COVID Webinar Series: Transcript of session with Susan Desmond Hellmann, MD, MPH

Susan Desmond Hellmann, MD, MPH, Former Chief Executive Officer, Bill & Melinda Gates Foundation
Recorded, July 8, 2020
Her session is available for viewing online.  This is a transcript of the Q & A:

KRIS REBILLOT: Thanks for being with us today.

SUSAN DESMOND HELLMAN: Thanks for having me. Glad to be here.

KRIS:  What’s your assessment? Why are we where we are?

DESMOND HELLMANN: Well, the… I think in public health, one of the most important attributes of success is simplicity. And so the most simple way to answer your excellent question is the virus is still here. The virus is still here. When there was a sense that the number of cases were dropping, when New England, New York, and other places seemed to see some improvement, the… I think the opening up, the message of opening up, of getting closer to normal, I think, was unfortunate, because I think people heard, ‘Okay, maybe the virus isn’t here anymore. Maybe we don’t need to use the cautions that we’ve been using. But, in fact, we don’t have herd immunity, as people call it. We’re far from having the number or proportion of the population that would need to have antibodies to be safe. And so the three simple things—keeping your distance, wearing a mask, and washing your hands—remain extremely important, extremely important, no matter where in America you are, and even in areas that have seen their numbers drop, now what we’re recognizing is… and California is such a good example, it can come raging back quite promptly. And so in the absence of a vaccine, in the absence of a safe and effect vaccine, we all need to get in our head the virus is still here.

KRIS:  It seems like testing would part of a thoughtful response to this pandemic. Do you think the window has closed for a strategic approach to how we deal with this public health crisis?

DESMOND HELLMANN: You know, I don’t think the window has closed. I think that is… that is too pessimistic, and I’ve started to feel like the… if every American had in their mind two simple things. First, ‘What am I going to do? What am I going to do to protect myself and my family? How are we going to think about where we travel, where we go, how we work, how our kids get educated?’ Mask-wearing is a very important part of that. Distancing is an important part of that. so that sense of self, and how I’m going to keep others around me safe and keep myself safe. But the second thing is, ‘What am I going to advocate for?’

And so I don’t think it’s too late. And one of the things I am extremely motivated by, and I don’t think I’m alone, is school. So if people in power, if President Trump, if this administration, if the 50 governors came out and said, ‘Here are the things we need to do for our children to safely go back to school.’ I think people would do it.

You know, so I think it’s both that individual set of things we need to do, but also what’s the collective mandate? What’s the collective mandate that… getting the economy back up and running seemed to be very motivating to people, but I’m telling you, if you want the economy to come back, and you want parents to go back to work, kids got to go to school. And if you want not to lose for a generation and backslid a lot of education, going back to school is a very big deal.

And so I do think that testing is a part of that. Having the appropriate funding for personal protective gear and protecting teachers is a part of that. And we can learn from other countries that have successfully restarted schools. But the problem with testing now is the capacity just isn’t there. So having a test that you get back in eight days, and that’s as if you don’t have a test. So having the capacity to have the turnaround that’s required is a critical part of testing. An illness that has so many people asymptomatic, testing has to be a part of our strategy, because we can’t count on people being sick to tell us when they’re infected.

KRIS:  Got it. So this conversation is a perfect segue to our first question. Do you think that the US is ready to send elementary school kids back to school? And what do you think about this issue to guide parents? What needs to happen on a policy and in an individual basis as far as getting kids back in classes?

DESMOND HELLMANN: Well, the… I would say not yet, but the kinds of attributes... CDC has now put forward, some of the attributes of spacing and distancing for kids in classrooms, what it needs to look like for schools to safely open. And so I think parents need to work with their schools to ask questions about what will be done. How will the school manage it if someone is infected or needs to be quarantined? How will classroom learning be managed vis-à-vis what kids have seen before about distance learning? And so I don’t think we’re ready, but I think we could be ready.

KRIS:  Yesterday the United States put the World Health Organization on notice that we are withdrawing.  What’s your take on that?

DESMOND HELLMANN: It is a massive mistake. It is a massive mistake. It is… the only thing that’s worse than us backing away from WHO is the US doing that during a pandemic.

