September 8—B.C.—before COVID—children bemoaned the end of summer while parents waited with bated breath for a return to school, work and well, the normal routine of life. That was then. Today, the Delta variant has pushed up case rates, while vaccination rates in certain states remain anemic. Are mandates the needed shot in the arm to get us up and running on the road to normalcy? And what is our obligation to make vaccine rate inroads globally? Chief Investment Officer Tony Roth and New York University Langone Medical Center’s Dr. Arthur Caplan discuss these matters and much more.

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Dr. Arthur Caplan, Mitty Professor of Bioethics, NYU Grossman School of Medicine

Please listen to important disclosures at the end of the podcast.

Wilmington Trust’s Capital Considerations with Tony Roth

Episode 40: COVID and Another Season of Our Discontent
Tony Roth, Chief Investment Officer, Wilmington Trust Investment Advisors, Inc.
Dr. Arthur Caplan, Mitty Professor of Bioethics, NYU Grossman School of Medicine

ARTHUR CAPLAN: What we face is not so much more and more death because the virus is running around rampant, but they start to tip over, fill up the hospitals. We’re not built to handle a giant pandemic over and over and over again in our ICUs and in the ERs.

So, the real problem there is you want to get vaccinated so that you don’t fill the hospitals.

TONY ROTH: That was Dr. Arthur Caplan, professor of bioethics at New York University’s Langone Medical Center, sharing his thoughts on the coronavirus, future mutations, and the ethics of vaccine mandates.

Welcome to Capital Considerations, the market and economic podcast that’s fully invested in your success. I’m your host, Tony Roth, chief investment officer of Wilmington Trust. I’m sure many of you, like me, are returning from a nice summer, maybe even a vacation, and preparing to head back to real life, whether that be work or school. But with the reemergence of the widespread coronavirus driven by the Delta variant and on top of that the recent reports that question the longer-term efficacy of the vaccines, it’s somewhat challenging to picture what this return to so-called real life might really look like. What does a future with COVID-19 hold and how will unfolding of vaccines and their questionable efficacy over the longer-term perhaps affect how we live with this disease and affect policy that have been adopted to fight it both over the short and long term?

To help us answer these questions and more, we’re pleased to welcome Dr. Arthur Caplan. Dr. Caplan is the Drs. William F. and Virginia Connolly Mitty Professor and founding of head of the Division of Medical Ethics at NYU School of Medicine. Prior to coming to NYU, Professor Caplan created the Center for Bioethics and the Department of Medical Ethics at the University of Pennsylvania. He advises major medical institutions across the country and internationally, including the U.S. Department of Defense and the World Health Organization. Dr. Caplan has numerous academic papers and books, including a recent one, Vaccination Ethics and Policy. Professor, thank you so much for being here today.

ARTHUR CAPLAN: Thank you, Tony. And, please call me Art.

TONY ROTH: Art, thank you for being here. We’re really excited for this conversation. Before we begin, I want to stress that Wilmington Trust is nonpartisan and we take no political position one way or the other. We had so many conversations around COVID for our audience, our listeners, last year and we’ve sort of taken our foot off that particular pedal this year because the space is so saturated. But, Art, it just feels like we’re coming into the fall here, Labor Day weekend, and it really seemed like it was the right time to have a conversation. And one of the reasons is that it really feels like maybe there’s a light at the end of the tunnel because there doesn’t seem to be anything behind Delta.

I mean, listen. We’ve had hundreds of millions of people now that have actually had COVID. The virus has had a chance to give us its best shot, to morph, to mutate, to do all these crazy things that it does. It’s given us the Delta variant. I’ve read enough to know that these viruses tend to become more transmissible but not necessarily more lethal. And so, it sort of feels like with the number of people that have been vaccinated, over 50% now of our total population fully vaccinated and we’re going to be having more people added to those rolls. And then, on top of that, folks that have had the virus, we’ve got to be close to herd immunity. And if we don’t get another variant that’s more lethal, maybe we’re going to be out of this thing soon. So, where do you see us right now in terms of the permanence or the durability of this public health crisis?

