. He's been a figurative uncle, uncle to my daughters. He's very much still in our lives.

Biddy Martin (00:06:14):
Wonderful. All right, well let's switch to COVID because that's what everybody wants to hear you talk about. And so do I. The news changes every day, but the state of the knowledge of the virus, and where it's headed, also seems to change. It's a complex. Is it a complicated virus or is it just that we haven't yet figured out, we haven't had enough time yet to figure it out?

Zeke Emmanuel (00:06:42):
Actually I don't, I think by virus standards it's not that complicated. I think the uncertainty is how it interacts with the body. The kind of clinical conditions it produces is complicated. How we shed it, how it actually is producing the damage in the body. We understand that there's a hyper immune response, but exactly what the components of the immune system are going out of whack and seeming to produce all the complications we see, whether it's clots or the lung, acute respiratory distress syndrome or now the auto-immune syndromes that seem to be popping up, why it seems to have this a very strong age gradient such that it's people over 65 who 80% of the mortality is concentrated in that group, what kind of co-morbidities that are associated with the worst outcomes, whether they're diabetes or hypertension or obesity.

Zeke Emmanuel (00:07:45):
I think these are all mysteries because we have not had a COVID virus, a coronavirus, excuse me, that has really had this negative impact on so many people. A lot of Corona viruses we get are relatively benign. We often don't even know we have the virus. And then SARS came and infected a number of people and killed about 775 people, but then disappeared. So there was no real followup. I think its mystery is more that we just don't have enough experience, clinical or virological of this particular kind.

Biddy Martin (00:08:30):
Yeah. And we don't have reliable therapeutics. But the testing is getting better. Is that accurate?

Zeke Emmanuel (00:08:39):
Well, we're getting more testing. True. That is both necessary if we're going to get a handle on this and a good thing. I would say the serological testing certainly at this moment. So the serology testing is the testing that you do to see if someone's been exposed and has antibodies to COVID-19. Those tests are like the wild West out there and you have no idea whether what you're getting is any good. I think there were a couple of bad judgments by the FDA on sort of permitting the wild West as opposed to making sure that every test had a sensitivity and specificity that they've now put in place, and hopefully that marketplace will become more regulated and ordered over the next four weeks or so, so that you know the quality of the tests you're getting. And that if it says you don't have antibodies, you don't have antibodies. If it says you says you do have antibodies, you actually do have antibodies. I mean, we are getting some good news. There's a report out today that it does look like everyone who recovers from COVID-19 infection does develop antibodies. Even if some people are a little delayed in that process. How long they last, we still don't know, and how protective they are. We still don't know.

Biddy Martin (00:10:01):
Yeah. And the testing for the virus, you and I have been talking about whether it will be as widely available and as capacious as all of us need it to be to open up. What are, what are your thoughts now about how quickly we're ramping up in the testing for the virus?

Zeke Emmanuel (00:10:25):
We're doing better. I think we can say that. We're still not at the level that I'd say that almost all the experts agree--several to 5 million tests a day. To really be sure that people are infected and we need them in, if not in real time, at the point of care, the way the president has it, then at least in real time that you need the results in 24 hours, not seven days. Can we get there? Of course we can get there.

Zeke Emmanuel (00:10:55):
This is not trying to send a man to the moon kind of problem that'll take eight years to solve. But it has been a problem. Part of it is, again, a lot of the people who would normally get in and solve this problem are sitting on this, have been sitting on the sidelines because they're...why get revved up for something where the market's going to go away in a couple of years when we have a vaccine, and I've just spent all this capital investing in revving up for the agents, new machinery, et cetera. That makes no business sense. As an economist, a health economist friend of mine said, that's not a problem that can't be solved. We know how to solve it. It's called money. Guarantee them that we'll pay for the revving up and we'll pay for the revving down, and switching, the focus afterwards.

Zeke Emmanuel (00:11:50):
That's kind of necessary to get people to commit. And we need that commitment to actually get not only the machines in place, but the supply chains that we need in place to provide the reagents and all the other stuff around it. Actually, I think it was yesterday, I talked to venture capitalists out in California, got the entire process robotically done. 24 hours a day, I think he said, his machine, for a hundred thousand dollars, could could do 2,400 samples reliably. You know, if we had 1a thousand of those machines, we'd be well on our way to solving this problem. Doesn't really require any human input. I think that that's a money problem. That is a, you know, commit the capital and we could have it. I think Congress has been, for whatever reason, partially because there hasn't been the right leadership in the White House, hasn't, I mean we've allocated $33 billion to testing rather than say $250 billion, which would certainly have solved this problem.

Biddy Martin (00:12:58):
Well, that's interesting because I certainly, we hear a lot of criticism of the federal government and Congress for the delays. I hadn't really understood, I don't think until he just said it, that there are people on the sidelines who could have been doing more, but for the risk of investing in something that might go away, but that makes total sense. Are people now investing in it with the realization that it's wise, necessary, and also wise business?

Zeke Emmanuel (00:13:34):
I think a big capital investment for a two year time horizon is not a wise move for a lot of businesses and it's not necessarily good. I think they have become convinced, and understanding that that was the barrier, something that should have been done, and the task force should have had, and it should have been part of rescue bill two or three. There was $33 billion put in for testing, but that's a small amount of what we need. That's roughly a hundred dollars per American for the testing. That assumes one test per person, not multiple tests over time per person, which is very likely what we're going to need going forward. I do think the proper planning and the proper understanding of what the demands for this kind of pandemic were going to be just didn't seem to filter into the legislation.

Biddy Martin (00:14:33):
Zeke, do you have a view on whether it's even worthwhile to talk about whose fault all the delays are? Is it China, is it our administration? Is that an even even a worthwhile conversation? And if so, do you have a view of how one gets at that?

Zeke Emmanuel (00:14:54):
It is a worthwhile conversation to the extent, not for today necessarily, but to the extent that we want to learn from this episode for preparedness for the next episode. You've got to know what do we have to do, what mistakes did we make, why didn't we take this seriously enough? Or why did some people take it seriously, but not others? Because this isn't going to be the last viral or some other serious threat. It's just the latest. It may be that, you could say in 2019, Oh, 1918, 1919, that was then, we're safe from it. That obviously is a mistake. It may not be an influenza pandemic. It may not be a COVID pandemic. Who knows what the next one will be, but we can be pretty darn sure there's going to be a next something.

Zeke Emmanuel (00:15:51):
We had SARS in 2003. We have H1N1 in 2009, 2010, we had MERS Zika, Ebola, COVID. If you can't see the pattern there, maybe you're not looking hard enough. These things, yes, some of them get burned out, but they're pretty serious and we can't tell what the next one's going to be necessarily and how serious it is, how easily transmissible, how deadly it is and when, in the cycle of things, it's going to hit. So learning what those signs are, having early warning systems, knowing what does preparedness mean, what do we have to put in place? Which agency's responsible? How are we going to coordinate it from the White House? All of that is I think, a necessary post-mortem to be done here. We used to, when I was growing up, have these big problems and we appointed presidential commissions, whether it was the Warren Commission or the Kerner Commission on civil rights, to study these things and come back with recommendations, that's probably is a useful item to do here. I'm not sure in the midst of trying to fight this pandemic. That's necessarily the first place I would start, but we should not say that's just past history. Let's move on. I don't think now is the time to do that investigation, but we should not ignore that investigation.

Biddy Martin (00:17:20):
What about the ethical dilemmas that have arisen in the treatment of the virus and a range of other domains? You're a bioethicist. You're writing about these ethical dilemmas, or you've written about them obviously before. What do you think are the

Biddy Martin (00:17:41):
most compelling, the most important ethical dilemmas this COVID-19 pandemic has created for us?

Zeke Emmanuel (00:17:50):
I began writing on the ethical dilemmas on pandemics in 2005. My first publication was in 2006 because there was that year that I mentioned that Secretary Lovett had his pandemic planning commission. They came out with a preparedness plan. I heard about the plan, listen to it, and I realized that their philosophy or their approach to allocating scarce resources during an influenza pandemic, especially vaccines, therapeutics like Tamiflu, that was wrong. They had prioritized first responders. But then the next group was the elderly with comorbidities who would likely die from a influenza pandemic, would be the most likely to die. I said, hmm, that doesn't sound right to me. You probably want to be saving kids first, because they have more life years. So we wrote an article on it and then I spent the next 15 years both writing about how to think about allocation of scarce resources when you had to choose between patients, whether it was for organ transplantation or for people during a pandemic, a therapeutic among people or a vaccine among people.

Zeke Emmanuel (00:19:08):
I taught a course at the university of Pennsylvania on it, every year, called, Rationing and Resource Allocation. I've been wrestling with that problem. And interestingly, when this came up, we had a framework for applying to this problem. We wrote it up in the New England Journal and circulated it. And I think there's been, I won't say universal consensus, but a pretty widespread consensus about that kind of framework, who gets priority and who doesn't. Probably some people out there will be loathe when I say I think that ethical problem has been solved. That may be overstating it a bit. But I don't think that's the most pressing ethical issue going forward. The most pressing ethical issue going forward is one I'm working on now, which is we're not going to have an unlimited amount of vaccine when, if we've discovered a vaccine, that is effective.

Zeke Emmanuel (00:20:05):
We're going to have a limited amount of vaccine and there are big ethical problems there. Now some people may be thinking, oh well the big ethical problem is who gets it first? I think again, we've solved that. It's going to be first responders. And then we're going to look at people whose lives can be saved, and a variety of other criteria. But the big issue is going to be, well, you have a limited amount of vaccine. How do you distribute it among all the countries? Cause you're not going to be able to immunize 7.8 billion people right away. And it may actually take years to immunize 7.8 billion people. If you look at what the production capacity for various vaccines is. The question is, how do you distribute that vaccine? How do you make that decision? I'm a little less interested in how you make that decision. I'm more interested in the substantive principles of who's first on the priority list, who's second, who's third, who's fourth? Really hard problem because not only is it domestic justice and domestic ethics, but it's international global between nation States and that's even harder. We're trying to work on that problem.

Biddy Martin (00:21:17):
Yes. And speaking of what's just and fair and right, we've certainly seen a whole set of inequities in this country and internationally highlighted by the effects of this pandemic. How does that play into your thinking about resources and allocation?

Zeke Emmanuel (00:21:40):
Well, it is, I mean, one of the things this pandemic has done is to highlight the inequities, both the disease burden of the rest of society and also, health inequities in terms of coverage and the delivery system. Doctors and hospitals and access to care. I'm here in Washington, D.C., 45 to 49% of the population is African-Americans. 79% of the deaths are African American. That has stayed pretty stable. What causes that? Well, probably, let's be honest, we're not one hundred percent sure, but probably three or four things all coming together. One is the comorbidities which we know put people at higher risk. As I mentioned, diabetes, hypertension, obesity are more prevalent in the African American and other minority communities. That is playing into this, those are related to lots of inequities in diet in this country in ability to exercise, in educational attainment, and other things.

Zeke Emmanuel (00:22:51):
Serious problem playing itself out in the COVID context. There's inequities as we know in access to healthcare services, the distribution of hospitals, the distribution of physicians, the access to health insurance, that we've had for a long time in this country. That probably plays into this as well because many inner city hospitals are not as well as equipped. Patients don't have a primary care doctors and don't get the kind of care over time for their chronic conditions. Third, there's inequity around housing issues. There does appear to be a strong relationship between crowding and housing, close family gathering, arrangements and spread of COVID. And we know that the housing arrangements for minority communities and poor communities is much worse and probably lends itself more to a spread of the virus. And last, there's also this information absorption and trust in the whole society as well as specifically the healthcare system and the willingness to believe that physical distancing is important,

Zeke Emmanuel (00:24:06):
wearing a mask is important. So you take all four of these things, each one of them to some degree a result of the socioeconomic and racial disparities in this country. And they're all compounded in the COVID case to lead to much worse health outcomes. We can talk all about equalizing attention once you're in the hospital to treatment for COVID in terms of getting into the ICU and getting a respirator and if remdesivir actually works while getting remdesivir, but that's chicken feed compared to the underlying socioeconomic disparities that go to, in our society and for racial minorities. And that has to be addressed if we're actually going to get even more equalized, the health outcomes, both the COVID and [inaudible] to all the other conditions that people suffer from.

Biddy Martin (00:25:05):
Before I turn to questions from the audience of you, you've just given a good segue to healthcare reform and you've played a major role in the past. Where's your thinking now? Not about what could be done immediately, but what's your thinking now about healthcare systems?

Zeke Emmanuel (00:25:25):
It's ironic that we should be talking about that just after the president has called for getting rid of the affordable care act. You know, 22 million fewer people would have had health coverage in 36 States. People who've lost their job would not have access to Medicaid if we went to the pre-ACA days. One of the things that COVID has made clear, we've now have, whatever, 35 million plus people who've lost their jobs. Tying health insurance to employment, really crummy idea. We really should probably not be doing that. Or if we do it, we need a much better safety net so that if someone loses their employment, they instantaneously have very adequate health coverage. And unfortunately, we don't have that in this country yet. It's especially problematic in places that have not expanded Medicaid,

Zeke Emmanuel (00:26:29):
the 14 states like Texas and Georgia and Florida that haven't expanded Medicaid. But I don't think the American public has a tolerate any longer, not having universal coverage and a system that really works. And I do think that the employer-sponsored system will shrink. If we provide an adequate alternative, a lot more people are gonna find themselves in that adequate alternative. Bernie Sanders-style Medicare for all, I don't think is going to...it's too contentious. I don't think it's going to happen. We could go to some other kind of Medicare expansion like vice president Biden has talked about, decreasing the age. I think actually, allowing all sorts of competition, for private insurance or regular old Medicare, fee for service, traditional Medicare as we call it. I think that could be an alternative. We could have Medicaid for anyone who doesn't have either Medicare or employer sponsored insurance and just fold everything into that. I think we're going to have a serious need for some alternative that is comprehensive going forward. And I think there will be a big push from the American population for that, especially when you have these 35 million Americans who were working, who never imagined that they would be unemployed all of a sudden, literally overnight, finding themselves without a job and without, in many cases, without health insurance. I think that is going to force change in this country.

