Over the next several weeks, Distillations will be talking to people who have special insight into the coronavirus crisis—biomedical researchers, physicians, public health experts, and historians.
In this episode, we talk to William Haseltine, a scientist, entrepreneur, and author who has lived through three epidemics (polio, HIV/AIDS, and now COVID-19). He tells us how his lab in the 1980s was better prepared to deal with HIV/AIDS than we are now for COVID-19 and what he thinks lies ahead for us with this pandemic.
Lisa: Hello and welcome to Distillations. I’m one of your hosts, Lisa Berry Drago.
In response to the coronavirus pandemic we’ve launched a brand-new series focused entirely on COVID 19. Over the next several weeks we’ll be bringing you interviews with people working at the heart of the crisis: including biomedical researchers, physicians, and public health experts.
In this episode we talk to Bill Haseltine, a scientist, entrepreneur and author who’s lived through three epidemics (Polio, HIV/AIDS, and now Covid-19). He tells us how his lab in the 1980s was better prepared to deal with HIV/AIDS than we are now for Covid-19. And what he thinks is ahead for us with this pandemic.
Alexis: We’re a history organization, so we certainly think about how we’ve been through epidemics in the past. But can you talk a little bit about data and sort of what role it plays in kind of predicting and dealing with epidemics just based on all your years of experience working and thinking about all this sort of thing?
William Haseltine: Well, looking back, this is the third major epidemic of my own life. I’m old enough to have experienced the polio epidemic and its effects on life. I remember not being able to go to the swimming pools in the summer, not being able to go to movie theaters, not being able to associate with more than two other, young friends. And I remember the change in those restrictions upon the advent of an effective polio vaccine.
Second epidemic I have lived through is the HIV epidemic. Most people, when they think about COVID, forget that there’s an ongoing HIV epidemic.
It is still one of the biggest killers in the world. It has not gone away. It’s gone from our memories in the United States because we have effective treatments, but it certainly hasn’t gone from the memories of sub-Saharan Africa and other countries.
So this is the third epidemic that I’ve encountered. I also would point out that there was a period in the early 2000s when the U.S. was on high alert for bioterrorist attack. That could be considered to be a, maybe epidemic 2.5. Certainly, it was the first epidemic where we took serious proactive measures to protect ourselves. There were a number of workshops that were created. A number of think tanks, including the RAND Corporation; the Defense Department; the CIA; the National Security Council; the CDC; Homeland Security, all these organizations ran simulations for a biological attack. We created a whole legislative and regulatory infrastructure to allow very rapid development of responses to a terrorist attack with biological weapons.
And I created the first approved drug that fell under the BioShield BARDA [Biomedical Advanced Research and Development Authority] regulations, i.e., you create it and they buy it for stockpile. That was for the prevention and treatment of anthrax.
So we’ve had all the preparation and thinking that we need, that we needed for this epidemic. However, it had been shelved. It had been forgotten. Many of us had warned, and since 1985 and even earlier, that we were due for a highly contagious, highly lethal respiratory infection, and that we needed to be prepared for that.
We outlined very specific measures, including programs to develop drugs against the coronaviruses, influenzaviruses, and other series of potential diseases. Those programs were ignored, neglected, as well as was the civil preparedness. We are now reaping the consequences of that inaction. And it is a tragedy that never needed to happen.
Alexis: Wow. So, I mean, from sitting like in that seat, you know, what has impressed you or I guess also worried you about science’s response to the pandemic?
William Haseltine: Science will save us from this. We will have drugs and we will have vaccines. The progress has been extraordinarily fast. Unfortunately, we had made most of that progress prior to this epidemic, and it didn’t need to occur. We had chemicals on the shelf that will be effective drugs for this. Had they been approved, had they been taken through by any government around the world, not just the United States—East Asian governments in particular had the experience and should have taken these drugs. We didn’t have to have more than 10 people infected and ill before this epidemic was stopped, but we didn’t have those drugs. And as a result hundreds of thousands of people will die, and millions more will be infected. We are far from over.