ARTHUR CAPLAN: Well, I think as sometimes said, you’re fishing for compliments, in this case fishing for some good news. And I think you’re partly right. We have had a lot of natural in-, infection building natural immunity, a fair number of people are vaccinated, and those are all to the good. But not quite there yet. Got to get more vaccination done. We’re still a distance, even with the people who’ve caught the disease, from herd immunity. So, I worry about that.

Good news. A lot of the older—elderly—Americans have been vaccinated, so the death rates should really be far less, even if the virus spreads. I’ll say this about mutations. If you look at evolution and viruses, viruses always try to become more transmissible, but it’s never in their interest to become more lethal, because they kill their host.

So, in terms of transmission, we may still see more because, remember, the bad news is a lot of the world not infected, a lot of the world not vaccinated. There’s still enough, if you will, human population out there that I think you can cook up a few more strains potentially. You’re a guy who deals with risk all the time. I’d bet that things will be better, but I want to be cautious.

TONY ROTH: What about the ability of these new strains to circumvent the vaccines? So, in other words, we’re seeing that the new strain is more transmissible and can actually cause symptomatic illness more readily, but—that is the Delta variant—but not severe illness. Do you think that to the extent we get new strains that, again, may be more transmissible but unlikely to cause more severe illness or death than what we’ve seen so far?

ARTHUR CAPLAN: I think there I’ll go with that. I think we’re likely to see, if you’re betting, easier transmission, more mutations that make it easier for the virus to spread. Viruses love those kinds of mutations. But I do think it’s harder for them for the reason I just said, don’t like to kill all your hosts, to evolve, if you will, more lethal, nastier strains. It can happen but they’re really rare in viral evolution.

So, yeah. I do think we may see more contagion, more cases of people with moderate illness, more cases of people we could treat in the hospital and get them better, not just have them die because their lungs really fail, or the virus just shuts down their entire organic function. So, yes. I think we may have gotten as bad as it’s going to get on lethality. Still could get more on transmissibility.

TONY ROTH: So, it really does sound like the key to our getting on top of the situation are vaccines. On an individual level we each want to be vaccinated because we don’t want to die and get seriously ill and we’ve just sort of established, and we’ll talk more about the permanence or the durability of the vaccines. Can you talk to us about why the vaccines are so important in terms of getting this thing under control as a community of people globally?

ARTHUR CAPLAN: Well, look. There’s still a lot of people unvaccinated around the world. If transmissible, high-transmission viruses get into those populations, they really could get wracked with a lot of sick people and they don’t have the hospitals, antibodies, experts to do much about it. So, their death tolls would be worse, not because the virus is worse, but they don’t have the safety net health care system. So that, that’s a risk.

Here or the developed world, Japan, Europe, what we face is not so much more and more death because the virus is running around rampant, but they start to tip over, fill up the hospitals. So, even as we learn how to do better in combating the virus, whether it’s giving you some antibodies or operating ventilation in the right way, so we actually get your lungs time to recover, we’re not built to handle a giant pandemic over and over and over again in our ICUs and in the ERs.

So, the real problem there is you want to get vaccinated so that you don’t fill the hospitals, not so much with people who are doomed to die. I think we could do better. But they may be there two weeks, three weeks, four weeks. Meanwhile, you have a heart attack, you have cancer, you have ALS. You can’t get in there. So, that’s where the community mindedness really starts to show.

TONY ROTH: So, there’s really kind of three levels that I can think of right off the top of my head, and I’m sure there are more, reasons to get vaccinated that even extend beyond our own personal survive, survivability. One is to be able to have a health system that’s actually available for other types of needs. Second is the need to have a world where at some point the virus doesn’t have as many hosts to create new strains. And then lastly, which is more in my area, we clearly see a very significant supply chain disruption that’s leading to inflation and economic risk. And to the extent that we continue to see periodic and rolling shutdowns in supply chains around the world, that is building as a risk, both on the inflation side and the consumption side.

One of the things, Art, that I have found to be really interesting is that in my short life of 54 years, I would say this is one of the greatest crises the world has faced and it would seem that hesitancy is probably lower in many places around the world, most of the places around the world, than it is here. And given the nature of that crisis, why wouldn’t we say, hey, Pfizer and Moderna, this is really, you know, your strike zone. Why aren’t we being pushed harder, frankly, by other countries around the world to give the recipe to everyone? And by the way, it’s in our interest to do so.