Biddy Martin (00:28:10):
That's an excellent point. Let's just talk for a minute. I'm told I have a few more minutes to ask questions. Given that there's not federal coordination, which States do you think are doing a good job of opening up or of declining to open up?

Zeke Emmanuel (00:28:24):
I think probably, one of the best certainly was, both getting on top of the virus, decreasing the actual impact and now looks to be having the best situation may be Washington State. Jay Inslee, the governor there listened to his epidemiology people right after they had that death. In quick succession they found that high school kid who was infected, with no known association to China, and then a death in the nursing home. They jumped on it. They asked Amazon and Microsoft and other companies to send workers home and have them work from home, impose physical distancing and what the public health officials call NPI-- nonpharmacological interventions. They have done a remarkably good job of skating through and having a limited number of, that's and a low number of new cases per million population.

Zeke Emmanuel (00:29:35):
If you had to pick out one where the response has been good and really does seem to have been pretty textbook as far as the country goes, Washington state is it. Two things seem to have characterized that, first they were, quote unquote, lucky in that they had an early case that was detected and they had an early death that I think shocked people and brought them into this is serious and let's do what's necessary. And they had a governor who listened to his public health community, and a public health community that was well-informed, well-trained, understood what was necessary, understood what the messages had to be, the importance of the consistency of the messages. I think Georgia is a textbook example of the opposite. You have a governor that doesn't seem to listen to public health people, even though the CDC is located in his state and Emory has a phenomenal school of public health.

Zeke Emmanuel (00:30:40):
He was shocked that people could be spreading the virus and be asymptomatic. I guess not paying attention. First thing he opens up our barbershops, tattoo parlors, beauty salons, places where you need close physical contact for over prolonged periods. Probably not a wise move. There are some parts of the academy that can be opened up. Probably his rate of infections was still going up as he was opening up the state something with even the president's plan for opening up the country did not recommend these. They recommended 14 days of decline. I don't think, I personally don't think that's an adequate standard, but even that minimal standard was not met in Georgia. So that's a model of how not to do it.

Biddy Martin (00:31:37):
Let me go to some of the questions from our viewers. One asks, how will our response be different if there is no vaccine? There is no vaccine, but I think if we have...

Zeke Emmanuel (00:31:54):
That is a very black day if we're not able to develop a vaccine relatively quickly. We will have prolonged, serious, adverse events for a long time because you're going to have to physically distance for a long time, or we're just going to have to let it run through the population, have very high mortality rate in the population. Then we have to assume that you have prolonged immunity. If you have short-lived immunity and it's constantly running through the population, that gets you more to a sequence like the black death where the plague went through and every few years you have these big eruptions, all very high death rates over centuries. That would be an incredibly awful situation. So let's best not think about that. Okay.

Biddy Martin (00:32:55):
Here's an interesting one. The World Health Organization says that those who are infected may not be immune. You addressed this a little bit earlier saying that there was an announcement today about antibodies, but not necessarily of immunity. Why would a vaccine provide better immunity?

Zeke Emmanuel (00:33:14):
I don't think the World Health Organization said that those who get infected and recover are not immune. I think what they said is we don't know. It's a very different. It's not that we're sure they get infected, they get antibodies, but they're not protective or they don't get antibodies and they're not immune. We don't have that the other link in a large cohort of people, which is you get infected, you generate antibodies, which does seem to occur. And yet that the antibodies in general are not protective. That would be, again, a very bad situation for us because it means that you're constantly under threat of dying from COVID, of getting infected and dying from COVID. That would be a disastrous situation for us actually. So one of the reasons we think of a vaccine is possible is that people do develop antibodies and we hypothesize that those antibodies are protective at least for a while.

Zeke Emmanuel (00:34:18):
We can give people a vaccine. They will develop protective antibodies. It may be that we have to re-immunize them periodically, maybe even as frequently as every year. But you know, that's uncharted territory and we have to see how long the immunity lasts and how frequently we'd have to immunize people. Let's just say if it's an annual immunization, it's going to be tough because we know from influenza about two thirds of kids get immunized every year, but only about 45% of adults get immunized every year. And that's too low for herd immunity, which was one of the reasons that on an annual basis we get somewhere between 30 and 60,000 deaths every year from influenza. It's not the only reason, but it's a contributing reason.

Biddy Martin (00:35:09):
Here's a question, Zeke, about the ethics of mandating vaccination. What are the ethics of mandating vaccinations?

Zeke Emmanuel (00:35:18):
We should do it. We certainly can. There's no two ways about the question that we can mandate it for kids, everyone up to 18. I think above 18 you could mandate it because from an ethical standpoint, you're being immunized is important for my health and your spreading it to me. And so I think we can, from an ethical standpoint, easily say that people need to get it to protect the wider community. I am not a lawyer. Sometimes I practice one on TV, and as I understand it, I think it's Prince versus Massachusetts, if I've got it right, from the turn of the 20th century that said, yes, you can require adults to get immunized for the protection of the wider community, for the public health. I don't think this is a hard one, frankly.

Zeke Emmanuel (00:36:16):
It's certainly not a hard one, ethically, in my opinion, and I don't think it's a hard one legally given that precedent, and I know that the anti-vaxxers are already out there. I've always wondered, you know, why do we let them do that and endanger us and then also demand resources from us to treat them when they're sick because of the exposure to a virus that they could have gotten a vaccine for. Part of the problem I think is, and one of the things COVID is curing, if I can put it that way, people who are slightly older than me experienced widespread serious illnesses that were life threatening or if not life threatening, like polio, very, very life-transforming, in a negative way. They understood the value of vaccines.

Zeke Emmanuel (00:37:19):
They got rid of this scourge. I know from when I was growing up how frightened parents were of polio. I was really a first generation of kids who got polio and my parents didn't have to worry about me in the summer. Parents, you know, the generation just older than me, it was a real worry. Every summer, vaccines were a godsend to those people. If you look at the lines of kids for the polio vaccine, getting it in school, I mean, people were just so thrilled that they could protect their kids. And then we became complacent. You know, childhood became very, very safe, not totally safe, but very safe. And people became complacent about the value of vaccines and the value of preventing things like measles, mumps, diptheria. That shows you what happens in human beings when these threats are taken away. We forget the value while they got taken away because we have vaccines and you no longer have to confront this terrible, horrible illness that's life threatening. So I think COVID, if anything, has probably convinced a lot of people were on the fence: mandatory vaccination, probably a really good idea.

Biddy Martin (00:38:37):
Zeke. Um, a related question. How, how do we protect ourselves from disinformation?

Zeke Emmanuel (00:38:51):
I'm a physician and a bioethicist. You're asking me about, you know, the scourge of the internet and every false statement out there and how easy it is to spread a false false statements. Not only how easy it is to spread false statements, but the fact that it's easier to spread false statements and hysterical statements than it is to spread the truth because it requires more understanding to reason through the truth. Look, I'm a guy who it doesn't do Facebook, doesn't do Twitter, doesn't do Instagram precisely because I'm fed up with all of the, and I've never done them by the way, but I'm fed up with all of the how easy they are to sow disinformation, how easy they are to be plagued by...how misinformation is much easier to travel and to be retweeted and recirculated. These are horrible, horrible problems from this technology. And I don't know that we have a solution to that problem, but get off the damn thing. It's also not good for your productivity or your concentration.

Biddy Martin (00:39:58):
All right. Dr. Emmanuel. Well said. By the way, should

Biddy Martin (00:40:03):
colleges and universities

Biddy Martin (00:40:05):
be using Apple and Google apps that allow tracking of contacts, is that a good idea?

Zeke Emmanuel (00:40:14):
I think you mentioned, Biddy, that I'm a Senior Fellow at the Center for American Progress. And we released a report, I think almost exactly a month ago, about how to do testing and contact tracing and how. We do need technology to help us with contact tracing. But we can't entrust it to Apple, Facebook, Google, we need to use the data and the capacities that they have, but we need a trusted intermediary who is using that data to help with contact tracing, that trusted intermediary. We've made a proposal that it should be, I think it's the American Society of State and Territorial Health Officers, or the Association of State and Territorial Health Officers. They would get the information, hey would destroy the information after 45 days when it was no longer relevant to contact tracing, they would pledge not to commercialize it, not to merge it with other data, to not to keep a shadow, a record once they destroyed the data. I think there are ways of doing this in an ethical manner. Giving Facebook and others the power, I don't think so.

Biddy Martin (00:41:35):
Zeke, here's a question from an alum who says, I am 72. This is my 50th reunion year. What do I need to do to remain safe?

Zeke Emmanuel (00:41:47):
To remain safe, stay at home.

Biddy Martin (00:41:48):
Stay at home. We cancelled reunion. Stay at home.

Zeke Emmanuel (00:41:53):
Stay at home, especially if you're over 65. I mean, can you go out? Yes, but you've got to make sure you're not near anyone else. You're wearing a mask. You wash your hands the moment you get back in. You know, I live in Washington D.C. and literally I'm blessed because right out my front door is a part of the National Park, Rock Creek Park. I can walk down there and avoid people. I can ride my bike and be away from people. You've got to find places you can go out and at times of days you can go out and really go out and exercise and get some fresh air. You also have to be aware of staying away. It does appear, let me just say, that the casual contact, walking past someone six feet away with both of you having masks, on probably no sharing of the virus. In closed spaces where you're with someone new for a prolonged period of time, those look to be the problem areas.

Zeke Emmanuel (00:43:01):
So I would expect that for restaurants to come back, one of the things that might be wise is for outdoor seating, widely spaced, everyone wearing a mask, except while you're eating, is probably going to be the necessary ingredient. Being indoors [in restuarants], probably not that smart of a thing.

Biddy Martin (00:43:21):
Here's an interesting question. What is the ethical framework for developing risk tolerance for opening up?

Zeke Emmanuel (00:43:30):
I don't know. I'm not sure there's an ethical framework for that. I do think what we need, and many of us are stumbling towards that, my group at Penn included. We've got some very smart people working on this. We need the right model that tells us how many deaths and hospitalizations and complications, how many people get unemployed? How much does the GDP go down. Based upon various measures that we put in place, where those measures, we can see if we tailor them to this age group or we tailor them to this group of people with comorbidities or we open the schools. What's the impact on health? What's the impact on economics, et cetera. That complex model is what we need. It is a matter that now people will have different risk tolerances. Some people are risk averse and they really want to reduce the risk as much as possible.

Zeke Emmanuel (00:44:29):
Most of us are not consistent in doing that. We do things that are much more risky than other things. For example, we drive cars even though that's a pretty risky activity. But we don't do other things, say fly, which is typically safer. At the other end, some people are more risk-tolerant. I'm probably at the risk tolerant end. I do a lot of things that most people probably wouldn't do. I don't know, I mean we have to make clear what that trade off between number of lives, hospitalization, economics, unemployment, and the level of imposition is. We're going to have to reason together. This isn't something for each individual. This was something as a society as a whole, when do we open up, under what conditions, how much pain in terms of economic dislocation is that going to cause?

Zeke Emmanuel (00:45:22):
That, I think is where it goes. I'm not sure that it's an ethical framework over risk tolerance. People do naturally diverge in their risk tolerances. And let's face it, in a free society, where we want people to live a life that they can choose, we want to recognize that. We want to embrace people. We want to allow them to have that kind of difference. We don't want them to impose the consequences of that on the rest of us in terms of infecting the rest of us with COVID. You know, they do have to pursue their own life in a responsible manner that is aware of how it might increase the risk for other people. I hope that's a coherent answer.

Biddy Martin (00:46:05):
I thought it was completely coherent. There's a question about protestors calling on governors to end lock downs. I guess I would ask, given what you've just said, I'll just make a statement and you see what you think. It's hard in this country for some people to combine individual freedom with a sense of responsibility. How does one think about the confusion that emerges when people believe freedom in this country should mean the right to do whatever one wants regardless of its impact on others. I mean...

Zeke Emmanuel (00:46:41):
Well, we know about that. We know that that phrase that you just said, Biddy, is false. Your freedom. You can do whatever the hell you want no matter what its impact on others. That is a false phrase and we ought to take it more seriously. That we want to embrace your freedom. We want to celebrate your freedom. We want to give you the opportunity to exercise your freedom, but it has to be done in a way that doesn't impose costs, unacceptable costs, on other people at all. And that, I think, we haven't done in a consistent way, but we definitely need to do it in a consistent way. Let me just say something about the people who are protesting in state houses and demanding things open up. Maybe I'll say two or three things about that. The first thing I want to say is all the data, and there's some recent economic models that have just been produced within the week, suggest that fully opening up,

Zeke Emmanuel (00:47:35):
it's actually not the most optimal situation from an economic standpoint. Forget from a public health mortality, health care standpoint, purely economically, it's not the optimal thing. Some lockdown, some shelter in place, some physical distancing, some prohibition on gatherings actually saves you more money. Why is that? This is my second point. All the data suggest that people are not going to participate in commercial activity. Businesses are not going to stay open if people are afraid of getting COVID, right? I ain't buying a new set of jeans if I'm risking dying. That's just not a calculation people are going to do. So we, by imposing some of the public health measures, we actually inspire confidence in people and allow them to engage in routine activities. So we do need some public health measures for maximal actually economic activity. That's what all the models suggest.

Zeke Emmanuel (00:48:45):
That's what behavior suggests. There's recent data out that shows that economic activity went way down before the shelter in place orders by states were issued, which means that the public behave, even if the government did issue the stay at home orders, because people were not going to risk their lives for economic activity, going to a restaurant, going to a bar. If you want to open those things up and stimulate economic activity, you need some public health measures and you need a degree of confidence that people aren't going to get infected. And that's, I think a point lost on those protesters. All of us want to open up the economy. The question is to do it in an intelligent manner that protects the particularly vulnerable, and opens up the activities that are least risky first and most risky at the end, when we're going to understand more and maybe we'll have a therapeutic and maybe a vaccine.

Biddy Martin (00:49:46):
Yes, which leads to a question that I'm afraid to have you answer, but I'm going to ask it anyway and you'll say whatever you want. What is your specific advice to the Amherst community and other colleges about reopening?

