About Nesta

Nesta is an innovation foundation. For us, innovation means turning bold ideas into reality and changing lives for the better. We use our expertise, skills and funding in areas where there are big challenges facing society.

Ravi Gurumurthy: Hello and welcome to The Mission. This is the podcast to listen to if you’re interested in mission driven innovation. My name is Ravi Gurumurthy and I’m the Chief Executive of Nesta, the innovation foundation. And on this podcast we’re going to be talking to practitioners, academics and policymakers about how to tackle society’s intractable challenges.

Today on The Mission we have Nicholas Christakis, who is a physician and social scientist. He’s another person on this podcast whose intellectual interests are incredibly broad and deep and it’s a great privilege to have him on today. His work focusses on how human biology and health are affected by social interactions and social networks. He directs the Human Nature Lab and is the co-director of the Yale Institute for Network Science. There’s a lot we could do with Nicholas, we could probably have many podcasts, but the thing we’re going to focus on today is his new book, ‘Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live’. Nicholas, welcome to the podcast.

Nicholas Christakis: Thank you so much for having me.

RG: So you’ve tried to put your crystal ball on and actually paint a picture of how we get out of this crisis, and one thing I just wanted to start with was the timescales. I think you’ve talked about three phases and how we might be out of this by 2022, you might have a couple of years of a hangover and then by 2024 we’re in a sort of post-COVID world. I know these sort of things are rather stylised, but just tell us how you see the next years unfolding.

NC: Well, let’s start, as a preamble to that, talking very briefly about this concept of herd immunity, which is a deep and fundamental concept of infectious disease, and then once we get that fixed in our minds then we can kind of lay out these phases. Herd immunity is when a population of animals, including us, can be immune to a pathogen or can resist the epidemic taking off in a population, despite the fact not everyone is actually immune. So, for example, if you vaccinate 96% of the human population for measles, even if one of the 4% of the people who’s not immunised gets measles, they are unlikely to be able to start an epidemic because they’re not going to bump into anyone – on average – who is susceptible to the condition. So we can say that the whole population is immune even though let’s say 96% in this measles example has been immunised. Well, it turns out measles is, I think, the most infectious disease known and it has something known as an R nought [R0], an R sub zero, which is the basic reproduction number, that’s the number of new cases you get for every existing case in a non-immune normally interacting host population. That’s like a measure of the intrinsic infectiousness of the pathogen, like how able is it to spread, and measles is really able to spread. And so you need a very high level of immunity, whether from vaccination or naturally acquired, to stop epidemics. But for less contagious diseases, for example, seasonal flu, might have an R nought of 1.5, you might get away with only vaccinating, let’s say, 30%, or when 30% of the people have been naturally exposed to influenza the epidemic kind of peters out. For coronavirus, the R nought, the intrinsic infectiousness of the pathogen is somewhere in between, it’s between 2.5 and 3.5, let’s say it’s about 3, that means each case of coronavirus causes three new cases, that’s its intrinsic infectiousness in a natural setting where people aren’t taking any action to stop the spread, and with that level, with that R nought, the level required before we reach herd immunity is about 66%. Now, this is a very long-winded opening, I’ll actually have to say one more proviso and then I don’t know, maybe I should pause before going on, I don’t want to just rat-a-tat-tat at you. But it turns out there’s a little network science wrinkle, which is technically called population heterogeneity, and it means that actually we don’t need to get to 66% in fact to get to the herd immunity threshold. Probably for coronavirus when we get to 40-50%, let’s say 45% of the people infected, then we will have reached this herd immunity threshold and the epidemic will die down. It doesn’t mean the virus is gone, it just means the epidemic force is now behind us. Okay?

RG: So does that mean basically over the next year, whether we have a vaccine or not, we may well get pretty close to that point where herd immunity kicks in?

NC: Exactly.

RG: Right. Where are we now, if you were going to guestimate, in America or parts of Europe?