I will say that I do not love bureaucracies. I’m sure congenitally against bureaucracies. I’m a little bit more of a startup biotech kind of lady. On the other hand, the power of WHO, the power of every country on Earth coming together to decide how we collectively are going to stay healthy, is so important. And so let me tell you two things that, WHO uniquely can do that I think is just… we will so miss out on.

The first thing that WHO does is they have what would be called a normative function. We all know in the San Francisco Bay area how difficult HIV AIDS is. If you were in Malawi, how do you treat a patient who presents with a new HIV infection? You actually look up what WHO recommends. So WHO puts forward vaccination schedules for small children all over the world, poor countries, rich countries. WHO’s normative standards take data and assesses it, and helps us understand truth. That is massively important.

The second thing WHO does is it brings experts, in part, to set these normative standards, and has a healthy debate about what the right thing is to do, including things like disease eradication. The only disease ever, smallpox, was driven by WHO. Polio eradication, where we’re nearly there, driven by WHO. Those experts come from all over the world. And those experts contribute and they bring back to their home country a lot of knowledge. US will not be engaged in that work. So all of our… you know, I like to call it, all of us smarty pants’, you know, no more WHO for us. What a loss for the world and what a loss for the US, not to have that sort of collective action and collective scientific discourse that’s so important. I’m sure it’s true at Buck, but it’s true in every part of science that we benefit from that collective dialogue.

KRIS:  I got a question from a woman who’s a 62-year-old high school teacher. She’s concerned about lack of funding for disinfecting, PPE, improved ventilation. So how can teachers stay safe during this?

DESMOND HELLMANN: Yeah, so I am so with you. I am so with you. I think that the thinking about schools opening as what happens with children completely understates the risk and the concern. So teachers, the staff, people who keep the schools clean. There’s just a ton of people involved. And somebody who is 62 is in a higher risk group, being over 60. So one of the things that I think is incredibly important is to advocate for, as part of this of what Congress is thinking about with the next wave of funding, there needs to be much more funding that goes for schools, for better ventilation, for protective gear, for cleaning materials. And, also, it’s going to be difficult because class size has to be smaller. You can’t keep your distance if you’re in a packed class. And so all of those things will need to be... masking, will need to be part of the funding that’s required to open school safely.

KRIS:  So I would think that you would recommend that this teacher, teacher unions, that they really start lobbying Congress?

DESMOND HELLMANN: Absolutely. Congress is in the mood to pass bills that help with COVID. And so I think advocacy at the level of the a teacher’s union in Congress, but I also think there needs to be state advocacy, as well.

KRIS:  Let’s talk about folks being unwilling to wear masks. What’s going on culturally, leadership-wise? Why is it so difficult to get people to wear masks?

DESMOND HELLMANN: Well, let me say a couple things that make it more difficult than it should be. One, is, sadly, at the beginning of the epidemic in the US, the Surgeon General, I think in a real wish to preserve masks for healthcare workers, spoke up against masks. So there was a bit of a mixed messages, which was a shame. And then the second thing is President Trump doesn’t wear a mask. I mean, that modeling matters a lot, and no matter what party you’re in, having the President show up with a mask would actually be a big deal. It would be a really simple, big deal. So I would encourage him to wear a mask in public. He hasn’t asked. And I’m looking at the phone, it’s not ringing yet.

But, look, here’s the other thing that I think is important for people to know. Most Americans actually agree with masking. These viral videos of people… or people, you know, saying that they got thrown out of target or, you know,  all this stuff. Most Americans want to protect themselves and their families and their neighbors. And so one of the things that I think we can all do a good job of is making it a cultural norm. I heard somebody talk about, ‘Okay, you leave your house. You take your keys, your wallet, and your phone, right? Add a fourth thing to the list. You take your keys, your wallet, your phone, your mask.’ And it’s… so I think we need to make it just like in Asia, a cultural norm for a while. And I’m sure we can.

The one thing to know, and this gets to bars and indoor dining, you can’t eat or drink with a mask on. And so I do think in addition to universal masking and really being aggressive with masking, it feels, given the backsliding in the epidemic, that it’s too soon for indoor dining and bars, in most places.

