Season 2, Episode 11 - President M. Roy Wilson talks with School of Medicine alumnus, epidemiologist Dr. Larry Brilliant on the current state of the pandemic
Famed epidemiologist, public health and infectious disease expert, technologist, philanthropist, and author Dr. Larry Brilliant joins guest host, WSU President M. Roy Wilson.
Dr. Larry Brilliant, a Detroit native and 1969 graduate of the Wayne State University School of Medicine, discusses the current state of the COVID-19 pandemic, vaccine hesitancy, why he created Pandefense Advisory 16 years ago, his time at Wayne State, the joys of a service-oriented life and his advice for current college students.
Dr. Larry Brilliant has enjoyed numerous achievements. He worked as a key member of the successful World Health Organization Smallpox Eradication Programme for southeast Asia as well as the WHO Polio Eradication Programme. He co-founded and serves as chairman of Seva Foundation, an international nonprofit organization known for preventing and treating blindness and other visual impairments. Seva's projects have given back sight to more than 5 million blind people in two dozen countries.He co-founded The Well, one of the first online communities, which has been the subject of multiple books and studies and is considered a precursor to today's social media platforms.
He was vice president of Google and the founding executive director of Google.org, the philanthropic arm of Google.
He has served on the board of the Skoll Foundation, the philanthropic organization established by former eBay president Jeff Skoll, and continues to serve as a senior advisor. He was also president and CEO of the Skoll Global Threats Fund. He was chair of the Advisory Board of the NGO Ending Pandemics.
And he currently serves as CEO of Pandefense Advisory, founded in 2020 in response to the pandemic and the successor to Pandefense, an interdisciplinary network of experts that help organizations respond to pandemics.
Dr. Brilliant is a CNN medical analyst. He authored *Sometimes Brilliant*, a memoir about working to eradicate smallpox, and a guide to managing vaccination programs entitled, "The Management of Smallpox Eradication." He is the recipient of numerous awards including the TED Prize, Time magazine's 100 Most Influential People and many more.
Larry Brilliant's Wikipedia page https://en.wikipedia.org/wiki/Larry_Brilliant
Read Sometimes Brilliant: The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History https://www.amazon.com/Sometimes-Brilliant-Impossible-Adventure-Spiritual/dp/0062049232
Pandefense Advisory https://pandefense.com/
Dr. Brilliant on NPR discussing what needs to be done after vaccine boosters https://www.marketplace.org/2021/10/28/what-needs-to-be-done-after-covid-vaccine-boosters/
Seva Foundation https://www.seva.org/site/SPageServer/?NONCE_TOKEN=1866AFFB5EC0519929C0EB23E0BBBA0B
Larry Brilliant TED Talks https://www.ted.com/speakers/larry_brilliant
Announcer: Welcome to Today@Wayne, a podcast that engages and informs the Wayne State University campus community with news, announcements, information, turn of events discussions relevant to the university's goals and mission, Today@Wayne serves as the perfect forum for our campus to begin a conversation, or keep one going. Thanks for joining us.
M. Roy Wilson: Hello, I'm Wayne State University President, M. Roy Wilson. I usually don't host Today@Wayne podcasts, but I just could not pass up the opportunity to talk to a very special guest today. So, I've got the pleasure of guest hosting today. Our guest is Dr. Larry Brilliant, a 1969 graduate of the Wayne State University School of Medicine, who has gone on to live one of the most interesting and impactful lives you could ever dream of. He's a Detroit native, and he's made a name for himself as an epidemiologist, public health and infectious disease expert, a technologist, philanthropist, and author. He has many, many achievements, I'm just going to go through a few.
Perhaps the most important aspect of his career is as a key member of the successful WHO Smallpox Eradication program for Southeast Asia, as well as the WHO Polio Eradication program. For this work, he has written a book which I will recommend to everyone, called Sometimes Brilliant. It's a memoir about working to eradicate smallpox, and it's a guide to managing vaccination programs, entitled A Management Of Smallpox Eradication.
Something else that he's done in his career is very dear to my heart, as an ophthalmologist who has practiced and global health. He's also the co-founder and serves as chairman of the Seva Foundation, which is a international nonprofit, known for preventing and treating blindness and other visual impairments, Seva's projects have given back sight to more than five million blind people in two dozen countries. I've got so many other things here that I could talk about, let me just skip to just one other work-related thing that he does, and that is he serves as CEO of Pandefense Advisory, which was founded in 2020 in response to the pandemic, but Pandefense was founded many years ago, I think 16 years ago, and Pandefense Advisory is a successor to Pandefense, it's a interdisciplinary network of experts that help organizations respond to pandemics.