NC: Yeah, so that’s exactly the right way to think about it from my perspective and that’s how I’m thinking about it. So right now in the United States and probably in Western Europe, about 12% of the public have been exposed to the virus - we’re now ten or 11 months into the pandemic - and have acquired natural immunity as a result of that exposure. And so if we’re ultimately going to get to, let’s say, 45%, we’re about a fourth of the way there. So I would say with respect to the coronavirus pandemic, we’re absolutely not at the beginning of the end of this pandemic. If anything, we’re just at the end of the beginning, we’re just finishing the opening act of this pandemic. So, what’s going to happen then, is we might, in fact we’re almost certain to successfully invent effective vaccines which will soon be released, probably in 2021 several such vaccines working in different ways will have been shown, using Phase 3 trials, to be effective. How safe they are and how exactly they work are still things we can discuss if you want, but, from the moment the vaccine is shown to be effective and approved by regulators, we still have a number of other steps. We’ve got to manufacture millions of doses, we’ve got to distribute these doses, including respecting something known as the cold chain. That means from the moment of manufacture to the moment of injection, this vaccine has to be refrigerated, sometimes at very low temperatures, and not every pharmacy in every village has such a refrigerator, for example, or even every hospital necessarily has such a specialised refrigerator. And finally, in addition to the manufacturing and distribution challenges, we’ve got to persuade large fractions of people to accept the vaccine. So all of that is going to take time. So my estimate is that even if the vaccine is shown to be effective, let’s say in the first quarter of 2021, that could take us as much as a year, getting into 2022 before we have sort of widely vaccinated people and reach herd immunity through vaccination. Meanwhile, the virus is still spreading, so my thinking is, either we will reach herd immunity naturally or by immunisation sometime in 2022 and that is the first important milestone in this pandemic and that will mark the end of the immediate period, which is when the biological and epidemiological force of the pandemic upon us will now be behind us. But then, we will enter what I consider to be the intermediate period, which is now we will have to recover from the psychological, social and economic shock of the pandemic; all these people who’ve lost their jobs, all these businesses that have gone out of business, all of these people who’ve now been wearing masks for two years. So until we reach this herd immunity threshold we’re going to have mask wearing will be required, gathering bans, intermittent school closures, all kinds of measures will still be required until we get to that point. And then, when we get to 2022 and we begin the intermediate period, it’s not like suddenly everyone’s going to stop all that, people are going to be used to that and/or traumatised or lost their jobs and so on, so it’ll take, I think, a couple of years before- and this is also based on an analysis of historical epidemics, how long it takes for people to recover psychologically, socially and economically, and that’ll get us, I think, to about 2024 and then, then we will enter the post-pandemic period, and we can talk a little bit about that if you’re interested.

RG: Yeah, I want to get on to the future in a second, but first I just want to understand a little bit more about how we’ve got here. And one of the interesting things about previous epidemics like scarlet fever, TB, typhoid, diphtheria, is that you say that vaccines have actually not been the thing that has driven the eradication. In fact the vaccine or treatment was only invented once the conditions were on the decline. So do you think that when it comes to COVID we’re likely to be in that same kind of situation where the vaccine is actually happening after the disease is on the decline, or do you think this is going to be unusual in the way in which the vaccine is really driving things down?

NC: Well, there are two distinct but related ideas and concepts here and what you’re alluding to is the very famous so-called McKeown Hypothesis by the famous British medical historian, Thomas McKeown, who published a very influential set of papers decades ago now, in which he, what he did is he mapped on the x axis time, you know, years, you know, from 1900, you know, to 1960 or ’80 or whatever, and then on the y axis he mapped a fraction of people or number of people, proportion of people dying from particular infectious diseases, like tuberculosis or measles or, you know, whatever, different conditions, typhoid. And then he showed a steady decline with time in the mortality from these infectious diseases, and then he put a little arrow above the year in which the specific treatment for that condition, whether a drug or a vaccine had been invented by human beings. For example, Isoniazid for tuberculosis, or the measles vaccine, for example or, you know, typhoid vaccine and so on. And what he showed was that most of the time, in fact all of the time, the diseases had been in long decline well before the invention of a specific treatment, regardless of the condition. Here where I live in Vermont in New England, it’s a very hilly part of the world and we have these sleds, you know, there’s a lot of snow and we go sledding, it’s a little bit like a child riding down the sled, down the slope, and then at the end of the sled run there’s this sort of long straightaway, when you’re just sort of coasting. And what McKeown showed is that again and again for these infectious diseases, the specific treatment arrived when you’re on the straightaway, you know, when you’re long past the slope. And the reason for this is that the real determinant in mortality from infectious disease is not what doctors do, it’s rather what society does. As we get richer, as we implement hygiene and other public health measures, that’s what brings infectious diseases to heel. So as societies became wealthier and as they implemented public health innovations over the last century, this is what brought these diseases to heel, these social and public health interventions more than the specific treatments. So that’s the big idea, that’s there all the time. But in the case of COVID there’s some similar ideas, they look like that but they’re a little bit different. Here the idea is, we have two different ways of responding to the pandemic, we have so-called pharmaceutical interventions, drugs and vaccines, for which so far we only have one, that’s Dexamethasone, you know, that was discovered in England, or the efficacy which was documented through a large trial organised out of Oxford University a few months ago. So, so far we only have one known drug that really makes a big difference in treating COVID, or we have so-called non-pharmaceutical interventions which are all the other stuff that we are all familiar with now: masks, testing, quarantining, school closures, gathering bans, travel restrictions, and all of that sort of stuff, and what’s happening right now is we are once again implementing these social responses, these public health responses in anticipation of and waiting for the hoped for outcome, which is some kind of very efficacious pharmaceutical response.

RG: And when it comes to comparing this with SARS-1 or other viruses, why had this been so much more deadly? Because I think it’s fair to say in some ways this is less deadly than other viruses and that’s partly why it’s tended to spread further because the actual people who get this don’t end up dying and end up spreading that virus, and also this spreads before symptoms kick in. Is that the reason why this…

NC: Yes.

RG: … paradox, this paradox exists when it’s more deadly yet less deadly?