KRIS:  What’s your take on the younger crowd not being as safe as many of us would wish that they would be?

DESMOND HELLMANN: Yeah. Again, I think it’s sort of societal value, societal norms, and a false sense that it doesn’t matter if you’re young. Whereas… and people are tired of being indoors. You know, it gets old for people. That said, I think that… being outdoors, actually, if somebody is at a beach, it’s easier to distance, and it is safer. I would start with the indoors. Really, bars, indoors restaurants, that’s a problem. Being outdoors, if you distance, and you wear masks if you can’t distance, is much safer. But what I would tell young people is, look, you want to go back to school, or go back to work, or go back to normal? The faster we protect ourselves and others, the sooner you’ll get back to normal. And I think the… if that is what’s expected, and that’s what people see around them, they’re more likely to comply with that, than thinking it’s a sort of freedom issue, or that the virus would go away when the weather’s warm. Clearly, when we see Arizona, Texas, Georgia, Florida, this is not a virus that is going to go away when summer comes.

KRIS:  There was a study that came out today from the University of Washington Institute for Health Metrics and Evaluation. They predict that there will be over 208,000 Americans dying by November 1st if no further mitigation efforts are enforced. If mask use becomes widespread, then those projected deaths would drop to 162,000. So that’s a significant amount of protection that we could buy just by wearing masks.

DESMOND HELLMANN: It’s… masks are… if there’s one public health message, it’s masks. And I think that the IHME that you just cited from at the University of Washington does beautiful work. They’re actually… most of their funding comes from the Gates Foundation. And they’re terrific modelers and terrific statisticians. And so the… the profound impact of masks on decreasing deaths, you can draw a straight line between the two. So I’m glad I decided that. I think it’s… that is… that makes me even more put that mask on.

KRIS:  What causes you to be optimistic? What gives you hope?

DESMOND HELLMANN: What gives me hope… one thing that gives me hope is the product development innovation. So there’s over 130 vaccines in trials, and the level of science… there’s RNA, DNA, adenovirus vectors. It’s incredible that a lot of the new things we’ve been excited about are actually leading the way in vaccines against coronavirus And it’s not crazy to think that we will at least have some answers by the end of the year, if not a vaccine that can start to go into use. So I’m very positive about the vaccines, and the work that’s going on in vaccines.

The other thing I’m really positive about is the monoclonal antibodies. Now, we haven’t talked a lot about, but Operation Warp Speed granted Regeneron, one of the big drug companies, a grant to advance their monoclonal antibody. Regeneron made one of the most effective anti-Ebola antibodies, so we know they have the capability to do this. Antibodies are injected, they’re expensive, they’re not ideal, but they could bridge us to where we have antibodies. We now have two effective regimens, we know Remdesivir works in decreasing the number of days before people get better. And we know dexamethasone, an inexpensive steroid, helps patients who have severe COVID. So… and product development is actually pretty good.

I wish I had more optimism about the public health stuff. I know people who are public health experts feel overwhelmed and beat up. You know, it’s sort of thankless telling people to put a mask on. It reminds me of HIV, with condoms, and abstinence, and a lot of things like that. It’s hard, behavior change is hard. So I’d like to have a little help from politicians on the public health front. I think we need that, those very simple, consistent messages. I’d like to see more of CDC, more of Fauci, more of a NIH.  But I’m optimistic about product development.

KRIS:  You mentioned Remdesivir, which is showing promise, is working in patients. There was a piece out this morning, actually, a news release from South Africa that talked about the fact that the United States pretty much has a lock on the supply of that drug. How do we approach sharing the wealth, or dealing with countries that don’t have the resources, are not able to get to the front of the line? How do we deal with who gets vaccines, who gets treatments?

DESMOND HELLMANN: Well, a couple of things give me some optimism. One is Remdesivir is made by Gilead, and Gilead is a company that understands how to do what you call tiered pricing. So they, in their HIV and hepatitis drugs, have used this before. So it is possible to go to generic or low-cost manufacturers in India and other countries to have an additional supply made, and to have differential pricing for low income countries. Very important and extremely important on the distribution front. One of the organizations that I’m really fond of is the global vaccine alliance, Gavi. Gavi works with manufacturers all over the world to bring vaccines that are low-priced into different countries of the world in a very fair way, and looking at what they can afford, their GDP. So that Gavi model is one that would really help with some of the administration of anti-COVID remedies.

