3 Billion Shots

Quinn:
Welcome to Important, Not Important. My name is Quinn Emmett and this is science for people who give a shit, welcome back shit givers. There's a lot going on out there, our world is changing and being changed every single day and you can take part in that change, you can help fix this shit. I talk to the smartest most impactful people on the planet to provide you with the inspiration and tools you need to, one, feel better and, two, to fight for a better future for everyone. Our guests are scientists, and CEOs, doctors, and founders, nurses, journalists, farmers, policymakers, activists, astronauts, we even had a reverend. If you want to be inspired to find out how to make that radical change hit the subscribe button right now to get even more conversations, stories, and tools coming your way. You can also scroll through the feed or go to podcast.importantnotimportant.com to find 130-ish evergreen episodes covering everything from clean energy to cancer and artificial intelligence ethics to regenerative agriculture. A reminder, you can send questions, feedback, or guest recommendations to me on Twitter @Importantnotimp or you can always email me at questions@importantnotimportant.com.

Quinn:
My guest today is Dr. Madhukar Pai, he is the Canada research chair of epidemiology and global health at McGill University and the associate director of the McGill International Tuberculosis Center. He trained in Vellore, India and completed his PhD at UC Berkeley with a postdoc at UCSF, is that correct?

Dr. Madhukar Pai:
That's right.

Quinn:
And anywhere in our conversation doctor please just jump in and tell me all the ways I'm wrong, it's how I live my life. He is the commissioner of the Lancet Commission on diagnostics and is on about 500 editorial boards including Lancet Infectious Diseases and the Public Library of Science Medicine where he is I believe editor in chief. He is the recipient of the Union Scientific Prize and a number of others, has about 300 publications. For context, I once lost a Webby to Malala. Dr. Pai is here with us today because he is an outspoken advocate for vaccines equity, something that we've talked a lot about here and can be pretty frustrating considering it's how we're going to get out of this thing. So here's the deal folks, it's been 26 months or so since many of us, if we were lucky, started to pull our kids from schools and set up laptops in our kitchens or our living rooms.

Quinn:
But for so many others, especially in the service industry, for example in the United States and I imagine Canada as well, for many immigrants and marginalized citizens living in tight spaces in multi-generational homes, working in tighter spaces on their feet constantly exposed, kitchen Zooms and sweatpants were never and are still not an option. In January 2021 some incredible new vaccines were finally, and I'll come back to the word finally, they were released for the highest risk segment of the general public and then further and further. And now almost everyone over the age of five is eligible in some way and a multitude of vaccines around the world are available and frankly, plentiful in developed countries. I say finally because it felt like that year where those of us lucky enough to be able to stay at home times felt like 100 years especially if you had small children. This despite the fact that those vaccines were developed and tested and manufactured and distributed in truly record time, I mean, earth shattering time, and they are still, what are we? Four major variants in, some of the most effective we've ever made.

Quinn:
Many of us got our shots as soon as they were available to us, not enough kids have gotten them but they're available to them. Doctor, many folks, and as someone with a chronic disease I do get this, they are "done with this whole thing," they're done with boosters and constantly being told they might need another one, they're done with masks, they're done with kids living a restricted upside down childhood. And I do get it, they believe they have done all they were asked to do and most of the time and some of the time probably they did and they're just ready to move on. But we have failed, and I don't think I use that word lightly, to do what's necessary to actually bring this thing under control globally much less to get ahead of it.

Quinn:
When another coronavirus strikes and your N is every living person on the planet that means two plus years and your job is to still vaccinate every one of those people because every person, and again, this drives me nuts and it must drive you crazy, it's basic math, right? Every person who is not vaccinated with even just the first shot is not only still susceptible to sickness and death in some cases and all the second order effects, right? Of missing work and missing family obligations and the more macro effects blunting any progress we've made on poverty or other diseases, childhood diseases, malaria, but also for the people who are done with this, listen clearly, as vectors for transmission and potential mutations for SARS-CoV-2. Just to clean up this summary, as of this moment according to Our World in Data which I can't recommend enough, about 60.5% of the world's population has received at least one dose of a COVID vaccine and frankly in 25 months that's pretty incredible, but it also means about 40% have not and those 40% are not distributed equally.

Quinn:
Almost 10% of people in low income countries have not received a single shot, by some measures we've given more boosters in high income countries than first shots in low income countries. So that's, doctor, three billion people that over year after shots began rolling out do not have a single one yet and until they do none of us are done with this, it doesn't end for any of us. And it's really crucial that everyone understand this and it's really crucial we begin to take some real action on it. But it's complicated of course, it's one of politics and people and it didn't start with COVID and it doesn't end with COVID but understanding the machine is essential and that's why I'm so glad that Dr. Pai is here today. Dr. Pai, welcome to the show.

Dr. Madhukar Pai:
Thank you so much for having me Quinn.

Quinn:
Doctor, let's start at 30,000 feet if we could. I've written about vaccine equity quite a lot, feels like yelling from the rooftops sometimes, so our community is certainly not ignorant about any of this but I understand how they can feel impotent in trying to change it. Again, 30,000 feet, in the US health systems are more overwhelmed than they've ever been because Omicron is so contagious and again the math is very simple, the same percentage of a much bigger pie is a huge number.

Quinn:
Hospitals are overwhelmed, cases are starting to drop a little bit and Omicron has been described as more mild but again, that's for you with three shots most of the time. Because it's so transmissible because 25% of Americans don't have a single shot yet that's still 80 plus million people who are eligible to go to the hospital basically. But in low income countries the macro effect is just devastating, like we said, with poverty and all these other diseases. So doctor, as someone who spent their life working on these sort of disease, tuberculosis and others, where are we really starting to see the big second order effects of all of this time without vaccine equity?

Dr. Madhukar Pai:
Firstly, I want to congratulate you, that was such a brilliant summary really, it hit every single major important issue that I've been worried about. There's just one correction, only 10% of low income country populations have received even one dose. So it's a massive disparity between high income country and low income countries as far as vaccination coverage goes. About 80% of people like you and I on the richest parts of the world have received at least one dose and it's only 10% in low income countries, so 80 versus 10 is a massive differential in the vaccine equity. Now, what this has done is, imagine if America and Canada with all our wealth, with all our vaccines, easy access to vaccines, we were the first in line, weren't we? We are also the first in line for the new antiviral pills, for everything and anything we are the first in line.