ARTHUR CAPLAN: Absolutely. It’s prudent. You know, I have a nephew. He went out to buy a used car. There aren’t any. Parts are short on a lot of automobiles. Toyota I saw they just shut down production. So, these economic reverberations of supply line disruption are serious. They cause problems too, by the way, mental health issues. Unemployment is never good for health, never. People lose health insurance. They don’t go to the doctor. They try to ride out symptoms. It’s never a good thing.

So, granting that problem, it does seem to me that what we ought to do is figure out ways to get more vaccine overseas. Sadly, I don’t think it’s by giving away the secret formula.

I could give the secret formula to the Ivory Coast or to Gambia and they’ve got no factory and they have no skilled personnel. They don’t even have refrigeration. I’ve got to give them the tools to make the stuff so that really what Pfizer and Moderna should do, my recommendation is make some factories. Make some infrastructure, if you will. So, you’re making a ton of money. Here’s your responsibility. Go build them factories then give them the formula. Then they can make vaccines. And that’s not going to be fast. I think we’ve got a year before that happens. But you need infrastructure for vaccination, everything from electricity to roads to refrigeration.

TONY ROTH: But does it have to be – Art, does it have to made locally? If you look at the global vaccine manufacturing capability –

ARTHUR CAPLAN: Yeah.

TONY ROTH: And I know that they’re not all, they’re, you know, they’re not all the same, right. You can’t make Coke in a Pepsi plant perhaps on day one, although you could probably make it a lot faster than if you wanted to build a new plant. But if you looked at the global vaccine capability output. Couldn’t we, without having to create those new plants, couldn’t we require these mRNA companies to license the vaccine to other manufacturers so that we could supply the world?

ARTHUR CAPLAN: It’s tough to make vaccines. You may remember, Tony, we’ve already had a shutdown in vaccine manufacturing here because of problems in a plant in Baltimore.

TONY ROTH: In Baltimore.

ARTHUR CAPLAN: Yeah. I’ve studied vaccines a long time. I’ve yet to think of one that didn’t have a shutdown because it’s so tricky to make the darn things, whether it’s the old-school way of making them on chicken eggs and viruses or the new school DNA way. It’s not easy. You’ve got to make, you know, literally billions of products safe, identical. It’s hard.

Plus, you need the syringes. We need other chemicals to stabilize the vaccines. It’s not so easy. That said, we could do more. I think South Korea, I think there are many countries out there that could manufacture. We could, you know, could swing their factories over and learn to do it.

So, I’d say it’s a two-pronged plan that we need, and I don’t know where the Administration is on this. But let’s try to incentivize, give the formula, retool the factories in the, you know, relatively developed world, South Korea as an example. Vietnam can make vaccines. They’ve done it in the past. India has the capability. And then, we got to build the infrastructure, because even when you have them, in the history of vaccines there are a lot of cases where we send somebody H1N1 flu vaccine or HPV vaccine. It hits the dock. It sits there. They’ve got no road, no trucks, no refrigerators, nobody trained to give the vaccines. So, you’ve got to chase both.

You need both prongs to really get this done. Is it going to get done in six months? No. Could we have a realistic plan to take care of it in two years? Yeah.

TONY ROTH: At least in the media in the U.S., maybe it’s happening and it’s not something that the U.S. media focuses on, but we have this multinational organization under the, I believe it’s auspices of the UN, the World Health Organization. Are they equipped, both from a competency standpoint and a, if you will, a political standpoint to do what’s necessary to accomplish what you just described?

ARTHUR CAPLAN: No. Next question.

TONY ROTH: Why? Why is that?

ARTHUR CAPLAN: They’re not.

TONY ROTH: So why, why is that? Where’s the deficit and what should we, the United States, be doing differently vis à vie these international institutions, because, again –

ARTHUR CAPLAN: I mean I think people have this sense –

TONY ROTH: Forget altruism. Let’s just figure it’s our own self-interest.

ARTHUR CAPLAN: Sure. And both would work. Both would work. But WHO is basically a group of bureaucrats giving advice. They are all located around Geneva. They don’t have a quick strike force. They don’t have a deployment capability of anybody. They talk. And talk is important. I’m not knocking it. I do it myself sometimes.