Like I said, I'm going to skip most of the other stuff, otherwise we'd be here a lot of time, but I do want to just go ahead and start with the pandemic. I think that's as good a place to start as any. Larry, thank you so much for joining us. Let me ask you the question, how would you describe where we're at currently with the COVID pandemic?
Larry Brilliant: Roy, it's so nice to see you again. Thank you for inviting me. Well, I think all of us would agree that the pandemic has been a series of crossroads. Every time we come to one thus far, it seems like just as we feel like we're in the clear, there's a new variant, there's another country that's infected, there's something we haven't thought of. We get vaccine resistance, mass resistance becomes heavily politicized. We've had these obstacles crop up at every time and we're at another kind of a crossroads. We are the lowest vaccinated of the G7 countries and by a long measure, or if you compare us to Japan, which six months ago had done almost no vaccinating, is now well over 75%, while we're in the 60s. And that's generous because we're not really counting everybody who could be vaccinated like young children, when we say that.
It means that there's somewhere between 50 and a hundred million Americans who are vulnerable, who are susceptible to the disease right now, and we're going into the winter cadence and this cadence that begins with the Halloween, Thanksgiving, Christmas, New Year's, each one of these events are accelerants and they're especially accelerants if unvaccinated people and vaccinated people are together, if people are not wearing masks, and if booster shots are not available. There's only really four states so far, who have made boosters available to everyone. I know that the FDA's going to change that in the next couple of weeks. I think it's unrealistic to think that we won't have a bump or a bump-ette, because it has to be smaller than last year, God help us. And it should be smaller mathematically, because there will be fewer people who are susceptible, but there'll be counties, Roy, that will have outbreaks in the next few months that will look like Germany, which is on fire.
While we say that Germany has a bad outbreak and they're bracing themselves for a 100,000 deaths, Europe's bracing itself for 500,000 deaths between now and February. These are numbers that are ... but we will have counties in the United States like that. We won't have states, I don't think. And we certainly, as a country, we need not have that if people get vaccinated, if they observe masking, if they take care of themselves at the holidays to get testing, to be sure that they're not going to either bring in the disease or spread it. But we're at a crossroads again.
M. Roy Wilson: Yeah, scary numbers. You created, as I've already mentioned, Pandefense 16 years ago, and now successor, Pandefense Advisory. That seems awfully prescient to me, Larry. You knew there was a pandemic like the one we current experiencing, that it was going to be inevitable, didn't you?
Larry Brilliant: Well, after we eradicated smallpox, I got this TED prize and I was asked to think about what would be the best use of the money that they were giving me and the TED community. That led me to talk to epidemiologists because might as well be in epidemiology because that's my field. The more I talk, the more I sense there was this apprehension. When I started Pandefense, we were dealing with H5N1, that is an influenza strain that has a case fatality rate of 60%. We were worried as a world, that it would go from just being lethal, to being more transmissible because some of the other flus, it is a highly pathogenic bridge flow, some of the other bird flus became very, very transmissible and that's why I called the first meeting of Pandefense is, brought experts from the tech community, the investment community and epidemiology to this meeting, the first Pandefense meeting.
We did surveys, we had Baruch Fischhoff, who was the chairman of risk communications at Carnegie Mellon, and we queried hundreds of epidemiologists, what are you worried about? And the consensus was, they all worried about a pandemic, but they'd never articulated it. So, I started working on it, that helped lead to my becoming a vice president of Google. They gave me some money. I started working more on it. If you saw the movie Contagion, that's a derivative of that meeting and I became the science advisor for Contagion. So, there's a lot of things going on at that of time, as we all began to realize that a pandemic might happen. Then in a surprise, President Bush asked me to chair a presidential committee on bio-surveillance. That got me even more involved as we had to go through all the three letter agencies and all the other agencies.
So, the apprehension of a pandemic has been there, but it's been in pockets. I think it was in bringing it all together that I became, one of the many people who have warned about this. I don't want you to think that I was the only Cassandra, there have been a lot of people who've been warning about this for a long time and you have to ask yourself, did it really do any good? Have we heeded any of those warnings? Not for me, but from the whole community.
