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Saturday, March 2, 2024

The ‘Forever Virus’ Won't Go Away Until Kids Get Vaccinated

Vaccinations were supposed to end our nightmare and we’d enjoy a 2021 “summer of freedom.” But when the season ended with some of the highest case and deaths numbers to date, I knew it was time to talk to Larry Brilliant again. Brilliant is CEO of Pandefense Advisory and senior counselor of the Skoll Foundation, and he was part of the global team that helped eradicate smallpox. We have had several conversations about Covid in the past 18 months in which Brilliant dished out a mix of hard truth, science-grounded analysis, and reassurance that one day we’d be reacquainted with what normal used to be. But not necessarily soon: This summer, he was the lead author of an article in Foreign Affairs that called Covid-19 “The Forever Virus.” Which doesn’t sound very cheerful.

Indeed, living carefully in Marin Country, California, Brilliant, 77, now seems as impatient as the rest of us. Even in the 2010 disaster movie he consulted on, Contagion, scientists turned the pandemic around quicker than we have with Covid. He’s audibly frustrated after seeing failed policy and the devastating politicization of a viral outbreak. Yet he still reminds us that we’ve come a long way: We have an effective vaccine and a current presidential administration committed to addressing the problem. But obstacles remain, and at the moment, one of the biggest is the presence in school of millions of unvaccinated kids under age 12.

In a way, this was the toughest of the four conversations I’ve had with him. He struggles with the dissonance between having a vaccine and the ever-rising number of deaths, especially when some countries have abundant vaccination supplies and others have meager access. Yes, the virus is forever, he thinks. But, as people build resistance via both vaccines and natural antibodies, there will come a day when it doesn’t dominate our lives, fill our ICUs, and poison our politics. Just when that happens depends on … us. 

This interview has been condensed and edited for clarity.

Steven Levy: Have we blown it?

Larry Brilliant: We’ve blown this several times. The original sin was the Chinese government knowing that they had an outbreak—knowing it was respiratory-spread—and allowing probably single-digit millions of [Lunar New Year] festival holiday travelers to pass through the epidemic area, get on airplanes, and go to foreign countries. That was our first chance to nip this in the bud. 

Number two was Trump. If we had any chance after China, it would have been to take the virus seriously. But what Trump did would be unkind to ostriches, if we made the comparison. He pretended not to notice. To capture one moment, when the passengers from the cruise ship returned to San Francisco, Trump said, “I don’t want them touching American soil so that it doesn’t count against my numbers.” [Brilliant is paraphrasing.] That encapsulates the way Covid became politicized.

OK, but I’m talking about 2021. We have a new administration and things were looking up. Now it looks like we lost the momentum, and the White House has lost control of its narrative.

The problem we have right now is that people are continuing the myth that children don’t get it, don’t spread it. Last week we had 250,000 children in the United States who were sick with Covid. Roughly on the first of September, plus or minus two weeks, 100,000 schools opened up. The three things that we know will keep kids safe are vaccination, testing, and masking. And of those 100,000 schools, how many do you think won the trifecta?

You tell me.

I think single digits. This is a disease of the unvaccinated. Right now a major source of people who are unvaccinated are the children. The vaccine hasn’t been approved for them, and in these hundreds of thousands of schools that have opened, all the kids up to age 12 can’t get vaccinated. You also have several governors who refuse to permit school systems or counties to have mask mandates. And they're surely not tested anywhere near enough. So you've got kids all over who are losing the trifecta.

We shouldn't kid ourselves. We all want our kids to be in school in person. Every parent feels that. We understand our kids have lost a year of socialization, and maybe a lot of personal development. The poorest and the most vulnerable and the poorest-educated had the least access to schools—it was a triple whammy, because they were isolated and they didn't have computers and they couldn't get online.

But two wrongs don't make a right. By bringing them into a school situation where they are unprotected and vulnerable, we're not doing our duty as parents, community members, demanding that schools open safely. That worries me. This isn’t a time the United States has 5,000 cases a day, or 100 deaths a day. They're opening at a time when we have 150,000 cases a day and 2,000 deaths.

Not to mention that ICUs in some states are full.

A dozen states have no pediatric ICU beds. Not only the states that you would think of, like Alabama, where this poor guy had to go to, what, 43 hospitals before they would let him in for a heart attack. But I was on a call a couple of weeks ago with Michael Osterholm [director of the University of Minnesota’s Center of Infectious Disease Research and Policy], and he said that they didn't have any PICU beds in Minnesota that week. The ostriches are winning.

It sounds to me like you're saying we should immediately start giving vaccines to kids as low as age 5. Pfizer says it’s safe.

We can't do it that way. It's got to go through the process. We can't risk not knowing the right dose. I expect that we will see data on dosing to be sent to the FDA in October. And then the process goes from there. The most optimistic of us are hoping that the vaccine receives emergency authorization for younger kids by Thanksgiving. Other people think it won't be until next year.

Whether authorized or not, as you mentioned, we have a lot of governors who not only oppose vaccination mandates in schools but actually want to punish local school systems who require the shots.

You've got the right to vaccinate a community and to keep the community safe. You can't go to a public school unless you're vaccinated against childhood diseases. This is in almost every corner of the United States. We do that because we've called upon our most noble version of ourselves. We know we have an obligation to make public schools safe for children who might be on chemotherapy, who might have asthma, who might be immunocompromised, or who might have a parent who's immunocompromised. And because of that, we insist that everybody else gets vaccinated. It's the law. And it's settled law. In an epidemic, you can require vaccination.