In terms of vaccines we know that there were—one of the things that we’re making great progress in, vaccines had been brought for SARS and MERS, to the point where they were shown to be not only effective in animals and protecting animals that are susceptible to infection but safe in human beings.
So that we have a tremendous backlog of information which we just left idle. And I can tell you from my discussion with many of my friends who are involved both with SARS and MERS, who mobilized their intellectual and laboratory resources for this effort, and then were completely shut down. Absolutely, completely shut down, by any government or any private foundation from which they could get support.
They had to abandon the most promising research. They had to abandon promising vaccines. They had to abandon promising drugs. And we are now witnessing the consequence of that hideous neglect by every country in the world and by every private foundation in the world.
Alexis: Yeah, I mean, we talk a lot on the podcast and I think sort of in general about, you know, we sort of envision science as this thing that just kind of happens in a lab. And okay, the science happens, and, you know, science is straightforward, but in fact, science is tied to culture and politics and all of these other things.
And so, you know, you can’t have a lab if you don’t have funding. If you don’t have funding, right, you can’t do research, right? Like, it’s …
William Haseltine: For many years at Harvard, I taught a course on science and society to Harvard undergraduates. And one of the major points that I wanted to get across to many of the people who would be decision makers is that science is a servant of society. It is not—and scientists, many scientists, practicing scientists believe they are doing science for the sake of science. And for that I fully applaud them. I understand that. That isn’t why they’re getting paid. That isn’t why society supports them. We are a luxury for society. We are a luxury in the sense that if society decides they would like the benefits of some scientific discovery, be it navigation, weapons, they will pay for it.
And so I realized that very early on, that science is at the service of society and it’s very much dependent on it. We don’t generally produce enough of our own resources to do fundamental science and to create new ways of thinking about the world that are useful. Eventually, those get translated into business, but very rarely, especially more recently, does much of that profit go back into science. Most of it does not.
In fact, the industry funding of science is at an all-time low for the last 150 years to pay. So it’s a terrible record of corporations spending their money that’s based on scientific discoveries on new scientific discoveries. Whether it be the pharmaceutical industry, which is the best of the lot, or whether it’s the high-tech industry, which is not doing well in terms of investing in fundamental research. It’s been a real tragedy.
But I realized this connection between money and research very early on, and in the early days of HIV, I worked with two, I did two things.
One, I was a scientific lead for the board of directors of amfAR, the American Foundation for AIDS Research, and I encouraged them to use all of their money to give support to new, young postdoctoral fellows in a turnaround grant that would give them money within six weeks of application for two years of postdoctoral support. Many of the leading AIDS researchers started out with that money.
Secondly, I lobbied Congress. Fortunately I had made friends with Elizabeth Taylor, and she and I lobbied Congress after Rock Hudson was ill and increased the annual requested budget that HHS [Department of Health and Human Services] had given, from $1 billion—no, $1 million is all that they had requested. We had increased the budget to $362 million in one supplemental appropriation, and all of a sudden AIDS became changed from an uninteresting problem to a very interesting problem.
I remember one of my very senior Nobel Prize–winning mentors turning down, actually two different Nobel Prize friends of mine, turned down my best postdoc with almost the same comment. One said, “AIDS is not initially a problem to work on.” And the other one said, “The only value of retroviruses is they give us oncogenes.” Okay? That attitude changed instantly once the money was available and maybe leading AIDS researchers overnight. So money makes a difference.
William Haseltine: And money will make a difference in this case. And so what we saw is tremendous scientific progress, drugs almost ready to be used in human beings. The vaccines on the brink of approval. And the plug got pulled, and the research stopped and left us undefended for what we knew was coming.
Alexis: When we, when we get to the other side of this, what would you like to see changed or strengthened or discarded so that we don’t repeat this, basically?