KRIS:  What is the Bill and Melinda Gates Foundation doing in regards to COVID-19?

DESMOND HELLMANN: Oh, my gosh, what aren’t they doing? So the Bill and Melinda Gates Foundation, and Bill, specifically, have been incredibly focused on pandemics and pandemic preparedness. When I first started as CEO of the Gates Foundation in 2014, Ebola hit West Africa, and so it was like, ‘Whoa!’ And then Zika came a little later. And so this has been on the minds of folks at the Gates Foundation for a while. One of the organizations that Gates helped to found is CEPI, the Center for Epidemic Preparedness Innovation. And CEPI funded a lot of the vaccine constructs that are now being studied against COVID. So the Gates Foundation, I don’t know, I think it’s over $250 million now, have funded diagnostic testing, they’ve funded a collaboration with Wellcome Trust and others to accelerate therapies, and they’ve helped to fund CEPI and Gavi to make sure that not only are safe and effective vaccines brought forward, but when they are, there’s equitable distribution.

KRIS:  There was a piece in STAT News this week that talked about there are 1,200 clinical trials underway for various treatments, vaccine. They said that there’s a lot of chaos, that the trials aren’t designed well. Are you concerned about any safety concerns? Where’s the balance for safety and efficacy?

DESMOND HELLMANN: Yeah. Well, so on my hierarchy of things I worry about... and I just think this is basically something that should never happen… I don’t like... when somebody goes into a trial, when somebody becomes a human subject in a trial, that’s like a volunteer effort that I think is a real positive. I mean, you hope you’re helped, but you’re trying to help the world, right, when you do volunteer for a clinical trial. The worst possible thing is a clinical trial doesn’t teach us anything. Like you have 10 patients in a trial, it’s underpowered, and you don’t learn. That, for me, should be on the never list, no investigator should let that happen. Not learning is really bad. The second thing you mentioned which is you get so enticed by the efficacy, you forget about safety.

I will say one of the good news items is that there’s been so much publicity about a vaccine for COVID that the people I talk to are really hyper about safety. They are really hyper about safety. They are making sure that they see every patient in the trial, that they answer every question, that they pick the right dose. So there is a sense of pace of speed, but, also, that, you know, vaccines are for people who are normal, so they have to be safe. So there is a lot of scrutiny on safety, especially with these new constructs, like an RNA vaccine that’s never been done before. When you’re a product developer and you have a sentence that includes the term ‘never been done before,’ the hairs go up on the back of your neck. So you’ve got to be really careful. There was also a dengue virus vaccine that was studied in the Philippines for a really serious illness, but it had the unusual thing of making people worse. And it got a lot of publicity in the vaccine circles. And so there are a few very specific things that one might worry about with vaccines that are on the minds of FDA, and the people who are doing the trials.

So I think it’s… I always worry about safety. I mean, it’s like that’s the thing to worry about, but I feel like people are paying a lot of attention. It’s going to be interesting to watch, in China, they just made one of their vaccine constructs available for the military. They approved it for the military, which is interesting. I don’t consider it approval when you only do one patient, but it’s almost as if they thought their military was at such high risk that they would go fast and go into the military. It will be interesting to see the outcome of that. I could see in the US, if you... as we’re building the safety database and having more patients, you could say, you know, in nursing homes and healthcare workers, there’s some very high-risk populations that you might go into first. But you have to make sure the ethics are all squared away, because like there’s… people think about now that San Quentin has such a terrible outbreak, I think, could they be part of a vaccine program?  But the ethics of vaccinating prisoners is really tricky, so you got to be really careful on ethics and true informed consent.