Zeke Emmanuel (00:50:02):
[laughter] Should we reveal our secret, Biddy?

Biddy Martin (00:50:05):
I mean, you I have agreed to be one of my advisors and you didn't agree to be an advisor to everyone on this call but you go for it.

Zeke Emmanuel (00:50:15):
So, there's a spectrum from we're going to come back in the fall. We're going to have full online classes, full in-person classes. The students are going to live in the dorms, to at the other end, we're not going to have in-person classes. We're going to do everything online. Let me say, I think the former--we're going to have in -on classes for a full semester in the usual manner--I don't think that's viable. Why don't I think it's viable? We are going to have a second wave, whether that second wave is in, call it: July, August, September. Who knows. If we do have a big second wave at that time that would mainly be caused by this premature opening before we have a suitable testing regime, before the number of cases have gone down.

Zeke Emmanuel (00:51:06):
If we don't have it, then we're likely to have it in early fall, October, November, December because it's fall and people are going to do more circulating. We're going to have a flu season that's going to compound the problem. I think, though, the fact that we're likely to have a second wave during this is going to make it unlikely that we're going to have a full semester. So that leads to either we do it all online or we try to have this controlled togetherness where there are lots of safeguards in place. What are those safeguards? Well, students who are at high risk because they have a comorbid condition, don't come back. Students are tested, are asked the quarantine for 14 days and tested when they come in. We do institute a physical distancing measure in terms of how we hold classes.

Zeke Emmanuel (00:52:02):
We put kids in pods and ask them to remain in pods. It's going to be a different in person experience. That experience, I would suggest the idea that you do it in September and it's going to carry all the way through, call it Thanksgiving or further. Pretty unlikely, in my humble opinion. And so I think you have a plan, ability to say, alright, after the three weeks you're going home, and we're going to then transition to online learning. And if at three weeks things are looking fine, we're not seeing any increase, we've had a few cases amongst students or staff of COVID, but nothing terrible. Then maybe you continue it for a few more weeks and you play it week to week and everyone understands the situation you're in and everyone's willing to be flexible.

Zeke Emmanuel (00:52:53):
I think that's a possibility. It does. Your risk tolerance and your ability to live with an ulcer has to be high to do that. But I think it has certain advantages. It also has certain risks. Completely online I think is a problem from a pedagogic standpoint. I think it's a problem from students' standpoint. I think that's the range in which our discussion and deliberation needs to go. Here we are, what is today, May 6th, seventh, eighth. I know I've lost time, but we're not making that decision today and you shouldn't make that decision today. It's a decision that you would only make further down the line when you understand a little bit more on modeling what the campus can tolerate in terms of physical distancing, what the food hall can tolerate in terms of shifts and things like that. I think there's a lot of things that need to be assessed before you can finish that evaluation and make a final determination. And from what I know, not just of Amherst and other small colleges, but the big university that I'm a part of, everyone is gathered in the information gathering mode and everyone is putting that decision down before making a lot more scenario planning and evaluation of where is the epidemiology over the next couple of months.

Biddy Martin (00:54:24):
Thank you. Now two more questions. First, one from our audience. How would you build trust or how can we go about building trust among disadvantaged groups, disabled people or fat people who are worried they'll be refused necessary care?

Zeke Emmanuel (00:54:44):
I don't think it's a matter of refused necessarily care. Look, in our personal lives, all of us understand that trust is built up over time. It's not a one and done kind of thing. Right? You blow trust, you create this trust once. Trust is something that has to be built up over time. You have to walk the walk and you have to do things consistent with what you say you're gonna do. And I think that is what we need to do for minority communities. Frankly, it's what we need to do for the population as a whole. We need to have leaders who say what they're going to do, do it and apply it, not just to them, the voters, but to to themselves. So I'll just give what I take to be a simple no brainer: wearing a mask.

Zeke Emmanuel (00:55:39):
We've got good evidence. The CDC recommended it, although its recommendation has been a little watered down. There's a good reason. Is it foolproof? No. Is it an element that can reduce risk to some degree? Yes, we ought to all be wearing masks when we go out. I just think that's a no brainer. Modeling good behavior is really important. Physical distancing. We talk about six feet apart when you have a meeting, have people six feet apart. I don't want to be partisan here, but contrast the president's coronavirus press conferences with governor Cuomo's press conferences. Look at the crowding onstage versus we have a table. Everyone is six feet apart at the table. Night and day.

Biddy Martin (00:56:35):
All right. I know you have to go soon. I promised one of our faculty members about whom you said some very nice things that I would ask the following question.

Zeke Emmanuel (00:56:45):
Oh. And I get to say nice things about him again?

Zeke Emmanuel (00:56:48):
If you want to, only if you want to., Zeke, you wrote a piece sometime ago in the Atlantic in which you said living to 75 would suffice for you. I think you stated it a little more strongly, but I'm putting it in a tender way. And you gave your reasons why you thought that would suffice. I think we need you around far beyond your 75th year. I'm asking you to rethink that proposition.

Zeke Emmanuel (00:57:19):
[laughter] First of all, that's Austin Sarat who I have to say, I learned a huge amount from Austin about how to teach and how to get students really engaged. Austin used to put his face about two inches from my face and scream at me. I don't do that, but I do remember he used to scream questions and push you to give good answers and defend your answers. I do do that. And as I say, he was a very big inspiration in helping me understand how I learned and how I could help students learn. And so I'm always indebted to him for that. The second thing is I'm not at 75 and don't count your chickens before they hatch. You have no idea what a blithering idiot I might be at 75. There are many people who think I'm a blithering idiot now.

Zeke Emmanuel (00:58:12):
But one of my worries, so the best argument I think you can give against me at this very moment in time is Tony Fauci. Tony Fauchi is 79 and talk about a guy who's completely copos mentis, contributing, coming up with new ideas, developing policies, being totally creative. That's the guy. And if I were that at 75, I probably wouldn't reconsider my position, but my position is about curative medical treatments if I had cancer or something like that. I think that's a little different circumstance. It's not about I'm not taking any medication. It's not about, I'm not taking any medical care. But it does give you a sense of trying to think through what in life is valuable, what in life is meaningful to you, what is the reason you want to live and continue to live?

Zeke Emmanuel (00:59:09):
And that gets into what I think and have seen a lot of, which is sort of narrowing or coning in on life so that your ability to do less and less and less, ability to have meaningful relationships, ability to meaningfully contribute, ability to engage in meaningful activities has, slimmed down and you have to, you know, because we always accommodate to our situation. You accommodate to that. I'm not willing to do that and I think, I want to be a contributor as long as I can, and as long as I can, if I were Tony Fauci and being as amazing as he is at that age, that's a completely different circumstance.

Biddy Martin (00:59:56):
Well, I think we can count on that then. I'm very optimistic based on that. By the way, at the end of your book, you said your parents gave you, all three boys, an incredible sense of purpose and that you have had a life of striving. And then you said, perhaps, ironically, that when you each realized that you were satisfied with what you had achieved, you would be true adults. So have you reached adulthood, Zeke? [shakes head] No. Okay. I haven't either. [laughter]

Zeke Emmanuel (01:00:34):
You can evaluate your life in retrospect. It's what keeps me going. There's always more to do, more to learn, more to experience. I hope I'm not satisfied prematurely.

Biddy Martin (01:00:52):
I don't think there's any, any risk of that. Zeke, thank you so much. I know you have to go to a show. I really big show now and I just want to thank you. You're terrific. And this was a lot of fun and very informative and thought provoking and thanks to the audience for being here with us. Be well.

Zeke Emmanuel (01:01:11):
Thank you. Stay safe. It was a lovely interview, Biddy. I really appreciate the questions.

Biddy Martin (01:01:17):
Thank you. Bye. Bye. Bye.

Zeke Emmanuel (01:01:28):
Bye.

Biddy Martin (00:00:07):
At Amherst, David [Kessler] was part of the independent scholar program. He went on to earn a law degree at the University of Chicago before earning his medical degree from Harvard Medical School. Welcome, David, and thank you for being here. Dr. Harold Varmus, class ’61 was the co-recipient in 1989 of the Nobel Prize in Physiology of Medicine for studies of the genetic basis of cancer. He is the Louis Thomas University Professor of Medicine at the Meyer Cancer Center of Weill Cornell Medical Center in New York City. He's also Senior Associate Member of the New York Genome Center where he helps develop programs in cancer genomics. He's also adjunct professor at the Macaulay's Honors College at the City University of New York. Harold was Director of the National Cancer Institute for five years. He was President of Memorial Sloan Kettering Cancer Center for 10 years and Director of the National Institutes of Health for six years.

Biddy Martin (00:01:12):
He serves on numerous advisory groups for academic, governmental, philanthropic, and commercial institutions. He's authored hundreds of important scientific papers and five books, including a 2009 memoir entitled The Art and Politics of Science at Amherst. I'm pleased to say Harold Varmus majored in English and he went on to receive an MA in English literature from Harvard University before deciding to go into medicine at Columbia. Hosting and contributing to today's conversation is Amherst College trustee Shirley Tilghman, who is an honorary degree recipient from Amherst College in 2008. She's a professor of molecular biology and public affairs and president emerita of Princeton University. Shirley was a founding member of the national advisory council of the human genome project for the National Institutes of Health. She's received many, many awards as well, including a lifetime achievement award from the society for developmental biology. She serves on the Science Advisory Board or the Chan Zuckerberg initiative. She's director of the Broad Institute of MIT and is a Fellow of the Corporation of Harvard University. On Tuesday this week, just two days ago, she was selected by New Jersey's governor, Phil Murphy, to co-chair the state's restart and recovery commission, overseeing the timing and process of reopening the state after pandemic related closures. It's a great honor and a gift to have you all here. Take it away.

Biddy Martin (00:03:00):
Shirley.

Shirley Tilghman (00:03:03):
Thank you, Biddy, and good evening, everyone, who are listening to this and watching this podcast. I'm going to just launch right into some of the questions that I think are on many people's minds that our two experts have a great deal to say about. The first, I'm going to direct to Harold. This is not the first time that we heard the ’coronavirus.’ What did we know about coronaviruses before this pandemic and what do we need to learn about it now?

Harold Varum (00:03:42):
I think, Shirley, many people were surprised to learn that the so-called new virus was actually a member of a large virus class. There were hundreds of isolates that correspond to the term coronaviruses. They are named, as I think many people have recognized now, because of the glorious pictures that are on the news hour and other places, that coronaviruses have what looks like a crown of thorns around their entire spherical body. Those spikes on the surface that you see next to Judy Woodruff every night are proteins that the virus uses to enter cells. These many viruses inhabit a wide number of host species. They're not only found in human beings, although we know of at least four such viruses that have been causative agents of common colds as known for many years.

Harold Varmus (00:04:41):
But these viruses, as I think probably all of the listeners are aware, can be found in bats and pangolins and camels and tigers and many and many other animals. So that's one of their extraordinary features and it makes them at one level, somewhat akin to the influenza viruses that are also found in many species, and indeed their ability to hop from species to species and then infect human beings is one of the reasons they pose a risk to us. And indeed there have been at least a few other outbreaks, most famously the SARS outbreak and the MERS minor epidemic several years ago that have introduced coronaviruses to the general public. This one is different from the others in many regards. When you look at an evolutionary tree, you find that it's incredibly closely related to the SARS virus that was found in Southeast Asia 2003. A lot of what we've learned about this virus class has been one of many ways that science has prepared us for dealing with this epidemic. And I'm sure in due course we'll get into the issues of what that long history of studying coronaviruses has meant for this epidemic.

Shirley Tilghman (00:06:03):
What I'd like David to comment on is, despite what Harold has said, it seems that both the SARS and the MERS epidemics did not sort of produce a kind of canary-in-the-mine alert sign that would have made us better prepared for this. Why do you think that is?

David Kessler (00:06:26):
I think if you look at the epidemiology of both MERS and SARS, the fatality rate, the degree of infectivity, the human to human transmission, sort of waned after the initial outbreak. I mean, I went back yesterday in talking to the people who are developing monoclonal antibodies against, COVID-19. The good news is there's a lot of experience and they were working and doing these monoclonal antibodies. This is true also, certainly, for the Oxford group on their adenovirus vector vaccine. They were doing trials in the mid-East, and there wasn't enough epidemic to even continue to test those agents effectively. It didn't really hit us. I think if you ask Harold what people were really worried about, the virologists that I know and talk to, they were losing sleep. They expected a pandemic to come, but it was going to be influenza. It wasn't gonna be a coronavirus. I think that mistake or that lack of insight because when we saw the coronavirus, people were really focused on influenza being the overwhelming virus and not coronavirus.

Shirley Tilghman (00:08:14):
Harold, you wanted to add something?

Harold Varmus (00:08:16):
I'm going to go back to your question about preparedness. There's really two kinds of answers here to deal with this question of the difference with SARS and MERS. The first has to do with the question of anticipation. You know, David's right, there's been more concerned about flu in general in most virological circles, but we all recognize that there are lots of viruses out there that can cause a lot of damage. And it's not just flu that keeps most virologists up. Highly virulent viruses like ebola, the recurrence of coronaviruses because we know there've been a lot of coronavirus, but one of the things that society has failed to do, despite repeated warnings from scientists every time we have a pandemic, is to get our surveillance case together.

Harold Varmus (00:09:05):
We have incredible tools now for looking very widely at what's in animals, what's in the environment, what is the causative agent of some unexpected illness occurring in some remote place. There are so-called high throughput ways using remarkable sequencing technologies to look anywhere that you see signs of disease or unusual virus spread and find out what's out there. This surveillance mechanism, which wouldn't be incredibly expensive, has been proposed over and over again. We've not done anything about it. The other question though, the other side of this question is how is this different from MERS and SARS? And one very important thing I think we'll come back to, has to do with the course of infection. I think it's important to separate infection from disease because especially in the case of this virus, infection is followed by several days in which people don't feel symptomatic, maybe two days, maybe six days, maybe 28 days. And during that period people have a lot of virus, a very high virus titer as we refer to it, in the upper respiratory tract, in the nose, in the mouth, in saliva. People can just be speaking and they spew out droplets, some of which are very small and can float very slowly

Biddy Martin (00:10:24):
[inaudible ]vectors of transmission in a way that I think is quite different from what was true of MERS and SARS, which tended to cause disease more quickly. Without this prelude period, in which people are feeling pretty good and transmitting virus.