William Haseltine: I have hope that on the other side of this, we will take up long-term proactive programs to protect us from what we know is coming. There will be another coronavirus lethal infection. There will be a pandemic flu with the potential to kill one to two billion people before we can control it if we don’t take protective measures now. We will be devastated by superbugs that are resistant to all known antibiotics, unless we take proper precautions. We are going to be subject to an ever-increasing onslaught of what had been relegated to the field of tropical diseases, as a consequence of global warming.
Yellow fever will be back. Malaria will start to spread. Dengue is already coming, as is chikungunya. These are things we can see coming. There are good ways to protect ourselves, to have the weapons in our arsenal that can shut these things down early.
And we must invest in those. We have the infrastructure; we have the regulatory structure. We haven’t had the political or economic will to do it. Now, will we do it? I’m a little bit skeptical because Asia had been hit by SARS. They thought they were prepared. They weren’t prepared because they didn’t have the drugs.
They should have had the foresight to know, especially after MERS, that another coronavirus was going to come. Now, they did take action based on their previous experience and shut things down lickety-split. If you look at the difference between East Asian responses and their ability to control this epidemic by social measures, and you look at the Western Europe and American experience, vastly different.
Political leaders did not understand the economic consequence, let alone the human consequence of not reacting quickly and swiftly. East Asians did because they had gone through it in their living memory. The people like Xi who are now running big countries and their entire bureaucratic infrastructure were younger people who understood the devastation to an economy and a country that this virus could do. So they quickly reacted.
We, on the other hand, didn’t. We in the United States are particularly egregious in our inaction, and we continue to be disorganized and believe that politics, not health system reaction, can control this epidemic. And we are not in control in this country of this epidemic.
Alexis: No. I mean, and that’s a thing we talk about all the time, right? Like, this is one of those, the thing that feels like a lever we can pull, which is maybe the politics or maybe the, you know, other things that are going on, is it’s not actually, science isn’t, science is wrapped up in that lever, but that lever is not going to make it disappear.
William Haseltine: You know, fortunately, science has the capability to stop this epidemic. We will have the drugs; we will have the vaccine. It’s going to be some time, and until then we have to rely on social measures. I have to say that this weekend to me was very distressing. I wrote a little essay, which I’m about to publish, calling it “A Walk with Death.” Saturday dawned nice and beautiful in New York City. And all of a sudden the park was filled with people.
They weren’t observing distance. Many weren’t masked. And the beaches in California were jam-packed with people. That shows up 10 to 15 days later as a new hit on the emergency room and new body bags being hauled out of houses and hospitals. That is what I felt. I got, as soon as I walked out and saw what was going on, I ran right back to my apartment.
It was disaster. People don’t realize what a risk they’re taking, not just for themselves, but for everybody around them and for other human beings. And then what I worry about is we’re going to start to relax, and people seem to take cautious opening as a license to go back to “let’s party.”
Well, that is terrible, and we have a really strong hint of that with what happened on Saturday. We are, each person out there is walking with death at their side. Just like in those medieval paintings, that Grim Reaper walking by your side. Death was walking by their side, and they didn’t see it.
Alexis: I feel like every week there’s a different astounding number. So, it is, it’s difficult to wrap your head around to be sort of in this moment.
William Haseltine: And, you know, we count on our politicians to protect us, and it’s their job to do so. And if they don’t, they should be held accountable. It is not, it’s, you know, and we have good leadership in some places. And in our Congress we have some good leadership and its bipartisan leadership. But you need, you know, we, as a species, look to a leader. That’s what we look for because we all have our individual points of view. And so we organize society, which is leadership-focused. And we need it, and we need the help from our leaders.
Alexis: We know it’s sort of a stressful time, at the very least, right, for our listeners, for ourselves. And we think about sort of all the things we can do to cope. So I am trying to ask people in interviews to tell us sort of one thing we should be reading if we want to have more information and sort of understand how to take action. And one thing we could be, you could be reading or doing that is helping keep you sane. What’s helping you sort of cope with the stress?
