The Plague Cycle

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Emma Varvaloucas (EV): Hi, I’m Emma Varvaloucas. I’m the executive director of The Progress Network. And we are gathering together leaders and thinkers across different fields to present solutions where we need solutions and to celebrate progress where we’ve already made progress. So I’m here today with one of our members, Charles Kenny. Charles, welcome.

Charles Kenny (CK): Thanks very much. Good to see you.

EV: You, too. So, Charles was an economist at the World Bank for 15 years, and now he’s a senior fellow at the Center for Global Development, a think tank out of DC. He researches and advocates for policies that are good for industrialized and developing countries both. Charles, is there like a 10-second description of what kind of research you do?

CK: One of the joys of working at the Center for Global Development is get to research a lot of different things, from technology development through trade and migration and international investment.

EV: Wonderful. And what we’re going to talk to him about today is actually infectious disease, and his new book that’s coming out soon, or it will be out actually by the time this interview comes out. It’s coming out in mid-January. It’s called “The Plague Cycle: The Unending War Between Humanity and Infectious Disease.” And if you’re hearing that title and thinking, like, I’ve had enough infectious disease in my life this year, in 2020, and now moving into 2021, I should say, first of all, the book is very educational. It sets a lot of current events in sort of the broader context of history. So it’s educational on that front. And also, I should say that Charles sort of sets the tone from, I think page one or page two, that it’s not just a history, “just the facts ma’am,” but he purposely sets it as a story of progress.

So it is in some ways an uplifting read. So I think that it’s a good thing to add to our reading list moving into 2021, as we continue to deal with all the fallout of the pandemic. So, Charles, I was looking at The Plague Cycle as a giant report card on how the world and, as you put it, humanity is doing versus infectious diseases. If we use that report card analogy, what are our grades looking like? Are we passing or failing?

Charles Kenny (CK): It’s a bit of a tough question. My high school used to give report card grades with two parts for each subject. The first part was how you’re doing on the tests. And the second part was how hard you’re trying. Even with COVID, even with the tragedy we’ve seen over the last year, you still have to give us a pretty good grade in the long historical sweep.

To take one example, if you look at the death rates of children—those under five worldwide—every five seconds or so, a child passes away. Now that is a tragedy, and a lot of those deaths are preventable. But if we had the death rates of just a few decades ago, it would be one child every second. We’ve made immense progress against premature death. COVID has knocked us back a few years, and it’s tragic, but it’s still a blip in historical terms compared to the victories we’ve made.

That said, COVID is also an example of a disease that we should have been able to beat back far faster with far fewer deaths. So I think we get a pretty low grade in terms of trying hard against COVID. The cover of The Plague Cycle is a beautiful piece of artwork that borrows from a picture of Death stalking Manchuria in the late 1800s, when there was an outbreak of pneumonic plague. It was a terrible airborne version of the bubonic plague that killed many millions in medieval Europe. The disease was fought back in Manchuria within a few months using social distancing and travel restrictions and all of the techniques that, 120 years later, we still didn’t manage to lock down with COVID. And I think it’s a sign. We’ve made all this immense progress. We’ve got these fantastic vaccines so fast. And yet, we really should have done so much better. And that has led to a tragic loss of life.

EV: Another figure that stuck with me from the book was average life expectancy: something like a hundred years ago, the average life expectancy was 33. I read that and thought, “If I had been born a hundred years ago, I’d probably be dead in three years.” That was psychologically helpful for me. Even though we could have done so much better with COVID, we have still set ourselves up for success, and if we could follow through on that potential, we could do really well.

CK: Absolutely. The victories against premature death, I think, are humanity’s greatest victory. As you said, a hundred years or so ago, life expectancy was in the low- to mid-30s. And now, worldwide, the average is about 70. That’S largely because of victories against very young death in particular. And it’s changed the world in dramatically positive ways. The average parent 100 or 150 years ago would have expected one of their children to die at a young age—before the age of five, before the age of 10. That was just normal. That was the average. And now, thankfully, even in the poorest countries, most parents don’t go through the pain of burying a young child. I don’t think you can have any single measure of progress that’s better than that.

The long-term story is really positive and shows what we can accomplish, but it also points to how much further we’ve got to go. There are still hundreds of thousands of children dying each year from vaccine-preventable conditions, which are fairly simple things to fix. So we’ve got a long way to go, but we’ve come a long way, and I think that’s one of the reasons for thinking that we can get further.

