An ethical plan for ending the pandemic and restarting the economy | Danielle Allen

Transcriber: Ivana Korom Reviewer: Joanna Pietrulewicz

Corey Hajim: Hi, Chris, how are you?

Chris Anderson: I'm very well, Corey,

it's absolutely lovely to see you.

CH: It's great to see you, too.

(Laughter)

CA: Somehow, you're always smiling, no matter how dangerous, weird,

crazy things are.

Thank you for that.

CH: You don't see me in the other room crying afterwards,

but we'll leave that for the other [unclear].

So Chris, this is week three of these conversations,

how are you thinking about the people we should be speaking with?

CA: I mean, there are so many aspects to this, right?

There's understanding the basic pandemic itself

and all the science around that.

There's the psychology that we're all going through, the mindset.

And we've had speakers addressing both of these.

And then I think increasingly,

the conversation is going to be "what now?"

"How do we dig ourselves out of this?

What's the way forward?"

And there's a couple of speakers this week focused on that.

And I think it's --

These conversations are incredibly rich,

because I think one of the things

that people have got growing consensus on

is that step one, we kind of get, right?

You shut things down,

physically distance in whatever way you can,

different countries have gone about it slightly differently,

but basically that "flattens the curve,"

ultimately,

the number of cases, the number of infections slows down.

And, but then what?

Because you can't go back to life as normal,

when you're living at home completely.

You could do some things, but you can't.

And so that's what we're going to talk about today.

CH: Right, it feels really hopeful to talk about some actions we can take

besides just staying away from everybody else.

So, well, I guess I'll pass it over to you to introduce the speaker,

and I will come back a little bit later

to share some questions from our audience.

CA: Thanks so much, Corey, see you again in a bit.

CH: Thank you.

CA: And yes, if you know anyone out there

who has just got stuck on, "But how do people get back to work?"

"Where do we go from here?"

Those are the people who you should,

maybe invite them into this conversation right now,

because I think they're going to be really interested.

Our speaker, our guest

is a professor at Harvard, Danielle Allen.

She runs, among other things,

she runs an institute for ethics there, the Safra institute.

And fundamentally, she's thinking about the ethical questions

about what's happening here,

but she has pulled together an extraordinary multidisciplinary team

of economists, business leaders and others

who have put together a plan,

and I've been obsessed with this whole thing

and how we find our way out.

This plan is as compelling a plan as I've seen anywhere.

So let's dig into it without further ado,

Danielle Allen, welcome here to TED Connects.

Danielle Allen: Thank you, Chris, happy to be here.

I'm really, really grateful to have the chance

to have this conversation with you.

CA: It's -- It's so good,

I just enjoyed our conversation over the last couple of days.

This is such a complex problem.

What I kind of want you to do is just go through it step-by-step,

to see the logic

of what it is that your team are putting forward.

First of all --

Just the problem itself of how we get the economy going again,

just talk a bit about what's at stake there,

because sometimes this is framed as

"The economy? Who cares about the economy?

People's lives are at stake.

So let's just focus on that, don't worry about the economy."

But it's not as simple as that.

I mean, as an ethicist,

what's at stake if we don't restart the economy somehow?

DA: Well we have to recognize that we've actually faced

two existential threats simultaneously.

The first was to the public health system.

If the virus had been allowed to unfold unimpeded,

our public health systems would have collapsed

and that would have produced a whole legitimacy crisis

for our public institutions.

So of course we shut down, we had to do that,

it was a necessary self-defense action

that has, however, really devastated the economy.

And that is also an existential threat,

we can't actually endure a closed economy

over a duration of 12 to 18 months.

Nor can we really endure a situation

where we don't know whether we might have another two to three months

of extensive social distancing.

So we really need an integrated strategy,

one that recognizes both of these existential threats

and finds a way to control the disease

at the same that we can keep the economy open.

We call that combination of controlling the disease

while keeping the economy open

pandemic resilience.

We think that's what we should be aiming for.

CA: So people who aren't moved

by the notion of the economy, capitalism, whatever,

think instead about the millions and millions of jobs that were lost,

the people who are desperate to make money.

And I guess the lives that will be lost unless we solve this problem.

DA: Absolutely, the economy is one of the foundational pillars

for a healthy society with opportunity and with justice.