NC: Yes, that’s right. That’s exactly the way for those and certain other reasons that you emphasise. So if a disease kills you too fast, from the point of view of the pathogen that’s not a very efficient evolutionary strategy because you die and you don’t spread the pathogen and therefore it dies with you. Much better from the pathogen’s point of view to simply make you sick, and then you walk about and spread the disease to other people. So very deadly diseases that are swiftly deadly, like ebola, for example, and to a lesser extent but analogously, SARS-1 in 2003, they die, they kill their victims sufficiently fast that the victim doesn’t have an opportunity to spread the disease to other people as much. So ironically, slightly less deadly diseases might reach more people and wind up killing more people. So although on a case by case basis they’re less lethal, on a population scale they could be more lethal. Similar things happen of course with ebola outbreaks. Ebola’s a very deadly disease, but it kills its victims so swiftly that often ebola outbreaks are very contained and of course people have been fearing for a very long time that a strain of ebola that is perhaps slightly less deadly and also slightly less swiftly deadly could truly become like a bubonic plague, you know, and circle the globe and kill huge numbers of people. So that’s the first point. The second point, which you also alluded to, is that very unfortunately this sneaky virus that we’re confronting now is capable of asymptomatic transmission. So many diseases, for example, smallpox, you don’t transmit until after you get symptoms. So it’s very easy to identify who you should stay away from, you know, the smallpox person is covered in pox and you stay away from them so- or you isolate that person and as a result you can tamp down on the spread of infection. But other diseases, for example, HIV, you can be infectious, if you’re infected with HIV you could spread it to other people for years before you get symptoms yourself. And COVID is like that, COVID is a disease in which for a couple of days before you get symptoms you’re very infectious. In fact, some estimates are that 75% of the cases of COVID have been acquired by the people who are sick from other people who did not have symptoms. So that makes it very difficult to control the disease because we can’t rely on symptoms to identify sick people. And there are other factors too that distinguish them but, you know, I… the problem is I feel like I’m getting very professorial, and like giving long responses, whereas I should be giving, trying to give shorter responses to your questions.

RG: You’ve obviously been immersed in the last few months with your peers around the world trying to understand this and it’s…

NC: It’s all I’ve thought about for ten months, night and day, is coronavirus, since January, middle of January, honestly, and I haven’t slept much in months. So yes, you’re right, I’m a man obsessed right now.

RG: And everyone talks about how we’ve seen unprecedented co-operation amongst scientists, we’ve mapped the genome in record speed, what’s the thing that’s being debated amongst peers, amongst experts like you that isn’t visible to the public yet, that we should really know about?

NC: Well, there are a lot of things. I wouldn’t say debated. I mean there are a lot of things that people are working very actively on that are still unknown. I mean there are a whole range of topics, for goodness sakes. We don’t know still how sustained immunity due to the vaccination will be. We don’t know the safety of the vaccines. We don’t know natural immunity, how long it will last. It’s clear, and it was fully expected, that people’s antibody levels would decline over the course of a few months, there’s nothing surprising about, you know, periodically you read in the news, you know, scientists find antibodies are undetectable after six months after infection. There’s nothing surprising about that, everyone expected that. What your body is doing is it’s developing so-called memory immunity, which it can have for years, or decades for some conditions. And so we don’t know exactly how fulsome that memory immunity will be. We don’t know exactly how much, we know there’s some so-called cross-reactivity. A fantasy for our species would be that because there are four coronaviruses that infect us, there’s seven total coronaviruses, to our knowledge, that infect humans, many others that infect other animals, like bats, for example, or camels and so on, but seven that infect humans. Four of them cause the common cold, wouldn’t it be unbelievable if having been exposed to the common cold, one variant of a coronavirus, you’re immune to this more serious variant. This is called cross immunity. There is some cross immunity, this has now been shown by a number of elite labs around the world, but it seems unlikely that that is a big factor, unfortunately, and that is a big puzzle to be worked out. We also don’t know how much disability this disease will cause. So up to now you and I have been talking about death, but let’s not forget, a lot of people are going to get disabled by this condition. Some people think about five times as many people will have long-term disability as die. So for example, in the United States, I think that at least half a million Americans, at least, will die, unfortunately, before this epidemic is over, perhaps as many as a million, somewhere in that range, which is a devastating- this will be the second worst respiratory pandemic in the last 100 years, after the 1918 pandemic. But if half a million Americans die, maybe we’ll have two and a half million with long-term disability, some renal or heart or neurological or pulmonary problems, and that percentage is not yet known and can’t be known until time goes by. So there are many things that are still unknown, let alone about the virology and the genetics of the condition, so scientists are working, many different kinds of scientists are working round the clock on this.

RG: So when it comes to the rollout of the vaccine, you said earlier that it’ll probably take the whole year to be able to manufacture, distribute and deliver these vaccines, how worried are you about vaccine take-up? I think there were some stats about how around 70% of Americans would take up the vaccine, it was a lot lower amongst certain communities, the level was down about 52%. So are you worried about vaccine take-up or do you think once we get it, the domino effect will kick in and there’ll be, this’ll become quite widely adopted?