Dr. Madhukar Pai:
With all of that if our health systems are on the brink then I just want us to close our eyes and imagine countries where 5% of the population is vaccinated, 10% of the population is vaccinated, where the per capita GDP is several fall lower than us, where the health systems are already so fragile to begin with. I keep asking myself, how on earth would they withstand this virus? Right? And I myself got to see this kind of firsthand, right? So here like most of us I also have this privilege that I live in Canada, right? I got my shots when I was eligible, my family could stay at home, get a salary and we could battle it out, right? We are the most privileged people. Anyone who got their second shots or the third shots and who can survive during this crisis, have a secure income, is ridiculously privileged. And I saw what it could do to the other part of the world where those privileges may not exist and that was India, my other country, my country of birth.

Dr. Madhukar Pai:
During the Delta wave in India last some, I mean, the whole world saw India in distress, right? People gasping for oxygen, funeral pyres everywhere. When the dust settled they estimated three million people died, close to three million people died in three months. Three million in three months is what this virus is capable of doing at its worst, right? That Delta variant just blitz its way through India, leaves scores of people dead and the economy is collapsed. Any other disease progress that we've made, tuberculosis, we've lost a decade of progress in TB, immunization for children, basic stuff like measles, BCG, mumps, rubella, we've lost 15 years of progress of childhood immunization, right? HIV testing has gone down in Sub-Saharan Africa, violence against women and girls have increased during this pandemic period because of lockdowns and insecurities, extreme poverty is climbing up again and trillions of dollars of economic losses have mounted during the last two years or so.

Dr. Madhukar Pai:
And I keep asking myself, why wouldn't someone intervene to stop this carnage? Right? Why would world leaders sit by and watch such devastating impact of this pandemic and not do what is moderately, ethically, scientifically just and necessary? Right? And variant after variant has come by and yet G7 leaders, G20 leaders, they are doing shit to end this pandemic. They don't give a damn and they've not done anything to help vaccinate the world let alone share other technologies like antiviral medicines and rapid tests and all the stuff that is necessary to end the pandemic. So I had tweeted recently, I said, how many more variants will it take, how many more deaths will it take, and how many more trillions of economic losses will it take before world leaders get their shit together and do what is necessary to end this pandemic everywhere for all people?

Dr. Madhukar Pai:
Because if we allow this vaccine inequity to continue, like you said, 3.2 billion people unvaccinated, if this continues and if the Omicron continues to march through millions of people, I mean, just by math alone, right? Each person will generate billions of copies of the virus particles. And you multiply that by millions of people currently infected with Omicron you end up with a staggering number that I can't even do the math on. That many copies of the virus are being made worldwide right now, never seen during this pandemic, the amount of transmission we are seeing has never been seen in the history of this pandemic, why would it not produce mutations? And why would some of them not turn out to be more nasty than Omicron in the coming months?

Quinn:
Thank you for sharing all that. So again, sometimes I ask my guests among the world's smartest folks like yourself, as we say, working on the front lines of the future to speak to me as if I was a kindergartner. Despite my best efforts I always say, and I know you're at the university, I try to get a 301 in every one of these subjects before and eventually they add up but I'm still just me, a liberal arts major a long time ago. I want to go back to this idea, it's not an idea, I mean, it keeps happening, it's going to keep happening, it's how viruses work which is they're going to do two things, they're going to keep looking for hosts until they can't find any and it's going to keep trying to survive essentially and it's going to keep mutating. I had done some reading where, I know someone had talked about the possibility and I wonder if you can sort of quantify or explain this a little more, that there's this idea, right? That we got lucky with Omicron.

Quinn:
Because as much as, look, it's not SARS or MERS, right? And it's not Delta, but at the same time because it's less deadly it's more transmissible, et cetera, et cetera, it's in your upper respiratory as opposed to in your lungs and maybe that's making it having more breakthroughs, whatever it might be, forget everyone who's still unvaccinated. There's this idea that, well, if it's so prevalent and it wipes Delta off the map in so many places and it's sweeping through all these populations, even if there is another variant what are the odds that it would be a descendant of something like Omicron and thus still less deadly but more or transmissible? Does that hold up in any way or is that just a guess? I mean, that's way beyond my pay grade when it comes to virology.

Dr. Madhukar Pai:
I'm not a virologist either but I'm an infectious diseases epidemiologist, right? So there was a spectacular paper in Nature just published yesterday or day before, basically written by a viral evolution expert who basically is saying there is no preordained biological pathway that viruses will always mutate to being less severe. He said it's a big myth that is being currently circulated that, oh look, Omicron was mild so therefore the next variant will be mild, he said, there's absolutely no reason at all why that trajectory has to happen, it is not preordained by any stretch.

Dr. Madhukar Pai:
And then he also says that virus mutations and its trajectory is inherently unpredictable, it is a matter of luck on which part of the virus gets mutated, right? Which part of the virus, spike proteins or not, what is impacted and what its cumulative effect will be. We saw that Omicron has multiple mutations, right? Some of them may make the virus less dangerous, others may make the virus more dangerous, and the cumulative effect of that it's inherently hard to predict, right? There is evidence that the second wave of the Spanish flu 100 years ago was much worse than the first wave, right? The Delta variant which came much after the first Wuhan virus and then the Alpha and the Beta was much more lethal than the previous variants. So there is no reason at all to kind of buy into this myth or this hype that it's all done, right? Omicron has pretty much vaccinated the world that we can move on.

Dr. Madhukar Pai:
And I'm already starting to see a lot of articles in the lay press written by, I would say, the people from a business or econ background, people who have I think a vested interest in declaring the pandemic over. And I tweeted that triple vaccinated people in the Global North are tweeting that or saying that the pandemic is over when 3.2 billion people are still unvaccinated in the Global South. I mean, if you and I have had three doses, for example, what is a three dose coverage in low income countries? Zero, so effectively you have unvaccinated unprotected people in massive numbers. I think it's absolutely reckless and stupid and scientifically very, very irresponsible to claim that the pandemic is over just coming arguing from our position of privilege.

Quinn:
And that's what's interesting to me because these administrations are, not always, often filled with some pretty intelligent and capable folks, often well meaning, I mean, in the end it is politics, right? But there's some fantastic people there, I mean, things get caught up, right? You saw President Biden hired every progressive climate person that someone could find, our ranks were just pilfered to go into his new efforts and yet we've done very little outside of executive actions because of politics, that's the way it goes, right? And also because as much as on the one hand the climate crisis how we should define it is, it is the air we breathe and the water we drink and the heat we feel and all of these things, right? But on the other hand it's easy for folks. And again, I try to empathize with folks who are like, wait, I hear the jet stream is slowing down, what am I supposed to do about that? It can be vague, it can be just impenetrable, I get that.