David Kessler (00:10:38):
Therefore, because of what Harold said, the infectivity is less, I think because that asymptomatic period puts everyone at much greater risk.

Shirley Tilghman (00:10:54):
So the question I was going to ask David is how unusual is this asymptomatic period for this coronavirus? It seems to me that, that there are two curiosities here for someone who's not an epidemiologist or a virologist. One is the degree to which asymptomatic people seem to be contributing to the spread of the virus. The other is the invulnerability of children.

Shirley Tilghman (00:11:24):
With influenza, the two populations that are most vulnerable are the very young and the very old. With this virus, it seems that the very young are relatively protected from infection. Why is that? Do we know anything about that?

David Kessler (00:11:40):
Let me take the children as a pediatrician and Harold is a virologist can maybe talk about viral shedding and being asymptomatic. Shirley, I don't think we know yet the full story of how this affects children. There are two very conflicting views today. Switzerland--and please don't do this, for the grandparents who are listening, please don't follow what I'm about to say, because I have some concerns about it, but the chief epidemiologists in Switzerland say it's okay to hug your grandchild if that child is under ten. They did not encourage family gatherings. The German epidemiologists jumped on that. I don't think, that doesn't quite make sense to me. We are starting to see, and we have to worked this out, in young children, this kawasaki-like disease that that's basically a hyper immune stimulated disease in young children that we think may be associated with this virus. That we're just beginning to see cases, certainly in Italy and elsewhere, and we haven't worked that out. I think the answer is we don't fully understand the story when it comes to children. Harold, do you want to go ahead?

David Kessler (00:13:28):
It has greater concerns. I mean, because it's a constellation of symptoms that you do see after certain viral illnesses that are not the virus but the actual immune stimulatory effects that are associated with this virus. I think it's very early, but I think when you look at coronavirus, I almost see this course, this disease as two phases. And again, I think it's very early, but it's very important for how we're going to therapeutically approach this disease, right? You talked about the asymptomatic period prior to the onset of symptoms, but even with the onset of symptoms, you have certainly this viral phase of fever and cough.

David Kessler (00:14:36):
And then sometime around day eight, nine, 10, sometimes the second week, in some individuals, they crash. They have increasing [inaudible] requirements. They have difficulty, increasing shortness of breath. They end up being intubated, put on a ventilator, many of them several days later. We don't fully understand this second phase of this disease because it's the second phase of this disease that overwhelms the lungs. Is it the reaction of the lung tissue to the virus? Is it a viral toxicity? Is it a hyper stimulation of the immune system? Is it due to [inaudible]? Is it due to even the ventilator? We haven't sorted this out. The good news and the real good news, cause it would certainly be reminiscent, to me, going back 30 years, when we've had the first drugs on HIV, the announcement yesterday on remdesivir that showed biological activity. Clearly that's the first antiviral. If that will work, and hopefully we'll find other drugs for other targets and combination therapy of maybe multiple antivirals, it maybe likely that they work early. But we also are going to need to have drugs for this second phase. And again, I don't think we know the mechanism. It may be IL-6. I think we have to think about combination therapy and understand the course of this disease.

Harold Varmus (00:16:27):
Before we get back to therapy, which I think we should discuss in somewhat more detail, let me get back to your original question for this segment about kids. Two points I'd like to make. The first is that we simply haven't done enough testing of people who don't have symptoms because of the shortage of available tests for the virus to know the answer to your question about why kids clearly have less of the now garden variety version of COVID-19. We just haven't tested that many children to see whether they're getting infected less frequently. They clearly they have less clinical disease but why that is not apparent. The second issue has to do with things that David was speaking about and that has to do with our failure to understand fully the pathogenesis of this disease. We still don't know because we haven't tested enough people.

Harold Varmus (00:17:22):
How many people actually get sick? We don't know why certain people get sicker than others. We know that there is a clear age dependency that the older you are, the more obese, the more likely that you are to get severely ill. There are a number of other so-called comorbidities, hypertension, diabetes, and a few others. But what's even more interesting and striking is that there are a number of aspects of this disease which are totally unexpected. You can see in people who seem to be virtually asymptomatic, diffuse shading of the lung fields on chest x-ray. We don't fully understand what's going on there. People are frequently experiencing low oxygen, as David mentioned, without feeling short of breath because they're getting rid of their carbon dioxide because of the way this virus seems to affect the lungs. And then there are a lot of other manifestations of the disease including strokes and circulatory insufficiency in several organs, disorders of the kidney that are apparently caused by this virus or by the immune response to it that are very unusual. We just don't understand enough about why kids in particular don't seem to have disease and we don't know what the epidemiology of infection is. And it's important in this conversation to make a clear distinction between being infected with the virus and producing virus and being a carrier and actually having symptoms and being said to have COVID-19, the disease.

Shirley Tilghman (00:19:01):
I mean an issue that clearly is dominating the national discussion about this pandemic is the need for intensive testing. So the question I would ask both of you is why in the most scientifically advanced country in the world are we finding it's so challenging to develop the kind of testing capacity that we need to do, the two things that I think both of you have been talking about, to identify who has the disease, who is carrying the virus and who is carrying it in the population with asymptomatic.

Harold Varmus (00:19:42):
Let me start this one. And I think the word testing, first of all, has to be modified in every case by what you're testing for. When we say the word testing, what most of us are referring to is testing for the virus, but there is a whole other category of testing that David and I both want to say something about which is testing for a host's response to the virus. We're looking for antibodies that say, yes, this person has been infected at some time in the past. When you're testing for virus, you know, traditionally in virololgy--and I think this is a teachable moment as they say, for letting the people who are dialed in today to know something about the history of testing for viruses. What was done traditionally is you go to the site of disease, the lungs, the respiratory tract, and you see if there's a living particle we call a virus particle, which can infect cells and destroy them, copy and multiply itself.

Harold Varmus (00:20:43):
No longer do we do that routinely. What we do is we look with much more sensitive techniques that have been developed over many years of being molecular biologists, as all of us are. And that involves simply being able to detect the so-called chromosome of the virus, which in this case is a very long strand of RNA. We have methods. Some of them are from your terms like polymerase chain reaction, PCR and those methods allow us to see even very, very small numbers of a virus, particles that contain the viral genome. The reason we don't have enough testing going on is testing for viruses, incredibly important, it tells you who's infectious, who might be able to transmit this virus to somebody else. And we don't have enough, not because we didn't identify the virus quickly. Indeed, compare the speed of which we found this virus just a couple of weeks after the first cases appeared and the speed at which we had a complete count of the nucleotide sequence of the genome just a couple of weeks. Extraordinary. But there was a defect in the supply chain, the of tests, people were being unreceptive to the idea of using someone else's test. And we really failed to understand the epidemiology of this disease despite this incredibly powerful set of tools we have for being able to test the viral genome and say that there are virus particles there. But we'll come back to the serologic testing later.

David Kessler (00:22:20):
I think that if you look at the root of the delay, why did we lose a month or five or six weeks, till we were able to get testing to begin to get ramped up, is that if you look what happened, CDC decided, as it does many times, not to take the WHO tests. They were going to develop their own diagnostic. The FDA went in and saw from the beginning that there were contamination problems with the way CDC was making that diagnostic. So when it sent out these tests kits, they didn't work. There were problems. And I think both agencies really didn't get the urgency, certainly in February and even early March. These are generally, and certainly my old agencies are pretty conservative

David Kessler (00:23:33):
"small c" scientific agency, likes to get things right. It said to CDC, you know, there were problems, but no one got the fact the house was on fire. It took weeks for someone to say, hold it. We have a national emergency. Now, once that happened, things shifted. But I really think that we underestimated, I mean, certainly CDC and FDA now, there were those, if you look at the emails that have come out, there were those who were literally screaming at the top of their lungs in their emails, that this is coming, this is coming. Shut down. But, I think CDC and FDA for that five, six-week period before they figured this out, we're just flatfooted. And I regret to say that. I understand why testing is so important. Can I just go over to make sure everyone understands why--and let's stay with what Harold's talking about testing for the virus itself.

David Kessler (00:24:45):
In the absence of a vaccine and the absence of a therapy, what is this about? There's an infected person, there's a susceptible person and for the virus to be transmitted, there needs to be an effective contact. The only tools we have, I mean really when it comes down to it, is can we reduce the number of infected people. Well, if they're asymptomatic and they don't even know they're infected, you've got to test them, you take them out of the system, but in order to take them out of the system to quarantine them or isolate them, you need that test. The other tool we have is just to reduce the contacts we have with each other. In the absence of a vaccine,

David Kessler (00:25:33):
that's all we have now. Those two tools, for the last 200 years, are very effective public health tools, but you can't reduce the number of infected people without testing. As much as it was a mistake not to have testing early on, and we became overwhelmed because we really weren't able to contain this virus early on. We didn't have the testing to take those isolated cases and shut them down. Now testing has become equally important because we have no idea how many infected people there are out there. And I don't know how you open up. Maybe [signal lost].

Harold Varmus (00:26:32):
Someone's sending you you've talked too long. I didn't do it. Not me.

Shirley Tilghman (00:26:46):
While we try and get David back, David has said that the magic word 'vaccine,' which of course is something that is on everybody's mind, but before we talk about the vaccine, I think it would be very important to talk about what do we know about the human immune response to this virus that would suggest that a vaccine would actually be successful. Harold.

Harold Varmus (00:27:11):
This is an incredibly important, maybe the most important question we can discuss tonight. Let me say first of all that we are deeply ignorant of the potential for making a vaccine [inaudible], because we need to recognize that although we know there are antibodies produced in response to this virus and to infection by it, we don't actually know whether those viruses have the potential in all cases to either reduce the effects of a virus infection or to prevent infection entirely, which is the common principle objective of making a vaccine. But there are some encouraging signs. First of all, we know that some patients who have antibodies actually have antibodies that neutralize, that inactivate the virus. We know this because we can take the serum from a person who's been infected and we can show that that serum will prevent the virus from infecting cells in laboratory cultures.

Harold Varmus (00:28:16):
So that's encouraging. Secondly, people have identified specific components of those antibodies and shown that they are highly effective in blocking infection. Third, people have done experiments in primates, other nonhuman primates showing that antibodies can protect against infection. And then you can actually make a vaccine that works in rhesus monkeys that protects against infectious challenge. We also can observe that patients do clear the infection, how the immune system is doing a lot of things, as David has already mentioned. We know that the immune system appears to play a pretty intense role late in the disease when the disease is particularly severe. We don't know exactly what the lethal components of that reaction might be, but it seems to be a reaction that includes some attack on the virus itself because virus titers become very low and eventually people who had the infection and have recovered are free of any evidence of carrying a live virus.

Harold Varmus (00:29:25):
So all those things point to the idea that the immune system can control this infection. Now there are two questions. How well does it do that? How long does the recovered patient remain resistant to reinfection? And those are really important things we need to learn because they're going to inform how we approach vaccine development. And secondly, they're going to give us an idea about how long we're going to be dealing with the virus called SARS COV-2. Some epidemics go away and we don't hear about the virus very much again, if at all. In this situation, we just don't know whether we're going to be seeing this virus SARS COV-2, or some closely to the related version of this virus that's undergone a few mutations, call it SARS COV-3 and 4 and 5 in subsequent years because the immune system doesn't have a good memory for this kind of agent.

Shirley Tilghman (00:30:30):
So Harold, are there urgent experiments that need to be done to develop answers to those questions as the vaccinologist are developing an effective vaccine?

Harold Varmus (00:30:43):
They're huge numbers of questions, some of which could be approached simply with the tools that we already have, questions we've been thinking about such as the true transmissibility, the true prevalence of the virus. And what we need to do there is scale up the availability of tests. We have this point, a pretty good system for testing people who have symptoms, to see if they have COVID-19. But we do have, methods thanks to a number of amazing developments in the world of genomics and other kinds of molecular biology, some remarkable new ways to go about screening large numbers of patients who seem perfectly well to find out how many people in the population in New York and in Sioux falls and California have actually been exposed to this specific virus.

Harold Varmus (00:31:36):
I hope that we'll be able to sort that out pretty soon. Secondly, we're going to be able to do the testing on such a large scale, because of things that have happened in world's very different from studying infectious disease, the worlds of genomics, and so-called high-throughput DNA sequencing where machines have made it possible to test literally millions of people a day to get a much better picture of how much of the population is infected and able to transmit virus with time. We'll be able to do large scale tests for antibodies to tell us whether people have actually been infected in the past. And we'll eventually get a picture of the demographic of this virus that will allow us to feel more confident about whether we should be opening up our economy.

Shirley Tilghman (00:32:40):
One of the most recent studies was done by the New York public health department that did a survey of 3000 New Yorkers and discovered that roughly 20% of the population of a random selection of the population within New York City showed signs of having been exposed to the virus. Upstate, it was much lower. That's hardly surprising given that the city is the epicenter of this pandemic. How, as a new Yorker, Harold, how does 20% feel to you?

Harold Varmus (00:33:19):
Well, first of all, I have to question the result a little bit. It's not entirely clear that the test was perfectly accurate. There've been a lot of tests put out in the market because the FDA agreed that these tests could be used fairly widely without being subjected to the kind of evaluation that they normally would be subjected to. And many have found that many of these tests are unreliable with large numbers of false positives and false negatives. Secondly, the population of 3000 that were selected for testing were not a totally random population. They were people who asked for tests. So let's say those 3000 people were asked in shopping malls and other marketplaces, so they're not a random population. They were people who were more likely to be out, either flaunting the rules or just doing the shopping that's within the rules, but they weren't the people who were confined at home. So there's probably an overestimate, even if you believe the task was accurate. Nevertheless, let's come back to the question of New York. Let's assume for a moment the 20% number is correct. What we're all looking for, of course, is enough immunity in the population to believe that we've established what's called herd immunity, where so many people have effective antibodies against the virus that the virus simply can't any longer spread through the population, in fact others who might be susceptible to its effects. And you generally thought to need about 70 to 80% of the population to be infected to establish this thing we call herd immunity. And we're nowhere near that yet. And that's of course in the epicenter of this epidemic. And everywhere else in the country, the numbers are closer to 2 to 5%. So when Tony Fauci says, make no mistake, if you let down all of these, behaviors that have been shielding us from a wider spread of infection over the next few months, there's going to be a recurrent increase in the number of people who were infected, the number of people who get sick.