KRIS:  So they’re developing so many different types of vaccines and I’ve heard that there will probably be more than one out there. Is that going to be a cause for confusion about having so many different approaches to…

DESMOND HELLMANN: Actually, I think it will be great. I’m really positive about that. First of all, we’ll learn a lot about the biology of these different approaches, and… you know, in polio we have an intravenous… or an injection and a tablet. So oral polio vaccine and injected polio vaccine are really different. They both have specific attributes that help or hurt. And so I think it’s a net plus having more and having different ones. There may be some that… a really good example, I’m sure some of your listeners have seen the SHINGRIX, the zoster vaccine. It’s a tricky vaccine because it needs to work for people as they age. And your immune system is a little less active as you age, and so they use an adjuvant, something to boost the vaccine, so it hurts. But when it hurts, that’s actually giving you immunity to zoster. So because with COVID, as you get older, you get more severe disease, one of the concerns is some of these vaccines need to be really powerful, but if you’re young, that might be a little bit too powerful, and you may not need that power because your immune system is stronger.

So I think that studying all that, understanding all that, and having several is a net positive.

KRIS:  So, what do you say to folks who are against vaccines?

DESMOND HELLMANN: I’m confused about why anyone is an anti-vaxxer. I hope that they’re not using now very clearly disproved information on autism as the reason they’re anti-vaccine, and I would encourage people to read and get real information about vaccines. Vaccines have changed our lives. You know, COVID is scary. I’ll tell you what’s really scary, is measles. Measles is terrifying. If we didn’t have a measles vaccine, life would be different for us. And so I’m confused about anti-vax, one, because I worry that people got bad information; and, two, because me, as a physician, I think a vaccine is like a miracle, like a miracle. Like it’s a miracle that something that is just a shot or, you know, some liquid can protect me and my family from a scary, infectious disease.

KRIS:  People of color have been disproportionately impacted by this disease, both in terms of infection and also deaths. What’s your take on that? What do we do?

DESMOND HELLMANN: Well, first of all, I think that one of the things worth reading and going through is the New York Times analysis of the CDC data. I thought that was really powerful. They have almost one and a half million people who have been infected with coronavirus in a database, and the bottom line is it is inarguable that blacks and Hispanics have borne the brunt of this pandemic. Early on in the pandemic, there was a lot of discussion about comorbidities. Was there diabetes, hypertension, obesity? Was that the reason for the difference? The more recent updated information seems to suggest that the same kinds of inequities that we’ve seen in health that are negative for Blacks and Hispanics apply here, the not being able to work from home, needing to use public transportation, being in a job where you might be closer to others who could infect you, that, in fact, those are more likely to be the reasons why the inequalities exist.

KRIS:  You have talked in the past about precision public health, as opposed to precision personal health. Would that apply here, that really focused public health?

DESMOND HELLMANN: So, for me, precision public health is… you talked about the Institute for Health Metrics and Evaluation. I mean, that’s very much the kind of thing that I talked about when we talked about precision public health. So I find looking state by state and community by community to be fascinating. One of the things I think that we underutilize is something that is staring us in the face, which is extended care facilities, prisons. There are places where there is a massive coronavirus epidemic and a lot of deaths. And so, for me, precision public health is, yeah, I care about, you know, the seven counties in the Bay area because I live in one, but, boy, this thing in San Quentin, what the heck? And so I think there’s… and there’s areas in New Jersey and New York where the nursing homes were like 80% of the deaths. So just… I think what we all need to do is take a step back and instead of feeling overwhelmed, like, you know, where do you get the biggest bang for your buck with personal protective gear, with distancing, with protecting people with masks? Do people have everything they need in those very high-risk areas?

KRIS:  Is that happening anywhere that you’re familiar with? I heard here in Marin County, there were special efforts to go into the neighborhoods that are largely Hispanic to do some targeted testing.

DESMOND HELLMANN: Yeah, actually, UCSF went… and went into the Mission District. And, actually, that was one of the early… Diane Havlir and others showed a… it was really striking. I’ll tell you, here’s one statistic, that the proportion of coronavirus infections they found in this Mission District among whites, zero. It was like, wow. Wow. And so I think those were some of the early signs that, wow, this inequity is something really profound and needs to be understood. And, now, using that information to take action and protecting people is really important. I know, you know, like a lot of people my age, I have parents who are in an extended care facility. I’ve never been there. Nobody’s been there.

KRIS:  Right. Right.

DESMOND HELLMANN: And they haven’t had a… knock on wood, haven’t had any cases.

