Rapid Response Transcript – Sir Jeremy Farrar

Chapter 1: Mental health is among the biggest risks the planet faces today

JEREMY FARRAR: I have received both hate mail, death threats by mail, by email, by social media. I contacted the security forces here when your microphone arrived, and asked them to scan it, and look at it properly before I opened it.

The transmission of this Omicron variant is staggering. 

The transmission of this Omicron variant is staggering. 

What is the most likely scenario for the next 1, 2, 3 years? But then what are the other possibilities? What do we need to prepare for on the downside that would really dramatically change the way we do business? 

It’s not going away. We’re not going to wake up one Tuesday morning and somebody will say, “The pandemic’s over.” It’s not going to happen like that. It’ll be a bumpy ride through ’22 and into ’23 and beyond.

BOB SAFIAN: That’s Sir Jeremy Farrar, the chief executive at the massive research foundation Wellcome Trust and, in recent years, the UK’s pre-eminent scientific authority on Covid-19.

Farrar is a doctor who spent decades in the trenches researching and fighting viruses from Bird Flu to Sars to Ebola.  

I’m Bob Safian, former editor of Fast Company, founder of The Flux Group, and host of Masters of Scale: Rapid Response.

I wanted to talk to Jeremy because, with the omicron variant raging, the pandemic is creating a fresh set of uncertainties.

Farrar has been a steady source of advice since the initial Wuhan outbreak – a counselor to governments, individuals, and businesses.

He offers a framework for reacting to this latest stage, and observations both cautionary and reassuring about what’s to come.  

He also talks about how efforts at Wellcome, with its $50 billion endowment, have been shifting,  and his emphasis on sparking what he calls catalytic change through risky, disruptive investments in scientific discovery.

He also stresses that mental health is among the biggest risks the planet faces today – and that safeguarding his own psyche has been an essential lesson in leading through this crisis.

Chapter 2: A degree of humility is really crucial

SAFIAN: I’m Bob Safian and I’m here with sir Jeremy Farrar, the director of Wellcome Trust, one of the world’s largest NGOs dedicated to scientific research and impact. Jeremy’s coming to us from London, as I ask my questions from my home in Brooklyn. Jeremy, thanks for joining us.

FARRAR: Yeah. Great pleasure.

SAFIAN: So in recent times, you’ve had to juggle a variety of leadership challenges. At the helm of Wellcome’s growing operations, as a world renowned infectious diseases expert, as a spokesperson and trusted public voice during the pandemic. You also managed to author a book during this time, Spike, about the outbreak of the pandemic and how it was dealt with. Many topics for us to cover.

But I have to start with Omicron, this latest variant has many of us rethinking our approaches yet again as individuals, as businesses. The Covid positivity rates here in New York have been off the charts. Some reports that half of all Europeans will eventually be infected. China is locking down entire cities again. How much should we all be hunkering down?

FARRAR: Yes. Perennial question. It keeps coming back and we keep reacting to events rather than being ahead of them. And too often, I’m afraid in the pandemic we’ve thought we’ve seen the worst, and we’re through it now, and we’ll have freedom day. And it comes back to bite us. A degree of humility, I think, is really crucial. We’re only two years into this pandemic, and this will not be the last variant. I’m sure we’ll see more.

There’s a lot of good news, in a sense. The vaccines continue to be incredibly good at protecting you from getting severely ill and dying. That’s hugely positive. There is a lot of good news and a lot of progress, but the transmission of this Omicron variant is staggering. In London, around New Year, it got to one in nine, one in 10 people infected. I’ve never seen anything like that in my whole career.

We have to be hopeful that with that very high transmission we will gain some degree of immunity. So maybe Omicron is the turning point when we start to see some light at the end of the tunnel of this pandemic.

SAFIAN: And when you say we’re only two years into the pandemic, it sort of sounds from you like this is just going to continue. That in some ways Covid-19 will become endemic in the way influenza is endemic.

FARRAR: Yeah. It’s not going away. This is now part of humanity, and the next generations will still be talking about Omicron. I don’t really like the comparisons with influenza, I think it’s a little bit too simplistic to say it’ll become like influenza. I think we’ve got quite a while to go before that will be true. This is happening all over the world at more or less the same time. That’s 7 billion people being infected on a cycle of waves. And that of course raises the possibility that there’ll be new variants. We’re not going to wake up one Tuesday morning, and somebody will say, “The pandemic’s over.” It’s not going to happen like that. It’ll be a bumpy ride through ‘22 and into ‘23 and beyond.