But you need boots on the ground, and they don’t have that. They’ve never been budgeted for that. The other problem, and you know this, I’ll remind you. When we started fishing around to find out where did that virus originate and WHO set up a trip to China, China basically said get lost. We’re not going to give you access to anything. Beat it. WHO has no enforcement, no ability to compel.

So, they can say do this, make factories, blah-blah-blah-blah-blah. Somebody’s got to budget it. Somebody’s got to put the boots on the ground. We’re in a better position, as would be Europe, to do it.

By the way, one other small problem. We assume it’s the sort of lower- and middle-income countries that have the biggest problems with vaccines. You know, Japan is like 30% vaccinated. They have an anti-vaccine culture that’s been around there for, I don’t know, 40 years. We haven’t cracked it. It’s a real problem. It’s a very populous place. So, what I’m saying is there are some countries near us—Mexico, Haiti—they need a lot of help in terms of not only getting the vaccine but overcoming their cultural hesitancy to taking vaccine.

TONY ROTH: So, when you look at the landscape, are we as a leader doing enough? We were obviously instrumental in developing these vaccines. Are we doing enough given our historic position in the world? Are we letting the world down? Are we letting ourselves down by being too focused inwardly? What are your thoughts around the more pressing question on using output for booster shots instead of diverting that to other countries that haven’t had any inoculation yet? What’s your scientific opinion on that?

ARTHUR CAPLAN: Well, first, let’s start with my bitter cynicism. Nobody ever failed to get elected in the U.S. for not providing lots of vaccine to Gambia. I mean literally domestic politics gets driven by a short-term, I think, distorted view of self-interest and we’ve said it here a couple of times. Even if you want to write-off the world and say, well, if they die, they die, not my problem, I’m in Fortress America. It’s in your interest to go knock this vaccine out to drive it down to tolerability levels. I haven’t seen that in the Biden Administration. I didn’t see it with Trump. Trump pushed vaccines hard, but he never pushed hard to get them overseas and I have to say I don’t see Biden doing much of that either.

So, we’ve let down the world, but we’re letting down our self-interest. I don’t want to have another podcast with you in a year where we’re kicking around the same issues about how come we haven’t vaccinated Africa or Haiti or many other places to get this thing down to a tolerable level?

In terms of boosters, so here’s my thinking. Many vaccines require three shots. I think, Tony, you’re familiar with the HPV vaccine for cervical cancer.

TONY ROTH: Of course. Yes.

ARTHUR CAPLAN: That’s a three-shot vaccine, three shot vaccine spread out over I believe 18 months. Hepatitis B, three shot vaccine. I’m old enough to have gotten a shingles vaccine, two shots. A lot of vaccines require three shots to get serious immunity. I don’t think we’re really talking about boosters. I think what we’re talking about and what we found out with the COVID vaccines is that they’re three shots and they have to be spaced out more to get maximum big boost immunity.

I was just looking at some papers actually this week that showed the bigger the interval between the first and the second shot, the more immunity you’ve got. They just didn’t test them that way but we’re learning that. Some European countries delayed the second shot. And data’s flying in that makes it clear that a third shot really kicks immunity.

So, I’m not sure it’s a booster. I think what the world is going to need is three shots when it’s at least Moderna or Pfizer that they’re dealing with. Do we have to do the three shots? Yeah. Because that’s what makes the thing work. And what do I mean by makes the thing work? Makes the immunity huge so you can fight off all strains. And last, let’s say two years, three years, that you’re not running around, you know, really having to use boosters, say, every nine months.

TONY ROTH: I know that the data doesn’t exist yet. But do you have a reason to believe that one – those of us that are vaccinated with the two-regime protocol, that we need to get the third one before, probably before a certain time where we’d have to start over again? If we don’t get the third shot, let’s say by 12 months or 18 months, do you have any sense of that or is that just there’s obviously no data on it at this point.

ARTHUR CAPLAN: Yeah. Completely unknown. I know what you’re asking. If we just stalled out, said I’m going to get the third shot let’s say 12 to 18 months from now, am I still good with – because I was primed by the other two? We don’t know. The whole dataset on these vaccines is probably the longest that a human’s been exposed to them when the trial started, not the emergency use authorization, probably clearing about 18 months right now. So, don’t know.