KRIS:  So in addition to folks living in overcrowded housing situations, working in areas that are more prone to support infection, there are those issues of comorbidity—obesity, high blood pressure. How do we get people healthy?

DESMOND HELLMANN: Yeah. I think there’s a couple of things that are sort of interesting that have come up in the discourse around COVID-19 that are worth pointing out. One, is that our system of employment-related health care doesn’t work. It just doesn’t work. It’s inequitable, it’s choppy. If 30 million people are out of work, 30 million people now just lost their health insurance. So I think that in a positive way it brings forward if we consider healthcare a right, our system is not working. You know, and that, I think, is important to everyone. But I also think that there’s a... Robert Wood Johnson has had as a foundation this saying that I really like, which is the social determinants of health. I don’t think you fix these comorbid conditions until you fix the social determinants.

KRIS:  Do you think this pandemic will open up the conversation or make it more likely that we would have some sort of single payer healthcare that we would change how health care is delivered in this country?

DESMOND HELLMANN: Yes, but I think that will, in part, depend on the outcome of the upcoming election. But I think it will definitely reopen that dialogue.

KRIS:  Let’s talk about some of your work on past pandemics. Does that work inform how you’re looking at COVID-19?

DESMOND HELLMANN: Yeah, for sure, the… so in the Ebola epidemic, I think there was so… there was such an intense reaction, people were so afraid of Ebola, that it was… it was almost like COVID upside-down. On the other hand, there was a lot of fear and mistrust in Congo, that there’s been so much unrest that it was really important to get to the community leaders. And I think that’s one lesson that I haven’t heard talked about enough in COVID, which is who do people believe? Who do people care about, and who will they follow, and who do they trust? Because I think that trust issue was such an important, profound thing. I think that was a really, really profound thing. The other one that I think I learned a lot from, it’s not a pandemic, but really a vaccination program, is polio. In Northern Nigeria, actually, going to the imams, going to the mosques, going to people who were trusted, who would actually go in front of everybody and get their polio vaccine, to show that it was safe and effective, and that they trusted it. So I think this thing about community spirit and who you trust really matters.

But then the last thing I’ll say is just… and this is true about a lot of things in research and academia, and it’s just true in life, you need money. That’s why I mentioned opening up the schools, it needs... it’s going to take money. And to fight a pandemic, you need community health workers, social workers, you need people who reach out, and who can help people be protected.

KRIS:  Somebody wants to know what your take is as far as people being able to trust scientists, how leadership is dealing with scientists, and has the pandemic elevated science?

DESMOND HELLMANN: Youi know, it’s… I would that it’s such a profoundly important responsibility that scientists and physicians have right now. I think public trust, in general, is poor. I think social media, the sort of discourse, the polarization in politics has all conspired to bring about a lack of confidence and trust in science and scientists. And yet the scientists, themselves, can drive a better outcome. A really good example, I think, is publications, and withdrawing publications. When publications are withdrawn, having a good public dialogue about what went wrong and being really open and honest about that. I think there’s a difference between trust in science, and acting like scientists and science are some religious thing that can never be questioned.

And that’s why I think there’s two pieces of this for me: there’s sort of science that should be kind of messy, and should be debated and argued; and then there’s public policy. And public policy and public health should rely on science, but should be able to say, ‘Look, we have new information. Things are different because we have new information, and here’s the new information.’ I think, masking is such a good example. The two things that came forward. One is masks were more available. They weren’t so special or rare. You could make your own mask, in fact. But the second thing that was so important and is so important is many, many people with COVID-19 are asymptomatic. If you tell me that, I want a mask on. I might be asymptomatic and you might be asymptomatic. So I think that a really simple, clear message like that is what policymakers need to do when they update the science.

KRIS:  You talked about those super spreaders, asymptomatic folks. I mean, it seems, from my understanding, that we’re really going to need to find those people if we’re going to bring this virus to heal. Is that happening?

