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Harry Siegel

In some pockets of the United States, if you squint hard enough, the coronavirus pandemic might feel like it’s almost over. Larry Brilliant would beg to disagree. With U.S. COVID-19 deaths soon to surpass the domestic toll from the great influenza of a century ago even as widely available vaccines have worked wonders, Brilliant, the epidemiologist who worked with the WHO to help eradicate smallpox and was the science adviser for the eerily prescient film Contagion, thinks there’s still plenty left to worry about—but also lots of good news to appreciate.

In an hour-long interview that’s been edited for length and clarity, I asked him about why he thinks it’s too late to hope for herd immunity, and what he thinks we need to be doing now in what looks to be a long fight against a Forever Virus. We also ended up talking about MERS, SARS, Ebola, the “Spanish flu,” anti-maskers, biological warfare and Yogi Berra.

Harry Siegel: Let’s start with the big question: Why is it that you think COVID-19 isn’t going away, and does that mean the U.S. is in a bubble right now, as vaccines are being widely distributed here?

Larry Brilliant: Boy, I wish we could reach herd immunity. But there’s a number of reasons why we can’t. First and foremost, a virus that infects multiple species, animals and humans, and a virus that has multiple new variants, each one having the potential to reinfect people, is sort of disqualified from being a candidate to be eradicated. Because in both cases, the denominator keeps changing, of how many people could be exposed to the disease. If you’re exposed to or get vaccinated against the disease and then a new variant comes in that can still infect you, the concept of herd immunity no longer really applies. And if animals—and we’ve got 12 different species who’ve been infected with COVID-19, usually from humans—if they can harbor it, and then infect humans, then you can’t eradicate the disease like we’ve been unable to eradicate yellow fever, because monkeys get it and they just don’t like to put their arms out to get vaccinated, and it’s really tough to get them to stand in line.

How should Americans who’ve been vaccinated and are feeling a sense of relief and maybe going inside restaurants again or sending their kids under 12 to camp for the summer be thinking about all this and their behaviors?

If they’re like me, they’ll feel grateful. After an abysmal start in 2020—where America was part of the problem, as China was part of the problem, instead of being part of the solution—we’re getting there. President Biden at the G7 announced that we will supply 500 million doses of mRNA vaccines to the rest of the world that needs it the most, and I’m very proud of that. And we should be very proud of the mRNA vaccines. When I was at Google, we used to say that any sufficiently advanced technology is indistinguishable from magic, and the mRNA vaccines and the speed with which they were made are, in many ways, magic. We shouldn’t forget that the scientists working on mRNA vaccines had been working on them for 10 years, and almost had an mRNA vaccine against MERS [the Middle Eastern Repository Syndrome that was first identified in 2012]. And that’s what helped us to get off of the starting line so quickly.

Is Middle East Respiratory Syndrome (MERS) the Next SARS?

Just think about this: It took us well over 200 years after we had a vaccine before we could eradicate smallpox, 70 years after we had a vaccine against polio before we could have a global polio program. And by January, really, a year from the day that COVID-19 began, we already got the start of a global vaccination program. It’s astonishing, and we should feel really grateful. Those of us who’ve been vaccinated, I think many would share the feeling I had when I had my second dose, and just felt like a load was off my shoulders.

<img src="https://s.yimg.com/ny/api/res/1.2/CoxLN5lEtgG8jKEq2hQb2g–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTQ3MDtjZj13ZWJw/https://s.yimg.com/uu/api/res/1.2/pTZ8fyBV1IPDqq_Xuv6_CA–~B/aD03ODA7dz0xMTcwO2FwcGlkPXl0YWNoeW9u/https://media.zenfs.com/en/thedailybeast.com/163db12e1de04912ddbe0ae08eded864" alt="<div class="inline-image__caption"><p>Beachgoers flock to Clearwater Beach during spring break, as the COVID-19 pandemic continues, in Clearwater, Florida, U.S. March 19, 2021. </p></div> <div class="inline-image__credit">REUTERS/Octavio Jones
Beachgoers flock to Clearwater Beach during spring break, as the COVID-19 pandemic continues, in Clearwater, Florida, U.S. March 19, 2021.REUTERS/Octavio Jones