NC: I am worried about it. I… it’s hard to predict. The numbers, Gallup just released a survey, actually, the numbers of vaccine acceptance have been trending down for months, many different survey firms have been surveying American public and if you look across all of the data, it had been trending down to, let’s say, about 50% of people said they would take the vaccine. But Gallup just released a survey this past week that showed a blip up in that number, significant blip up, to about 58%. You know, as I said earlier, we might be able to get herd immunity at that level of vaccination, but of course the more the better, and I think it will take time to persuade people to get it. Now, on the other hand, if the disease continues to spread and more and more people die, this could increase the appeal of the vaccine among the public. On the other hand, if there are problems with the vaccines – and there might be, because we’re rushing to develop them - and we know the vaccines are effective, or they’re almost surely to be effective, we’ll know definitively soon, but we don’t really know enough about the safety of the vaccines yet and if there are safety problems with the vaccines this will sap public interest in the vaccines. Plus, in the United States, I don’t know about England, we’ve had an enormous problem because our President unfortunately has been lying about what is happening with this pandemic for months, there’s a tremendous loss of credibility and has been silencing some of the vastly more experienced scientists. Tony Fauci was writing about respiratory pandemics when I was in high school, you know, but he and others have not been allowed the freedom to speak and, you know, help the country confront their problem as effectively as they would have liked, plus the many, you know, career experts in the CDC and the FDA and elsewhere, these people have not been given the rein they needed. And as a result I think there’s a lot of scepticism in the public, there may be, about is the vaccine effective and is it safe. So we have to get the public to, we have to earn the public’s trust and get the public to trust us when we announce that this vaccine is good, worth taking, please take it.

RG: Presumably, we won’t know necessarily whether it is safe for some time?

NC: Yes, that’s one of the problems. Let me put it this way; we’ll have good safety evidence, but with all vaccines… you see, what’ll happen is, like the trials, for example, the Pfizer drug trial had 43,000 people in it, that’s a large number of people for a drug trial, for a vaccine trial, but the rate of safety we typically expect from vaccines is that maybe one in a million or one in ten million people will have a serious, will have death or a serious adverse effect as a result of the vaccine. That’s very small, I mean that’s an unbelievably safe drug, and the lives saved are in the thousands or in the tens of thousands as against one life lost, this is a no-brainer from a public health point of view. But, if the vaccine, let’s say, had a serious side effect rate of one in 100,000, let’s say, which would be, you know, which would be large, which would be a rate ordinarily that we would not accept as a safety of a vaccine, we wouldn’t necessarily detect that in a trial with only 40,000 people. And it’s only when we start giving the vaccine to millions of people that we’ll discover this and monitor what’s happening.

RG: How do we calibrate the public messaging around that, because I think there’s a real risk that you over-claim, and then there’s a backlash. How do we actually give the right level of reassurance?

NC: I think we have to share that with the public, we have to say exactly what I just said. You know, we have to say, you know, here’s all the evidence we have for the safety of this vaccine, here’s what we know about prior similar vaccines. Now, in the case of the Pfizer and the Moderna RNA vaccines, these are the first such vaccines that have been released for using this technology for humans and so, you know, we may not be able to speculate based on prior experience with this category of vaccines. But, you know, we put scientists, vaccinologists and people with such experience in front of the public and we have them lay it out and we say here is why we believe that this vaccine is the right course of action right now. And you have a phased, and here’s the rollout we’re going to do. First, for example, we’ll offer the vaccine to members of the trials, volunteers who participated in the trials who were randomly assigned a placebo, they clearly should have first dibs on getting the vaccine, and then we’ll offer it to healthcare workers who not only deserve it first because, you know, healthcare workers and first responders, because of the risks they’re taking, but also because we want them immunised so that they can protect the rest of us and care for us, and furthermore they’re in the best position to judge whether it’s worth it to take the vaccine since they’re healthcare workers. So that’s like a million or two million doses. And then after that we have, you know, we’ll have a whole host of distribution and ethical issues.

RG: So, you did some social network analysis of this pandemic and others.

NC: Yes.

RG: And you looked at how certain people obviously are much more likely to spread the virus and therefore could be potentially targeted by a vaccine first. Now theoretically I’m sure that’s true, but I’m interested, first of all, how much of a difference would it make if you actually targeted vaccine rollout at those highly networked individuals and is that frankly just a theoretical idea that you’d never actually apply in practice, or should that be considered as part of the rollout?