EV: What are the things that have brought us to this point? We know, as you just said, that there are simple fixes that somehow haven’t been done. What are those simple fixes and how can we make that final push?

CK: We need to vaccinate using the vaccines we already have. COVID is showing us that now; it’s incredible that we might be throwing away COVID vaccines because we aren’t using them fast enough. But this is part of a longer-term story of not vaccinating everybody against the diseases for which we already have vaccinations.

We also need vaccinations that we don’t have. Most important, perhaps, we need vaccines for the mass global killer of malaria. We are seeing progress on that. And I think maybe in the next few years we will see a malaria vaccine, and that will be fantastic news, especially for tropical parts of the planet.

I have hope for new vaccines. But there’s also a bunch of old stuff—stuff we’ve known about for 100 years. There is better sanitation: making sure everybody has a decent place to go to the toilet really helps. It massively reduces the spread of disease. There’S making sure everybody has easy access to clean water. There are basic public health measures that we still need to make sure the world as a whole has access to. And if we achieved all of that, we would be going a lot further and making a lot more progress, and there would be much lower child and adult mortality worldwide.

EV: The simple power of having clean toilets and washing your hands: it’s easy to forget these things are not a given for a lot of people and weren’t a given for most of human history.

CK: One of the things I talk about in the book a bit is—and apologies to believers out there—Christianity in its early stages was a really dirty religion. In ancient Rome, Christians went around saying that young women should never be naked. They should be ashamed to be naked, so they should never take baths.

For a lot of history, we were pushing back against the things that improve human health. And one of the great things about the last 100 years or so is that we figured out the germ theory of disease. We figured out how infection spreads. And that knowledge is a massively powerful tool in reducing the burden of disease.

EV: Right, and again, it’s easy to forget this stuff. You talk in the book about the miasma theory that infection was spread through bad odors in the air. It’S such a boon to know exactly how COVID is spread. We knew exactly what to do, even if we didn’t do it perfectly, or even well.

CK: One example I mention in the book is John Snow, who was a London anesthesiologist who realized during a cholera outbreak that a lot of the cholera cases were connected to a single pump that people were using to collect water. He theorized that whatever was causing the cholera was coming in through the water, and he was right. Then he took his theory with a lot of evidence—maps of where the deaths were and who was drinking from which pump— to Parliament. The members of Parliament in London turned around and scoffed at him and said, “Oh, come on. We all know that cholera is caused by bad smells, not by little particles in the water. Don’t be so ridiculous.” And they ignored him.

The lucky thing was that, in London at the time, the sewage system emptied into the Thames. Parliament is right by the Thames. It’s a beautiful Westminster building right on the Thames, and the smell from all the sewage worried parliamentarians that they were going to get sick. So they financed a much better sewage system because they believed in the miasma theory, because they were worried about the smell. As it happened, the sewage system took all of the sewage way downstream. And that meant the water that the Londoners were taking out of the towns stopped having cholera in it. But it was by accident. It was this belief in a completely incorrect theory that luckily paid off. But now we’re in a much better position to know how to fix problems and how to do it well, because we have a much greater understanding of what’s going on.

EV: We don’t have to be relying on success by accident, although we’ll take success in whatever form it comes, I suppose. So this is just one example of this sort of, like, interesting anecdote from history that, you know, most of us just don’t know about. And the book is really full of them. It really talks about infectious disease as this kind of, like, major player in world history, causing some to win wars, causing others to lose wars. So you talk about the role of infectious disease in driving the slavery trade, in colonization and some of the failures of countries to colonize because of infectious disease. Can you give us a little bit of a Sparknotes version of some things that infectious disease had a hand in, big world-changing events that we might not expect?

CK: Sure. So, one story I talk about at some length in the book is around what happened when Europeans rediscovered the new world, if you will after Columbus, and the hideous disease toll that took on Native American populations in the New World. And, you know, the numbers dying; two-thirds of of the population dying over time from these new diseases, along with, I should be clear, an immense amount of violence as well. But, you know, infectious disease taking the biggest toll. That was one of the reasons that led to a labor shortage in the New World, which led to bringing in African slaves to replace, you know, local labor, if you will. Bringing those slaves into tropical areas brought their diseases with them. So, you know, malaria spreads throughout the New World. And there’s some fantastic history of economics papers around looking at places that are more suitable for mosquitoes to spread. You see slave populations rising particularly fast in those places, because people who have been exposed to malaria from birth are more likely to be able to deal with the disease slightly better as adults, and so had an advantage over other workers, including indentured workers from Europe.