But while feeling grateful, we shouldn’t misunderstand the situation we’re in. It’s a Dickensian moment. It’s the best of times, because we’ve got the vaccines, and it’s the worst of times, because of the people who don’t have the vaccine. You can’t help but look at the funeral pyres burning in India and Nepal and contrast that to Americans, joyfully ripping off our masks and going to the beach for a summer holiday, without understanding that it’s a tale not of two cities but of two worlds, and two lived experiences.

<img src="https://s.yimg.com/ny/api/res/1.2/d1LgFUPHBFy1xQorGqHsaQ–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTQ1NC45MzU4OTc0MzU4OTc0NjtjZj13ZWJw/https://s.yimg.com/uu/api/res/1.2/wDrBzBNUpO07f3RguYjpcw–~B/aD03NTU7dz0xMTcwO2FwcGlkPXl0YWNoeW9u/https://media.zenfs.com/en/thedailybeast.com/8f03b8c1610735bb9b64938484eed846" alt="<div class="inline-image__caption"><p>The body of someone who died from COVID-19 lies on a funeral pyre during a mass cremation, at a crematorium in New Delhi, India May 1, 2021. </p></div> <div class="inline-image__credit">REUTERS/Adnan Abidi
The body of someone who died from COVID-19 lies on a funeral pyre during a mass cremation, at a crematorium in New Delhi, India May 1, 2021.REUTERS/Adnan Abidi

Could that second world, the one consumed with illness and suffering right now, return to America with the mutations? I mean, you’re writing about variants that could be more transmissible, or could be vaccine resistant, or could even be able to evade the tests we have now.

They’re already back. I mean, all the variants—the alpha, beta, gamma and delta variants—are all back in the United States. In my county, Marin County in California, when I looked a couple of weeks ago, 30 percent of all the cases here were the British variant, the B.1.1.7, and that’s the alpha variant, but we also had the beta and gamma and delta, the others that we call variants of concern.

It’s likely that if a super-variant, a variant of high consequences, as WHO calls it, emerges anywhere in the world—including, you know, in Canton, Ohio, it doesn’t have to arise from an exotic place far away—it will be everywhere. It is the nature of a new variant. What makes a new variant succeed is that it outpaces all the prior variants, all the ancestral strains, and then infects all the people we have in our community who haven’t been vaccinated. Even many, perhaps, who’ve had the disease before. What we fear the most is that kind of a variant that will infect people who’ve already been vaccinated, and that the vaccines will turn out to not be effective against it.

And we have a reason for concern: that we already have one vaccine that, when matched against one variant, becomes 90 percent ineffective. And that’s the AstraZeneca vaccine matched against the beta variant, the South African variant. In trials, its effectiveness is reduced to 10 or 20 percent. It’s perfectly effective against other variants, but just not against that one. This should be a big red light blinking for us, that one variant has rendered one vaccine ineffective. We have a reason to be concerned that it could happen again with a new variant, and that new version could in fact render all vaccines we have to date ineffective.

I don’t think that’s a very high risk—it’s not a 50 percent risk, but it’s a non-zero risk, and Harry, if I told you that there was a 5 percent risk that if you drove from wherever you are to the closest Starbucks, that you’d be killed in that car, you wouldn’t go. You’d walk! And there’s a non-zero risk that we’ll have a super-variant like that. I don’t want to exaggerate it. I don’t want it to be the thing that everybody thinks about all the time, but epidemiologists have to think about it sometimes.