Chapter 3: The pandemic wave will come down fast as well

SAFIAN: A lot of the folks who listen to this show are business people, like yourself running large organizations. One of the challenges is: how do you plan when you really don’t know what’s going to be happening next? With this particular variant, do we have a sense of what the trajectory is going to be like and how we plan around it?

FARRAR: Many people have got used to the concept of R, how transmissible something is. The natural R of this infection may be nine, 10, or 11. If you think the original strain from China would have had an R of three, you can see that’s a massive difference. One of the results of that is that the upswing of the pandemic wave will be very fast. This started in November, and before the end of December, this had spread to the whole world. 

My guess is that this pandemic wave will come down fast as well. And actually we’ve seen that in London, we’ve hit a peak within less than a month in London, and it’s already starting to come down. I think we’re already starting to see that in New York. We’re probably hitting a peak, and it’s starting to come down.

So I think this particular wave will go up quicker, reach peak quicker, and we’ll come down on the other side quicker. And we’ll get back to lower levels of transmission quicker than we have done perhaps with some of the other variants.

But your comment about how we deal with uncertainty, I think is at the heart of this. And every organization is going to be different. I think the world has become much better at handling that uncertainty. I think actually many companies, individuals, and families have become pretty good, pretty sophisticated at judging their own risk and changing their behavior depending on what they perceive the risk to be. And actually, I think people’s behavior has changed ahead of where government policy has often been and that’s to be applauded.

The way I think about this is: what is the most likely scenario for the next 1, 2, 3 years? And probably base my decision-making around that scenario. But then perhaps quieter and more in the background, think: what are the other possibilities? What do we need to prepare for on the downside that would really dramatically change the way we do business? And what can we prepare for on the upside? And have a contingency set of options that get us ahead of our thinking. So that we’re not always reactive, but we’re starting to be proactive. We know what we would do in certain scenarios. And there aren’t 100 scenarios, there are probably five or six reasonable ones. And I think organizations can get their head around that sort of number.

Chapter 4: Transparency is the best way forward 

SAFIAN: You’re asked so often to give advice on imperfect information at this time. Things changing, advice shifting, things getting updated, which can undercut trust. In messaging, is there an impulse to be more conservative about how you describe what things are? So people are more likely to be surprised with good news than bad news. How do you walk that line?

FARRAR: Communicating uncertainty is really very, very difficult. But there have been, I think, good people that have stepped forward. We watch people like Tony Fauci in the United States communicating I think very clearly. The key to me, as I watch others doing it, is the humility that comes with being willing and courageous enough to say, “I don’t know.” These are the possible outcomes that we face from here on in. And there are some that we can’t predict. I think transparency is the best way forward. And I think people have got used to that sort of communication style now. Appreciating that nobody’s got a crystal ball.

But the range of scenarios is possible to play out. I mean, take Omicron for example, I mean, it would not be right to say, “Nobody predicted it.” Many people predicted we would see more variants. I’ve said already on this program that I think there’ll be more variants. What is the nature of those variants? We can’t predict. We can’t predict when it’ll happen, or where it’ll come from. But I think we have to be prepared that Omicron will not be the last variant for instance.

SAFIAN: You mentioned Tony Fauci. On these shores, you’re sometimes referred to as the Tony Fauci of the UK. Do you and he talk with each other?

FARRAR: Tony won’t be very pleased with that analogy, I’m sure. But it’s a privilege to be associated with Tony; I’ve known him for many, many years. Going back to SARS-1 and Bird Flu in Southeast Asia. And obviously he’s an icon of both scientific endeavors. He’s not just a communication’s guru. He’s also a brilliant scientist and a fantastic leader. And I think the U.S. has been, frankly, very lucky to have him. And the fact that he’s stayed around and been through some tough times. That’s a real tribute.

And I haven’t spoken to Tony since before Christmas, but I’m sure I will do later this month. And I look forward to that, but he’s faced some really tough times in the U.S., I think. And it’s a huge respect to watch the way he goes about what he does.

SAFIAN: Yeah. He was talking recently about the threats he receives, which … Is that a concern you have?