I think the Bush presidency, they set up a lot of pandemic defense entities. I think that Obama improved them and created what we had asked for in our committee report, which is a position at the National Security Council, of somebody working on pandemics. And then Trump just tore all that up, removed the position, defunded the work on pandemics. We were so unprepared, whereas a year before the Trump administration, we were declared the most prepared nation in the world, I think a year after, we were the least. It's really a tragic story.
M. Roy Wilson: Yeah. You've described this as a forever virus, which makes me think that you believe that we'll never get back to pre-2019. So, what do you think the new normal's going to look like?
Larry Brilliant: Well, it is a forever virus. It will be around for a long time. We can't eradicate it because it's in 12 animal species already and we can't reach herd immunity because the Delta variant is so transmissible that we would have to vaccinate or have people immune from getting the disease, we'd have to reach 90 plus percent of the population, we're stuck at 65. So, it will be in the US, ping-ponging back and forth from state to state and globally, most Americans have no idea what it takes to make a global vaccination program all over the world. WHO has categorized two billion people as being remote and rural. By definition, they mean that those are people who can't reach a health center. One billion who are the poorest and the most vulnerable the world can't be reached by a health center coming to them.
So, you're dealing with a huge number of people who will not be vaccinated this year or next year, or the year after, or year after that. So of course, the virus will always go where there are people who are susceptible and that means that it will continue to have hot epidemics that spill off variants in far away places, but also in some remote parts of the United States. That's the problem, but it's also the opportunity. There has never been in my lifetime, Roy, a moment where I could say to someone, the most selfish effing thing that you could do for yourself is also the most selfless thing. As a country, the most selfish effing thing that we could do for ourselves is to be selfless and to provide vaccine for the poorest and the most remote two billion people.
Now, we're not doing it. The Biden administration is doing a lot more, but these companies, Moderna in specific, I've been arguing with some of their close people there and they just have not been willing to help other factories manufacture mRNA vaccines. I think Pfizer's loosening up a little bit and both of them are under tremendous pressure, but we need these vaccines being manufactured closer to where people live to shorten the supply chain and we actually need a different kind of vaccine too, Roy. We need one that doesn't require a immunization, doesn't require a cold chain. Can you imagine these health workers, trotting five miles, carrying all of this stuff that they can't get to by road, and maybe they're on a motorcycle? We need to have a vaccine that give nasal immunity, mucosal immunity. The reason that these vaccines are having waning immunity is because they don't give immunity in the nasopharynx, where the virus first comes.
So, we need a different kind of vaccine that gives you more rapid immunity, it takes 14 days to become immune with Pfizer or Moderna. We need rapid immunity. We need post-exposure prophylaxis, mucosal immunity, we need a nasal spray or a drop, and we need it not to need a cold chain and easily manufactured. We can do those things. And there are about half a dozen vaccines that have those properties in trials right now. So, I'm optimistic about that. I'm also really optimistic about the two antivirals from Merck and Pfizer.
We might find ourselves really fortunate and both companies in this case are making agreements. I think Pfizer just announced that they have agreements with 97 countries to make the generic equivalent. So, we might get really lucky, but we got to get lucky fast, and we've got to be more serious about this and this nonsense about the anti-vax, anti-mask, COVID is a hoax, there really weren't three quarters of a million deaths. We in public health have got to look at that and look at it as an emergency. It's an emergency when so many people in the United States and in Germany, that's why they're having an epidemic there, why so many people don't take this seriously. This is a pandemic, it's not going to go away. We want to push it so that it becomes quiet. We know how to do that, but we can't pretend that it doesn't exist and we can't pretend that it's not serious.
M. Roy Wilson: Well, staying on the theme of the unvaccinated for a moment, you discuss one of the issues globally, that not all areas have access to the vaccine, but there are places like Germany and United States, where access is really not the issue. You just have people who don't want to take it. 70 million Americans, for example, adult Americans, who have not yet been vaccinated. Is it possible you think, to convince them to get vaccinated or we're going to have to have one of these newer modes of delivery or something else like we're discussing?