Quinn:
Again, the math on this seems so simple, this isn't for instance malaria, right? Which is relatively geographically restricted because of a host of number of factors, right? It's easy, it's almost understandable for privileged people in more developed countries to be able to ignore that, right? Unless they're giving to malaria funds or whatever it might be, but this is not that. So you can either take this action because it's just or you can take it because mathematically and scientifically it's the correct thing to do to get us out of this, again, much less ahead of it. Because this idea of relying on luck seems so just out of touch with how this actually works, I don't understand how there could be so many, again, intelligent well-meaning people involved in these developed administrations around the world and someone is not going, no, it's just a simple whiteboard and going, this is how it works.

Quinn:
So on that note though, and we've talked about this on our show which has been a little bit of a highest, but certainly in our writings there is a massive effort that exists it just seems to be broken from top to bottom. So I want to talk about COVAX, the failure points plentiful, right? From these pledges all the way to production and distribution. So the goal or at least the current goal, which is not going to happen to be clear, was to vaccinate 70% of the world by mid 2022 which is in five months now. If we could, again, I want to help folks understand how this works or how the sausage is not being made, I would like to go through this sort of supply chain to understand why and how and where it's not working. So if we could, let's actually start with the patent situation, could you talk us through the TRIPS waiver and what that would unlock and all that? We can get into the dominoes behind it.

Dr. Madhukar Pai:
Absolutely. So the TRIPS waiver isn't anything new, right? So in the early days of the HIV when the first antiretroviral treatments were available it was completely unaffordable and inaccessible to large numbers of countries, especially the African continent. So at that time a lot of people were courageous and bold that they wanted to use a TRIPS waiver to start manufacturing antiretrovirals in countries like India, generic medicines, and they successfully did in the end. They faced a lot of hostile opposition from the pharma industry but in the end countries like Brazil, South Africa, India were very bold and courageous because they thought HIV was going to decimate them and they did what they had to do to survive, right? So they used the TRIPS waiver clause, the Doha Declaration as it is called, and they went ahead and developed antiretroviral medicines. From $10,000 a year it dropped to $200 a year, dramatic case study in the whole field of global health, right? Books have been written about it, movies have been made about it so it isn't anything new.

Dr. Madhukar Pai:
This time around when COVID vaccines were developed India and South Africa, again, you see, it's the same historical countries that had the courage, India and South Africa petitioned saying that we need the intellectual property temporarily waived at least so that the recipe can be handed over to multiple countries companies around the world to start cranking the vaccines that we need in order to vaccinate our populations, why is that? Because the rich countries made a run for the vaccines. The minute vaccines came on board US, Canada, UK, Europe, Israel, all of them went to the front of the queue, pretty much bought up all of the supplies for the foreseeable future leaving very little for anyone else and virtually nothing for COVAX, right? So although COVAX mechanism was intended to supply low and middle income countries manufacturers preferentially started supplying US, Israel, England, so on and so forth, why? Because manufacturers will always supply those who are willing to pay a lot, right?

Dr. Madhukar Pai:
All of us, the richest nations, were willing to pay premium dollars and we pretty much bought up enough contracts, take Canada for example, Canada ordered close to 6 to 10 fold more vaccines than the population of Canada. That's the number of contracts and purchases that Canada greenlighted thinking that they were hedging the bets, they didn't know what was going to work or not, we pretty much clogged up the procurement pipeline leaving very little for COVAX. So COVAX was waiting, where is our vaccine? Where is our vaccine? Right? And countries like Canada although we contributed to COVAX we also undermined COVAX by directly making deals with Pfizers and Modernas and Johnson & Johnsons, right? Instead of waiting for COVAX to supply, we directly cut deals. And then COVAX donations and pledges were plenty but the activity on the pledges are dismal, even today barely a quarter of the pledges have been successfully delivered so COVAX is missing all its targets.

Dr. Madhukar Pai:
And even when vaccines are being donated they're being donated close to expiration, one month before expiration, right? And so African countries are saying, no, we can't take this because we can't possibly get them into arms with just a few weeks of life left on the vaccines, it's been a complete disaster. And lack of engagement of low and middle income countries and constructing COVAX itself is now painfully obvious that you don't have your end stakeholders in mind. So I'm starting to see COVAX as a failed charity exercise, right? Rich nations always like to do charity, they never want to truly empower or share power in any way possible. Today, to go back and close the TRIPS story, 100 countries have approved or backed the TRIPS waiver, 100 countries around the world, millions of people have signed off and asked for it, who is blocking it? Canada, UK, European Union. Biden administration was first blocking it and then Biden said, yes, but the government hasn't done much. As you know very well, Biden can't even get the domestic pandemic under control so he is in no position to lead globally.

Dr. Madhukar Pai:
This has also been pretty distressing to see, right? Two of the most powerful nations US and UK have done so miserably with their own domestic pandemic situation that they can't even get their head out of the weeds to look to see what the heck is happening outside. So global leadership itself is flailing and nobody seems to want to listen to WHO, right? It's like a headless horse running around the yard, nobody is driving the ship, nobody has a global plan on how to get the pandemic under control, every country has gone nationalistic, populist and isolationist, right? This is the flavor of how this is working out and look what it's doing. Because we are so inward looking there is nobody orchestrating the bigger pandemic control, we are getting slammed with new more and more variants and with every variant I fear that we are becoming more and more isolationist, more and more insular in our thinking, and this is guaranteed to prolong the pandemic.

Quinn:
Yeah. Again, it's math, it's also sociology and anthropology, I mean, this is what's going to happen. I mean, like you said, it's been 100 years since the flu, it's 30-ish years since AIDS exploded and of course the US purposefully ignored that for quite a while. Again, I don't want to always come back to, boy, if this is what's happening with this what about climate? But it's pretty indicative of how we're going to operate if this is the way it goes.

Dr. Madhukar Pai:
It's terrifying actually. When I think about this pandemic I have very little hopes that the world will get its shit together saving the world from climate crisis.

Quinn:
Yeah. Our ability, our desire, and our innate, and well practiced ability to move on from things quickly even things on the home front is spectacular to just not do the math. All right. So we've got government invests millions of dollars with Moderna to make these shots, Moderna reaping all the profits, it's the first product they've ever had, right? You've got Pfizer making their own version of the mRNA shot, you've got Johnson & Johnson, you've got Novavax, all these different options now. And correct me if I'm wrong, as you've described it, basically the richer countries put in a bunch of pre-orders to procure and essentially hoard, like you said, 6 to 10 times as many shots as we needed. That continued to happen through boosters so now we've seen, like we said, we're giving more boosters out than we are first shots. So it seems like the issues from, for example, the African countries are saying, not only are you not sending us enough shots, you are sending us the lower quality shots.