So, in a war, there’s a national mobilization; with the virus, outside of the medical world, there were shutdowns. Now, as things are reopening here, and with these concerns you’re talking about looming, what can we be doing to brace for what could be coming with a variant or the next pandemic?

We should realize that if 30 percent of Americans are not vaccinated, that’s 120 million people. And that’s plenty for the virus—the ancestral virus, let alone a novel virus, let alone a super-variant—to come in and create another wave, and a large one at that. So we need to have a defensive capability, a system of cluster-busters. That’s the term I’m borrowing from the Japanese, who use it to define teams that are mobile, that have highly computerized systems to have a situational report like a battlefield commander would have or like a CEO would have, and can see where every variant is.

We can find out where every variant is. We can find asymptomatics. We need to be doing sewage sampling, environmental sampling. Columbia University does this for all of their dorms. It’s very inexpensive once it’s set up. We need this to find out which countries are infected.

We’re Fighting Polio With Sewage Surveillance

We’ve done that in the polio program—this is not new! In the polio program, when we found out that Syria, which was supposedly free of polio, had causative viruses in the sewage, we sequenced the viruses to find out which polio variant it was. We did this 15 or 20 years ago—this is not science fiction. We should, all over the United States, have sewage sampling now. Because this virus is going to be with us for years or decades, and the variants are likely to return, and there will be new pandemic viruses. Why not? Why not have sewage sampling everywhere, especially in the cities, and be able to do virus sequencing to know what the variant is?

And we should be using exposure notification systems. I know there was a big article in The New York Times a few weeks ago about how bad they are. They’re not bad, they’re wonderful. We learned from scientists at Cambridge and in the U.K. that exposure notification systems, when compared to human contact-tracing systems, found two times as many contacts for people who are exposed (four, compared to two) and found them two days earlier. Well, that’s a lifetime for an epidemiologist. Then we’ll know who to test, who to isolate, and who to vaccinate.

There’s a whole host of electronic symptom-surveillance systems, we call them syndromic-surveillance systems, and I’ll name a few of them: Outbreaks Near MeFlu Near YouHow We Feel—and GPHIN, the first of these digital disease-detection systems, which was how we found the original SARS. These are opt-in, voluntary systems where if somebody reports that they’ve got a fever or the symptoms of COVID-19, you can send them an email or text: When did you get sick? Do you know about the doctor here? Can I tell you about a vaccine there?

Adding in testing, tracing, and isolation on top of situational awareness, a good digital disease detection, a good surveillance system, we can do it differently than we did before because of the COVID stimulus package. This is all doable. We’ve done every one of these things in part. What we have to do now is put it together. And the worst part, and the hardest part, is we’ve got to put it together at a time when everyone is feeling like we’re through with this disease, we’re over it, we can go to the beach.

And then the testing that we do is so much better now. In addition to PCR testing, we’ve got rapid PCRs and viral sequencing. So a baseline of surveillance, and then containment of the outbreak. And the containment will include better isolation and just-in-time vaccination—but vaccination with a vaccine that matches the variant.

<img src="https://s.yimg.com/ny/api/res/1.2/VaAehI6QdXOlOyO0zwxz.w–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTQ4OC4wNzY5MjMwNzY5MjMxO2NmPXdlYnA-/https://s.yimg.com/uu/api/res/1.2/1Ph6ytV7kKz5x7R6ZEYbJw–~B/aD04MTA7dz0xMTcwO2FwcGlkPXl0YWNoeW9u/https://media.zenfs.com/en/thedailybeast.com/a27dad839afc8464afbf760167717d71" alt="<div class="inline-image__caption"><p>Larry Brilliant, President, Skoll Urgent Threats Fund; Philanthropic Adviser to Jeff Skoll and Google.org, speaks during "The Swine Flu Epidemic: How Serious Is the Threat?" panel at the 2009 Milken Institute Global Conference in Beverly Hills, California April 28, 2009. </p></div> <div class="inline-image__credit">REUTERS/Phil McCarten