DESMOND HELLMANN: Yeah, that gets back to this thing about testing. And one of the aspects of testing that could help us use the precious test we have more broadly, especially in areas that don’t have such a surge, and in surge areas this won’t work, but is pooling. So, you know, you have 20 people in a workplace, a classroom, or whatever, you just pool and do a test. If it’s negative, fine, those 20 are safe. If it’s positive, every... you have to then test each one. That can extend your tests further. But if the prevalence gets too high, then every time you do 20 it’s positive. So using some tricks to decrease the cost and the overhead of doing tests can help. But, yeah, you’re right, a lot of asymptomatic people, you have to assume everybody’s infected. That doesn’t get you to opening up the economy or opening up schools.

KRIS:  I want to draw on your experience at Genentech and talk some about drug pricing. I think the price for Remdesivir is $2,300, or maybe $3,000 for a course of treatment if you have insurance. Is that reasonable?  How do these drug prices... how do they come to be? What’s behind all that?

DESMOND HELLMANN: Yeah, when... So the first thing I’ll say is I think it’s extremely challenging to defend drug prices. I wouldn’t sign up for that. The balance that the companies try and do is they try and pay off their research and development, they try and pay off for manufacturing, and they try and pay off for all the failed drugs, right, because there’s a lot of drugs that fail for everyone that works. And so it’s not a very precise way of doing it. What many companies do, and I’m guessing Gilead did, is they look at antivirals. So they’ll look at other companies that are selling anti-virals, they look at hepatitis, they look at HIV, they look at other viral illnesses where there’s approved products for those, and they try and pick a price that’s similar to other drugs that are out there. That’s... they may also talk to payers, especially Medicare, and look at things that are on the formulary, or they look globally and look at other areas.

I know... and that’s why I mentioned the tiered pricing, too. I know they announced like two different prices, one for private payers and one for public payers. I don’t actually know how they implement that, but then they’ll probably have a third price for very low resource countries, as well.

KRIS:  We have a question… somebody who’s an 81 year old man. He wants to fly to visit a friend on Cape Cod in mid-October. He wants to know that’s safe. How do folks assess their risk and make decisions on what’s safe and what’s not safe?

DESMOND HELLMANN: Yeah. So that’s a tough one. You know, the… given the jobs that I’ve had, I’ve spent a lot of time on planes, a lot of time in planes. And, right now, planes terrify me. You know, it… I was talking about like not going to an indoor restaurant. How about an indoor tube that flies in the air, especially a flight that’s like six hours?

So the... all of life is about risk-benefit, right? All of life is about risk-benefits. So if you had a... if you were on a plane that wasn’t fully loaded, which there’s no guarantee of, and you had a mask, and everybody else had a mask on, and you used hand sanitizer... but, you know, if you’re going all the way to Cape Cod, they’re going to eat and drink, so the mask is going to have to come off.

So I have to say, on my list of things that feel risky right now, indoor dining or drinking, planes, subways, things that are enclosed and you’re with a large group of people, feel really high on the list of risks to me.

KRIS:  When you get up in the morning and you think about COVID-19,  what’s top on your list when you think about what’s going on and how to move things forward in a positive way?

DESMOND HELLMANN: Well, I mentioned my optimism about product development, but it’s not fast enough. And so top of my list is this sense of basic public health things that… and hoping that rather than feeling depressed or overwhelmed or frustrated, that we… those of us who care about public health, that care about health, help others provide some leadership. And the leadership is really, okay, we can do this. You know, we actually can do this. We can get through the next six months with some pretty simple things to help keep people safe. And so when… I’m part of that, I’m part of thinking about the product development piece, how to get more tests that are available to people, but really, in the meantime… I used to… when… I had a great mom and dad when I was a kid, and one of the things they taught me is control the things that are under your control. So what’s under may control?  Where I hang out and how I protect others around me.  So I wear a mask and minimize my social interactions. So, you know, that’s what we can control.

KRIS:  Are the smart people going to be enough… what do the smart people need to do to get other people smarter so we start doing all the right things?

DESMOND HELLMANN: Well, I’m watching with great interest the governors in Florida, Texas, Arizona. I think particularly Governor Abbott in Texas is… you know, last time I saw him, he had a mask on. So I think that the only thing better than doing things in a way that protects your citizens is not doing that, but then adjusting. So I’m hoping for adjustment.

KRIS:  Thank you.