TONY ROTH: So, again, getting into the ethical space, there are a lot of commentators, some well-respected ones, that have really challenged the Administration’s approach to boosters at five months. And, again, we could call it booster or third shot.

It does though seem that as an ethical matter there is a re-, a real strong reason to think that not out of bounds ethically in wanting to provide a third shot to our population before perhaps we provide that material to other countries and other peoples.

ARTHUR CAPLAN: So, look. Part of the answer to this is where you stand on our obligation to get the rest of the world under the vaccination umbrella. I stand in the position of saying right now we don’t have enough warehoused vaccine to make a huge dent, even if we gave it all away and didn’t take a third shot, in what the world needs. World needs, you know, many billions of vaccines, probably tens of billions of vaccines of the two shot ones. Maybe with our surplus we would be able to supply them with a billion. It’s not going to make any difference.

We’ve got to figure out a path that’s build infrastructure, build factories, convert them over, and share the formula.

TONY ROTH: Do you see any meaningful activity in that direction, any credible activity internationally, any movement being led within the U.S.? I just don’t hear about it if it’s happening.

ARTHUR CAPLAN: I don’t see it. You’ll hear it from me. I whine about it periodically when I can. But, no. I don’t really see it yet. It’s almost a fight, again, about, well, we ought to get rid of our surplus, which, as I said, it isn’t that big a surplus and it’s not going to make a big dent. So, I find that discussion, which we hear about a lot, almost pointless. It’s sort of, you know, let’s assume we had 500 million surplus vaccines and we wanted to hold enough for a third shot and maybe enough for a fourth shot. What difference does it make? Five hundred million is not gonna-, that’s 250 million more vaccinated people. Not writing off those lives. But, you know, it isn’t going to solve our international demand issue by any means.

TONY ROTH: So, let’s, Art, try to imagine what the future of our lives is going to look like, those of us that are accustomed to being able to circulate freely internationally. It would seem that the ergo from what you’ve described is that we are going to move from a period of pandemic to endemic where the corona-19 virus will be with us for many years, many, many years, decade, maybe more, because it will, I think it’ll take that long to get enough vaccination done at the rate at which the world is moving and –

ARTHUR CAPLAN: Right. By the way. I think where we’re headed is make it tolerable, perhaps think the flu. Eliminate it like polio, smallpox, I don’t know. That’s going to be a long haul. By the way, getting rid of polio has been a 40-year project with full backing of the Gates Foundation and attempts to rollout the infrastructure. We’re still not done.

TONY ROTH: But the presence and existence of the coronavirus, both domestically and internationally, could be very consistent with—for those of us that are vaccinated and receive a third shot, with life as it was for the most part, including not masking, prior to this pandemic. Would you agree with that?

ARTHUR CAPLAN: I would, because I think you’ll get pretty broadband immune resistance. You shouldn’t wind up in the hospital off the third shot if it does everything that we’re predicting. So, I do think there will be a group of people who will be able to resume, if they can prove three shot vaccination, travel, back to work, and if our businesses get tough and start to demand authentication, maybe back to the restaurant, back to the gym, back to the theater and so on more of a normal life routine.

My other complaint, we never put in a good authentication system for vaccination. You’ve got to have a hard to counterfeit vaccination authentication card, a credit card type thing. People tell me, well, it might invade my privacy. But when they tell me this, they’re usually telling it, me this by an email from their cell phone, which has probably been tracked eight ways to Sunday about where they are and what they do with it.

TONY ROTH: Yeah. And I feel as though that horse just left the barn. In other words, it’s almost impossible at this point. I can tell you that I’ve had two shots of Moderna. But I don’t even know if the drugstore could even verify that. And at this point, it, it’s easier to create a false document for anybody than it is for my 15-year-old to create a fake ID.

ARTHUR CAPLAN: Yeah. So, look. I do think it was absurd not to proceed with authentication. The fears I heard about it basically were trying to defend the rights of the unvaccinated. But maybe we could reinstitute it in two ways. One, for international travel, you are going to see many countries demanding proof. If you want to go to Europe, you want to go elsewhere, I think they’re going to say show me your vaccination card. So, maybe private enterprise could pick that up.