You can't have a just society either,

if you haven't secured a just and functioning economy

that delivers well-being for people.

So all we have to do is remember back to 2008,

and think about the impacts on things like suicide and depression

and so forth, that flowed from that recession,

so the economy is a public health concern

in the same way that the virus is a public health concern.

CA: OK, so talk about why this is such an intractable problem.

People isolate,

in many countries in the world now you're starting to see the cases flatten

and in many cases decrease.

It looks like,

whether it's happened now in your country or not,

that will happen sooner or later.

So why isn't that problem solved,

we've beaten the virus, let's get back to work?

DA: That's a great question

and it really speaks to how new the experience for us is

to encounter a novel virus.

It just really hasn't happened to our society in a very, very long time.

So we are what's called the susceptible population,

meaning not any of us at the beginning of this had immunity.

We were all susceptible to catching the disease.

For a society to be safe,

it needs to have what's called herd immunity.

You could achieve that through vaccination

or through people getting the disease.

But it takes 50 to 67 percent of the population to get the disease

in order to achieve that level of protection.

We don't expect a vaccine anytime in the next 12 months,

possibly 18 months,

so we have to recognize that that pathway is not open to us.

And to get a sense of the magnitude

of what it would mean to live through the disease to get to herd immunity,

think about this:

In Italy right now

they estimate that about 15 percent of the population

has probably been exposed to the disease.

So you'd have to repeat what Italy has done

three or more times,

to get to a place where you can reasonably think

that there's herd immunity.

And I think you can see that when you think of that picture,

how destabilizing a process would be

of just leaving things broadly open without disease controls.

So the real trick is whether or not there's a substitute for social distancing

as a method for controlling the disease.

CA: Right. So Italy, even with that 15 percent

has suffered at least 15,000 deaths,

some people argue that it's underreported by 50 percent there,

it might be 30,000 deaths plus there,

and as they come down the curve, there will be more to come.

Multiply that by five or six, say, for the bigger population size of the US

and the herd immunity idea per se doesn't seem like a winning idea.

I mean, it's a horrible idea.

DA: It's a horrible idea, exactly.

And we do have alternatives, that's the important thing,

we actually do have a way of controlling the disease,

minimizing loss of life and reopening the economy,

so that's the thing we should all be focusing on.

CA: And again, the initial problem is that if you just let people start coming back,

as soon as they gather again in reasonable numbers,

the risk is that this highly infectious bug

just takes off again.

DA: Exactly.

CA: And so one scenario is that you have

countries lurching from a little bit of activity here

and then suddenly it explodes again and everyone has to retreat.

That does not seem attractive,

that also just doesn't work.

DA: No, exactly.

I mean, we described that as a freeze in place strategy

for dealing with this.

That is you freeze and you shut down all activity,

and then that flattens the curve, you open up again,

then you have another peak, you have to freeze again and so forth.

So you have this repeated process of freezing,

which just does tremendous damage to the economy over time.

I mean the upfront damage is huge,

but then there's never space to recover from it,

because of great deal of uncertainty

and repeated applications of economically ruinous social distancing.

So I think you're really pointing to the features of the disease

that make this situation a problem that it is.

And there are really two that people should focus on.

One is the degree of infectiousness.

This is a highly infectious virus.

So the comparison to the Spanish flu is a reasonable one

from the point of view of degree of infectiousness.

Then the second really important point about the disease

is that it's possible to be an asymptomatic carrier.

That is to be infectious, to carry the virus,

and never show any symptoms yourself.

Current estimates are still imprecise,

but people think that about 20 percent of virus carriers are asymptomatic.

And that is really the thing that makes it so hard to control.

People don't know they're sick

and then they become disease vectors,

spreading it everywhere they go.

CA: Yes, indeed.

So talk a bit, Danielle, about your thinking

about how we might outwit this thing.

DA: So the alternative to social distancing

as a strategy for controlling the disease

is really massively ramped up, massively scaled up testing,

combined with individual quarantine.

So we are going to continue to need individual quarantine

for those who are positive carriers of the virus,

until such a point as we have gotten a vaccine.

Now what does that mean exactly?

It means that the standard quarantine that aligns with the incubation period,

14 days is often what people talk about,

in the conservative picture

you might say twice the incubation period length,

28 days for individual quarantine.

And we need that quarantine for people who are symptomatic

and for asymptomatic carriers of the virus.