William Haseltine: I’ve been interviewing a lot of young people between the ages of, say, 7 and 17 about their experience and what they know and what they would like to know. And I think that the lesson that—first of all, of course, their major question is when is this going to be over and I can get back to my life? And whether it’s a 7-year-old, who said that I miss my friends and my sports, or it’s a 17-year-old, who says, I don’t know what the hell I’m going to do about applications and will colleges even be open, right? It’s that fundamental question that they need answered. But then below that there’s a deep concern. Why is this happening to me? What is the danger for me? What is really the danger?
Why can’t I see my friends? Or is this really virus going to get me? Or if it doesn’t get me, will it pass through me and kill some other people? So there’s some real questions that need answers, and, I think fortunately, there are good sources of those answers. The other thing I would say that’s really important in all this is, underlying a lot of our confusion and doubts and uncertainties is a deep ignorance of the general public about science, what it is. So I think, if you ask most people, they couldn’t tell you the difference between a virus and a bacterium or a bacterium and a fungus; they just couldn’t do it. They don’t have the information. That should never be allowed to happen.
You know, many of the people I work with say, well, you know, science wasn’t my strong point, or biology and I just didn’t get along. Well, that isn’t acceptable. It’s like saying, I can’t read or write. I don’t know how to use a computer. I mean, come on. This is the modern world, and we need a very strong renewed emphasis on science education, very thorough. Nobody should be allowed to graduate without science literacy.
Equally important, as is absolutely clear from our public debate, is people have no idea about civic responsibility. What should government do? What is HHS? What is Homeland Security? What is the CDC? What is the National Institutes of Health? What is the national security organization, NSA? What are they? What, how do we govern ourselves? What is the responsibility of Congress? Of the Supreme Court? Of the president? What about all these debates that are going back and forth?
Who has the power? How is the country intended to work? How has it worked for many years? How is it working now? What are the tensions? Those need, those lessons as well as science need to be deeply incorporated into most people. And I think, when you, you know, it’s astounding when you stick a microphone in front of somebody’s face on the street of how little they know about almost anything. Really astounding. It comes up again and again.
That isn’t the case around the world. You stick a microphone into a Frenchman’s face, an Italian’s face, a Chinese face, a Japanese, a Mexican, you’re going to get a very different kind of answer from the ones we get. We are particularly uneducated.
Alexis: This is for us definitely the sort of things we want to think about and grapple with.
William Haseltine: I think there’s a big lesson that’s come from this epidemic. The diseases, you know, the impact, the economic impact of what we are going through right now is going to be felt for the next 20 years. This is not going away. We are taking on so much debt around the world, not just the United States. The United States may be uniquely able to handle its debt in a somewhat productive fashion. Many countries are not, including most European countries. We are taking on so much debt that we are going to have to raise our taxes and inflate our currency.
All those taxes are going to mean that growth really slows down, and opportunities for our young are disappearing, and just at the time when they’re hit by the need to support an older generation. So it’s a slender stem to promote, if you would, a big flower, bigger, the old people, the flower; it’s doubly hit. They’ve got to pay taxes to—they’re triply hit. They got to pay taxes to help the old guys. They have to pay taxes to repay the trillions, many trillions of dollars of debt we’re now incurring and already incurred because of these nutty tax codes that we’ve just gone through, right? That were unnecessary and just drove the debt up another trillion or two dollars a year. A trillion a year.
And if that weren’t enough, there are not going to be enough jobs around for them because everything’s going to be constrained. That is the condition of my young, you know, young children who are now just exiting college and of our grandchildren, when they get to get jobs. So this is a serious, serious thing that’s happened around the world.
As I say, science could have stopped it cold, and you have to think that 5, 10 years from now, we might get hit from another one just like this, or even worse. That’s my prediction. In 5 to 10 we’re going to get hit, because we have created a wonderful new ecological niche for nasty viruses.