David Kessler (00:35:44):
And that's why as you go and let down these restrictions and as people have more contacts, testing and contact tracing become even more important, right? Because what we did was we took our number, that reproduction number, whatever it is by sheltering in place, we reduce that. By stopping to shelter in place, we're going to increase it. The only way we can keep it under control by not sheltering in place is testing and contact trace.

Harold Varmus (00:36:22):
I think it's important for people to understand that there is another step involved when you move from what we currently have, which is most of us, like me up here in my house in the Hudson Valley. I'm pretty much confined to one person that seems to be amiable most of the time, and that's fine, to a time when more of us are back in society and being tested regularly to see whether we've contracted the virus and should go into quarantine because the adjacent step to identifying me and telling me to go into quarantine for two weeks is asking me who I've been in touch with, and not just by Zoom, but by real human contact and may have infected. That's going to require a whole set of caseworkers that our country doesn't really have at the moment. We're going to need people who can go and interview folks who've been identified by this mass testing and then go to the contacts and appropriately approach them. We're going to need to harness a large cohort of people do this kind of thing, and I think this might be a good time for us to consider some fairly radical steps that are not unlike what FDR did during the depression. Take people who are out of work put them to work, learn these basic social skills to do contact tracing, give them a salary because we've got to get our money moving again. We haven't said much about the social, economic and legal effects of all this. I know that other nights, but it's so closely tied to the kinds of things that we as medical scientists are thinking about that I think really has to be connected to the kinds of epidemiological protocols that we're discussing.

David Kessler (00:38:10):
I don't think we fully understand the extent of the viral burden in the United States. We are 4% of the world's population but we have some 25% of the cases that we can talk about reporting. But in part because of world travel, because we got hit on both coasts, people coming from Asia, people coming from Europe, we have the highest epidemiological curves in the world.

Harold Varmus (00:38:41):
I think it's interesting to think about that, David, because you know, the fact that we're wealthy and move around and you're out there, we're very social, this may make us very different than people in Africa and parts of South America and parts of Asia who you might think traditionally would be the ones who get the hardest hit. They're going to be hit later on, but the virus has to come to them. They're not out getting the virus, they don't have as many visitors coming to their countries. And our affluence has probably hurt us here. You look at where has this epidemic been dealt most acutely. In Europe, in wealthy parts of Asia and the US and there's a sociological aspect of that's important.

Shirley Tilghman (00:39:22):
So what I'm hearing, I think from both of you, is an answer potentially to probably the most common question that I'm getting on my Google doc here of questions that are being submitted by people who were viewing this, and that is, what is it going to take for us to be able to come out of our sheltering. And what I think I'm hearing, David, you saying very clearly that we have to have extraordinarily expanded testing capacity and contact tracing or we are going to be back in shelter again as we are now. Is that accurate?

Harold Varmus (00:40:06):
We lost you again, David. We lost you. So let me just say one thing in addition to what you just said What you said is very true. But there's one other thing that we as a society are going to have a very hard time coping with. And that is, it's not just having these extreme measures of either sheltering in place or having a lot of testing and contact tracing. We're going to have to have a change in habits, no handshaking, wearing of masks, gloves, being conscious of contacts and ways you might transmit the virus. And this is going to be in place for quite a while until we have one of roughly three things. Either we're going to have good treatment. That'll mean you don't usually die if you get this infection and people are going to be less risk averse if they're just not going to care about wearing a mask if they can be treated with an effective drug. Second, we might have herd immunity eventually. That will entail, at least an undercurrent circumstances, a lot of loss of life before we get there in my opinion. And the third is of course, the most obvious, and that's to have a vaccine. I do think that there's a reasonable chance we'll have a vaccine, but everybody keeps saying it'll be in 12 to 18 months. And yet of course we don't know whether we actually will have one, number one, how good it is or whether it'll be that quick. If we look at the history of production of vaccines, there aren't very many vaccines that've been brought to market into a wide population in such a brief period of time. We do have much better technologies. There are vaccine candidates that have been put into people very, very swiftly after this virus was identified. So I'm encouraged by that, but we also know that if we have to use a traditional kind of a vaccine that it could be two or three years before we have one. And that's a very long time in modern life.

Shirley Tilghman (00:42:04):
Can I asked you a question that one of our viewers sent in, which is I think an interesting one, which is, is there any evidence that coronavirus is mutating in the way that influenza mutates, which would put us in a position of having to create a new vaccine every few years?

Harold Varmus (00:42:23):
Maybe I should answer that as a virologist. These two viruses are quite different. For one thing, the coronavirus chromosome is one piece of RNA, whereas the influenza chromosome is in eight pieces of RNA and those pieces can get shuffled very easily. And furthermore, mutation rate for the two viruses seem to be quite different, but the influenza rate appreciably higher than the rate for the coronavirus. So, we know that mutations occur. In fact, it's one of the reasons we can do such interesting studies of the evolution of this virus. How it came from SARS COV-1 to become SARS COV-2, how we can distinguish not just strains that were in Europe that came to the States or strains that were in China that came to the States, but how, within a single community, based on just one or two changes in the 30,000 nucleotide genome, you can tell who got the virus from whom. That's going to be very important very shortly because we're going to be asking, I predict within the next several months, where there's someone who seems to have the appearance a second infection with SARS COV-2 has had a recurrence of the original infection or has been infected by somebody else who has a slightly different strain of virus. And we can tell from these subtle differences in the genome, which is the case. And I think people have to reflect on the power of modern science to be able to distinguish between an example of the virus that has only one or two differences in that 30,000 nucleotide chain.

Shirley Tilghman (00:44:14):
So Harold, a number of questions are coming in about an understandable anxiety about the reliability of tests, not just the RTPCR tests for the presence of the virus, but the serology tests and how are we going to get to a point where we have confidence that we have a test that will give us a highly accurate reading?

Harold Varmus (00:44:40):
Well, let me take the two kinds of tests separately. Tests for the virus are most likely to fail because there simply wasn't enough virus on the swab or the sample that was used for the examination. And that's just a biological variation that we're going to have to deal with by sampling people twice or three times rather than just once and because people will be infected and the virus won't be detected for reasons that are understandable. Those tests in general are quite reliable with a pretty high rate of a pretty low rate of false negativity at extremely low rates of false positivity. But with respect to the serological tests, the issue is more difficult. And you can imagine that without being a sophisticated scientist or an immunologist, why that might be. I've already mentioned that there are lots of other coronaviruses. If you're testing for coronavirus antibody in the blood, which is what you're usually doing, with a so-called serological test, if you've been infected with one of these other coronaviruses, the cause of the common cold and the test that you're using is not designed to be specific for this current virus, SARS COV-2. It's possible to have a false positive because you're detecting the residual of an infection that occurred years ago with one of these fairly benign human coronaviruses, and for other reasons, false negatives are also possible. It's going to be important to have careful regulatory oversight of the tests that come in common use. I understand why federal agencies might've been eager to get some tests into play and curtailed some of the usual regulatory oversight, but eventually a few tests will emerge as the most effective. It's quite easy to construct samples that we know do and don't have viral antibodies to be sure that the tests are being done properly and give a very low number of false negatives and false positives. But I think it's also important to stress, and I like to do this repeatedly, that when you're testing for antibody against the virus, you may have a very reliable test that tells you whether or not that person has been infected with SARS COV-2 in the past. But it doesn't tell you necessarily whether that person is truly immune to reinfection unless you have a way to show the antibodies that are actually neutralizing the activity of the virus.

David Kessler (00:47:33):
All our experience, and again, I agree with Harold, that we don't know the clinical question about clinical immunity. There's certainly a reason to believe that neutralizing antibodies may confer. We don't know how long, but certainly on past

Harold Varmus (00:47:56):
we went over this when you were having trouble with your, with your microphone.

Shirley Tilghman (00:48:01):
But David, maybe you can speak to the question about the reliability of the test. I mean, what role do the regulatory agencies have in ensuring that when an employer is testing their employees, that their test is good, reliable and will give accurate results?

David Kessler (00:48:34):
[audio feed unavailable]

Shirley Tilghman (00:48:49):
Hold that thought, David, until we figure out how your sound. So, Harold, this profoundly important question about distinguishing people who have antibodies that are simply against the virus but not neutralizing, and those that are neutralizing, how, how are we going to be able to tell the difference in a population study?

Harold Varmus (00:49:24):
That's a really good question. I think it's going to be based on if we can figure out which proteins in the virus are targets that result in neutralization of the ability of the virus to infect, if there's a good antibody against them. Then we'll have a pretty good idea because well, for example, I mentioned earlier these spikes on the virus surface that mediate the interaction of the virus with the host cells. We actually know already based on work done with the SARS virus that exactly which part of that protein is required for the virus to enter cells by binding to a cell protein that is on the surface of the cell. And we will have I think very soon, tests that are based on the ability of that patient to have produced an antibody which attacks that part of the virus surface. And those will be probably authenticated as tests that are neutralizing. And there may be other antibodies that are neutralizing as well. There's a lot of interest in some of the other many surprisingly many proteins that are made by this virus and some of those proteins help to make the virus structure intact. And you can imagine that the antibody that attacks those proteins would be a legitimate target for an antibiotic that basically blocks the capacity of the virus to enter new cells.

Shirley Tilghman (00:51:02):
So are you optimistic about a vaccine?

Harold Varmus (00:51:06):
I think we'll have one eventually. I think it may take longer than 12 months to 15 or 20 or 20 months. But you know, I think it's reasonable. It's reasonable to be somewhat optimistic. The problem of course is that even a year, year and a half is a pretty long time in our society. And given the effects of this epidemic on our social lives, and especially on our economy, I don't think we can't wait that much time. Even if we have a good outcome, a good vaccine, a year or a year and a half from now, we still have a national emergency because we have to get back doing some of the things that we do. And you know, the effects on mental health, the effects on people's income, their attitudes toward life. It's not my latte I'm worried about, I'm worried about collapse of society in a much more dramatic way. And we've got to figure out ways to live with the virus still circulating. Many people still susceptible to virus infection in a way that's compatible with at least a reasonably effective economy. And the country will come back eventually. But you know, this whole episode is going to have an effect on our country that is similar to what happened during the great depression in the thirties.

Shirley Tilghman (00:52:33):
So what do you make of the experiment that they're doing in Sweden right now where they have made the decision not to sequester, to basically allow society to continue, but to sequester those who they identify as vulnerable, which are individuals over the age of 65 and those who have underlying health vulnerabilities. What do you make of that experiment?

Harold Varmus (00:52:59):
I think it's something we deeply need to understand much more profoundly. That means of course going in there and doing the things we've been talking about, testing everybody for virus, testing them for serological responses there, the evidence that the infection has occurred. It's easier from a political point of view initially at least to say everybody should sequester inside not knowing who's really vulnerable. I'm sure of it in Sweden. I mean, we know they have cases, they have people who died. But they minimize the risks in a way that probably would be seen acceptable to most people. And I think we simply need to do some epidemiological and sociological studies to find out how people were reacting. We can say that they didn't apply all the strictures that have been applied in the US and in some European countries, but we really need to know what people did as opposed to what they were told to do. Because I think we may find that there, you know, you can't sit in Sweden and be oblivious to what's happening in the rest of the world. They have newspapers, they have TV shows, they go on the internet. And I suspect a lot of people, you know, we see movies on the news hour of folks wandering around on the on the Dockside in Stockholm. And it all looks jolly in the sunshine. But I suspect that the people are being a lot more cautious than we think and that there are obeying social restrictions that are not usual.

Shirley Tilghman (00:54:44):
So one of the statistics that I've heard is that the actual death rate among individuals who do not have some underlying health problem is very, very low. Is that something that is likely to hold up?

David Kessler (00:55:05):
We don't have enough data, Shirley, to say what the death rate is. In the last day or two there were increasing reports that the death rate is maybe one and a half times to two times the number of deaths that we think it is. Just too early. The reporting is not been scrutinized to know what the actual death rate is.

Harold Varmus (00:55:37):
That is absolutely correct. But I also think that Shirley's right, the evidence is pretty strong to suggest that the, the kind of factors you're considering, which is the people. I have acquaintances who have underlying conditions who died fairly suddenly and would have normally been considered to have died of their underlying cancer or heart disease who were found to be positive for the COVID virus. And now being called COVID deaths probably were COVID deaths. And we see that by looking at the difference between the expected number of deaths and the real number. I still think that comorbidity is a huge issue and we don't really understand why that is. It's also true in influenza and other infections that have low mortality rates.

Shirley Tilghman (00:56:35):
We're very close to the end of our time. I want to ask a question that has come across from our viewers which is what do we need to learn from this one to protect ourselves more effectively from the next one? And the additional part of the question is, what are the other pathogens out there lurking that we should be paying a lot of attention to?

Harold Varmus (00:57:05):
David, can you try that?

David Kessler (00:57:08):
I think that one of the things we learned is that leadership is very important. Certainly from the beginning when there is intelligence of a significant threat out there that you have to go look at the experts from the beginning, take center stage, call it the way it is.