Larry Brilliant: I think we're making incremental progress towards better numbers, but it's nothing close to what we need. Only 15% of Americans who are eligible for a booster have availed of it. The booster is a huge difference between two doses of mRNA. The booster gives you close to sterilizing immunity. It prevents you from getting the disease or giving it at a much greater rate than having just two doses. So, you're not taking the booster only for yourself, you're taking it to prevent it from going to others, but it also protects you from getting it. I think we've underestimated the effect of long COVID. A booster dose really protects you from getting the disease and therefore will protect you from getting long COVID.
The vaccine mandates are a double-edged sword. They do get more people vaccinated, if a company or a county requires you to get vaccinated by law or by agreement, but they do set up a lot of anti-vax sentiment, so those are ... I'm in favor of them, they have helped and there's certainly cases where you just can't let vaccinated people bear the brunt of unvaccinated people coming into that same room or that same event. I'll give you an example, why do we have vaccine mandates for children for two dozen vaccines? Because we agree as a society that our public schools should be open to anyone, and there are kids who are immunocompromised, who have cancer being treated with chemotherapy, who have a parent at home who's immunocompromised, or the child has lupus, or some other disease that makes them not able to have an immune system against COVID, or against measles, or against mumps, or against chicken pox, or all these other diseases, DPT. So, we have a mandate, you can't come to school unless you're vaccinated.
This is the same thing, you can't come into a gathering unless you're vaccinated against COVID. That's why there are these mandates. It not so much to force you to do anything, it's just to prevent you from doing something, which is to get other people sick.
M. Roy Wilson: So, I neglected to mention this at the beginning, but you earned your medical degree at Wayne State. Can you tell us a little bit about your Wayne State training and your experiences? What really contributed most to your remarkable career? Any tidbits about your training at Wayne State, that allowed you to make such a difference in this world?
Larry Brilliant: Well, the fact that Wayne admitted me was wonderful because I never graduated from college and I was a philosophy major and I hadn't taken my pre-med courses. The fact that they were willing to bet on me, changed my life. There were two of us in my class of a hundred, who had not been pre-med, who had not taken organic chemistry, or any of the defining classes before we went into medical school and turned out, both of us were philosophy majors, so we became good friends. Why would a philosophy major student be prepared for medical school? And why would that be a helpful undergraduate course? And how on earth could you ever trust some jerk who never took any science courses to really be a good doctor?
But Wayne decided that they wanted to have a balanced class. They wanted to have people who thought differently and came from different areas. So, they deliberately wanted to have a couple of people at least, to try that. I think I wound up with pretty good grades, they were really happy with me. I was very good at math, but I hadn't really had a lot of the advanced pre-med classes that a lot of other people did and the compassion and the way that the deans, the associate deans, and the other students helped me to get better, faster at science and how much it turned out that I loved science, and I love the interface between math and science, which is of course what epidemiology is and more than that, I love the commitment to the public, which is what made me interested in public health.
Wayne gave me my junior year to go abroad. So, I went to London and I studied at Guy's Hospital. My year abroad was on international health. So we bought a Volkswagen Camper and we went to every European country and met people and talked about their healthcare system and how it was different from ours. Then we drove through Russia, this is my medical school roommate and I, we drove through Russia, the Soviet Union then, from Helsinki to Istanbul.
At each place we asked, "How do you deal with this disease? What are your hospitals?" How could I have had that experience any other place? Wayne allowed me to do that. I'm deeply grateful and I'll never forget what Wayne did for me.
M. Roy Wilson: Well, that was a great bet that Wayne took. Certainly, we've been a beneficiary of that also. You've led such a service-oriented life, what advice would you have for students, not just medical students, but just even from any discipline about serving their communities or working to make a difference in the world?
Larry Brilliant: Well, some of this always sounds corny. We're such a jaded and skeptical world. It is better to give than receive. We think about that now as being like a dad joke, but it's really true. My greatest moments of happiness was in seeing someone else receive the food that the food bank gave, receive sight that a Seva ophthalmologist gave...How can you not feel good about that?
I saw the last case of smallpox in the world because I had worked hard and I wound up in this little ... Bhola Island in Bangladesh, dirt poor. The last case of smallpox meant that an unending chain of transmission back to the pharaohs, billions of people who were killed by this disease, ended when she coughed, when the viruses on the soil and the sun cooked them. I would never have had that experience in corporate America. I would never have had that experience if I stayed in academia. A life of service opens up so many doors and it is the best thing you can ever do for your heart.