So the disease burden created by the sort of globalization of diseases that previously had only been in the Old World creates this massive pressure for slavery, which helps depopulate Africa. But not only because a whole bunch of slaves are taken out of Africa, but also because of what moving all of those people within Africa did to Africa itself. It spread a whole load of diseases that had been local in Africa far wider, as you moved all of these people across the continent. And so that made the disease burden in Africa much greater than it had been. And, you know, it was one of the reasons—and there are a bunch of papers showing these historical links between the extent of slavery in the past and conditions today. So, areas that were more affected by the slave trade have fewer nightlights today than other places. So, you know, you can’t see them as clearly from space because they’re poorer and they can’t afford as much light. These are the kinds of effects we see all of these hundreds of years later from the impact to the globalization of infectious disease.

Now, there’s a big argument amongst really heavyweight economists—Jeffrey Sachs and Daron Acemoglu and so on—about, why is it that places with more infection are poorer? And Daron Acemoglu says, “well, it’s all about colonists not wanting to invest long term in places where they were just going to die as soon as they arrived.” And Jeffrey Sachs saying, “no, it’s the current malaria burden; having malaria makes it much harder for you to work.” I don’t think you really have to have an argument between these two things. I think it’s both, right? The sort of historical costs of infectious disease, in terms of what it did to colonies, what it did to people at the time, was huge. And it has had long-term ramifications. And there’s still an immense cost paid by places that see really high malaria burdens. So, you know, I think it’s a bit of both. It’s a bit of history. It’s a bit of the present. And when you add those two things together, you see a really large economic effect of infection. And, you know, I think it really helps to explain why some parts of the world are rich and some parts of the world are poor.

But it goes beyond that. I won’t go on too much longer, but just to take one other example, we were talking about the immense burden of infection on children in particular. Just to keep populations stable in societies in the 18th and 19th century, women had to have five or six kids. That’s a lot of kids. It takes a lot of time just to keep populations stable. In a time before antibiotics, and a time before sterile surgery, childbirth was a really dangerous activity. And so, the burden on women, both of childcare and breastfeeding and looking after young children, but also of the health costs associated with pregnancy, were massive. And I don’t think you can explain why we’ve seen this huge increase in women in the workforce, in gender equality worldwide—although there is still so far to go in that battle—but I don’t think you can explain past progress without looking at the fact that, you know, now, the average woman worldwide has less than three kids. They’re much more likely to be disabled by having those children. I think that’s a part of the story of why we’re seeing this, this huge increase in women’s participation in paid work and so on and so forth.

The knock-on effects in terms of the returns to education for children, and why we’re seeing such higher education rates worldwide, knock-on effects in terms of sexual liberation—if sex doesn’t always have to be about having kids, you know, sex for fun becomes sort of more allowable. Just, you know, a huge number of impacts across a range of different areas, which is why I think it’s a really important story to tell, because I think people underestimate both sort of the health effects, but also the knock-on effects of infection. And that’s one of the reasons it’s really important that we keep on progressing against infectious disease. Because otherwise we’ll see some of this stuff backtrack or slow down.

EV: Yeah, I mean, some of those ripple effects, especially one that you just mentioned in terms of sexual freedom and LGBTQ rights, that’s something that I really didn’t expect the ripples to go out that far. So exactly for the reason that you said. Because it relieves this pressure of sex to have children, all of a sudden you have a society that’s much more open and much more free. And yeah, you also mentioned too that safe sex nowadays, too, is… You’re able to have it. I mean, there are condoms, there are treatments for diseases that you might catch through sex. And I think you said something like, if we just use the tools that we have at our disposal, we’re able to do really incredible things. Which is not to say, you know, to go have sex with whoever you want. All the sudden I realized it sounded like I was having an ode to promiscuity. But anyway, go on.

CK: But syphilis is… I discuss syphilis at some length in the book, and it’s a really depressing disease for a bunch of reasons. One, it’s a horrible disease. Two, it’s a sign of the early bad effects of globalization. Quite plausibly, it was brought back by Columbus’s ship when Columbus came back from the New World. It then rapidly spread around Europe, first known as the Naples disease and then as the French disease, and then as a German disease as it spreads around Europe, and then the European disease when it reaches Belize. But Vasco da Gama, just after Columbus takes the first trip around the Horn of Africa to India, and probably his crew was syphilitic, and that’s one of the reasons syphilis hits India so fast. So it’s sort of depressing from that point of view. But it’s also depressing that the response to the disease for so much of history was basically to blame women, right?