NC: Well, boy oh boy, that is a delicious question for me. We have done trials of these ideas in venues around the world, this network targeting. So let me back up for listeners and first just cultivate some intuition here. So many listeners will be familiar with the notion of social networks, they’ll have seen images of little dots which are the people, and the lines which represent the social connections between the people, and they’ll have in their mind’s eye a kind of knotty centre of the network where lots of people are interconnected and a kind of feathered periphery of the network where you might have people that have very few friends on the edge of the network, and their friends in turn have few friends. So you have a centre and a periphery of a network and you have a network with this complicated structure. And you should have the intuition furthermore that if you were a bioterrorist, for example, you know, who should you infect with a germ if you wanted to make the maximum impact, not a hermit that lives, you know, on Mount Athos in Greece on their own, you would want to infect a very popular person who would be interacting with many other people. And analogously, the same would hold with vaccination. If a pathogen is spreading randomly through a social network, it’s going to reach the central people first and when it reaches them they will in turn spread it to many other people. So vaccinating those central people actually is a very effective idea in terms of tamping down on the spread of a pathogen. And my laboratory has done field trials of some of these ideas with the support from the Bill & Melinda Gates Foundation and the National Institutes of Health and the Robert Wood Johnson Foundation and the Tata conglomerate, we have done studies of this in venues around the world and we have shown that using these ideas we can maximise the fusion of ideas related to health. In other words, if we wanted to get villages in India or in Honduras or in Uganda or online, if we want to get online communities to change their behaviour, let’s target central people, for example, with the innovation so that it’ll diffuse maximally. So we’ve shown that it works and that this is better than a strategy of random inoculation with ideas, for example. So it is theoretically sound, we and other laboratories have shown that it can work in other settings, but it has not to my knowledge been used as part of a national, you know, vaccine strategy. So the idea here would be the following – and then I’ll shut up. Let’s say you have, you know, the first few million doses of a vaccine, what would be the wisest course of action? A very rational thing to do would be to say, well, let’s give the vaccine – when you have enough vaccine to give to everybody you don’t have this, by then it’s moot, but let’s talk about earlier when the vaccine is just rolling off the production line – a very rational thing to do would be to give it to elderly people or people with chronic illnesses. You might say, they’re at the great, they are at the greatest risk of death, we should immunise them to protect, to minimise the loss of life. But the problem is, those people are actually at the end of transmission chains, those people are not the people who typically spread a lot of the disease. The people who spread a lot of the disease are working age adults who are out and about, or people who have many friends, you know, people who have many social interactions. So you might instead want to give the vaccine to those people who individually as people are at lower risk of dying if they get the disease, but who actually are contributing more to the spread of the pathogen. And you might save more lives, if I gave a vaccine to one popular person, I might prevent them from infecting five elderly people and that might be a much wiser strategy than giving the vaccine to one of the five elderly people. So, you could actually do the mathematics of this, you could work it out and you could figure out whether that strategy was wiser. But even if it was – and then I’ll shut up – even if it was wiser, it might be politically infeasible for a leader to go out and say, you know, we have this vaccine that’s life saving and we’re going to give it to the people at lowest risk because our experts tell us that that’s the way to save the most lives. You would need a really educated citizenry that trusted their leaders and was willing to work together to really effectuate such a strategy.

RG: Yeah, I mean that’s why I think you can imagine an authoritarian regime taking a highly technocratic theoretical perspective on this and doing it, but you cannot imagine a democracy doing it. I mean the other thought on targeting is would you target very influential people, not necessarily the most connected, but people who are leaders or people who take their cues from what you might call social reference, and healthcare workers actually could be classed as that. But that’s something that feels potentially a bit more viable.

NC: Well, we’re going to want that on some level. I mean we’re going to want, you know, we’re going to want trusted figures. You know, like in the United States this might be like Tom Hanks or Dolly Parton or something, you know, or Tony Fauci. You know, we’re going to want trusted figures to get vaccinated and to get vaccinated publically, to say, you know, I am taking whatever unknown risk there is because I think it’s the right course of action and it’s the right course of action for our nation. So on the one hand you could absolutely justify that. On the other hand I can see that, you know, some people would be concerned that, you know, is this vaccine preferentially going to elites or something. But let’s back up a moment on this as well and consider the case of Boris Johnson. Early in the pandemic we heard a lot about certain celebrities or certain politicians that were infected with the virus and now surely part of that has to do with the fact that these people are in the public eye, you know, if I’d been infected with the virus nobody would have known, if Boris Johnson gets infected everyone is told. But it’s not just that. The fact is that people like politicians or celebrities have many more social interactions than you and I do. You know, Boris Johnson was shaking people’s hands all day long. He shouldn’t have been, at some point he should have been modelling better behaviour, but nevertheless, this is what politicians do and so they’re more prone to get the virus as a result of their social connections and more prone to spread it. For example, President Trump, once he got the virus almost surely was the point source for the super-spreading event in the White House. You know, many of the other people who were infected probably got it from him. So vaccinating those people actually might not be an unwise strategy. For the rest of us, in other words, it’s not just that oh, we’re preferentially giving the vaccine to, you know, very popular people or very prominent people, it actually might be good for us to stop them from spreading the disease.

RG: And what about sort of misinformation? There was a really amazing fact in your book which said that from mid-Jan to mid-March the sharing of sites with misinformation on COVID on Twitter was almost as common as the sharing of sites that were credible.

NC: Yes.

RG: And I just wonder about, you know, you can imagine that happening in the next few months, I’m sure potentially Chinese and Russian influence might expand that as well, what do we do to counter misinformation and do you actually think that really influences behaviour as well? I mean, do people just see this and does it actually change what people do?