Dr. Madhukar Pai:
Stuff that we thought we didn't want. Canada is preferentially donating stuff that Canadians rejected, AstraZeneca and J&J.

Quinn:
Right. Which we decided weren't good enough because the mRNA vaccines are quite literally among the greatest human accomplishments, I mean, they're truly spectacular.

Dr. Madhukar Pai:
Agreed.

Quinn:
But we're not sending them those, so we're sending not enough of not the best shots, they're arriving with often barely a month left on the ticker before they happen with no real local distribution help. However, it goes further, right? Because the mRNA vaccines are actually, well, I know one of the early arguments was, look, this is a relatively new technology or at least we've just perfected it and made it so the body didn't inflame itself, Dr. Katalin Kariko it's incredible what she's done now they work, they're amazing but listen guys, you can't just make these anywhere. And meanwhile, and they might not be on the list yet but from what I understand a host of places like the Serum Institute have said, no, we can do this. So could you explain enough and dispel that myth if it exists? What are the capabilities that are out there should, for instance, there be a temporary dropping of these patent rights for other people?

Dr. Madhukar Pai:
Oh yeah. So there was a fantastic New York Times story by Stephanie Nolen who identified multiple, something like 10, companies across Africa that are capable of making mRNA vaccines. And subsequently a big report by Medecins Sans Frontieres and other groups all has revealed that probably that are closer to 100 companies around the world that are capable of making mRNA vaccines. So this has been an old trick in the book to say, oh, only the richest countries in the world are capable of making these vaccines, that other countries are not good enough to make them, right? Another commonly used argument is, okay, oh, countries don't have cold chain, they can't really use them, right?

Dr. Madhukar Pai:
We can come up with all sorts of endless excuses to not do what we need to do and that is give the recipe and transfer technology to as many companies as possible. Because if you actually did the math, if we now need three doses for protection, which is what I think we are starting to think of, then the global demand for vaccine just increased instantaneous, right? Earlier it was two, now it's three, so to do the math, seven plus billion people on the planet times three, right? That is the amount of vaccines the world needs. And to expect only Pfizer and Moderna to supply the whole world, especially with the hunger for boosters exploding here in the rich world, right? Already Israel is pushing the fourth dose, right?

Quinn:
I saw that.

Dr. Madhukar Pai:
This is new. The Canadian prime minister tweeted saying that don't worry, we have enough fourth doses for all Canadians, we are rapidly heading down this. It's already done, rich countries have decided, oh, we are going to block travel from a bunch of countries that we don't like, right? We are going to have stricter border controls and we are going to boost ourselves again and again and again and then we are going to say kumbaya and we're done, right? This is the myopic leadership that rich nations are demonstrating. Instead of saying, holy crap, we'll never going to end this, we got to vaccinate the world, here, for this extraordinary one in a century crisis we are going to hand the technology to as many people as possible.

Dr. Madhukar Pai:
My biggest problem Quinn is, well, it's a bit like, I have a fire in my house, okay? And I need water to put down the fire. I get it, right? You need to first get the fire under control in your own house otherwise you're going to burn, right? But then I'm going to hold the water, why? Because maybe there is another fire coming in the future. But then the neighbor's house is burning, do you want to hold onto that water or do you want to help the neighbor's house, put out the fire? Because that neighbor's fire is going to come to you if you allow it to let rage, right?

Quinn:
I'm aware, I just spent 13 years living in Los Angeles, I mean, fire containment is all I thought about.

Dr. Madhukar Pai:
Exactly. And so we are a village, right? The whole world is a village, no country is an island, we know it by now. We tried hard to keep Delta out of coming from India, right? Did we succeed? No, Delta came and whipped through the planet.

Quinn:
Mathematically impossible.

Dr. Madhukar Pai:
We tried to block travel from a bunch of African countries, what kind of bullshit was that? Banning just a bunch of African countries when the virus was already circulating in America and Netherlands and whatnot, that was just bullshit racism, there was no science to it, there was no logic to it. And then look, Omicron is everywhere now, when the next variant comes, there's already an Omicron sub variant already that has emerged, you think we can keep that out?

Dr. Madhukar Pai:
I mean, how long are we going to pretend as if national boundaries make sense to the virus, since when has any virus given two hoots for what the US borders are, Canada borders are, or African borders are, it's going to do what it does, it's going to whip through the world, right? So having a global solution. It's a bit like saying, oh, we are going to tackle climate crisis for just Canada, right? What BS is that, you either tackle the climate crisis for the whole planet or you don't. There is no such thing as I'm saving America, saving Canada, we are all sinking or swimming together as a planet, the same logic applies for the pandemic.

Quinn:
This is probably not the best analogy but I think the principle of it holds up which is how I think about, and I'm not sure how familiar you are with these things and I hope you're able to ignore them in some way, but a lot of folks whether you're in power or not at any level seem so content to rest on the laurels of, well, Omicron as we discussed is, quote unquote, more mild for an up-to-date vaccinated person but not the health system anyways. It reminds me of the companies and countries making these net zero pledges by 2050, right? With no transparency, no accountability, no measurable milestones of any sort. And it's usually on the back of these carbon capture either through nature or through technologies that do work but may never work at scale.

Quinn:
And to be clear, our entire mission here is predicated on action and measurable legitimate action. When it comes to climate the answer is, we need to be doing all of the things, right? That's where we are now, right? So I'm a big believer in, yeah, sure, throw money at carbon capture and find out if it scales, that's how we got solar to where it is today, right? It's because we worked on it and industrialized it and we made it happen, so we need to do all these things. But when you rely on these things that truly might not exist to say this is how we're doing our part, right? It reminds me of this booster thing, like you said, how easy is it for someone in the administration to say, closing down flights from these countries.

Dr. Madhukar Pai:
Probably took them a second to make that statement.

Quinn:
A second, I mean, how easy is that? You call a couple of airlines and it's done and you give everybody another round of boosters. But what's so shortsighted about it is you've got an administration in the US that's having an impossible time getting anything done, right? I do believe that they've gotten a number of things done, it's easy to look at that objectively, but these grandiose sort of FDR level things that they promised much less the pandemic and climate, right? Have not gotten done. You've got these midterms coming up which traditionally the party in power just gets absolutely swept rocked by, right? Unless you find a way to tangibly prove to people that you are improving their day-to-day lives.