There are a lot of us. We travel—a billion and a half traveled last year. We live in packed, tight quarters, and our politics is a mess. So when they arrive, we don’t react properly. And if you think of a virus as an intelligent engine, an intelligent machine, which it is—it’s got a machine-type of intelligence by solving problems by random combination.
They are cracking our code and they’re doing it with increasing frequency. And it’s, we’re just a great ecological niche for these viruses, and we’re going to get hit again and again. So if we’re not prepared, the new, the younger generation is already paying triply for what’s happened now: demography, death, and lack of jobs is going to get hit again. Talk about a sad world for them.
Alexis: So when, you know, years from now, those kids are sort of looking at, those ones who are very little now sort of get to high school and whatnot and are looking at this in a history book as a thing that happened a long time ago—what do you sort of hope that they’re kind of reading as we wrapped up, as the conclusion, as what we did?
William Haseltine: I hope they look back and they say this was a lesson for the world, that we have to pay attention to a number of things we’ve neglected. On the science front we have to look ahead and support science that will protect us, whether it’s economically, whether that makes economic sense for a company or not. If it doesn’t, the government has to step in.
Two, we have to repair our health care systems, and there’s—I work on health care system restructuring and strengthening now, and I’ll tell you one thing that’s really, really important. We need to get away from a hospital-centric system and get to distributed care where we have high-quality outpatient clinics that do most of their work without inpatient service.
As we’ve seen, we need big inpatient services that are quickly expansible to deal with recurring pandemics. But at the same time, if our, there’s a second epidemic going on right now that people are just beginning to realize, which is untreated care, untreated disease. We are probably losing as many people from untreated disease as we are from the epidemic itself.
People are dying of heart attacks because they didn’t see their cardiologist. People are dying of cancer because they didn’t see their oncologist. People are dying from diabetes because they’re not getting the information and the drugs and the care they need. People are dying from kidney disease because they’re not getting their dialysis and they need new dialysis. They can’t. People are committing suicide at a huge rate because of the stress and because they can’t get to the psychiatrist.
Our hospital systems are closed. You have to have something desperate, like, you know, you’ve got a leg which is half severed; then maybe they’ll take you in. But if you have a colon cancer that needs immediate resection, they may schedule you for a month or two from now. By that time you’re dead, or you’ve got metastatic disease that never—so we are having a double epidemic. And so that’s another lesson: we’ve got to restructure.
And then another lesson that I hope people learn is the importance of civic and science education—that it’s critical to a functioning society. And we have just neglected it in so many ways.
I hope we learn lessons about leadership that, and I’m afraid we may learn the wrong lesson. Because with increased taxes, with job constriction, with decreased opportunities for our young, we may be moving into a post–World War I Weimar Republic–type politics.
That is a real possibility because we already have well-positioned demagogues, well-funded, well-positioned, powerful demagogues that are willing to take advantage of the situation, to drive us still further in that direction. Whether it’s U.S. or other countries throughout the world, all in the name of individual freedom, which would be exactly the opposite.
So I see that this is a critical time, and I’m not particularly optimistic about the way it’s going to come out. I think there are more dangers than there are opportunities.
Alexis: When we thought about sort of what can we do in this moment, it was have these conversations and try to help people navigate through this. So thank you for being a part of that. We really appreciate it.
William Haseltine: Thank you for doing this. You’re doing something really important, so thank you.
Lisa: Thanks for listening to this episode of Pandemic Perspectives. We’ll be bringing you more interviews from all sides of this crisis so stay tuned and watch your feeds. As always, you can find all of our episodes plus transcripts and show notes at distillations.org.
And you can find tons of educational resources on our website at sciencehistory.org/learn.
The Science History Institute remains committed to revealing the role of science in our world. Please support our efforts at sciencehistory.org/givenow.
For Distillations, I am Lisa Berry Drago.