Second, I think it may not be too late to do it with a third shot. So maybe there might be some fuzziness, if you will, about shots one and two. But you could do the third shot, get your titers measured, see if you really get a strong immune response, then certify. If I was an employer, I’d be saying I expect everybody to get that third shot and I expect, given international business requirements, that you’re going to be able to prove that you did.

TONY ROTH: So, if you manage money for a living, Art, which I do, and you spend a lot of time thinking about not just where to place the bets, if you will, where to deploy capital, but as importantly even for deployment of capital domestically what the overall global economic picture looks like. I would say that you’re painting a picture that is going to be fairly compromised for a long period of time as it relates to the ability of countries around the world that are probably not the U.S. or probably Europe but certainly Japan and many others to maintain the type of economic output that’s predicated on people working in very close proximity with each other 365 days a year. You’re going to see rolling waves of problems around the world for quite some time.

ARTHUR CAPLAN: So, I would say this. I think there’s been a push. You can tell me if I’m wrong. You know the money side. I see it in our NYU hospitals, just in time supply. I don’t think you can rely on that anymore given these interruptions that are out there: raw materials stalling, people not being able to store, deliver quickly as outbreaks roll in different parts of the world, even for raw materials. So, it may be less efficient, but I think that would be a principle of business that I’d start to think that’s going to get compromised over the next couple years.

And I’ll also say we do have a lot of folks who are capable of international commerce, even in a plague, somewhat protecting themselves, somewhat using electronic, you know, means to communicate and get things done. So, to me it depends on the industry, if you will. See some industries really being able to sail right along. Container ships, the muscle part of the economy, we worry about that more.

TONY ROTH: Let’s switch our focus a bit. We’ve covered a lot of science and we’ve made a lot of predictions around what could happen, how this could unfold from a public health standpoint. But let’s talk about some societal challenges that we face. And I want to remind our listeners that none of this is meant to be judgmental from a political standpoint. We’re just trying to understand the facts.
So, we have a lot of people in the society that don’t want to take vaccines and that are refusing to take vaccines. What kind of consequences should they suffer, if you will, by not taking a vaccine, by being unwilling to take a vaccine? Should they be permitted to show up at the workplace and mix with the majority of their peers that are vaccinated? What about schoolchildren where they’re not vaccinated. If they’re not vaccinated, it’s because their parents have chosen not to get them vaccinated. Should they be required to sit out that critical developmental experience? How do you tackle those issues?

ARTHUR CAPLAN: So, morally I think we’ve tried to persuade people to take vaccines. We even tried to incentivize them, right, free beer, free restaurant meals, lottery, college tuition. And now, we’ve got a lot of hardcore resistance. And I think the answer is mandates.

Do I mean the vaccine police coming to your house holding you down, putting the jab in your arm? No. But it does mean if you don’t vaccinate, you’re going to be restricted as to where you can go, where you can work, what you can do to entertain yourself, where you can travel, just to put it simply.

If I ran a cruise ship and I would like my business to be going, you’re not coming on my boat as a worker or a vacationer unless you’re vaccinated. I’ve got to retain public confidence that this place isn’t going to make you sick. And the only way I can do that is by a blanket vaccination rule.

People have said to me what about kids? Can they go on the cruise? I’d probably say no, not right now. I think we’ll see kids vaccinated probably by January down to age five. Then we can sort of loosen that up.

But morally, a good citizen should be looking out to protect the vulnerable, immunocompromised, very old, cancer, transplants, and kids. Protect them by getting vaccinated. It is harder to transmit, not impossible but harder, if you’re vaccinated. Keep the hospitals from getting overwhelmed. Anybody who doesn’t know what it means to be a responsible citizen just has to look at what happened in New Orleans when they had Ida on top of COVID. They couldn’t even move people out of the hospital to get them out of harm’s way because the other hospitals were full of COVID patients.

TONY ROTH: So, are we doing enough to get our children vaccinated quickly enough? I have a 13-year-old who was 12 when she got vaccinated and we have lots of friends that have 10 and 11-year-olds that are very frustrated that those kids are not vaccinated. I know you have to draw the line someplace. But why can’t we in a rolling fashion provide the vaccine to increasingly younger children on a more rapid basis. Because, what I can tell you is that I don’t know a child and I know a lot of them that are not having or have not had at some point serious issues of either depression or anxiety as a result of this.

