- I'm Nicholas Thompson.
I'm CEO of The Atlantic.
It is my great pleasure to be here with Dr.
Jay Schnitzer, chief technology
and medical officer of MITRE, and Dr.
John Halamka, Mayo Clinic,
president of platforms.
Hello, Jay.
Hello, John.
- Hey, great to see ya.
- Hello.
- All right, first question,
so clearly, one of the things
we need to do is to get the vaccine
hesitant people to get vaccinated in this country.
And last night I was playing soccer,
and afterwards I was talking to one
of the guys I was playing with. And he said,
he hadn't gotten his vaccine.
Everybody else's at least signed up for an appointment.
And he said, well, you know,
I'm worried about the health effects.
I don't trust authority.
Had a conversation that probably
a lot of people have had.
And I said, well, you know,
you're going to need to get a vaccine
if you're going to go to a Nets game
because you're going to need to show it
on your medical credential
or what some people call the vaccine passport.
So help me understand, is having verifiable
information showing that you've
gotten a vaccine on something,
is that going to be a key tool
in getting everybody vaccinated?
- We've known for several months
that vaccines are the way out of this pandemic.
There are lots of other things that help us
bridge to that. But getting
vaccines at scale into the population
with adequate vaccination is the only way to get
out of this pandemic.
And right now, in this country
we are in a race between vaccination
and variants. And we have to win the race.
We have to accelerate the rate of vaccination
such that we suppress the variants.
If we fail to do so we're
going to be in very serious trouble.
And when they are vaccinated,
there will be occasions,
if they so choose, when they want to do something
where they will be asked for proof
that they've been vaccinated.
We want to make sure that, at their full control,
and only if they want to, having been vaccinated,
they can produce a credential that verifies
that they have in fact been vaccinated.
- So imagine that, to Jay's point, with my choice
I want to go to a concert.
And the concert has said, well, you could be vaccinated.
That's one kind of credential or verifiable information.
Or you could have, say, a PCR test that was negative
within the last 72 hours.
Or we have this onsite testing,
and we'll test you here. Your choice, right?
All up to you.
What society needs a way of producing, for entry
into such events, verifiable clinical information
that the individual controls, right?
This is not about government tracking
or some corporate database.
So we've worked together now with
over 300 organizations to produce a free open source
standard that enables the presentation by the patient,
by the consumer, of signed digitally validated information.
If I got my test at Mayo Clinic,
it's signed digitally by Mayo Clinic.
And when I go to an event it's checked
against Mayo Clinic's signature to make sure
it is valid, and that in fact, I am presenting
a credential that is a reasonable way
for me to get into such an event.
- And when we talk about this app or whatever it is,
if it turns out that this app can be built quickly
and work extremely well, but only on high-end Android phones
and iOS phones, is that a good thing or a bad thing?
- I am very concerned about the digital divide,
disparities and equity. So as we designed this,
what we said is, it needs to be rendered
on a piece of paper with a QR code that embeds
that digital signature that anyone can get
for free and carry with them anywhere
with zero technology investment.
How do we meet the patient, the consumer,
at their level of income and technological comfort?
- This has some similarities
to the contact tracing apps that were a bit of a failure
in this country. Explain why this might work
where the contact tracing apps failed.
- There's a fundamental difference
between what the contact tracing apps
are designed to do, and how they do it,
and how they engage with the healthcare system,
and what this kind of credential is all about.
This kind of credential is for the individual,
under the complete control of the individual,
and has the individual's information contained
in a very safe, respectful manner.
Contact tracing is all about public health.
And it's all about having public health agencies
and officials have access to the data.
Big difference in terms of how it's handled.
And that's why one is going to be very successful,
and the other one not so much.
- Let's go to a different topic, which is what we've learned
during this pandemic that will, God willing,
help set us up better for the next pandemic.
- We have in the last 20 years
digitized our healthcare system.
Doctors and hospitals have electronic health records.
So that means we're capable of extracting
data and analyzing that data to deliver
knowledge, new cures, new treatments.
In the first few weeks of the pandemic,
we started asking clinical questions.
Like what was the efficacy of an anti-malarial drug?
You know, hydroxy chloroquine. We were able to go
out to the hospitals of this country
and in an anonymized aggregated way,
ask them to submit data to an analytical
engine to determine that these antimalarial drugs
really didn't help so much.
And we did all this from start to finish in two weeks.
And so what it illustrates is that a properly
instrumented healthcare system with the right
urgency can discover new knowledge
in very short time, for very low dollars.
- And I'll just add to that, about the mRNA
and other new platforms, yes,
we've absolutely learned about new platforms
that we didn't have before a year ago,
and we didn't even know whether they'd work.
And we now know that we can create new
countermeasures, vaccines, drugs, therapeutics,
even diagnostics, what have you, on platforms
that are based on chemistry not based on biology,
that'll be far faster and more reliable.
We've learned if we compare what went on in this pandemic
versus some pandemics over the last 20 years,
80% of the findings in those previous events,
in the after action reports,
and 80% of the recommendations are going to be true
for this one too, which means we haven't
really learned yet from the past.
And this time we got to make sure we learn.
we have to be able to carry them out.
- There's nothing like a sense
of urgency to bring people together.
And so to give you this concrete example,
on March 13th of 2020, Jay and I
just started getting email from a number of colleagues.
By March 20th of 2020,
we had 1,000 companies working together,
with the MITRE corporation serving
as an independent facilitator, right?
So nonprofit person in the middle that everyone
just could trust. And we were doing
this for the benefit of society with the hegemony of none.
It was no cost to anyone. It required no legal agreements.
It only required the willingness to be helpful.
And that lesson learned, this coalition building has been
to me, one of the great takeaways of the COVID era.
- And it's been, the COVID era has been
horrible and immensely painful,
but what are the other things that we've gained from it?
- We've learned how valuable telemedicine
and telehealth are, and how it can be used
at scale beyond anything we've done before.
And that's going to endure.
- It isn't so much a technology that
we will now use forever. It was a cultural change.
And I use the example of my almost 80 year old mom,
who is not a technology guru.
And she over the last year said,
well by force of fear and convenience and access,
I've learned to see my doctor and get a hundred
percent of my healthcare virtually.
And I like it, and I want it to continue.
And so as Jay and I did surveys with our
telemedicine task force, what we
discovered is over 75% of people in this country
engaged with their clinician, had a great
experience with their clinician,
and want that to continue in a virtual way.
So, wow. How often do you see
a cultural change in 10 months?
- And do you think that the spread of telemedicine
and some of the advantages we've seen
in how research is done will also
apply around the world? We're at this moment
right now where it feels like we're starting
to get the crisis in hand in the United States.
But it's now massively out of hand elsewhere.
- I am caring for patients in India personally.
And that is because we're global,
and I am asked questions like,
what's the right dose of this med?
what would you expect the lab value for this or that to be?
And I am doing that in real time remotely,
from where I'm sitting outside of Boston
to colleagues in India.
- And this global aspect is really important,
not just for the care of patients,
but also for lessons learned.
It's because of allowing larger gatherings,
and people to abandon masks, and other things
that we know work in this setting.
Not only is it a humanitarian crisis for India,
but we here in the States need to learn from it too.
This is a cautionary tale for our future.
If we don't win the race, back to your friend
who's reluctant to get vaccinated,
if we don't win the race between
vaccines and variants, and we've got to win that race,
we are at risk for exactly what India is experiencing.
- Well, that is the perfect note to end on.
Thank you very much, Jay.
Thank you very much, John.
I will go out to the soccer field tonight
and try to do my part to get more people
into the vaccine line.
- Thank you, Nick. - Be well