So who was it who was spreading syphilis? It was prostitutes. And so it led to mass invasions of privacy for women. And because of this weird attitude about sex not for procreation, even during the First World War, when it’s spreading like wildfire through troops, and you would have thought any general would just want to control it and stop it however we could. And they all knew that condoms worked to stop disease. And they’re like, “oh, well no, we can’t hand out condoms to troops because, you know, that will encourage them to have sex outside of marriage.” So the weird attitudes about sex really drive a lot of the spread of syphilis through time. And I do think it is, you know, one of the things we should be thankful for is that slightly more rational views about using a condom are one of the things that are saving lives today.

EV: And I wanted to just touch on the globalization point that you just mentioned. So thanks for bringing that up. Of course when you started writing the book—I think you said it was five years ago you started writing this book in the book itself—of course you didn’t know that Covid was going to hit. You didn’t know that it was going to come out in the middle of our very own pandemic. But like I said, in the beginning, the book does set into context a lot of the stuff that we’ve just been dealing with in our daily lives during this time. And one of those things is this sort of, like, debate about globalization and travel bans. And is it good or is it bad, especially in the last couple of weeks with this new mutation of the coronavirus. You know, these debates are coming up again. Like, I saw an article this morning, it had sort of a… Not a snarky headline, but it was like, “we all know how the mutation is getting around, and it’s not by its own feet.” You know, just making the point that people’s travel is making the spread go very fast. So, where do you lie on that kind of debate of, should we shut ourselves down? Should we open ourselves up?

CK: So, this is a complicated topic. But I actually think that the recent Covid mutation demonstrates the problem, if you will. It was discovered in the UK, and there was this instant reaction from around Europe for travel bans. It’s since been discovered in a bunch of other places. Way before it was discovered and seen to be a problem, it had already spread. That’s pretty much the story back in January, February, March last year, that the travel bans were put in place after infection had spread.

Now, there are cases where I think travel bans do make sense, or at least serious travel restrictions make sense. If you look at New Zealand, if you look at Taiwan, where they’ve really basically controlled it in the local population, so the only way it can come in is by somebody traveling in with it, by golly, I think we ought to be having long quarantine periods and multiple testing before you let people into the country. Sadly, for most of the world, I wish we were in that situation, but for most of the world, we’re so far away from that being the risk, that I don’t really think travel bans have much sense to them.

And they do cause problems, right? So if you shut down travel, you shut down the movement of people who can help. You shut down the movement of doctors. You shut down the movement of scientists. You make the global response harder, moving vaccines around, you make it all harder. And so there’s a trade-off here. And one that I don’t think we’re addressing very sensibly. You don’t want to have masses of people in an airport at the same time during Covid for the same reason you don’t want to have masses of people in a church or in a restaurant. That said, one way to make sure you get masses of people in an airport is to say, “I’m shutting down travel tomorrow.” Again, we think one of the things that caused a big early spike in New York was the fact that a travel ban was announced. Everybody rushed to get at home and ended up in huge long queues at JFK, right?

So I think travel bans really have shown to be not very effective in a world where everybody travels so much. And instead, sort of as our first line of defense against a new infection, we have to rely on the sort of the power that globalization has given us to respond. Just to take, you know, some examples of that. The first tests came out of East Asia, right? Well, sorry, the first RNA sequencing came out of China for Covid. The first tests were out of South Korea and China, and how to do those tests, the knowledge spread worldwide. If you look at the Pfizer vaccine you know, developed by Turkish immigrants living in Germany, working for a US company who was run by a Greek expat. Globalization has helped create the solutions to this problem as well as definitely playing a role in spreading it.

But we have to go towards using the power that globalization has given us to respond as our technique. Because, as the example of syphilis shows, if you just have three or four sailing ships crossing oceans, you’re going to have infection move around, right? We can’t go back to the level of globalization that will stop disease spreading, because that means going back to, you know, no travel at all pretty much. So the only way to go sort of long term is to use the power that globalization has given us to respond and use travel restrictions in particular ways, in particular places where they make sense. Frankly, most of the existing travel restrictions, I think, make no sense at all.