Quinn:
And that's the only way that they're going to say, maybe we should keep these guys around is if you are able to show them, it's the idea of like when Biden was giving out the pandemic checks and people were seriously saying, we should call them Biden Bucks so people associated with us when it's time to vote again, right? Like you said, hopefully, probably not, but hopefully once in a lifetime opportunity where we are in such a hole that you could measurably improve the life of every person in your country and around the planet whether it's just or it's correct, turns out it's both, to actually measurably show people, I'm getting us out of this thing which would improve your political fortunes possibly and you're just choosing not to do it. Again, it feels like I don't understand how that message is not getting through, you have this amazing opportunity in front of you it's just, I don't know.

Dr. Madhukar Pai:
So I want to ask you that question too because you're clearly thinking a lot about this and you're approaching it from the climate crisis and all the work happening in that area, right? All the activism around that. I mean, they've been shouting from the rooftops for, what? How many years now? Right? Climate activists. So The Economist magazine published a story a while ago saying that the leaders of G7 are walking away from what they call the opportunity of a century, right? Somebody has done the math, it might cost what, I don't know, 50 billion to vaccinate the world, right? I don't care what it is, somewhere in that range, okay? 50 billion for G7 would've been trivial compared to their GDP, right? And The Economist said the return on investment, ROI, that all business people care about would've been in the orders of ten thousands, 10,000 fold return on investment.

Quinn:
I mean, you think about the economics of just, if everyone got back to work today and children were able to go back to school, if you freeze the economics there forget all of the people that wouldn't get sick and wouldn't die down the line and what that does to-

Dr. Madhukar Pai:
And we've lost 20 million people so we are not even counting that, right? The economic losses.

Quinn:
Again, to keep coming back to it, I mean, the other day they said in 2020-21 the US suffered the climate losses that were attributable to climate change from natural disasters were about $145 billion, and you're like, that's a check we're paying but we won't put a down payment down to do the rest of the work.

Dr. Madhukar Pai:
This is it, we pay billions or we paid trillions in losses and we are choosing to take trillions of losses, how do you explain that? I think we need to really ask the question that if our politicians everywhere are only capable of thinking about, how do we win the next election? How do we hold onto our power? They can never think long term because climate crisis requires you to think long term, right? They can either think long term in terms of time horizon or they can think geographically to anything outside of their voting base, right? So for a Californian even thinking about Texas is too far away, they don't care, right? So then why would they care about Abuja or Dakar, right? They don't care about the vaccination threats there.

Dr. Madhukar Pai:
So it seems like we are screwed fundamentally because our politicians will only do what is politically expedient, they will only appease their voting base. They will never do anything that's long range because they don't know if they're going to be in power three months from now or three years from now, so 30 years is too long for them, 20 years is too long for them, even two years is too long for them, nor can they justify to their voting base why Kenya's vaccine coverage matters, why Afghanistan's crisis is important for them, right? Or why the civil war in Ethiopia is important to them. If this is the way we are worldwide and this is what is happening everywhere, how will we ever get out of this pandemic or a climate crisis?

Quinn:
Yeah, it's frustrating. Forget 10 years, 20 years, 30 years down the road and climate and all these things. Again, you're looking at being effectively swept out of power in 11 months, 10 months, and you have an opportunity to spend the next 10 months to stand up and say, this is how it works, this is the math, and this is the money we're going to spend to do it. And because we're going to do this because we're going to commit everything we have to this, by the time we get to November we're not going to be out of it but we are going to be measurably better and possibly even ahead of it to the point where we can control it. And now, I've had these conversations with Sam Scarpino and Nahid Bhadelia, there are all these amazing new institutes that have sprung up and Sam is working with Rockefeller Center on wastewater.

Quinn:
We're doing these things, we can do genetic sequencing and we can do even more of that, we can scale that up, all these after fix. There's all the people who've been talking about pandemics for years saying, it's coming, get ready for it, just like with antibiotics. We have these opportunities to not only deal with this one, get ahead with this one, but prepare for the next one to build up these capabilities to say, okay, next time there are, like you said, 10 to 20 companies in Africa that can and build mRNA vaccines, right? We're ready to do these things, why would you not? So that's it, we've covered that ground and I don't want to keep you forever here. We have developed some other options for dealing with folks who do get sick, like the antiviral pills, what does distribution and availability look like for those that have been developed in some of those countries? Is it a similar situation?

Dr. Madhukar Pai:
So the Pfizer pill predicatively which looks the best is predictably all gobbled up by the richest nations, so US obviously has first dips, Canada approved it, right? Canada is fighting to get some of that. So it'll go exactly along the well chart and path of the vaccines, right? Richest countries in the world will make a big line and purchase as many stocks as they can, it'll take months and years for it to trickle down to the Global South. The only exception was Merck, right? I didn't have any hopes of Pfizer having seen how they behave, right? All these months. Merck the minute their product was approved by FDA, cut a license, a voluntary license, with dozens of companies and Indian companies are manufacturing it now for pennies, right? That is remarkable. So it's already available in generic forms in India for 10, $20 for a course which is remarkable if you think about it and the speed at which it was done.

Quinn:
It's incredible.

Dr. Madhukar Pai:
I just wish there were kind of more companies in the world that thought like Merck, they'll still make money that's the point, right?

Quinn:
Right. Just not as much.

Dr. Madhukar Pai:
Not as much but they're going to make money on volumes, right? Volumes is what the world offers us, right? Imagine an affordable antiviral pill for the whole world, that's remarkable.

Quinn:
It's still a lot of money.

Dr. Madhukar Pai:
It's still a lot of money. And I must say many countries are not asking for charity, they're saying, we just want to pay something that we can afford, right? We are not asking, give it to us free, we're willing to pay for it but we just can't pay $500 a pill. And that's what I think big pharma simply does not understand because their entire model if you really think about it they only care about their returns, right? So keeping their shareholders happy is the only goal and there is no pressure from their investors. There are people now trying to get pharma investors to challenge their boards and the CEOs to say, what have you done for vaccine equity? Right? Your salary as a CEO should also be tied to your performance and how well you address vaccine equity. By their own admission the big pharma have said they have failed with vaccine equity, right? They've said it in public but what are they willing to do about it, right?

Quinn:
And it's tough when you look at the history. Again, literally the definition of what a corporation is for in the United States is to provide value to a shareholder, so that is their inherent issue from the start. And look, this is a for-profit business, doesn't make much but I think I can be more capable of affecting change by doing that. I believe in capitalism, I think it's gone down 1,000 wrong roads, I think trusting the market to do it on its own is going take us down 1,000 wrong roads. I mean, you look at pharmaceuticals on the one hand, we've seen 1,000 times, there's nothing they love more than a chronic condition where you have to take a pill every day or every week for the rest of your life.

Dr. Madhukar Pai:
Or boosters every year is beautiful for them, right? A dream situation.