Harold Varmus (00:57:39):
Obviously, having a strong government response to an outbreak is critically important and we would all endorsed the idea, at least all of us on this call I think, would endorse the idea that we've had abysmal leadership from the top on this occasion. But there are some specific scientific issues that this pandemic brings up. Perhaps the most fundamental is taking more seriously the kinds of recommendations that the scientific community and the public health officials always make after a pandemic. And I think because of the magnitude of this one as opposed to the relatively modest impact that even the influenza epidemic of 2009 and certainly outbreaks like Ebola outbreak and SARS and MERS, which had pretty marginal effects on the US produced. This one will really make us reflect on the wisdom of an investment of even hundreds of billions to prevent the kinds of disaster we're seeing which are costing us trillions. The second thing is that we are developing tests with new methods and possibly vaccines and therapeutics with new methods that should inspire us to have platforms for developing new tests that are rigorous more quickly and for developing new ways to control outbreaks regardless of what the organisms might be. I think it's very difficult for us to say what the next pandemic is going to be. It Will probably be a virus. But you know, we were pretty well equipped for identifying viruses quickly. In general, we seem to be encountering viruses that belong at least to viral classes. We know something about. That's good. It's a good argument for investing in fundamental virology just as we were prepared for HIV because we had invested hundreds of millions of dollars in the study of that virus class, the retroviruses before year two, we had invested a fair amount of money in the study of coronaviruses, which were known to be widespread in the animal kingdom. And that did help to prepare us even though it doesn't feel like we were prepared. But we at least knew enough to recognize this virus and many of the things it does, and we're remembering that the only drug that's shown any signs of efficacy so far, remdesivir is a kind of an agent which was developed to interfere with the enzymes required to copy the RNA chromosomes of RNA viruses of animals. Let me stop there, I see times getting late.

David Kessler (01:00:33):
CDC used to be the gold standard. There's a agency that we all look to and what we see is that investments not only at CDC and local public health agencies, that's taken a hit over the last decade or so.

Shirley Tilghman (01:00:56):
Yeah. So leadership, public health, basic science, all of those are the things that we're going to need to invest in going forward.

David Kessler (01:01:07):
And just to add, there's one other point and that is we also need deep wells of patience right now. There is no doubt that as we lift these restrictions, if we increase our contacts, no matter what the testing, no matter what the contact tracing is, we go back to having the same number of contacts that we had in our cities, in our close spaces, were going to have very significant another wave. We need to have deep wells of patience..

Shirley Tilghman (01:01:54):
Thank you both. And David, I am so sorry that we had trouble with your audio. It was wonderful to see you and hear you when we could. And Harold, thank you so much for being a part of this. And perhaps on the note that we have been talking about for the last a minute or so, perhaps it's appropriate in bringing Biddy back to conclude this session to point out that five of the six nations that have overcome this pandemic most successfully in the world, five of the six are led by women. And with that, Biddy, I'm going to turn it back to you.

Biddy Martin (01:02:39):
Well, Shirley, that puts a lot of pressure on me, but also on you. Thank you so much. I want to apologize to you three and also to all of our audience for the technical difficulties. I'm sure it was terribly frustrating. And I'm really sorry, but thank you so much for being available, for all that we learned tonight and thanks to the audience for your attendance and your questions. There will be two more programs next week, which we'll make sure you're aware of. And all technical difficulties will have been fixed, and David Kessler will have any opportunity that he wishes to have to speak at great length on every subject that came up tonight. Thank you all so much. Goodnight. Thank you.

Biddy Martin:
I'm Biddy Martin, President of Amherst College. I want to welcome you to this first in a series of programs designed to help us think through the pandemic. And we're in for a big treat today. We have with us Joseph Stiglitz, the Nobel prize-winning economist and a winner, before the Nobel, of the prestigious John Bates Clark Medal, which is awarded to an American economist under the age of 40 for significant contributions to economic thought. Joe is well known for pioneering work on asymmetric information and his written work focuses on income distribution, risk, corporate governance, public policy, macroeconomics, and globalization. He's the author of many, many books and several bestsellers as well. His most recent titles include People, Power and Profits: Progressive Capitalism for an Age of Discontent, Rewriting the Rules of the European Economy, Globalization and its

Biddy Martin:
Discontents Revisited: Antiglobalization in the Era of Trump, and The Euro: How a Common Currency Threatens the Future of Europe. Also, a memoir, recently published. At Amherst, Joe Stiglitz majored in economics and math. He went on to get degrees from MIT and from Cambridge. He is currently co-chair of the High Level Expert Group on the Measurement of Economic Performance and Social Progress at the OECD. He is also the Chief Economist of the Roosevelt Institute. We're so delighted to have Joe here and to hear from him. He will be interviewed by Dave Novak, a trustee of Amherst College, uh, a graduate with a degree in economics who received an MBA from Harvard Business School with honors. Dave Novak was appointed to the board in 2018 he is the co-president of the private equity firm, Clayton Dubilier and Rice. He is based in London and has responsibility for CD&R's European business. He's a member of the firm's executive and investment committees. And in 2009, Dave Novak was selected to join The Forum of Young Global Leaders of the World Economic Forum. We're delighted to have you both. Thank you.

David Novak:
Thank you, Biddy, and welcome everyone. Joe, I'd just like to extend my thanks as well for you giving us your time today in this incredibly different times for all of us and I know everyone in the Amherst community really appreciates hearing what you have to say and what you think about the crisis. So before we dive into the topic at hand, how's lockdown treating you? Where are you sheltered in place? Have you picked up any new hobbies, dropped any hobbies?

Joseph Stiglitz:
Well, I'm sheltered in our apartment in the Upper West Side. It looks over the Hudson River, so that's very nice. We can look down at the flowering trees that I won't be able to enjoy as I do normally in the spring. I had thought when this shelter in place began that I'd have a lot of time to catch up and read some of the books that I haven't had the time to read, but actually it's turned out to be an incredibly busy time. I continue to teach my students, my graduate students on Zoom. There's a lot going on all over the world, and in the United States, you know, discussions about, shaping the recovery package. Didn't go very well. We'll probably come talk about that.

Joseph Stiglitz:
Talking about initiatives of the IMF, G-20. There's just been a lot of activities, so I don't think I've ever been busier. The fun thing about Zoom is, you know, it used to be, to get a taste of what was going on in the world, you had to spend a lot of time in the airplane. Right now I can go in the same day and have a morning meeting in Beijing, an afternoon meeting in Bolivia, an evening meeting, a discussion, with some journalists in Australia. I's an amazing moment in our technology.

David Novak:
Well, thanks for that. And we might come back to that later actually. Before we jump into the economics, I learned just last week that in addition to all your economics research, you've actually done a bunch of research on diseases and epidemics. Tell us about that. What was the driver of that? What'd you learn?

Joseph Stiglitz:
Well, there were actually several motivations. One of them was when I was Chief Economist of the World Bank, one of the important aspects of development is improvements in health. So one of our major programs was concerned with improving the health of developing countries, doing something about contagious diseases. And then roughly at the same time the HIV AIDS epidemic was going on. Contagious diseases are about human interaction and economics is about human interaction. There were some very nice models, mathematical models, describing contagion that I found fascinating at the time that I was doing my work 25 years ago. And of course those models have now been brought out of the closet by everybody as they try to understand the Covid-19.

Joseph Stiglitz:
I have to say, because I was so familiar with those models, I had an inkling that things were going to evolve in the way that they have evolved. You know, the exponential growth of the number of people with the disease, one could feel it, one could see it coming, one knew in the equations that it was a very good chance that it was there. That led us perhaps to be a little bit more cautious in the beginning, buy a little bit more food, other stuff, storing all kinds of medical stuff. We were in a little bit better position than a lot of other people.

David Novak:
Well, that's good to hear. Next time your models or your crystal balls gives you that indication, please let us know, at least pass it on to Biddy and she can send it to the community. Joe, the last time you and I were together actually with an Amherst group was in London in June of 2010. It Was just after the financial crisis of course. And you gave us an hour of your time to talk about your perspectives of the financial crisis as we were just coming out of it. What, as you reflect back to then and think about where we are today as it relates to markets, as it relates to some economic behaviors, what is similar today and what is different?

Joseph Stiglitz:
Well, the major difference that's very striking is that was a crisis that was a top-down crisis that began with a failure of our financial system. Excessive risk that then became global in nature, began in the United States but what became a world crisis and affected every part of our economy. This is beginning--obviously very different--it's not just a problem on demand [inaudible] supply. The disease, COVID-19, people don't want to buy, but they also don't want to get together to produce. In that sense it's totally different. But there are some aspects where there's some similarities. Whenever you have a very deep downturn, no matter what it's cause, it eventually gets translated into a problem in demand. The fact that people aren't going to work, that they can't work, is going to mean that going forward we are going to have a problem of insufficiency of aggregate demand or we would without adequate government intervention.

Joseph Stiglitz:
It's even possible that we could have financial problems, this time not coming from the top down, but coming from the bottom up as ordinary individuals can't pay their bills, businesses can't pay their bills. Any protracted economic downturn winds up as a financial crisis. There's one other element of similarity. In the 2008 crisis, we became very aware of the ways in which markets don't often work well. The markets engage in excessive risk-taking and we saw that markets weren't resilient. The collapse of one bank led to the collapse of the whole financial system. So the market economy as it had been constructed over the preceding years was not resilient. And I think we're seeing some of that same thing today. In a way we created an economic system that was again, focused very much on the short term.

Joseph Stiglitz:
We were proud that we had so few hospital beds because we were using every hospital bed very efficiently. And that's fine as long as nothing goes bad. But when you have a surge as we have now, the problem of the shortage of hospital beds becomes a real crisis. You know, I have a metaphor describing it. We took out the spare tires from our cars. The reasoning was most of the time you don't have a flat tire, so why carry the spare tire with you? But of course, when you have a flat tire, you really want the spare tire. The cost of not having the expert tire is enormous. So we didn't think about . And this is true not only obviously in the private sector and the public sector, the Trump administration got rid of the office of pandemics that was supposed to prepare us against this risk. It tried to defund the CDC, the Centers for Disease Control, which are the mechanisms that we have for responding to crisis. The argument was, well, we are aren't having a pandemic this year, so why fund it? That kind of shortsightedness, which was very pervasive in markets and in some politicians, not in general, but in some politicians has had a devastating effect on us.

David Novak:
Thanks for that. You know, when some people reflected on the financial crisis, some people thought, well, maybe the government didn't respond quick enough. I think this time, in terms of once the government figured out there was a problem, governments actually around the world started acting in different ways depending upon what part of the world they were in. In terms of where we sit today, the financial contributions by the governments are significant. Let's talk a little bit about some of the policy decisions that have been made. How's Trump doing? How is the Fed doing? How's the treasury doing? And maybe we can talk a little bit about what do you think would be the positive results from it, but also then some of the distortions that could result from some of these policy decisions.

Joseph Stiglitz:
First, you were talking about the speed of reacting. Going back to the models that we were talking about epidemics, one of the things is you have to act early. So if the administration had listened to the scientist, we would have acted earlier and we would have been better prepared. We would have had the test. We would have contained the growth of the disease. There would not have been the number of deaths that occur. And you see, in the state of Washington and the state of California, in Silicon Valley where the firms responded, there was a quick response. As soon as that uptick in incidents was seen, they responded and they contained the disease. But nationally, we didn't respond in a timely way. And quite frankly, thousands of people have died as a result of that untimely,

Joseph Stiglitz:
the failure to act in a timely way. Now in terms of the economic package, or I would say, economic and health package, I would say we responded massively in terms of dollars. Nobody can say $2.7 trillion is a little money. It's a lot of money, but it was not a well-designed program. And so what we've gotten out of it is a lot less than we should have given the amount of money spent. Let me just give you a couple of examples. As we went into this crisis, America was in some sense the least well prepared of of the advanced countries because we have the worst health conditions. In many ways the worst the health system. At the top, we have the best, but life expectancy in the United States is lower than any other advanced countries.

Joseph Stiglitz:
The life expectancy is not--2018, the latest data we have, is lower than it was, in 2015. So things are not good. This particular disease is not an equal opportunity killer. It goes after people with poor health conditions. And we have a lot of those people because not only do we have on average a healthcare system that doesn't deliver, but it's a healthcare system marked by huge inequalities. Some people do very well, but the disparity in life expectancy is larger, much larger than in other advanced countries. So one particular aspect of that is that we are the only advanced country that doesn't have a mandated paid sick leave policy. Where that relates to this disease is you don't want sick people going to work because if they don't, they have no income.

Joseph Stiglitz:
And remember part of the problem is that 40% of Americans are living paycheck to paycheck. And if they miss that paycheck, they can't buy food, they can't pay the rent. So in the absence of paid sick leave, they're going to be working. And if they're at work, they're spreading the disease. Now at one level, Congress recognized this and they passed a provision mandating paid sick leave. But then, under the influence of the major companies, they exempted 80% of American workers. So having recognized the principle, they then exempt 80%. And the poorest Americans are the ones who are particularly not only vulnerable, but most likely not to have paid sick leave as part of their compensation package. So that's an example of a really flawed policy. Let me give you a second example. And this again contrasts very starkly with what's happened in Europe.

Joseph Stiglitz:
The principle that you want to maintain people's connection with their employer is very important. It means that you can restart the economy much quicker. In America, it's particularly important because most Americans depend on their employer for health insurance. If they lose that health insurance, they've get put on Medicaid. The Medicaid system is not equipped to have a massive increase in the burden. So, when workers get disconnected with their employer, the productivity effects, the wage effects are really significant. So everybody understood that it was really important to keep the connection with the workforce. You're figured out how to do it right.

David Novak:
You know, it's really interesting, Joe, because sitting here in Europe quite close to the European approach to that issue, and you're absolutely right. Across Europe, even though the decision was made by individual governments, the British government made their own decision. The French government made their own decision, the [inaudible] et cetera, they all came to that same conclusion

Joseph Stiglitz:
And it worked. And now we see the data that the increase in the unemployment rate in the United States, you know, 24 million in the last three weeks, is so much greater than in every other country. We used to pride ourselves in having the most dynamic, flexible labor market. And it's the one now that's most afflicted. We knew what to do. Let me make it very clear. I was talking to, you know, trying to put things into the political process. The Democrats were very much aware of it, but unfortunately, there was enormous resistance to getting the kind of program that Denmark and France and all the other countries. So there was a model we could have used and there was just resistance. And this comes then to the third part, the third example of this where things have not gone very well.

Joseph Stiglitz:
We wanted to maintain health. We wanted to protect the most vulnerable. When we didn't do that very well. We still haven't been able to get their paychecks out to the lowest-income Americans. The President said it could be done in two weeks. Now they're saying for those who are at the bottom, whose income is below the level that they had to fill the tax return out last year, that they may not get the checks until September. They're supposed to go for five months without any source of income. So we failed in that. We failed to protect jobs. The other thing is, creating the preconditions for a quick recovery. And that was getting money to the small businesses, particularly that needed it. And that was what was called the PPP program. That's been a disaster.