FARRAR: Yes. When you and your team kindly sent me this microphone that I’m speaking to at the moment, it came in what looked like a Bulletproof box, with a customs thing that said “Wires and things.” And actually I have received both hate mail, death threats by mail, by email, by social media. And we’ve received some very odd packages that have come to the house. So actually I contacted the security forces here when your microphone arrived, and asked them to scan it, and look at it properly before I opened it. I think many, many people have had horrible abuse, but also physical threats. And Tony’s certainly been one of those, and so have I here in the UK.

SAFIAN: You were a member of the UK’s Scientific Advisory group for Emergencies, SAGE, and you resigned late last year. Were these sorts of threats any part of the motivation behind that?

FARRAR: No, they weren’t. No, they genuinely were not. The reason I stepped away from SAGE, SAGE was in place for 18 months, and the amount of work that goes into those SAGE meetings is enormous. And in September, October of 2021, I felt largely the work of SAGE had been done. That the advice from within the government system was now very strong, and the need for independent members on SAGE had become less. So, it was a good time to step away.

SAFIAN: One of your colleagues said to me that you’re pretty even keeled, but that, “Even he’s had some harder moments during all this.” And I’m curious what you found to be the hardest moments. Is it about the volume of work, as you’re referring to?

FARRAR: The work for everybody particularly those, of course, in the health systems around the world, the volume, the strain on systems has been astonishing. And because of the worldwide nature of this as well, issues in Asia, issues on the west coast of America, issues here in Europe, and in Africa, the day has been stretched to meet with those time zones. So there are times when you’ve been on calls four or five o’clock in the morning. So just the sheer volume has been staggering.

But then also the combination of very many different activities from, yes, running your own organization as a chief executive, then as an advisor, then as a scientist, as well. As well as contributing to the World Health Organization, international agencies, World Bank, and things. So it’s the being pulled in multiple different directions that I think has taken a while to get used to. I’m fortunate, I have a fantastic team at work, who can take a lot of the burden and share that burden with me. So, without a great team with you, I just don’t think it would be possible.

SAFIAN: You’ve said, we need to move faster than the pandemic. But at the same time, as you talk about it, this crisis is a marathon, it just keeps going. So, it’s almost like we have to learn how to sprint non stop.

FARRAR: We do. In the last two years, we’ve been too slow, and we’ve been too reactive. There has not, perhaps, been sufficient stepping back from the chaos, and saying, “What are the possible scenarios, and how would we deal with those, if they came to pass?” So if you get ahead of the pandemic rather than chasing it.

And then I think, and I understand the reasons for this politically, there’s a strong desire in many quarters through ‘21 to start saying, “We’re through it in the UK. We had a day.” I think it would be better to change that narrative around getting people used to the fact that this is not just going to disappear. That we can certainly mitigate and reduce the true impact of it on health, and education, and trade, and travel, and economies. But we are going to have to learn to come to terms with it.

Chapter 5: What role can philanthropy play in scientific progress?

SAFIAN: People often think about philanthropy as being a bit stodgy. You’ve argued that in science, the role of philanthropy is to be disruptive, to take more risk. Can you explain that?

FARRAR: Philanthropy, I think’s role is not to be conservative, in a sense. Philanthropy can’t ever be at the scale of government. And it cannot either be at the scale actually in truth of industry either. Philanthropy’s role, I think, is to be catalytic. To take risks that inevitably taxpayers money would struggle to fund.

And parts of industry, certainly big industry, would struggle to fund as well. I think that is a critical role for philanthropy, experimenting, and taking risks. Recently, we set up the Wellcome Leap to look at science in a different way, to fund it in a different way, to do it at a speed and a scale that was far faster than philanthropy often works. And again, it’s an experiment. We’ll see, in a few years time, whether it’s been successful in disrupting the way we look at science.

SAFIAN: There’s talk in government and in business about investment in science, but if it doesn’t pay off, it’s often looked at as waste, as you’ve missed. And that can be chilling, both for the government to invest in things, and for investors to take a run of things. Whereas I guess you have the freedom to explore.

FARRAR: I think that sense, that if something doesn’t work it’s failed, has become far too pervasive in science funding. You actually don’t know if something’s failed for decades. Take the RNA technology that we are now, most of the United States is vaccinated with an RNA vaccine. That hasn’t developed overnight. That builds off years of work, much of it painstaking. If you looked at it five years ago, you might say it was failing. And yet here it’s saved humanity.

SAFIAN: Before the break we heard Sir Jeremy Farrar of Wellcome talk about what Omicron means for the course of the pandemic, his relationship with Tony Fauci, and the need to take what he calls catalytic risks.