ARTHUR CAPLAN: You know, Tony, I’m going to accept that argument because I do think we’re underplaying the damage done by closing schools, even to some extent by requiring masking, which I don’t think is usually burdensome but interferes with social interaction. I live in Ridgefield, Connecticut. I was talking the other day with a teacher who runs orchestra and band. He’s not going to be able to run orchestra and band at the high school until we get a better handle on COVID. You know, you have to take your mask off to play the clarinet. It’s just not going to happen.

I’m very familiar with trying to run sports events. I’m on the NCAA COVID Committee. You have to lock people up for weeks to make this happen and it’s tough on the athletes. The pros are seeing the same thing too. So, there are psychosocial, mental health consequences that are big, very big. And, as you said, educational development is hindered as you lose time because maybe your school gets quarantined, or closed, or certain activities are just—can’t be done.

So, I favor going year by year. Collect the data on the 11 year olds, put them in. Collect the data on the 10 year olds, put them in. I think that is a reasonable strategy to go with. Interesting enough, the problem is the younger you go, the fewer kids have been exposed to the vaccine. We’re trying to recruit them now.

But there are some 10 or 11-year-olds, and I’ll tell you one group that’s out there. You’ll like this. It’s parents who go off to the pediatrician, say my kid’s 11, would you vaccinate him? And there are a lot of parents doing it. I hear about it.

ARTHUR CAPLAN: And what we’ve got to do is sometimes in the science end called forget about a trial, just collect real world evidence. Just monitor some subgroup of these folks, tell them you’re going to watch them, don’t penalize them for going outside the recommendation. By the way, for approved products like Pfizer is now a licensed product, doctor could prescribe that tomorrow for an 11-year-old legally. You don’t have the risk, yeah.

TONY ROTH: Is that right? Because the CDC has said that you can’t use it for an off-use purpose and –

ARTHUR CAPLAN: Correct. That’s their, as we like to say, recommendation. But they don’t practice medicine.

You’d be at risk if something went wrong and then people would say that’s – you didn’t follow the recommendation, will haul you to court because they had a bad outcome. But, I don’t see any bad outcomes. I’m a pediatrician to an 11-year-old kid. Probably ready to take that risk to protect that kid. So, you get a lot of leeway.

By the way, for those listening who don’t know, I’m going to say, making up a number here, 65% of drugs used in kids have never been studied in randomized trials in kids. They’re always extensions from adults. In other words, it’s an off label. They just run the whatever it is, sleeping pill, anti-anxiety med. Nobody waits around and says let’s run another five-year trial on the kids who have anxiety at age 12. If it works on 14-year-olds and it’s licensed, let’s go.

TONY ROTH: So, again, this is going to be an inherently political question that I’m trying not politicize the conversation. What kind of grade would you give our health or domestic health organizations? They don’t seem to be showing a lot of imagination or vision as it relates to providing vaccines to the rest of the world, which are in our self-interest, forget altruism.

ARTHUR CAPLAN: So, just to be nonpartisan, Trump C-, didn’t pay enough attention to masks, didn’t pay enough attention to testing. You know, one of the things we haven’t mentioned yet is when you’re trying to stay in school, give every kid a home test kit. If they come up positive, how about we don’t go to school that day? That will cut back on the need to close schools. All Trump did, and it was something, was push vaccine. Took a while to get it out there. In the meantime, we saw plenty of outbreaks and plenty of problems.

Biden, C+. Hasn’t really addressed the foreign challenge, overseas international challenge to us and on humanitarian grounds to save more lives over there. And I’m going to say I think there’s been a lot of fuzzy and inconsistent communication in the Biden Administration. Boosters aren’t coming. Boosters are coming. Boosters are coming in five months, eight months, tomorrow morning, I don’t know. You can’t do that. You’ve got to be consistent in your messaging.

Last point. I love data. I come out of a science culture. But what you and I are starting to hone in on is, you know, sometimes you have to make a policy decision when faced with a gigantic worldwide emergency on less data. We did it when we said emergency use would be okay for some of these vaccines. The kid issue is one where I’d settle for less data, not no data but less. If you ask me, can I prove 100% what the absolute impact is of masks, no. But there’s enough in there that I’m pretty sure they do help. Ventilation, yeah, not great but something’s going on there. Let’s do that.