Public health tells you that preventive medicine, working in that field, both on yourself and on your community, is the healthiest thing you can do for yourself. There's not enough time for me to laud the unexpected gifts that you get when you give.
M. Roy Wilson: Wow. I'm sure our students would take that to heart, we have great students. You served as an advisor and you mentioned this already, on the pandemic movie Contagion, which I saw by the way, it was a good movie. So, much of what we went through in this pandemic was depicted in Contagion. You connected the director of contagion, Steven Soderberg, with Wayne State to provide COVID testing for the crew of his new movie, No Sudden Move, which we really appreciate you doing that. That was also shot in Detroit. Are you connected to any other movie projects that you can talk about?
Larry Brilliant: I am, and quite a few. In fact, one which is coming out this week, that Participant has done. I'm part of the group that works with Participant movies. They've made many Oscar movies, including Al Gore's movie and so many others, and also Spotlight, and many other movies, but they've done one now on the very first cases of COVID and New York City, and that's coming out this week. I work with a really sweet guy named Seth MacFarlane, who does the Family Guy, and we've worked together on a bunch of PSAs using the Family Guy characters to tell people about vaccination. He's also got a TV series called The Orville, science fiction story. I've worked with him on that, on the COVID protocols for the last year, but I've also gotten into the plot and enjoyed it a lot.
My colleague and I made the protocols for Hollywood, for the Director's Guild, the Producer's Guild and that has put us even more in touch with Hollywood. I think they're turning my book into a TV series, so I'll continue to have a relationship with Hollywood. The idea for doing Contagion as a fictional movie was not mine. I wanted to do it as a documentary and the folk at Participant and Warner Brothers convinced me that nobody watches documentaries in the quantity that they do a fictional movie. They were right, I was wrong, but we tried to make it as accurate, scientifically, as possible. So, that while it might have been fiction in the script, it was not fiction in the way the science was descriptive. We also wanted to make it as an homage to the people at CDC, WHO, those on the front line who risk their life every day, dealing with pandemics. I'm glad that it came out the way that it did.
M. Roy Wilson: Great. Great movie. Okay, last question. As we head into Thanksgiving and given the tone of this conversation about global issues, and the many meaningful holidays around the world, particularly during this time of the year, is there a message of hope and gratitude that you can share with people?
Larry Brilliant: There is. Throughout history, pandemics bring out the best and the worst. Throughout history, nations and empires rise and fall because of enduring the pandemic, whether it's the Black Plague, the 1918 pandemic that coexisted with World War I, or now. I think the Trump administration ended because of the way that the pandemic was handled under their watch. I think it's always the case that you see the best and the worst. The best, the first responders. I still member when they sang from the balconies in Italy to celebrate the first responders. In my community here in Marin County, for some reason we decided to howl. I don't know why, but we howled to thank the first responders.
I still remember the phone calls that I got from China and from Italy, when doctors who didn't quite understand the disease that they were facing died, the frontline workers died, the patients died and they were just brokenhearted. To this day, you'll see, anytime you go into a hospital, just turn around to the first nurse's aide, or operator, or phlebotomist, intern, resident, just turn to any of them at random and say thank you, because we would not have had as few deaths as we had ... That sounds terrible, we've had three quarters of a million Americans die, more than died in the 1918 pandemic, more than died in all the wars the United States has fought ever, more than all the Americans who died in all the wars in the 20th century, it's a huge number, a quarter of a million. It's going to cause a notch in our life expectancy curve that we haven't had since 1920.
So, just thank the people who have given their life, risked their time, their everything, to make you safe. That's the question. Can you think about that, everyone listening to this? Can you think about all the people who had to run the supply chains, the essential workers, the first responders, the healthcare workers, you and I would not have been as safe as we were and got through it thus far, if it hadn't been for them.
M. Roy Wilson: Yeah. Well, Larry, this has been terrific. Thank you for taking the time to do this. You've had just an incredible career and I'm sure that those listening this podcast will be inspired by all the things that you've done. Please send my regards to your lovely wife, Girija, and take care. Really, thank you very, very much.
Larry Brilliant: Roy, thank you so much. Remember, my wife is from Detroit. We met when she was 15 and I was 16 in high school. We're proof that hippie relationships do in fact, last and endure, as does my love for Detroit and for Wayne, that also endures.
M. Roy Wilson: Thank you very much. Larry.
Larry Brilliant: Thank you, Roy.
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