Joseph Stiglitz:
The money didn't go to the small businesses. The banks were paid to administer it, not to make judgments about who was creditworthy. That wasn't the issue. It was to be nothing more than electronic transfer of the forms from the government when the government already has all the information on every company and the IRS and the social security because they have to. They have that electronic information and they're getting paid more than $6 billion for just sending these electronic forms to the IRS. Then the problem is the banks are frustrated because the government is changing regulations. Nobody knows what's going on. The first traunch of money, $350 billion or so, went in 13 days. They ran out of it. And the poorest, smallest firms--I've talked to some of those firms--so frustrated. They've got their application in right away. They couldn't get it through their banks. What they said is the banks categorize people into two categories, good customers, the bigger firms, and others. And so the construction companies, which were not listed as the most vulnerable, were the largest recipients of money. The second traunch, people are talking about that money will be gone in a couple of days. So the point is, that program has been a disaster and in the end, hundreds of billions of dollars have gone out and it was supposed to protect jobs. It didn't do that. That means going forward, I think when the pandemic is put under control, we can anticipate a rocky recovery.

David Novak:
Let's build on that a little bit, Joe because I think that's a really important point, this what maybe you'd call an inefficient allocation of capital during this period of time, will invariably lead to capital in the wrong places. And we'll give some companies a second lease on life potentially. And others who could benefit from the capital to grow won't have access to it. How do you think that does play out both in terms of the shape of a recovery, but also once we get through the recovery, the allocation of capital then, the cost of captial, for in its inefficient way, what kind of impact could that have ultimately on?

Joseph Stiglitz:
Let me say one other thing. It's going to have a lot of effect on politics too because of the sense of injustice is very strong and we saw a little bit of that after 2008. I think we'll see another big dose of that. Now, you're absolutely right, you know, in the government, through these programs, is giving life and death to different companies, but it's not at different sectors of the economy. But it's not doing it in a coherent way, in a way of prioritization. It's being left to the randomness of who has good bank connections, who gets their form into the government in this rush to get your form in first. And that means capital is being massively misallocated. But it's more than capital misallocating. These are life and death decisions for small enterprises. So we're giving --I don't want to call it euthanasia because it's not painless.

Joseph Stiglitz:
We're giving a painful death to a lot of small firms and then we're giving a lot of money to firms that shouldn't be. We didn't do any sense of accountability for instance in saying if you got a big tax cut in 2018, you took that money and rather than create a capital buffer, you bought back shares so that you're in a more precarious position. They didn't say those firms were not going to give you so much money. You're in the predicament that you are because you make some bad decisions. There was no sense of accountability. So some firms are going down who did behave very badly, some firms going down, are being rescued, who behaved very badly. It's a totally random process except for this issue of who has good connections, which is biased toward the rich and the large.

Joseph Stiglitz:
So, to me, we're going to emerge with a more distorted economy, more inequality than we had before. I think it's going to have a long-run cost. Let me just give you two examples and misallocation of funds which I think absolutely...the first may sound a little self-serving since I work at Columbia, but that is, one of the sectors of our economy, of our society that's very important, is higher education. To a very large extent, the strength of America depends on science, on investments in education and higher education. It's in many ways one of the strongest sectors of the U S economy. It's why we have done so well and the higher education sector is going to be suffering very, very seriously.

Joseph Stiglitz:
Every one of their sources of revenue is being attacked. Endowment contributions, tuition enrollment. You know, the whole thing. It's a disaster. And yet almost no money is being given to protect the higher education sector. A few of our institutions of higher learning got some money, which they said was going to go for fellowships, scholarships for poor students, and the administration attacked, even [inaudible] ]there was money going to these universities for poor students. So that's one sector that's suffering. The other sector that's really suffering a lot is the state and local governments. One-third of all the public sector is state and localities. It's a very big sector. The 2008 crisis, the decline in tax revenues of the states was twice, almost twice that of the GDP.

Joseph Stiglitz:
If anything like that happens now, we know how much GDP is going to likely go down, much larger than before. Their tax revenues, income, profits [inaudible] are going to go to sales taxes. That's going to plummet. All the states at balanced budget frameworks. That means that when the revenues go down, they have to have cut back expenditures. That means that unless they get assistance from the federal government, there are going to be enormous cutbacks and states provide education, health, general welfare. They're central to our society. They've been central. Their response to the pandemic. And they are going to be really constrained, and it will mean that we will not have a robust recovery because they're going to have to fire workers, a lot of workers. A striking statistic is that after 2008, so many workers were fired from the public sector in the states it led, it's a kind of austerity which you know about in Europe. It's an austerity that comes not from the federal government, but austerity imposed by the federal government on the states. And so we're going to be experiencing that austerity and our unemployment rate is going to go way up just because of this.

David Novak:
I want to build on that a little bit, Joe, because as you point out, from a European perspective, the whole, the political decision-making process is quite different because once you have a parliamentary type system, for example, once you have a government, the government can make its decision. There's a lot less negotiating between the executive and Congress, etc. So decision-making is a little faster, a little bit cleaner. And then you also don't have the differences between the federal government and the state government. So you spent a bunch of time in the government, you chaired Clinton's Council of Economic Advisors. What do you think, how do we get through some of that? Because some of the, both the time lost and the inefficiency in the decision making combined with the risks that you just pointed out, which is if there is not a strong supportive relationship between the federal government and the state and local governments, that could significantly delay the recovery.

Joseph Stiglitz:
This is a central question on fiscal federalism and if we had a more cooperative spirit, you know, a more typical politics where you face a crisis and everybody says, let's pull together,

Joseph Stiglitz:
this was a kind of an occasion where, you know, in a normal government, you would have said, look at you, states, you're closer to what's going on. We're going to give you a lot of responsibility for doing it, for making decisions. But we know you have fiscal constraints. And we, as a result of that, we're going to have a kind of, we're going to help the states that are most affected both on the expenditure side and the revenue side. You know, this principle of shared responsibility has been a mark of bipartisan support. It was part of Nixon's administration. We've had it for a very long time. We could have done it. I mean it's a little bit more complicated in the United States and other countries, but it's not that complicated to say, in this current context,

Joseph Stiglitz:
let's compensate the states for the loss of revenue and the extra COVIT-19 expenditures. A simple formula, a one-line bill that could do it. You know, maybe it'll take five pages, but we're not talking about a 500, 800-page bill like we had. This isn't that complicated. it should have been at the basis of where, you know, what is the best way to use the instruments of government to deal with the problem that we individually can't deal with. We're going to need collective action at some level. And in some sense, it's the mayors and the governors that are at the forefront of this, of this fight. But there are some things that have to be done at the national level, making sure that the tests are available, making sure that there's a supply of masks. You know, those are things that have to be done at the national level, the supply, the national stockpile, the CDC. There were certain things that have to be done at the national level. We haven't done those, but we also haven't provided the support for the states and localities to do the part of the job that they need to do.

David Novak:
I want to shift focus a little bit. You know, Biddy mentioned your recent book, People, Power and Profits: Progressive Capitalism for an Age of Discontent. And in that book you argue for something you call progressive capitalism. I think it's very related to some of the topics that you're raising now. You describe it as a system that basically shares benefits more evenly, more fairly across the population, all while can still encourage growth. So tell us a little bit more about this because you've kind of touched the inequities that we're seeing right now and tell us where do we go from here if we wanted to embrace a more progressive capitalism, particularly given some of the challenges around the politics of it all.

Joseph Stiglitz:
Some people, when I came out with the book Progressive Capitalism, some people said that's an oxymoron. My view was no. Any well-functioning society of the complexity of ours has to have some degree of decentralization. A key part of that has to be the market economy capitalism, but it can't be unfettered capitalism that hasn't been working for very large fractions of our population. That's why I used the term "progressive capitalism." Try to evoke the progressive era at the end of the 19th century where once before we realized capitalism wasn't working for most citizens, and we have these progressive reforms. I guess I would identify two aspects of this that are absolutely critical. I begin the book by saying why is it that we have a higher standard of living, so much higher today, than we did 250 years ago?

Joseph Stiglitz:
What can account for that or another way of putting it? What is the real source of the wealth of nations? Why are we so much better off? And the answer very simply is the advances in science, our understanding of nature and the advances of social science, understanding how we can coordinate, cooperate, work together in a complex society. And these two advances are really foundational to our progress. Behind them, of course, are systems of ascertaining the truth, buying the truth, discussing it, but it's basically knowledge in the end. And the second point is that a well-functioning society requires a balance between the market states and civil society. And that we've lost that balance. And part of that balance is you need governments to make investments in science, infrastructure, education.

Joseph Stiglitz:
You need government to regulate. You need government for social protection. You need government to act collectively when we have to act, do things that are beyond what are individually able to do. So in many ways, this crisis illustrates very forcefully those things. Just to mention two examples. When the pandemic occurred, it was very clear that was beyond the ability of any of us individually to deal with it. We turned to government. We had to turn to government. Economists would use the word externality. When people are out spreading the disease, they're imposing costs on others that they don't take into account. And so this is like climate change, a classic example of an externality. And that's why we have to have government regulations. We need government help for dealing with the risks that are beyond

Joseph Stiglitz:
the market's capability of handling these risks. We turned to government because markets are not simply up to the task. But the second thing is we turned to science. It was science that enabled us so quickly to identify what was the source of people dying. Science identified the particular virus. And now you know, the pace of what is going on and developing an antiviral, figuring out how to control the contagion is absolutely fantastic. Epidemiologist, social scientists, businesses, chemists are all working together all over the world. And you know, we wish it happened faster, but the reality is if weren't for science, this would have been much more like a black plague. And so we, we really should appreciate what science has contributed and recognized that what's been happening, the defunding of science, has put us...and the weakening of our protection aspects like the CDC have put us at much greater risk and undermined our ability to respond to this pandemic and this risk to our economy and to our health.

David Novak:
We're getting a number of questions from the community. So before we turn to those, let me just build on this last point because you talked about potentially two positives that are coming that could come out of this. One is a better appreciation for the role governments can play, and two a better appreciation and need for science, an investment in science.

Joseph Stiglitz:
It's science and knowledge more broadly, but science particularly.

David Novak:
What else can we be hopeful for? What other positives could that could come out of this?

Joseph Stiglitz:
I think two other things that might come out this, I talked in the very beginning about our coming to understand the limitations of the market. That we've not created resilient system. It was too shortsighted. We can, you know, like 2008, we need to think a little bit more how to make our economic system more resilient, thinking more longterm. And the second thing I think is thinking about the many aspects of globalization. Climate change made it very clear that we share one planet. I used to joke that the carbon dioxide molecules didn't carry visas and didn't carry passports. And wherever they originate, they go all over the world and they cause climate change all over the world. And of course, this virus also doesn't recognize boundaries. It doesn't carry a visa. It doesn't carry passwords.

Joseph Stiglitz:
And it's a global problem. And both of these have to be solved globally. There's any part of the world in which the pandemic is raging it's threat to the rest of the world. So we need global cooperation. Policies that undermine multilateralism are going exactly in the wrong direction. One example of a kind of policy that will come back and bite us is the U.S. had talked about putting restraints on the export of medical supplies. You can understand that except if you look at the data and you realize that America imports so many more medical supplies that we're dependent on then we export. So if other countries reciprocate and do what we're doing, if we set the role model for them, then we're going to be in a big pickle because we are so more dependent on others than they are on us.

Joseph Stiglitz:
So this is just one example of global cooperation. Right now there is a big effort being made within the IMF to generate $500 billion in what are called special drawing rights, a way the IMF creates money that can give resources to the developing countries. Emerging markets that may wind up being hit much worse than we've been. They don't have the healthcare systems. They're packed together. Their health is weaker. They don't have the economic resources. So, it's imperative. So far the U.S. has been an impediment to the provision of this assistance. Hopefully, we'll be able to persuade it's in our self-interest that this be done. So I think one of the other things that I hope comes out of this is a better understanding that we do live, we share one planet and we have to learn about how to cooperate and we have to support our multilateral institutions that help us work together to address these global problems.

David Novak:
It's a really interesting point, Joe, because as you know, one of the conclusions some people are taking from this is quite the contrary. This is evidence that we all need our own supply chains. We all need to make our own decisions, goes back to, of course, duplicative investment across a lot of different countries and across companies. How do we kind of balance that concern with the one you just raised?

Joseph Stiglitz:
I mean, you're right. We became too reliant on global supply chains that were not sufficiently diversified and resilient. So that was a mistake and that's very much linked with the point I made before. Lack of resilience. But going the other extreme of saying self-reliant, we can't be self-reliant. You know, some of the critical raw materials that we use in our cell phones, and to make it possible to have this Zoom conference, come from developing countries. So the reality is that a modern technology requires interdependence. We have to manage that interdependence, manage it better than we have. And that's why I wanted to emphasize the need for cooperation, but it's also the point that you raised. We also need to make sure that we have a higher degree of resilience than we've had in the past.

David Novak:
Good. Well, thanks for that. So let me turn to some questions from the community if I can. This one has come up a bunch. Given all the support from the government and the Fed, the national debt is growing a lot. I guess we came into this well north of 20 trillion and it's only growing. How's the US going to be able to pay that down? Does it matter if they pay it down or not? And what's the balance sheet look like if there's another crisis in the future?