Quinn:
It's a recurring revenue stream, right? On the other hand I've had family with stuff like ALS and you just don't see a lot of money in it because there's frankly not that many people with it, it's not difficult to see how that operates and how that works.

Dr. Madhukar Pai:
Can I just ask you that question? And I've been thinking a lot about this too.

Quinn:
Please.

Dr. Madhukar Pai:
It seems to me that there are two industries for which world leaders are simply not able to find a way to, I don't know, for the want of a better word, to regulate them or to work with them but in a manner that is also meeting the global good, for climate change it's the fossil fuel industry, right? Weren't they all over the COP26 this year and they were the dominant group there? So it is in their interest to prevent the 1.5 or whatever the goals are.

Dr. Madhukar Pai:
And just like the Pfizers and the Modernas of the world want us to buy into the yearly boosters forever and they don't care about low income countries, they will obstruct the TRIPS waiver, they'll do everything possible. So it seems like if we can't get big pharma on board and if we can't get the big oil and big gas on board we will neither really tackle the pandemic nor tackle the climate crisis. So what prevents leaders from having a thoughtful strategy about these companies? We need them, at the same time we cannot work with them as they're currently designed, they're not fit for purpose for our two big crisis that we have.

Quinn:
I honestly think this is probably both a gross over simplification and also pretty on board which just comes down to money. We had this Supreme Court decision in the US, God, what was it now? I don't know, time is a black hole for me at this point, I don't know about for you, but it's called Citizens United where we decided that corporations and et cetera could give as much as they wanted. And we've seen over and over and over again, it might not be a president or a vice president or a majority leader of some sort but because we don't have term limits, because we don't have age limits, these are jobs for life for a lot of these elected officials and certainly for the non-elected officials like the Supreme Court.

Quinn:
And you see that the amount of money that they receive from these interests, even if the fossil fuel industry itself even this year when their profits are back up because there's not enough demand or there's not enough supply and there's more demand and natural gas in Russia and all this stuff, even if they're so much smaller than they used to be the amount they're willing to contribute to hold onto power in any possible way. Truly from the local level where they've got a plastics factory, which is like, they don't give a shit about cars anymore, they know that cars are there, they're just going to make plastic all the way up to the national level.

Quinn:
It's not difficult to literally trace the effects of that money, even if we don't have the accountability we have the transparency, and you just see that, I mean, it is the human condition that they're going to keep folks in office while going, the longer you're in office the more power you'll accumulate from being in office because your positions are almost entirely based on seniority, you're going to gain more money and gain more influence. And then those folks, I mean, we've had conversations with folks before, these interests whether it's fossil fuels or it's big tech in some way, like you said, pharmaceuticals, they will literally write the legislation. It's not just give money and hope it goes away, they will write the legislation and that's when you're going-

Dr. Madhukar Pai:
And have it rubber stamped.

Quinn:
... oh, I get it now.

Dr. Madhukar Pai:
And I think the inability to control the gun control itself is a beautiful case study, right? I mean, year after year kids are getting slaughtered in schools and yet no politician is able to actually do anything about this.

Quinn:
An informal colleague and co-conspirator Azeem has this great thought of, framing a thing is trying to frame our work as future positive, right? Which is, we can pick it apart intellectually as much as we want but let's try to have a little not hope but optimism that we can affect change in some way. And so I do try to do that, I do try to help our community see where they can spend their money and their time and their resources most effectively because we can make change, we can bend this needle. But there are times to look around and go, boy, in the US 10 years ago a classroom full of kindergartners was mowed down by semiautomatic weapons and we didn't do anything then and so if we didn't do anything then, when are we going to do something? What is more horrific?

Dr. Madhukar Pai:
Exactly. What is the tipping point? What is the tipping point to change? And hope is, as you rightly said Quinn. I've been through really bad burnouts during this crisis, I try to advocate, I mean, I get agitated to see no action, and I'm sure I understand how climate advocates and climate scientists feel, right? They're like, oh my God, we've been telling you guys this is coming and yet you're not doing anything. And I wonder, what is the reason to be hopeful? Right? Especially given the track record of our leaders. And I read this wonderful book by Jane Goodall called The Book of Hope, right? And I said, God, Jane has written this just for me right now, because I was absolutely devastated to see this happening with the pandemic month after month, variant after variant.

Dr. Madhukar Pai:
And I think one of the reasons that she gives in her book to be hopeful is young people. And I've got to tell you, I think that to me stands out in my own life, my students give me hope, right? I teach a course on global health, I have 160 young undergraduates in my class. They're so progressive, smart, they can think it, they can see clear as daylight climate change coming in their future, they can see vaccine equity is such a problem, right? Inequity, they are angry about all of this. And so maybe is one solution somehow getting rid of the older adult leaders who are failing us left right and center and giving a chance for young people to lead, I think that's where the future of humanity truly lies I think, what do you think?

Quinn:
I mean, I'm fully with you, I couldn't be more inspired by them. My children are relatively young but also relatively incredibly privileged and so I try to start these conversations with them early which is just, it's a Spider-Man quote, with great power comes great responsibility. And I imagine your students who are much more human beings than my small children are more aware of that because they're more aware of what's happening every day, they read the news, they see it. There's certain structural barriers, for example, they're not on the board of Exxon at that age, they literally cannot run for federal office until, in the US what is it? 35 or something for president but I can't remember what it is for the House and senators, but they are able to start a company, right? They're able to run for local office, to run for a school board to help out kids or educate them to pass that down, to run for their city council.

Quinn:
Because again, climate change and COVID it's the air you breathe, it's the water you drink, it's the food you eat if food is available to you, if clean, healthy, affordable food is available to you. And I think people are aware of that not just because these generations like your students, I mean, they're 20 so they've been through two recessions at this point which we've clawed our way out of, but we're still dealing with them. And I think, and from the folks I've talked to, I appreciate that their attitude it's pretty black and white that's just like, look, this isn't good enough, it's not good enough and you get fucked, it's got to be a million times better. And this is why I think you see a lot of folks who are like, we have this idea in the US of primaries which is, if you were an incumbent office holder Dr. Pai and I was some young progressive rebel I would primary you even though I'm from your own party.

Quinn:
Just saying, sure you might have good principles but you're voting record shows that you're aligned with the money and the status quo. And look around, California is burning down, Canada is burning, that wasn't supposed to happen and it's not good enough and I know that you think it's radical but look around and it's not. And vaccine equity is not good enough and, like you said, we're 10 years back now in tuberculosis and all of these things. And yes, there's always going to be an argument certainly and I believe in it that experience does matter in those places but the only way to get experience is to do it-

Dr. Madhukar Pai:
To go through it. Yeah.