NC: Yes, I do. I’m also very worried about enemies of our countries. I mean I’ll just speak about the United States because I’m not quite so familiar with the intelligence landscape in the UK. But, you know, we know now, for example, that there’s been Russian disinformation campaign related to gun ownership in the United States. The Russians have been quite interested in getting Americans to arm themselves with the idea that we’ll kill each other. You know, it’s better for our enemies for us to be at each other’s throats. Similarly with race relations, there’s been a lot of Russian misinformation, probably Chinese misinformation too, around race relations, fomenting discord in our society. You know, this is the country that elected President Obama twice and yet, you know, we’re seeing a growing kind of racial conflict in our society which is being the fuel, is being fanned in part by enemies of the United States with a kind of, misinformation and propaganda campaigns. And ironically and pathetically, we’re even seeing this with respect to COVID where a lot of the misinformation is coming from state actors outside our countries who are interested in deluding the public into believing that this is just a hoax, because we are weakened if we are sick, if our public is dying, if we’re directing our resources to caring for people with coronavirus, this weakens us. Plus, from the point of view of the Chinese Communist Party, this has been a propaganda miracle. In other words previously they used to have to tell their people, look, the Americans, you know, they would have to sort of lie to their people about the inefficacy of our society, but now we’re doing it for them. I mean we are, you know, we’re like the Keystone Cops over here and the Chinese don’t have to, I mean it’s like they don’t have to say anything, or they’re saying look, we are controlling the virus in our country and look at the poor Americans, they can’t do anything about it. So there is, our adversaries are in fact – we know this – are using online tools to spread misinformation to our own detriment. For example, a lot of the hydroxychloroquine studies were, you know, were trumped up by people who, some people believed those in good faith, but a lot of them were just trumped up, these drugs don’t work, hydroxychloroquine and chloroquine, you know, they were being trumped up and so on. Or this misinformation that the virus is, you know, only as bad as the flu, for example, which is false, this virus is ten times deadlier than the flu. And on and on and on. You know, using bleach, for example. And the President of the United States was picking up on these things, you know, Russian misinformation sites, and magnifying it. I mean can you imagine the glee in, you know, in certain parts of, you know, the parts of - and I should say that I have wonderful relations with Chinese scientists and wonderful relations with many Russian scholars – I’m now speaking about state actors and, you know, tradecraft and what these countries do to each other, which depresses me. But, you know, the idea that you would be able to spread propaganda in a foreign country and have the leader adopt it is mindboggling.

RG: So why do the peddlers of falsehoods gain undue influence in these networks and what can you do to address that?

NC: Well, part of it is our human tendency. So one of the things I talk about in the book is that, you know, plague is one of the Four Horsemen of the Apocalypse and mendacity is its squire, following right behind the germ are lies and denial. And this has always been the case. You know, during medieval times, you know, there were all kinds of superstitions about what caused the plague and people selling nostrums and, you know, quacks that were preying on people’s fears and so on. This is a very human response that, you know, during times of stress, people will grasp at straws. And it takes a lot of self-discipline to try not to do that as an individual, but the point is that our leaders who are entrusted with these heavy responsibilities, it is their job not to do that. I mean we would hope that our leaders would do better, but in fact it’s one of the ironies, you could even say that it is the perfection of our democracy in the United States that if the people wish to elect leaders who will lie to them, they will successfully do so. In other words, that’s the democratic will, people want leaders who will lie to them, so that’s who they vote for and that’s who we get. Now of course, from my perspective that doesn’t excuse leaders, I mean I think we can still think they’re awful because they’re lying to us, but the irony is that that is maybe in fact what people want. So that’s part of the problem, is that people are gullible, people wish to be lied to during times of plague and during times of stress, and so there’s a very fertile terrain for liars, for people who will exploit that. And I think, you know, I think we have a duty as citizens, as leaders, as politicians, as scientists to push back against that and try to stem that tide. And one last thing, you’re right, modern technologies have absolutely abetted and made this easier. The ability to spread misinformation is greatly enhanced - as is the ability to spread true information by the way - is greatly enhanced by these modern tools.

RG: So I want to go back to your timescale. So you’re hoping that by early 2022 the first phase will be over and then we’re into a, the sort of psychological and social fallout will remain, but we’re in a sort of recovery mode for a couple of years. Just talk us through about how you see that period and what kind of things do we need to be doing to mitigate the psychological fallout from all this.

NC: Well, I mean there’s, you know, that intermediate period I think as we said, the virus will still be around but its epidemic force will be behind us, the virus, just to be clear, will be with us forever, you know, we happen to be alive at a moment when a new pathogen has been introduced into our species. Incidentally, you know, we may think the way we’re living is just so unnatural and alien, but this experience is not new to our species, it’s just new to us. You know, what makes us think that we would be spared this experience that has afflicted our ancestors for thousands of years and we are alive at a moment when this is happening and we need to grow up, I mean we need to be mature about it and face it forthrightly and work together to repel the virus and endure, which we will do, we will see the other side of it because, you know, plagues always end, eventually they end. So, so yes, so the economic, social and psychological fallout are going to be substantial and I think governments are going to have to deploy all of the customary tools, the economic/social tools to respond to that. One thing I didn’t have a chance to say earlier, which I just wanted to finish the thought now, was that during times of plague, people, religiosity rises, you know, there are no atheists in foxholes, you know, so when we’re under stress people get more religion. Abstemiousness rises, savings, people save money, people are risk averse, you know. But by 2024 when we’re beginning to emerge from this long period of biological, social and economic stress, I think that then we’re going to have a bit of a period like the Roaring Twenties after the 1918 pandemic, influenza pandemic. I think people are going to relentlessly seek out social experiences, you know, nightclubs and restaurants and political rallies and sporting events and so on, I think there’s going to be a lot of spending, you know, I think people’s pocketbooks are going to open up. Religion will decline again at that period, there may be sexual licentiousness and risk taking and joie de vivre and, you know, one of the reviewers of my book who read this description, you know, said, ‘Here’s hoping’, you know, [laughs] that that is what the world will be like then. But…

RG: You mentioned sex and I’m just going to say that obviously to get the ratings up on this podcast, but you mentioned dating actually and how people are firstly having more contact with exes now…

NC: Yes.