Now the only way that you can actually run an individual quarantine

as opposed to a collective quarantine regime,

is if you do massive testing.

We really need to make testing in a sense universally available,

so that we can be testing broadly across the population.

There are ways to target test, make it more efficient and so forth,

but in principle, what one should imagine,

is really wide-scale testing,

tens of millions of tests a day,

connected with quarantine for those who test positive.

(Coughs) Excuse me.

CA: So weird.

Anytime anyone coughs today, you go, "Oh, God, are you OK?"

DA: Yeah, no, no, I'm fine,

Frog in the throat, that's all it is.

CA: (Laughs)

So just to play out a thought experiment.

If we had an infinite number of tests available,

and after the curve has flattened and cases have gone down,

everyone came back to work,

but everyone was tested every day.

Then what we think is that the tests will show up positive

at the same time,

or possibly even ahead of the time that people are infectious.

But certainly, let's say at the same time,

regardless of whether they're symptomatic.

And so you could --

Those people would immediately go back home

and the rest of the population should be OK,

we should be able to get work done,

in that thought experiment, right?

DA: Right, in that thought experiment, exactly, yeah.

CA: But the trouble is,

that that would mean doing, whatever, like, 200 million tests a day.

DA: Right, exactly.

CA: Which is many, many orders of magnitude more than we have

and could even imagine ramping up to.

So you have a proposal, and this is the ingenuity,

the proposal,

of how to potentially administer tests in a way that's much more efficient.

Talk a bit about that.

DA: Sure.

So if you were going to use a purely random testing method

to control the disease,

you could probably actually get away with testing everybody

every two or three days --

I'm playing along with your thought experiment here --

and bring the number down to 100 million tests a day.

But even that is a magnitude

that would take us multiple months to get to,

let's just say if we even wanted to try to do something like that.

So the thing that you really need is smart testing.

So rather than testing the population at random,

what you do is you use testing

to identify people who are positive,

and then you add to that contact tracing or contact warning,

we think about it in both ways.

And what this means is that once you know who's a positive test,

you figure out who else has been exposed to that person

over the previous two weeks,

and they all get tested as well.

So you start to identify a class of people

who are a higher probability of being infectious

and you test that group of people.

So you move away from random testing,

you target it through contact tracing or contact warning.

And then, depending on the level of effectiveness

of your contact-tracing and contact-warning strategy,

you can reduce the numbers.

So on a moderately effective contact-tracing regimen,

you could imagine doing 20 million tests a day.

On a highly effective regime of contact tracing and warning,

you could get yourself down to the order of five to 10 million tests a day.

CA: And some countries in Asia seem to have pulled off

a version of this strategy that has been effective.

But it requires one of two things, if I understand you right, Danielle,

it requires either just this massively scaled up,

or potentially quite intrusive sort of manual contact tracing

where you have big teams who swoop in to anyone

who's tested positive

and try to unpack their complete recent social history.

Or technology plays a role,

and this is where it gets complicated,

because you know, there are apps in some of the Asian countries,

like, China has an app

which most people are, I think, required to carry,

certainly in Wuhan and elsewhere,

where it's very good at predicting

whether someone may need quarantine.

And they will be required to do so.

And so there are all these concerns about government control,

government intrusion.

You are in discussion about ways of doing some kind of technology

that would be more acceptable in a democracy,

and I'd love you to share what those are.

DA: Sure, I'm happy to do that.

So I think it's an important thing to say upfront

that the rates at which we would need to test per capita

are higher, much higher than Asian countries used,

because prevalence is much higher here.

They caught it earlier,

they had these tools built before the pandemic hit.

As a consequence,

they're able to control it with a lower per capita rate of testing

than will be the case for us.

We just have to accept that fact at this point

and recognize that massively scaling up is specific to our situation,

because we weren't ready before it hit.

So then, yes, OK, if we're trying to do the smart testing,

trying to use tools, what can you do?

So we're actually open to manual testing in the plan that we've developed,

I want to just say that,

and I think that society, we have a big choice to make,

whether what we want is a big core of manual contact tracers

who are tracing people's histories

and figuring out who they've been in contact with

and who they've been exposed to.

Or if we want to try to use a technological system.

The important thing is there is a diversity of options

within the technology space.