Now he talks about the huge role that business has played, and needs to keep playing, in leading Covid response. He describes what he calls second- and third-generation vaccines to come and talks about the two most important leadership lessons he’s learned during the pandemic. And he makes a plea for all of us to say “never again,” and to push for the necessary reform to make that a reality

So, at Wellcome, you’re implementing a new strategy in your giving. More focused around three core topics: infectious diseases, climate change, and mental health. But my understanding is this was a strategy that was conceived before the pandemic. How have your priorities and operations at Wellcome shifted, as a result of going through what we’ve been through in the last two years?

FARRAR: Yeah, they were formulated before the pandemic. But actually, if anything, the pandemic experience of the last two years has reinforced the reasons for the change.

One of the hardest things is to bring about critique of yourself. I feel very, very strongly. You need to reform and change when you perhaps least feel the need to do it. Change when you are comfortable. Change when you think you are strong, rather than react and have to change when others demand it of you. And really at the heart of the strategy was to say, “How can we make our biggest contribution to society?” And I felt that was by being really catalytic and risk taking in the discovery science. And then to focus on three things, which I think are going to define the 21st century.

Climate’s obviously the existential threat we face in the 21st century. Infectious diseases are not going away. Pandemics will continue. And then I think mental health is perhaps the one area of medicine that has made some of the least progress over the last 20, 30 years. And I think particularly young people’s mental health is a huge and growing problem.

SAFIAN: They sound like areas that you might have come to today based on what we’ve experienced in the last two years.

FARRAR: The pandemic was not on our agenda when we developed these four areas, but I think you’re right. They do come together in sharper focus as a result of the pandemic. And very importantly for us, they will, I think, have a disproportionate impact on young people. They’ll have a disproportionate impact on people marginalized in any community and in the most vulnerable.

Chapter 6: Has Covid changed your leadership style? 

SAFIAN: In the last two years in your leadership role, are there new lessons that you’ve learned, anything your perspective has shifted on that you maybe didn’t appreciate the same way or maybe has been reinforced in new ways?

FARRAR: Yeah, many. I mean, the importance of finding time for yourself, in a sense, protecting yourself, finding space to retreat to in a way. I’ve found great regeneration, if you like, by playing sport, by playing cricket, which I appreciate nobody on this call will perhaps understand, but I take great joy in it. Others will go and play a musical instrument or go to a gallery or something, but I think finding space where you can clear your head, where you can stop and think, where you can just buy yourself that little bit of time for yourself actually, or your loved ones, I think is so important. So that would be one key lesson for me.

And the second is to take warnings seriously. The Covid-19 did not come out of the blue. Over the last 20 years, we’ve had repeated warnings going back to SARS-1 and work I was involved in, in Southeast Asia with Bird Flu and Zika and MERS, and many, many others, Ebola of course. Take these warnings seriously. And I think at a time where politics has become very short term, where the key issue is the midterm election or the next election, everyone’s on a two to four year cycle at most, if not the 24 hour news cycle. Really important to stand back. What do we want in the 21st century, and what are we going to have to do to invest over the long term?

SAFIAN: In your book, in Spike, it references both the incredible scientific advances during this time and the challenges in coalescing global efforts for good. As we look for silver linings from this tragedy, how does that net out? Are you optimistic? Are you worried?

FARRAR: So I’m optimistic because I think on the whole, in the end, humanity historically has ended up in pretty good places. The trouble is humanity often finds ways of going through some really bad periods to get to the good place. And I think we’re going through a bad period at the moment. Geopolitics is part of the pandemic, I’m afraid. It goes back to where the virus came from and the way that was handled at the start, and the blame game that was associated with it. And it’s panning out now in the way that the United Nations, the World Bank, the WHO can function, the G7 and G20 agencies. And we really need these organizations in the 21st century, because if you look at the great challenges – climate change, infection, migration, access to good energy, clean energy, water, whatever we think of the great challenge of the 21st century – they are all transnational.

You cannot find a solution to these problems just in America, just in the UK, just in China, just in India. You are going to be dependent on what your neighbors do.

And so until we can see that our national boundaries are not going to suffice to address our great challenges, then I think we’re going to make some very major errors and mistakes. And I think the pandemic has, again, brought that into focus, and we’ve got to learn, in my view, that lesson.

Chapter 7: What Wellcome investments are most exciting? 

SAFIAN: Within Wellcome, you guys invest in so much forward-looking research. I’m curious whether there’s any research that you’re most excited about.