RG: … and, you know, people are also sort of obviously just doing lots of video dating and maybe that will produce more sustainable, better founded relationships, but also you said that people might confuse emotional stimulation and physical danger with romantic arousal. They might have some sort of false romantic consciousness.

NC: Well, there’s a very famous study done in the social sciences. I may garble the details a little bit at the moment, because all I’ve been thinking about is coronavirus for ten months and although I have many things in my mind, I can’t remember everything exactly right. But the study, I think, involved a man, what they did is they randomly assigned where the man, who was a confederate of the scientist, would ask a strange woman for a date. Would it be at the bottom of - and listeners could try this experiment for themselves perhaps – would it be at the foot of that London bridge, that footbridge that crosses over where the London Eye is… I love London, I mean, you know, when a man tires of London, he tires of life. But anyway. So you could either, this experiment, there was some kind of a somewhat dangerous bridge, the man could ask the woman for a date before she started up on the bridge, or he could ask her for a date at the top of the bridge. And it turns out that women were more likely to say yes to go on a date with a strange man when he asked her at the top of the bridge than at the foot of the bridge. The reason being, the speculated reason being that the woman was confusing a state of feeling danger about, you know, an arousal, a physiologic arousal, not sexual arousal, by being at the top of this bridge with romantic interest or perhaps sexual arousal. So there is a sense, some people think that during this time of pandemic - and this is also seen, by the way, during previous plagues – that this time of, you know, cities under bombardment, for example, there’s a lowering of, there’s a disinhibition of people to engage in romantic interactions, which is quite understandable, you know, people are afraid, we’re animals like any other animal and get solace from partnerships, not just sexual, but, you know, feeling attachment to other people, it makes us feel safer. So some people have speculated, and there is some data that is beginning to come in to support this idea that this is a factor, may be a factor in the formation of relationships at the present time.

RG: So, back to the Roaring Twenties…

NC: I don’t know what that did for our, I don’t know what that conversation did for our ratings! But, you know, okay. There’s more in the book, by the way. There’s something else which you’re not asking me about, about the Department of Public Health’s, the New York City Department of Public Health’s recommendations on safe sexual practices during the time of pandemic, including some specifications for, you know, how to have safer orgies, for instance. But we can leave that for the reader to discover.

RG: [laughs] Just one other thing on the kind of current situation before we get on to the Roaring Twenties, which is right now as we’re in a second lockdown in the UK, there is definitely a certain degree of fatigue where you see people just not really obeying the advice quite as much. And this shouldn’t really surprise us, you know, we know from, for instance, diabetes patients, telling them to change their diet doesn’t work even though there’s a very clear incentive for them to do that, or HIV didn’t really change necessarily people’s sexual behaviour, so why should…

NC: It did. No, HIV did and that was partly because there was a community-wide effort. In the United States at least, the gay community that was struck by this, the sexual practices changed…

RG: Yes.

NC: … very dramatically. Condom usage sky-rocketed, number of partners declined, the bathhouses were closed.

RG: I think I was thinking more of sub-Saharan Africa, some attempts to try to change, it didn’t really have any effect. But just, I think the bigger point though is, you know, one, can we do anything to address this, to actually make sure that people respond in the same way that they did in the earlier stages to reduce that sense of fatigue, or, and/or, should we actually almost take a harm reduction approach to this and say maybe people are going to go for Christmas to their family and we need to try and find ways of mitigating that and maybe, you know, people should get tested before they go and they should do Christmas dinner in a certain way, rather than sort of being in denial and then people going and doing it anyway.

NC: Well, I think the first thing I would say to that is again, what we are being called to do right now as living things and as citizens is to show maturity and accept reality and work together. So I think that the sort of wishful thinking that it’ll be fine if we have Christmas dinner in a large group is immature and is not properly recognisant of the nature of the threat that we face. The example I like to give a little bit about this on the COVID denial thing is I have the misfortune of, I grew up, my early childhood was in Greece and I don’t think there was fluoride in the water, and anyway, that’s my story as to why my teeth are not so great. And I’ve had like six or seven root canals, which are awful, any listeners that have had root canals know what I’m talking about. And so if you’re in the dentist’s chair and you’ve had two root canals and you’ve really quite had enough, you just, you know, you don’t want any more, your not wanting more root canals has absolutely no bearing on whether you need them, okay? So I understand that people feel like, the fact that they’ve been locked in their homes for nine months or can’t go to the pubs or wearing masks, they don’t want any more of it, you know, they’re done with it. But unfortunately that has nothing to do with what the virus is doing. The virus doesn’t care whether we’re done with it or not. So unfortunately we just have to accept that we need seven root canals and we’ve only had two so far. And, you know, that we are being called to show some maturity and show some pacing and some self-discipline and work together to enact policies which minimise the harm to us as individuals and as a society. And here’s the irony, if we did better, you know, if we didn’t go to pubs, if we wore masks, if we kept physical distancing, if we minimised excursions, instead of shopping twice a week we kept shopping lists and went out once a week, which minimised our risk, minimised our probability of spreading the virus if we had it, and thinned out the crowds at the grocery stores. If we did lots and lots of little things like that, we might, might have been able to escape some of the more onerous things like school closures or business closures and we might have been in a better shape right now so as to have been able to have, let’s say, limited gatherings over the winter holidays. But, we haven’t done that enough and so unfortunately we have more suffering ahead of us.