Quinn:
... to get these people in it, to get them going and to do things. And that's why you see there's one of my favorite organizations you would love is this organization in the US run by a friend, Amanda Litman, it's called Run For Something. And they work with, if you were under 40 and progressive and you said, I want to run for city council, school board, state office, whatever, they will help you build a campaign basically and learn how to do it. And that's our idea is we've got to get younger people, these progressive people that care about the people around them, that are ready to do the right thing, that are demographically so much more diverse.

Quinn:
We have to put them in office, that's the only way we're going to get there, and it has to start from the bottom up because the top down the well is just so poisoned with the money. And again, it seems crazy when you watch Armageddon and all these movies over the years about we come together and Independence Day and this and this to go, no, we just literally have to take all of our resources, you've got the world's biggest military which inexplicably still has bases all around the world, whatever it takes to help these countries, the shots that aren't expiring, the shots that work really well, to end this thing and you can take the muscle and it's going to be incredibly complicated to spend the next 10 months doing everything you can.

Dr. Madhukar Pai:
Well, we did it in the past, didn't we? We got rid of smallpox, we brought polio down to the last few digits, we're capable of doing great things but it really requires enlightened leadership, right? Global level leadership. Imagine a Zoom call of all G7 leaders get together and say, hey guys, this is just completely out of control, right? We're bleeding money globally, right? Our own countries are wrecked by these new variants, let's get the shit done, right? Let's put 50 billion on the table, right? Let's carve it up, right? And then let's be saviors, right? We come out looking superb, right? G7 leaders managed to end this carnage for the whole world, right? The world will be eternally grateful to the Bidens and the Trudeaus and, no, they're just not interested.

Quinn:
It's perplexing to me.

Dr. Madhukar Pai:
And what about all our billions Quinn? Single handedly they could have vaccinated the world, just single handedly, one person, one of these rich guys. And instead they're choosing to fly off to the space right now in one of the biggest pandemic crisis the world has seen in a century with so many people dying, struggling to get basic stuff, we can't get a fair wage, right? That's why that Netflix movie, I'm sure you watched Don't Look Up, right? It was dramatic to watch, right? It was funny but at the same time all climate scientists and pandemic scientists are like, oh my God, this is too close to reality.

Quinn:
Necessary, traumatic, funny, all the things.

Dr. Madhukar Pai:
It was almost like the script was designed with the pandemic in mind. I realized that later on it was more about climate crisis.

Quinn:
No, I think you can apply it to a few systemic things certainly.

Dr. Madhukar Pai:
Yes. So if there was a comet headed towards the earth in say two, three months, do you think we'd get our shit together to take it off course?

Quinn:
I think we would. I think it's so singular and specific this one thing that we need to do as opposed to, oh my God, the logistics, there's 88 countries in Africa, how are we going to do and they're all different leadership? It's not dependable on this, whatever. We have actually a fantastic episode, I'll send you after this, with a gentleman named Dr. KT Ramesh who effectively has worked his entire career to figure out how we're going to deflect an asteroid and was one of the minds behind the DART mission that just launched and he's just the most tremendous and funny and intelligent human being.

Dr. Madhukar Pai:
And I've been just following this James Webb Telescope, right? Yesterday it was in orbit.

Quinn:
It's incredible.

Dr. Madhukar Pai:
Think about it, the human ingenuity of doing the origami in a flying spacecraft, the 300 actions-

Quinn:
Talk about failure points. Yeah, it's crazy.

Dr. Madhukar Pai:
And so we're capable of ridiculous stuff as humankind and yet we can't seem to find the compassion to equitably share it and deal with it in the midst of a crisis. That's what is astounding at the same time tragic about the human condition I think.

Quinn:
I write these original essays sometimes when I have time, the sort of mantra is do better or better. And it's just the idea of not just like, hey, here's what to do, which is what we focus on a lot, here's the news and what to do. It's more of like, look, we're in this moment where we really have to retrain how to think about things, we have to go down to these first principles of how problems work and how we dissect them and how we work on them for your bank account, Dr. Pai, or your department or your school or your industry, whatever it might be, and I think we could probably spend another couple of hours talking about this. But it is interesting how, and I don't think it's a blanket statement by any stretchers, some incredible organizations and folks out there in office and nonprofits, whatever it might be, we have ceased to care for whenever in an interesting way.

Quinn:
And I think there's a lot of probable reasons behind that, I think a lot of folks for instance the unvaccinated at least in the US. I don't think it's everyone but I think there's a lot of folks who have been so adversely affected by misinformation from Facebook, et cetera, that they couldn't even begin to even if they wanted to. And I think a lot of them probably do want to do the right thing genuinely don't know because it's not just some surface layer thing they've seen, it has been their language for so long.

Dr. Madhukar Pai:
I know.

Quinn:
The loss of community in a lot of ways I think it's interesting and we're really going to have to rebuild a lot of those things in order for us to address some of these systemic challenges.

Dr. Madhukar Pai:
And just also to regain public's trust in science, right? All these years as a scientist, right? I'm an MD, PhD for Christ’s sake, science has been a big part of my life. I didn't even realize we have to defend science now, right? Even the most basic scientific fact is no longer sticking as fact. It's like some mediators trolling me trying to teach me what medicine is or what public health is, I'm like, people who don't know anything about anything are now weighing in on things that they don't know anything about. Tech pros are telling me how a pandemic works, right? And I'm like, what is wrong with people? Right? It's like science itself is under such attack, sustained attack. And the Republican Party in the United States, right? Look how they're absolutely undercutting science, anti-science is a big platform. So fighting misinformation and getting science back to where it needs to be will be another decades worth of work ahead of us I think.

Quinn:
A friend of mine is this wonderfully talented and successful and thoughtful screenwriter named John August and he wrote a movie 10 years ago with this wonderful quote and I'll send it to you and he had it made on t-shirts and it says, "They love what science gives them but not the questions that science asks." And you can calculate that, everything from GPS and the microchips that we're so reliant on and now they're backed up everywhere in the world to putting them in our electric cars, but not these questions of like, no, it's called public health for are a reason. We discovered this when we realized that water was dirty and was making everyone sick and then we decided, by the way, on the list of shit we need to do, we decided at one point water shouldn't be dirty and so everywhere we can we're going to do everything we can to make sure water is not dirty, and look at what that's solved over the past 100 years.