We've forgotten that that's part of our DNA. We agree that you can say “Fire!” in a crowded theater—if there's a fire. But at the same time, you can't falsely say “No fire” in a crowded theater when there is a fire. And there is a fire in the United States right now, and in the world.

I watch these deathbed confessions—these poor people who are on the eve of dying, on the eve of getting ventilated—and saying, “I'm so sorry I didn’t get vaccinated.” I don't want to watch any more of those. If you get vaccinated, you are not dying. And we need to remember that the vaccinated can still transmit the disease. You have to be masked. But we have all the tools that we need to defeat this disease.

We all had this optimism that the Biden administration would be competent and effective. That’s now in question, and not just because of Delta. Look at all the mixed messaging on boosters. I feel that the CDC is not dealing straight with us, tilting what they say because of outside pressure and political considerations.

I think that’s absolutely true about the CDC. Can an organization have PTSD? Post Trump. We didn’t understand how deep it went. You had a bunch of political hacks, going through and changing scientific papers to make them more appealing as they go up the line. It takes a long time to change that.

Culture takes a long, long time to build, and it's easily smashed. I think I said to you last year that most epidemiologists look at CDC as our Mecca. Now it's just not the same place. You've got an exodus. There were probably some people who stayed on just until the Trump administration left to protect against more harm. And then the moment Trump left, they felt “OK, I can leave now, I can get my retirement.” A lot of people left because they're just so tired.

And look at the doctors and first responders in hospitals today, who are just tired. They see patients who are the same people who say that Covid is a fraud—while they're about to get ventilation tubes put in. I have never seen doctors so angry. I mean, it's one thing to talk about the anger on the right, who object to masking because it’s going to “deprive my child of oxygen” or something. There is now a huge anger about that—health workers are really mad at the unvaccinated.

Have you had a booster shot?

Yes, I’m over 75 and a first responder. I don’t think of it as a booster. I think of it as the third of what should have been articulated as a three-shot dose.

Now you tell me.

We did everything right. But we were in such a rush, all the studies were done with two doses. And the studies were done against the Alpha variant. Now we have the Delta variant. It’s the most infectious disease of our lifetimes.


Tell me something more infectious. Sometimes we think of measles or chickenpox as the most explosive. What people get wrong, including a lot of my friends, is that they're forgetting about the cycle time. The incubation period of measles and chickenpox are approximately two weeks. The Delta variant has a cycle of about three and a half days,

A lot of experts said that Delta outbreaks would take on the form of an inverted V—a rapid peak and an equally rapid decline in cases. But here in the US, after the rise, it seemed to plateau.

Yes, with Delta, cases in a region will spike very high and then, at a certain point, they fall precipitously. And you have this tip of this inverted V and then you're expecting a ski slope going down. You're looking at Mount Fuji. But we also had all these events in the summer. You had Biden saying that we're going to have freedom from Covid on the Fourth of July. That was a really unfortunate thing to say. And then you open 100,000 schools!

In New York City, they had a rock concert in the park with 100,000 people.

You should add that to the list of horrible errors that humans made in dealing with the pandemic of 2021. There’s a long list.

You say Delta might be the most infectious disease you've ever seen. But there certainly could be a more deadly variant. Shouldn’t we be doing everything we can to vaccinate the world? President Biden is now vowing to buy 500,000 doses of vaccines for poorer countries and urging other wealthy nations to follow suit, but that’s not enough.

I totally agree with you. We've done 5 billion doses, roughly. And this skewing of that is really unethical. It's immoral. This is country by country, vaccine by vaccine. It's just unconscionable. And it's epidemiologically wrong. Our biggest error going forward is a failure to understand that wherever there is a nexus of people who are vulnerable and not vaccinated, that's where the next variant production factory will be.

You’ve called Delta the Forever Virus, and that’s disheartening. Will I be wearing a mask indoors for the rest of my life? Is this going to kill me one day?

I don't think it's going to kill you. It may. But in this country, it's killed one in 500. Not 499 out of 500. And if you put down the names of all the people who had had two mRNA vaccine doses and who had died this year of Covid, I don't think that those names would cover four or five sheets of paper. The unvaccinated are 99 percent of the people who die, and unfortunately, that now includes some children. And that's where the problem is.

I do think that it's the forever virus, and a lot of people were mad about that title. I wasn't particularly happy that I wrote it. But it's right, unfortunately. But influenza is a forever virus and we live with it. Measles is a forever virus and we live with it. I would argue smallpox was forever for 10,000 years—which isn’t exactly forever, but it's a long enough time. And we found a way to vaccinate people and go about our business until we eradicated it. So I think that Covid or coronaviruses are a new category of forever viruses. But what Covid doesn't need to be is the forever-virus-taking-all-the-oxygen-out-of-the-air-and-ruining-everybody's-life-and-stopping-people-with-heart-attacks-from-going-to-the-hospital virus.

Tell me something optimistic.

I think that in the longer- or medium-term future of this pandemic—six months from now, a year from now—there will be safe spaces. In Hollywood, recently, I worked with Seth MacFarlane—we just completed doing season three of his fantasy sci-fi series called The Orville. We had to prepare protocols so that nobody would be sick. And we did not have a single case of transmission, in a year, of almost five-days-a-week shooting, where the actors were unmasked to do their jobs. What it took was testing either every day during the peaks of the epidemic or—when things were a little better—three times a week.

So you created an island of compliance in a country where millions of people resist compliance.

Maybe if I was 30 years old, instead of being over 70, I'd be looking to keep this as my professional interest. But I don't need any more work. I want it to end more than anybody wants it to end. But we're not doing the things that we have to do to make it end.

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