EV: And that’s certainly something for us to chew on. Something else that you talk about in the book that we’ve, again, seen a lot in 2020, and probably moving into 2021 as well, is scapegoating. I mean, you certainly talk a lot about all the different viruses, and you mentioned some a few minutes ago that had names that… “it’s The Italian virus, or the Polish one, or the Jewish one,” or what have you. And I have to say, when that started happening in the US, with Trump talking about the China virus and Chinese virus, what have youI know that there was a rise in hate crimes, that people were saying that people who are Asian-American or of Asian descent were bearing the brunt of this. But I also, when I was reading the book, I felt like, maybe we’ve evolved a little bit. Because it did seem like there was a very large amount of pushback against that in the States as well. And I wasn’t sure, like, you know, am I being totally Pollyannish about this? Have we evolved at all, or is this just the same replaying of exactly what we’ve seen throughout human history?

CK: I think you’re right. And maybe I was a bit too down in the book. I mean, compared to the mass attacks on human rights that the Chinese-American community in San Francisco faced during the “Asian Plague,” the “Asian Flu so-called, at the turn of the 19th century, I think we have made progress. Things have got better in that regard. I do think travel bans are an example of, you know, this problem still existing, right? We hear about an infectious disease? Travel ban. And it’s related to a natural and reasonably sensible sort of human response, which is, when there are lots of infectious diseases out there, strangers are more dangerous. But you know, strangers needs to be carefully defined in that case. Ethnic group isn’t the way you define “stranger” in any way that’s sort of epidemiologically relevant, right? So I think we have made some progress. We’ve still got some way to go in making sure that our responses are appropriate and not driven by neuroses sort of left over from our ancient history.

I would say one more thing. I think it’s been really hard during this particular outbreak to go after migrants. And that’s because if you look at the US, or you look at the UK, or you look at most of Europe, the proportion of frontline workers who are migrants is really high, right? So the proportion of nurses and doctors in the United States who are immigrants is 30, 40%. To turn around and say they’re the problem when they’re the ones keeping us alive, I think, is really hard. And so again, this is a case of sort of, globalization, sure, it helps spread disease more quickly—a bit more quickly—but it also provides a huge part of the solution to the problem.

EV: So looking at the future a little bit, you know, and going back to this report card analogy, what kind of grades are you expecting for the future? I mean, I was, again, struck by the fact that you sort of rated the threat of antimicrobial resistance as equal to the threat of climate change. I mean, and not just from an, “oh, I think this might be a problem,” but from the estimated death tolls. And certainly there is a huge narrative around climate change, about the threat of it, how much it matters, and that we need to meet that threat. And it’s not like people have never heard of, you know, antibiotics not working anymore. And it doesn’t take that much to imagine how terrible that would be. But there’s certainly not that kind of momentous narrative that’s built around that in the same way that climate change has, or other narratives like populations being too high and the Earth not being able to support that. So yeah, I mean, how do you think that the future is going to turn out for us with infectious diseases?

CK: So, first of all, I should say, I think, you know, climate is a really serious problem, which we know how to fix and can fix affordably. And, you know, we need to get on it. It’s just that I feel exactly the same about antibiotic resistance and antimicrobial resistance. A study financed by the UK government a few years ago suggested by 2050 we might be seeing 10 million deaths from antimicrobial resistance worldwide. That’s a lot of deaths. And the problem is that we are misusing this immensely powerful tool, this tool that allows us to do modern surgery, this tool that makes a whole load of diseases that were deadly into comparatively minor threats. We are misusing it. We are prescribing it to humans who don’t need it because they’ve got a disease that doesn’t respond to antibiotics. Quite often, you know, they’ve got a virus and we’re giving them an antibiotic that’s against bacteria.

Even more so, 90% of the antibiotics used worldwide go to animals. Mostly it’s just part of an attempt to make them grow faster in massive factory farms. This is not good news. I mean, a lot of our diseases, including Covid-19 are zoonotic; they come from animals. You put a massive amount of animals together in a really small space and then give them all low doses of antibiotics, it’s the best way to create an infectious disease that’s going to be resistant to antibiotics. Like, you know, you can’t think of a faster way to do it. And so, you know, we really need to be taking a lot more care of antibiotics, and that’s just sort of one example of us not treating this problem with the seriousness it deserves, the problem of the risk of new infection with the seriousness it deserves.

Another one is, frankly, the whole anti-vaccine movement, I think born of a generation that has benefited so much from previous victories against infection that they don’t think it’s serious. Well, you know, you wait. And another example, again, is the biological weapons convention. And we do actually have an international treaty about biological weapons, which are a growing serious threat. Scientists with a bioreactor can create new infections quite straightforward. It’s not nearly as hard as creating a nuclear weapon, for example. You don’t need a big factory to do it. The Biological Weapons Convention has four people working on it full-time worldwide. It’s not going to be too hard for somebody to slip through the net of the Biological Weapons Convention.