FARRAR: Yeah. Huge number. It starts with discovery. I do think curiosity, so-called basic science, whether it’s biomedical or social sciences, I think is the bedrock of future advances. Very excited by all of the work over the last 20, 30 years on genomics and genetics. And now that’s starting to translate into patient benefit and population benefit. I thought the recent work from DeepMind on working out protein structures from genetic sequences was groundbreaking. In the more translational areas, I think work on the malaria vaccine and the tuberculosis vaccine that is coming now could transform the lives of people everywhere.

What I’d love to see, and I hope this comes, is similar developments that we’ve seen in cancer and diabetic care coming into mental health. Both at the senior people, obviously with Alzheimer’s and dementia, but then the anxiety and depression and other illnesses of mental health that start in young people. It hasn’t seen the same advances, and I think we’ve got to try and create a community that will bring the various bits of science and prevention together to make a real difference in mental health.

SAFIAN: We’ve mentioned vaccines a couple of times. We’ve seen these so-called Omicron boosters announced by Moderna and Pfizer. They could be ready by the spring. Are these targeted single variant approaches the future, like I’m going to be getting lots of different shots of lots of different kinds?

FARRAR: No, I think they’re the short-term future. I think the first generation of vaccines, the ones I’ve had and I hope you’ve had, are what I call first generation vaccines. Incredibly safe, highly effective at stopping you getting sick or going to hospital. The second generation vaccines are, I think, the variant-specific, Omicron-specific vaccines, and they’ll come very quickly in 2022. Then I think the next step will be multivalent vaccines. So, you get a broader immune response to maybe two or three different variants within a single vaccine, a bit like we do for influenza. What I’m really excited by is what I call third-generation vaccines. So, vaccines that will be against all Coronaviruses. Vaccines that’ll stop transmission, as well as stopping illness and sickness. And vaccines that won’t have to be given every three or four or six months, but we could take and would give us long-term protection for hopefully many, many years to come. And that’s what I think we need to be investing in now, so that at some point in the 2020 decade, we have vaccines which are long-lasting, cheap to produce around the world, accessible to everybody, and which protects us not just against Covid-19, but against any Coronavirus that may come in the future.

SAFIAN: What’s at stake for Wellcome right now?

FARRAR: We have an endowment that was left to us by Henry Wellcome, an American. we’re always very grateful to America for sending Henry Wellcome to us. I think Covid has demonstrated how dangerous it is to have such an unequal world. Throughout history, I think, when we’ve had such unequal inequitable worlds, it’s led to conflict, and I think we need to avoid that. So, being edgy, being disruptive, funding great science, but also translating that science to patient- and population-benefit the world over. That’s what’s at stake. And on that, I’m very optimistic.

SAFIAN: And I mentioned earlier that a lot of our listeners are business people. What’s the role of business in addressing public health versus that of the government, or even philanthropies like Wellcome?

FARRAR: Huge role and multifaceted. The Edelman Trust Index, if you look at that, it’s clear that many, many people trust their employer. Many people entrust the people they work with, even more so maybe than governments. And so I think organizations and companies have got a really critical role to play in providing information and yes, indeed when necessary services to their workforce inevitably government cannot provide everything. And largely through the pandemic, I think companies have really stepped up and provided that sort of additional level of information and support.

I think we could push that even further. For instance, workforce mental health – providing a good working environment, which puts wellness at the heart of it is something that I think all good employers will increasingly have to build into the offer they make to heir staff.

SAFIAN: You have a very nice way of delivering some hard to information in ways that sound like they’re upbeat, but we need to make some steps, right?

FARRAR: We do. I just came off another call with a high level panel that’s been advising the G20 process. Leadership in organizations and companies, I think actually on the main, I think that has been very good. We need political leadership. We need political leadership that’ll say, never again. When you face a crisis like this, and obviously going back to the 20th century, we faced some crisis. It was always after those crises that reforms happened, that change happened, that political leaders stepped up and said, “Never again.” And I think we need that now, and we need to bring the world back together again. I suppose my one plea for the next few months, weeks, years would be for that political leadership. Philanthropy can do something, companies can do something, but in the end it’s political leadership that is needed to at least frame how things work, even if it doesn’t necessarily do everything within that.

SAFIAN: Well, Jeremy, that’s great. And thank you so much for taking the time to talk with us and with our audience. We really appreciate it.

FARRAR: No, it’s been a great pleasure. Thanks very much, indeed.