So it's really important to recognize that places like Singapore and China

have used highly centralized data systems for supporting this.

And so what happens is, sort of, you carry your phone around,

and everybody is connected to a central data system,

and then when somebody in the system has a positive test,

that gets put into the app,

and then their phone communicates to other phones

that it's been in proximity with over the previous two weeks,

to alert people that they too need to get a test, OK?

That's the basic concept.

In China and Singapore

the data structure for doing this is highly centralized.

There are, however, a lot of innovative apps

under development right now

that depend instead on a very privacy-protective structure

where the data lives on the individual user's phone

and through a combination of encryption and tokens

users of phones can communicate with other users of phones,

but the data is not centralized.

So in that regard, it becomes more of a peer-to-peer sharing,

sort of concept of friends warn friends

that they should probably go get tested.

Then you would have a central repository of test data,

but the truth is, we already have that,

because all influenza tests for example,

already roll up into CDC

and Health and Human Services databases,

so that they can track influenza patterns every year.

CA: So tell me if I understand this right.

You would carry on your phone an app

that would, when you got, say, within six feet

of another human carrying that app,

the phones would exchange a Bluetooth -- using Bluetooth technology

they exchange a kind of token

that says, "Hi, we connected."

But it's encrypted.

And that is not communicated to a central server,

that is on the phone.

But if either of you

in the next week or two tests positive,

your phone will be able to communicate to all the people

which it exchanged token with,

to say, "Uh oh, someone who you were close to in the last two weeks

has tested positive.

You've got to isolate."

That's basically how it works, it's done that way.

DA: Exactly.

CA: And then after, what, three or four weeks,

the tokens can actually autodelete?

They go, they're not there anymore.

DA: They expire, that's right.

Because you only need the most recent two weeks' information or data

about where you've been

and what other phones your phone has interacted with.

So that's the really key thing.

CA: Alright, we'll come back to that in a minute,

but let's see what our friends are asking online.

DA: OK.

CH: Hi, Danielle, hi, Chris.

Yeah, we've got a lot of great questions,

people are super interested in how this is all going to work.

There's a couple of questions I'm trying to cobble together here.

I think people are really interested in your thoughts

on the United States health care system.

We have so many underinsured and uninsured people

and the changes that you might make to that system,

I mean, does that situation make things worse,

and what changes would you make to the system

so that we're not as vulnerable in the future?

DA: So that's a great set of questions,

and so just from the point of view of the testing program,

it is absolutely critical that the testing be free.

And so there is absolutely,

a sort of necessary feature of this,

which is about, kind of, universal access element to the health system.

And so I'm sure there will be tweaking that's necessary

in the existing health system to achieve that.

We've also without any question seen vulnerabilities

that relate to and stem from our fragmented health system.

So I think there's a much bigger, longer-term question to be had,

or conversation to have,

about how we overcome that fragmentation.

So yes, I do hope this moment will be a spur

for that longer-term conversation about improving our health system

and really achieving that universal coverage that we so badly need.

CH: OK, thank you, I'll see you both again in a little bit.

CA: Thanks, Corey.

So let's stay with this tech issue for a bit.

And the sort of civil rights or privacy questions

that it might still raise in some people.

So one concern is that

surely, if your phone is able to contact these other phones,

someone somewhere is ultimately going to reverse that

and we'll have some kind of record of your,

you know, everyone who you've connected with,

and that might be concerning to some.

Is that a legitimate concern?

DA: I think it is, I mean, I think we've been working hard on this question

and really trying to think it through

and when you talk to legal experts and civil liberties experts and so forth,

everybody starts with the same premise:

assume failure.

Assume that you'll have a data breach.

Think for that

and what kind of protection you want in that regard.

And so when you think that way,

you of course are trying to minimize any likelihood of that happening,

so hence the privacy-protective structure of phones communicating with phones,

data living on the hardware of the phone,

not in the server, etc.

And then also you would want

a kind of democratic accountability feature,

so for example having the Department of Health and Human Services

have an auditing function to audit whoever is manning the server

or controls the server

through which the tokens are exchanged

you would want to audit their functionality

and how they're using the data.

But then again, you presume failure,

that somebody's reverse engineering, the audit system fails in some fashion.

What's your protection then?

The answer to that would appear to be upfront legislation

that prohibits the commercialization of this COVID testing data.