RG: So I want to end, Nicholas, by asking you about how you think COVID will reshape society in the longer term? I think there’s been a massive range of columnists chipping in, usually predicting how COVID will make their pre-existing ideological beliefs come true, conveniently enough. I’m just interested in whether you think, I mean you’ve written about sort of the inertia of social systems and how they have a sort of unchanging reality, but do you think beyond the sort of moment of hedonism that we might have in 2024, this will have a lasting impact on society?

NC: I mean yes and no. So I don’t think fundamentally, you know, we’re going to be changed as a species and I don’t think the way we live in modernity, you know, right now people are fleeing cities, but people will go back to cities, and right now people are unsure in manufacturing and appeal of globalisation is descendant, but it will come back because the economic arguments in favour of globalisation are so compelling. So I think that many of the changes we are seeing are temporary. But some changes in the way we live will of course be enduring. The toy example I like to give about this in order to fix ideas is the existence of spittoons in the American built landscape a hundred years ago. So in the 1900s there were many, tuberculosis was a serious problem and there were many efforts to get Americans to reduce spitting. I don’t know whether British, whether the Brits spat in public in 1900 or not, but the Americans did and in fact every restaurant had a spittoon, a little brass bucket that you would spit in if you wanted to and it would accumulate all of these people’s spit. It was very gross and unsanitary. And so there was big movements to reduce public spitting and to, because of tuberculosis in the 1900s. And then the Spanish influenza struck in 1918 and there was a really big push and all of the spittoons were eliminated. And afterwards when the epidemic was gone, the spittoons did not come back. I mean nobody has been going into restaurants for the last hundred years and saying, you know, where are those spittoons, I want my spittoon. It’s gone. Okay? So I think there are going to be some things like that in our society, some changes that we make and how we live that when people look back in 20 or 30 years, it will be noted that this disappeared, but nobody will miss it. It’s also a little bit like in living memory for many listeners, the disappearance of smoking sections on airplanes. When I was a boy and I would fly to Europe the people in the rear of the plane, you know, the last ten or 20 rows, they could smoke, which was ridiculous because the smoke just came forward anyway. Now nobody can smoke on airplanes, you know, and mostly people don’t miss it or even think about it as a loss. So there are going to be things like that in our society. I’ll give you one example and then maybe we can close. A speculative example, which is – and I think, so there are going to be many different sorts of ways – I think working from home, I think business travel, I think many technological advances which will have been prompted by the pandemic, there’ll be lots of ways, small, medium and large, that our society is changed, but some will be a little bit indirect and not so obvious while they’re happening. Let me give you one example. If you consider the stereotypic heterosexual couple, so of course there are homosexual couples, there are families that have a single parent, you know, single head of household families, but just for the moment think about the modal couple, which is a man and a woman and let’s say their children. In the United States at least, and I suspect in England, it is still the case that on average the man earns more money than the woman, and it is still the case that on average – and this is not always the case, we’re talking about stereotypes here – that on average women will have a preference for being with their children compared to the man. So now put yourself in a situation in which there’s an economic calamity and schools are closing. Individual couples might sit around their kitchen table and say, you know what honey, the man is going to keep earning money, because his salary was higher than the woman’s, plus the woman is saying, you know, I’d rather be with the kids than you, so I’ll stay home with the kids that, you know, can’t go to school. So the couple makes what is for them a very rational decision from the perspective of their own family. But now, hundreds of thousands or millions of other families are probably making a similar decision and as a result of this we may find that women’s labour market participation, the labour market gains that women have made wonderfully over the last ten or 20 years are partially reversed by the pandemic. So 20 years from now we may look and see, wait a minute, women were joining the workforce and occupations in tremendous numbers and in tremendous equality up until 2020 and then, oh my goodness, this was partially reversed. So this is another kind of change that may be a sustained change because of this virus.

RG: One of the things I’m sure you’re looking forward to, Nicholas, is being able to stop talking about COVID and go back to devoting your life to all your other research. I’m interested in what are the things going on in your lab that you’re most excited about getting back to.

NC: Oh well, my laboratory does all kinds of stuff. We have a very active agenda in artificial intelligence, we were working on climate change and using, making certain models. We have a huge initiative supported by the NOMIS Foundation in Switzerland on the microbiome. You know, my laboratory has lots of interest and, you know, most of its attention right now is COVID related, so I’m certainly hoping to do that. And then of course on the personal front I’m really looking forward to having dinner parties with my friends again, and frankly, travelling again. I mean it’s, you know, it’s… and we’ll see that, that’ll happen, but for now we have to, you know, accept that we can’t do those things.

RG: Nicholas Christakis, thank you so much for being on The Mission. And do

check out Nicholas’s book, ‘Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live’. Thanks very much everybody and we’ll be back in a couple of weeks.