Quinn:
And now you look at, oh, my kids don't want to wear a mask or I don't want my kid to wear a mask in school and it's oppressive and it's this and this, it's like, at what point do we decide that air should not be dirty or at least should be filtered well and ventilated and just do that work? Because whether it's grossly negligible stuff like the air pollution in the US or in New Delhi or the streets of London that are making kids sick. I was an asthma kid, I know how horrible it feels not to be able to breathe, but my family had enough money to go to the hospital, so many of these kids don't. But just down to the basic classrooms where, yes, this virus is invisible but, Jesus, I mean the government passed enough money to build ventilation in every school system in the US, we have to do the work and we can do these fundamental things.

Quinn:
And again, it's called public health for a reason, but as soon as we had these pharmaceuticals and as soon as we were able to make it more personalized, we forgot about the shit like washing our hands and making our water clean and our air clean, that is just a fundamental barrier against issues like this. And like you said, we are capable of incredibly hard things, of doing incredible things, but we have to decide to do them. So on that note, piece of the action, so we usually try to give people really specific action steps that they can take not just, call your congressperson, we say, call this person, say this, this is the phone number.

Quinn:
I have struggled so much and I'm sure you feel the same way, finding an effective specific action step. As we put it for our community to take that, we're literally building a whole tool to fix this fucking problem, it's going to take a while, it'll apply to a bunch of different stuff. But in the meantime right now and then we can put in the show notes too and we're going to send an email to everyone, any specifics you have to put pressure on decision and policy makers on corporate boards in Congress and executive branches, wherever they might be, parliament, to get this thing moving? Anything you have? Any recommendations?

Dr. Madhukar Pai:
I think the most important thing we can do is to pressure our governments to transfer the vaccine know how and technology to as many countries, whoever wants it should be able to make their own vaccine, right? Vaccines for all should be the rallying cry. We simply cannot have the situation of one or two companies holding the world to hostage, not in this crisis, right? It's simply unacceptable. And certainly I think Americans should really put pressure on the Biden government to make sure modern technology is shared publicly, you know why? Because Moderna has already been paid for by you, right? By you and your listeners, you've already paid for it with your hard earned tax dollars, you have every right to ask your government to pressure that company to share the technology.

Dr. Madhukar Pai:
They're claiming that they will do it but they haven't, right? So there's no accountability here and NIH scientists co-created it, right? So this is truly a global public good and so that should be absolutely fundamental. Here in Canada we are pushing all our citizens to write to our MPs and our prime minister asking Canada to back the TRIPS waiver, asking Canada to donate way more than we have done and increase our financial contribution to ACT-Accelerator and COVAX so that countries will have syringes to buy. Vaccination campaigns take a lot of resources too, right? And that's what we are pushing for. I think, as you said, there's no one magic bullet, we need to do multiple things to get this pandemic under control.

Quinn:
All right. Well, we will try to make this specific for folks as we can so we can make some progress on this thing. I just have last couple of quick questions we ask everybody and then I will get you out of here if that's okay, a little more philosophical. Doctor, when was the first time in your life when you realized you had the power of change or the power to do something meaningfully either yourself, as part of a group, or a lab, or a class, whatever, or in your family on the playground, whatever it might have been?

Dr. Madhukar Pai:
The first time I felt that I could meaningfully do something was when I was training to be a doctor because I was learning something, right? I knew I could actually help people with that medical knowledge that I had. So as a young medical student I felt for the first time that that is something meaningful that I could achieve in my life.

Quinn:
I love that. Who is someone in your life that has positively impacted your work in the past six months?

Dr. Madhukar Pai:
In the past six months, actually in the past one year, I have been relentless advocating for global vaccine equity if you can go back and look at my posts, my tweets, because I realized that this is going to be ending up in a very bad situation if we didn't do that, right? But I think I've met wonderful global experts along the way who have truly inspired me with their work in this area too, right? I cannot at all claim that I'm the only one, there're many, many people like me. But some of them have been absolutely gangbusters on calling out the inequities and the injustice so I would say my fellow vaccine equity warriors around the world have been very inspiring. And we are a small community so we are in touch with each other on phone and Twitter and whatnot and we try to amplify each other and lift each other, so I would say those are the people who've inspired me a lot in the last six months.

Quinn:
I love that. And last one, what is a book you've read recently, we like to say in the past year, that has opened your mind to a topic you haven't considered before or that's actually changed your thinking in some way? We've got a whole list we share with everybody.

Dr. Madhukar Pai:
The book that I think I read and I blogged about it is by an author called Ben Phillips, it's about how to fight inequity, How to Fight Inequality: (and Why That Fight Needs You), right? Highly relevant to the topic of how do we fight against vaccine inequity or climate crisis. And Ben Philips, it's a small book and it's beautifully written, simply written, basically his conclusion is leaders will never lead the fight because it is their job not to do so, in other words, don't expect leaders to solve climate crisis, don't expect politicians to solve the pandemic.

Dr. Madhukar Pai:
He said citizens mass movement is the only thing that finally works and he gave lots of historic examples on civil rights, right? It takes passionate average people like you and I to finally tip the scale to where it needs to be tipped, right? That's why I'm starting to believe that citizen advocacy will push our leaders to end this pandemic because by themselves we have seen that they're not doing it. Same thing like Greta and Malala and others, it is citizens movement that they've created around gender right, citizens movement around climate crisis. I think it is that kind of mass movement of average everyday people that will finally bend the arc towards model justice, so to speak.

Quinn:
I love it. I can't wait to get my hands on that, I mean, it feels like it's written for me. That's the delightful. Dr. Pai I cannot thank you enough for your time, for your advocacy, for everything you're doing, I desperately want to be one of your students now.

Dr. Madhukar Pai:
Thank you so much. And I've really enjoyed learning from you. I love it that this was a conversation that I learned something from you and you learned something from me and not just a monologue from my side, so nicely done. Thank you so much for having me.

Quinn:
Thank you so much. Hopefully we can check in down the line, we've made a little progress but we're going to put it in this thing, we're going to do what we can. Thank you so much, I really appreciate it sincerely. Thanks to our incredible guest today and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dishwashing or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com, it is all the news most vital to our survival as a species.

Brian:
And you can follow us all over the internet, you can find us on Twitter @importantnotimp, just so weird. Also on Facebook and Instagram at Important, Not Important, Pinterest and Tumblr the same thing. So check us out, follow us, share us, like us, you know the deal. And please subscribe to our show wherever you listen to things like this and if you're really fucking awesome rate us on Apple Podcasts. Keep the lights on. Thanks.

Quinn:
Please.

Brian:
And you can find the show notes from today right in your little podcast player and at our website importantnotimportant.com.

Quinn:
Thanks to the very awesome Tim Blane for our jam and music, to all of you for listening, and finally most importantly, to our moms for making us. Have a great day.

Brian:
Thanks guys.