Joseph Stiglitz:
I don't know if, you know, the CBO just a couple of days ago came out with the estimate that our debt GDP ratio will be 101% by September. I'm not greatly worried. Let say that the first priority is getting us over the pandemic and you know, there's no economy to save, then we don't have to worry about the debt. So, first thing, let's save the economy. Let's save our people. Those are the first two priorities. I think we have to go back and think about World War II. When we fought in World War II, we didn't ask could we afford it? We said, we have no choice. We've made the right decision. There wasn't a lot. It was debt, and we wound up at the end of World War II, with a debt GDP ratio of about 135%. Like this,

Joseph Stiglitz:
it wasn't debt that was spent, money that was spent in increasing our infrastructure. We had some things to sell [inaudible]. There were a lot of advances in science, but it was basically munitions that got destroyed and we didn't have anything to show for it. But our response to that was not the kind of policies that Europe has done, which is austerity. Eisenhower and Truman took the view that the right way to deal with the debt was to grow the economy. You know, you've talked about the debt GDP ratio. There's a numerator and there's a denominator. And what they said is, let's focus on the denominator. If we can get the GDP up, the debt GDP ratio will go down. And that's why under Eisenhower, we add the massive highway program, massive research programs and massive education programs. You know, it was a very successful set of programs that led, in 15 so years, that debt GDP ratio went down from 135 down to 45% of GDP.

Joseph Stiglitz:
We had cooperation from the Fedck, keeping interest rates low. That was called the accord. So it's a little bit more complicated than that, but it worked. And I think that's the lesson that we ought to learn, that we ought to begin from a focus on expanding GDP. Now what some people worry about is, well, won't there be inflationary, in the immediate aftermath of a crisis? I'm actually worried about just the opposite. Deficiency in aggregate demand for two reasons. A lot of households and firms are going to see their balance sheets devastated, especially because of the randomness of the way that the $2.7 trillion is being given. Secondly, the nature of this disease is, we don't know whether it's going to come back. You know, whether there's going to be a second way, a third wave. We don't know even whether the antibodies, how long they last. They're just a lot of things that we don't know.

Joseph Stiglitz:
We've never been through an economic trauma like the trauma that we've just been through. The implication of all this is there's going to be a lot of uncertainty. Uncertainty leads to precautionary behavior. That means low consumption, low investment. So I'm more worried about a deficiency in aggregate demand that will require more stimulus. Not inflation if we're wrong. What I think is we have to monitor it very carefully and if that turns out to be wrong, what we need to do clearly is increase taxes and we have a lot of scope for increasing taxes in ways that would actually strengthen an economy. Environmental taxes, increasing corporate profits' taxes, monopoly taxes, lots of scope for natural resource taxes, lots that we can raise that will actually stimulate the economy in certain key areas.

David Novak:
So if you take your premise says there'll probably be less demand coming out of this and probably ongoing role for government action here, both in terms of from the Fed's perspective, keeping interest rates low and then the government, federal government supporting investment of sorts. You talked about potential infrastructure. And then in the beginning of the conversation, I said I'd come back to this, some of the learnings from, for example, the efficiency that you mentioned of being able to sit in Manhattan and do a lot of your meetings, to be a Zoom and spend less time on planes and other ways you used to spend time. So if you think about the combination of the role for the government to help us get out of this and some changing, both demand drivers and behavioral factors, what industries do you think should be prioritized? To the extent the government can do that and why, and then how would we do that while at the same time making sure that we don't bomb out some other industries that still employ a lot of people?

Joseph Stiglitz:
First of all, let me say, you know, I think one of the pivotal things we have to do is the green transition. This is an existential threat to our planet. The first priority right now is the investments need to be green investments to help shift the basis of our economy to renewable energy and to energy conservation. That will entail a lot of innovation. I think that it's going to make us much more dynamic, but that would be one set of priorities I would put very high on the agenda. The second thing is we're transitioning increasingly to a knowledge economy. And you know, part of that is supporting our knowledge institutions. That goes back to the problems that I talked about before. The third thing is I think, we have to address some of the deep weaknesses in our society, the inequalities, the disparities in health and income and wealth that we face. That's a rich agenda. That's a lot for us to do that would really stimulate the economy. So that's the framework. But as we do that, I think the point that you made is important.

Joseph Stiglitz:
There are some people who will lose their job as we make this transition. We're probably going to be traveling a little bit less than we did before. We've discovered that the wear and tear on our body is a little bit less with Zoom than it is on an airplane. So, you know, we'll continue to do some airplane travel, but I don't think we'll get back to where we were before.

Joseph Stiglitz:
The markets do not do a good job in that kind of restructuring. One of the things that we've learned, the people who lose their income typically don't have the resources to make the investments in human capital that are necessary to move to the new sectors. The new jobs may be in a different place from the old jobs. So that transition is extraordinarily difficult and we are going to need assistance in helping the economy make that structural transformation. So, I think, we have to

Joseph Stiglitz:
bear that in mind as we think about the priorities, among the priorities of protecting those people who are going to be structured out as we make that structural transformation.

David Novak:
Let me build on transformation. Here's an interesting question. Do you think the virus and how it's spread could impact some of the migration and growth toward major urban centers that we've been seeing for a while now? And if so, how would you advise cities to respond to that?

Speaker 4:
Uh, I think

Joseph Stiglitz:
we will live learned a lot about contagion and about health. So, you know, I think there'll be some social norms that don't change. Handshaking is a medieval custom that will finally come to an end, we'll be more elbow and foot-tapping and there'll be other changes. You know, I think we'll learn, washing the hands will be much more deeply ingrained. There are things like that that will change.

Joseph Stiglitz:
Humans are social beings. The agglomeration advantages in terms of knowledge of people being together. The cities have always been

Joseph Stiglitz:
the center of the, you know, where knowledge is bubbling up, and we may have a more diversified, you know, not all concentration in the way we [inaudible] up, but I think cities will continue to be very important part of the structure of our society. It may be that we will have to think a lot about how we maintain more distances within the city. But I think the advantages of cities, of the interactions which are so much part of our being, especially part of a knowledge economy, are just so great that I think we'll figure it out.

David Novak:
Here's a question that I think many people want to know. It's our own little version of either Scrabble or alphabet soup. So what do you think the recovery is going to look like? Is it a V, is it a W, a U, or dare I say an L? And then someone asked, is there any chance we can avoid a major depression?

Joseph Stiglitz:
Yes, there is a chance we'll avoicd, a major depression if we put in place the right policies. A depression that we had was a lack of aggregate demand. And we know how to stimulate demand now, but of course if we don't give the assistance to the states and localities, we will have a serious economic downturn. If we leave some important sectors like the higher education sector behind, there's going to be unemployment in those sectors and that will, through a multiplier process, be magnified. Let me say we have a knowledge of a how to avoid a depression, and it's only the politics and I think we should have a resolve not to allow this to develop into a depression. There are a set of problems that we haven't confronted since World War II, which is supply-side shortages in the short run.

Joseph Stiglitz:
And we saw that in the case of masks. We're beginning to see it in the case of certain foods. Early indication, the price of rice may have increased two or threefold. The wholesale markets. I mean there are problems that are very significant. In World War II, we stepped up and we figured out we had to use rationing. We ought to be thinking about, you know, in the allocation of masks, we would have been a lot better if we had a more rational way of making sure the people who really needed it in the hospitals got the mask rather than leaving it to the highest bidder. So in the context that we have the markets are not the best way of sorting out these problems. And sometimes we have to do things that are unusual.

Joseph Stiglitz:
We wouldn't want it as part of our normal life, but this is not part of normal. Now, in terms of the shape, I think there is a high likelihood of a second wave, possibly a third wave. The other countries have had that second wave. If you look at the dynamics of the disease, grows sort of exponentially. Social isolation quarantining has gotten the numbers down, but once it opens up, if we haven't succeeded in social distancing enough, if we start interacting too much, the interaction effects will mean that it will start to grow again. We know that. And so we know that there's a significant probability that the numbers will start growing again and we will respond to that by having another clampdown. So the fact that there might be what you call W seems quite possible. What worries me is not the W so much as when you talk about the W, there's a V-shape at the second part of the W. I don't think it's going to be a V shape at the second part of the W. That may be a long L-shape if we don't get things right. So if a lot of small businesses go bankrupt, if our municipalities and states are in bad shape, if our higher education institutions are in bad shape, I could very easily see a long slog getting out of the pandemic.

David Novak:
Do you think, Joe, that once we're through the pandemic, there'll be a kind of post-pandemic of who are good actors and who were not. How will history look back on not just the policy decisions that were made, but how people reacted to them, corporations, other institutions, individuals?

Joseph Stiglitz:
Inevitably, I mean, that's the nature of history. There's a whole profession of historians saying, you know, counterfactuals. What would have happened if only we had done such and such. This is particularly, going to be, I'd say both a contentious and difficult issue. The standard story of accountability is who knew what when and should have acted. Clearly there was a lot of uncertainty. We hadn't experienced anything like this before, but that having been said,

Joseph Stiglitz:
China, Korea, Singapore went through it before we did. Italy was going through it before we did. We had lots to learn from. And we have a wide body of scientific information about previous epidemics, SARS. And we had a very well developed theory of epidemiology, what I referred to when you asked me in the beginning. So we had actually a wide body of knowledge that even though we hadn't been through this particular thing before, we've been through things that had a lot of similarities. So if we had done what we should have done, which is at the national level, assembled the wisest people, the best scientists, the best epidemiologist, the best doctors, and said, what can we learn? And brought them from other countries and say what has your experience been? You know, China could do things in quarantine that we couldn't in our democracy, but why were they doing it?

Joseph Stiglitz:
And you know, if you can't do that, what would you have done as the second best? There was a lot that we could have learned if we had only asked those questions. And then what if we had a science-based policy looking at what was going on in Italy and Korea and Singapore? We would have been able, I think, to have responded so much better. And as I said before, I think so many thousands of lives would have been saved. So I do think that when history is written, the judgments will be harsh because even though there was a lot of decisions being made with a lot of uncertainty, we knew a lot, but we didn't marshall the scientific evidence that we had in ways that would have protected as well as it could have.

David Novak:
Thank you for that. Well, I want to bring it a little bit closer to home to Amherst now. There's been a lot of speculation with remote learning and all that, that things will change a lot in the world of higher education. How do you think this crisis will impact higher education? And do you think the future of schools like Amherst is certain, is their risk, will Amherst thrive as a result of this? How do you think about that?

Joseph Stiglitz:
Well, I think I'd like to come back to what we've been talking about, the importance of knowledge and almost, I would say the importance of a liberal arts education because what we needed was not only science, we had to think about the social interactions, what were going to happen to poor people if they couldn't get to work. We were making decisions about the interactions, the design of a whole society, with an awareness of our health system, with our awareness of the social inequalities that were preexisting. So that kind of broad view that you need science, you need public health, but you also needed a broader perspective. I think that was, something that's essential and that's the kind of thing that a liberal arts education is particularly good at engendering. So to me, I think that the value of higher education will be enhanced.

Joseph Stiglitz:
The valuable liberal arts education will be enhanced. Not for everybody, but there is clearly an important part of the role for this in our society. I think the economics of it for the next few years are going to be very difficult. I mentioned before all the revenue streams of universities are being hit., Amherst is not as dependent as many others on tuition from foreign students. And those that are very dependent, foreign students are very worried that the foreign students won't come. Particularly in the context of the kind of atmosphere that sometimes being created an anti-foreign atmosphere. I think we're going to go through a difficult time, not Amherst so much, but of our universities that do depend on foreign students whose endowments are not quite so large, who before the crisis, we're in a more fragile position.

Joseph Stiglitz:
How well they do, how many survive, and I think some of them will not survive, will depend on the kind of assistance that is provided. You talked to before what our priority sectors and I believe that knowledge in a knowledge economy has to be a priority sector. So it ought to be given, but they didn't have the lobbyists that the airline industry had, so they didn't get, you know, we would have been able..what we spend in saving three airlines would have transformed American higher education. It gives you a sense of, we were talking about the allocation of money. Money that went to three airlines could have supported the whole entire American higher education system. Rally a misallocation, I think, of resources. I think there will be changes. I think we'll probably do more classes, online learning.

Joseph Stiglitz:
There are contexts in which it works. There are local seminars that I participated in that have been very exciting. You know, 700 people on Monday, discussing the economics, COVID-19, from all over the world. These are actually new communities being created. But in the end, I think all of us who've taught online miss being in the classroom with our students. It doesn't, it's not the same. It's not the same for the teacher. It's not the same for the students. And so I think that the kind of education where you're in a small room with a small number of students interacting, is, you know, it's just vital and I think we'll go back to that.

David Novak:
Well, that's a great lead into my last question for the day. You spent a lot of time at a number of great universities, as Biddy mentioned. You've traveled the world. Let's stick to Amherst. What do you miss most about your time at Amherst?

Joseph Stiglitz:
Well, I suppose, you know, it's hard to name one thing. You know, you think about your friends that you had in college. I think a lot about my teachers and how much I learned from them. We spent a unit in our

Joseph Stiglitz:
world history course talking about what we call it encounters, which was the early version of globalization. So when I started to write about globalization, I reflected a lot on what I've learned in my Amherst class, as a freshman and sophomore about encounters, about the globalization over time. And it really did shape my mind in a very important way. And I think I brought a perspective that a lot of people who haven't gone through that historical, those historical studies. But at the end, I guess that what brings me back to the nostalgia is the setting and beauty, looking down from Memorial Hill, the fall and the leaves, walking through the woods. So I think in the end, it's the beauty of Amherst that I miss now. One of the things I enjoy so much about being on the trustees, besides having wonderful fellow trustees that stayed friends, is going up four times a year and seeing Amherst in all the seasons and going for those walks through the woods.

David Novak:
Well, thanks for that. I think that's a memory that we all share and I think we're all looking forward to getting out of our houses and our apartments and finding our way back on campus. So with that, Joe, thank you for your time. I'm going to turn it back to Biddy. I do want to give a shout out to Austin and Davis and the Amherst events team that helped make this all happen and to Andy with Jx2 who helped us with the technology. So thank you for that as well. Biddy, over to you.

Biddy Martin:
Thank you, Dave. Thank you, Joe. I can't thank the two of you enough. That was an extraordinary nearly hour and a half. Just amazing. Thank you for your generosity. I urge any of you who are interested please to join us on Thursday at 7:30 in the evening, at least our time day, a little later in London, when we'll have Nobel prize-winning biologist, Harold Varmus and former commissioner of the food and drug administration, David Kessler in conversation with Shirley Tilghman, herself a cell biologist, a member of our board of trustees and the former President of Princeton. In many of the same issues will emerge I'm sure. Thanks again. This was just wonderful. Thank you. Thank you.