So, let’s not, as I think Biden sometimes does in his group, let’s not fantasize the data. Data’s important. We need data. Sometimes you want to take a little bit of a gamble in the name of prevention.

TONY ROTH: So, I’m going to stop us here because we’re running out of time and provide three takeaways for the listeners as I always do. And I’m going to give you the last word, Art, after I do that and ask you to say what is the most important thing that I haven’t asked you.

Number one is due to the vaccines and due to the very gradual increasing vaccination rate here domestically, which will go up in certain incremental bounds if you will when we get those kids’ groups approved, the U.S. is going to be, unless we come up against a very rare mutation that really messes up our outlook, we’re going to be significantly better off in three months, in six months, and in 12 months than we are today. This is probably domestically the last major gasp for this public health crisis and we’re probably going to be back in a situation, for those of us that have had the three shots, where we can live the way we used to live domestically at least prior to the crisis by the end of the year I would think. That’s number one.

Number two is that the vaccine mandates are critical and it’s going to take an increasing period of time for people to get comfortable with them. But ultimately you’re going to have enough people that are vaccinated that they’re going to be loud enough to demand that mandates occur or they won’t participate in whether it be sending their kids to school or whether it be showing up at work, etcetera, that eventually the mandates are probably going to win and become commonplace and they’re going to be very important in the first takeaway I think, which is getting enough vaccinations domestically to get back to normal.

But the third takeaway is that it’s going to take a much longer period of time to get the vaccines broadly enough distributed internationally to be able to provide many areas of the world with the same privileges that I just described that we’ll have soon. And that means that the bug is going to be endemic globally for a very long time and it means that as investors and as students of the global economy and the supply chain situation we have to be very serious and thoughtful around how we invest and which companies are really able to appreciate these concerns, provision appropriately, create the type of back stock. And that’s something that we’re going to be doing at Wilmington Trust increasingly, because we see this as notwithstanding the very rosy outlook for our domestic lives, we see this as a very long-term economic event.

So, with that, Art, what’s the one thing that you’d like to say that we didn’t ask you about for our audience today?

ARTHUR CAPLAN: Okay. I’ll accept those highlights enthusiastically except the first one. I’m going to say next spring for the third shot roll out and impact. I don’t think we’ll get it by the end of the year. That’s fast. We’re already into September. Got to vaccinate a lot of folks with the third shot and pick up the recalcitrant. So, there I might quibble.

One thing you didn’t ask and one thing to think about that’s fun, you know, there are 33 vaccines in stage 3 or Phase 3 trials. There may be some better ones out there that can do it in one shot, don’t need as much refrigeration, don’t need as much handling, if you will, to get them done. Some of them may even be inhalable, gets past a lot of the phobia that people have sometimes about needles. Are we going to give up on the rest of them or is there a possibility that we can still try some of these vaccines, maybe in some of those other countries that don’t have any, and advance vaccine effectiveness more?

Moderna, Pfizer, Janssen, kudos. They moved fast. They work. Great efficacy, pretty good safety. But they’re not perfect. Maybe there’s some stuff out there that’s better.

TONY ROTH: Well, it’s interesting because there’s obviously not going to be anyone to give those vaccines to here domestically. Everyone will either have been vaccinated or won’t want the vaccine. And so, at that point these companies that have spent the resources to develop those vaccines, it’s going to be tough to find the path to understand how they’re going to be economically motivated to do those things that you’ve just described.

ARTHUR CAPLAN: Well, the market may need a little kick, whether it’s the Gates Foundation or the Japanese underwriting their—I don’t know. But it would be sad if we got stuck with the first-in-class vaccines thinking they’re wonderful and they’re warp speed and they did all this, you know, good. But you know what? There are even better ones and we never got to them.

TONY ROTH: Thank you so much, Art, for joining us today and thanks to our listeners for joining. You can keep up with Dr. Caplan on Twitter @arthurcaplan for his thoughts on healthcare and bioethics and his day-to-day comments on headline stories. I’d encourage you all to visit wilmingtontrust.com for a roundup of our investment and planning ideas. You can subscribe to Capital Considerations on Apple Podcast, Spotify, Stitcher, or your favorite podcast channel to ensure you get updates on future episodes. Thank you again for listening.

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