So, you know, we really need to be taking this stuff more seriously. And I feel, you know, that’s one downside of our huge victories against infection in the past, that we don’t think of it as being such a huge threat as it could be. Now, if there’s a silver lining to Covid, and I worry about even saying that, but if there’s a silver lining to Covid, perhaps it will be that the international community will come together and start treating infection with the seriousness it deserves and, you know, getting stronger conditions into the Biological Weapons Convention, more oversight stronger conditions around antibiotic use worldwide, more upstream research into vaccines, so on and so forth. Because we really don’t want to go through this again. And we certainly don’t want to go through something worse than this again. And frankly, that’s quite likely if we don’t do something about it.

EV: Yeah. I mean, really the whole time I was reading the book, I was thinking about this one interaction I had with somebody, which is related to what you just said about how we’ve sort of triumphed over infectious diseases so much until Covid that it really does seem like we’ve forgotten the threat. I was having a little bit of a debate about vaccines. This person was vaccine-skeptical, I suppose I would say, vaccine suspicious. And he said to me, “well, give me an example of a disease that a vaccines has obliterated.” Because I was like, “look, you know, vaccines have saved us from a lot of things.” And I said, “smallpox.” And he said, “that’s not fair. Like, I don’t think of smallpox as a current disease. That’s, like, from the ancient times.” And that whole interaction was so illustrative of just how complacent we’ve gone about the solutions that we have at hand, because we don’t even think about these things anymore.

Smallpox is not that old of a disease. It’s just not something that we deal with in our lives, day to day. And certainly, you know, just to tie this back around, I think, whenever I listen to conversations about these sorts of things, there can often be this feeling of, like, “what do you want me to do about this?” You know bioterrorism weapons, there’s not a whole lot an average person can do to really fix that problem in their daily life. But vaccines are different. Vaccines are really something that we can take on and personally make sure that we’re following, you know, established protocols and so on and so forth. So I’m wondering if there are any other things like that, just to give people a little bit of, like, “look these are the types of things that you can bring into your life to continue this progress in terms of humanity versus infectious diseases,” as you put it.

CK: Your smallpox example: Here is a disease that probably killed more than a hundred million people last century, fairly recentlyand was wiped out by a global effort that involved vaccination. I do think people definitely making sure their kids get vaccinated, that they get vaccinated. The flu vaccine each year, you know, again, a small silver lining with Covid was that flu cases this year shot down, because all the things that work against spreading Covid work against spreading the flu. But you know, we have a flu vaccine. It’s not perfect, but it does save lives. And sadly, few people take it. I mean, I own up in the book that a few years ago I didn’t bother getting my flu vaccine. “Eh,” You know, “problem for other people.” And I regret that, and I promised, you know, ever since then I have, and going forward I’ll continue taking the flu vaccine religiously.

But beyond that, washing hands social distancing when necessary, and please may it not be necessary for too much longer. There are a bunch of sort of sanitary and behavioral responses that make us all safer. I’d also, frankly, you know, I try not to eat meat laced with antibiotics, not because I think there’s a huge direct danger to me from eating meat that was injected with an antibiotic a week or two ago. They break down. It’s not that I don’t want to accidentally ingest antibiotics. It’s that I don’t want to be part of the food system that is creating potential catastrophe by encouraging antibiotic resistant diseases. So I do think there are small things that, you know, we can do in everyday life. But a bit like the climate change problem, I think that the small things we can do in everyday life are important, but frankly, this is a problem that takes government. So, you know, infectious disease is a big government problem. It’s always been a big government problem. It’s taken quarantines. It’s taken massive sewage systems across cities. It’s taken big public health mechanisms to get vaccines to everybody. This is a government problem, and I do think that, you know, we need to hold our politicians to account. Are you taking this issue seriously enough?

EV: Oh, I think that’s a great way to end. But I always like to ask if there are any other lingering thoughts that you have, anything that we didn’t cover in the discussion that you’d like to get out?

CK: I don’t think so. Thanks very much for a great set of questions.

EV: Yeah. Thank you so much, Charles. And we really appreciate you being a part of the network.

CK: It’s a fantastic network. It’s a great idea. Thanks very much for inviting me to it.

EV: Thank you.