So that anybody who in any way tried to commercialize it

in any kind of way,

would be subject to legal penalty.

So I think that's how you build the fence up upfront

in the expectation that somebody would find the way to crack it.

CA: And then there's a set of questions

around how you get this app out there at scale,

because it's only effective if,

say, two thirds of the people who are working are carrying it, right,

something like that.

DA: Right.

CA: And so short of authoritarian "everyone must have this app,"

I guess there are ways that are interesting

to say to people, one, this is a really useful app,

it will alert you quickly if you're at any risk.

But two,

to get to the kind of scale we're talking about,

you might have to say to people,

"Look, we're slowly going to come back to work,

industry by industry, company by company,

and the deal for you to come back and break isolation,

the societal deal,

is that you have to be willing to carry this app."

And you could, for people who didn't want to do that,

I guess you could have some protection,

you can't lose your job for that.

But, I mean, can you picture society making the choice

that it is reasonable to require people who want to come back to work

to carry that alert technology with them?

DA: So this is the hardest question.

We know we don't want an authoritarian model,

such as the one used in China and Singapore,

so we have to figure out instead how to activate that thing,

which is sort of the most important democratic resource or asset,

namely solidarity.

So what is it that, from a solidarity perspective,

it's reasonable for us to ask of each other?

That has to be the frame for deciding how we approach this.

And so one aspect of this

is really, truly the building a culture of opting in to this.

And there are examples of this.

So for example, New York has tackled HIV testing

through a program that goes by the label "New York Knows,"

and it started out with labels of "Manhattan Knows" or "Brooklyn Knows,"

and so forth, of the different burrows.

And what this program is

is one that is owned by community organizations,

community partners,

that do the job of spreading the word

and recruiting people into testing programs.

And New York has the goal of having every single New Yorker

be tested for HIV,

so in other words, it's established as an expectation,

that universal participation,

and it's activated a network of community partners and organizations,

to cultivate that commitment to solidarity.

And so I think, in all honesty,

that that would be a really huge part of what you would need to do

in order to tap into solidarity,

to have this work.

I'm sure that we would see some amount of requiring in different context,

I think that's a very hard one,

because you don't want to generate labor discrimination problems.

And so the model there,

to think about and to sort of figure out what are our parameters,

what we think is fair,

connects to things that schools currently do,

for example, when they require that students show vaccination proof

before they can start the school year and things like that.

So there are multiple states that do that in schools for vaccines.

Would schools do the same thing,

what's the sort of labor, the workforce question like,

I think that very much remains to be worked through,

but it's a hugely important question.

CA: I'd be curious what the watching audience thinks about this,

maybe you could enter a comment on it.

But I mean, is it reasonable, in the world that we're in right now,

for a company, let's say, to say,

"Look, we want to get back to work,

but we want to do so and respect the safety of all our workers.

That means that for you to come back to work,

you need a test showing that you're negative.

And you need to carry this app

so that we alert people quickly if there's a problem."

Is that --

"We won't fire you if you don't come in,

but if you want to come back to work,

that's what you'll have to agree to."

Is that a reasonable chance?

I'm curious what people think.

Is there any other way to get --

Sorry.

DA: I mean, again, there is precedent for this

in the sense that drug testing works this way

in many employment contexts, right.

There are many roles where people have to do routine drug tests

as a part of preserving their job.

That was a hotly debated issue in the 1980s,

people sort of think back when that sort of first came in,

and there was a lot of concern about it.

We have managed to develop a regime for that,

that has achieved an equilibrium of a kind.

So I imagine that something is possible in this space,

but we would have to draw on the prior experience

with things like drug testing in the workplace, I think.

CA: I mean, one problem that we face

when you think about these big systems introduced

is that in the past, there's history

where something got introduced,

you think of the PATRIOT Act that came in after 9/11

and a lot of people have a lot of problems with that Act,

and it gets renewed relentlessly, relentlessly,

and here we are, nearly 20 years later,

and it's still with us.

So that creates quite a high bar

for any standard that we push out here.

How do we persuade people

that this is custom-made for the current situation that we're in,

and it's not going to be picked up and subsequently abused

by companies or by government?

DA: That's an absolutely critical question,

and I think we have a lot to learn from places like Germany,

which are really, really strong and rigorous on privacy protections.

Perhaps having some of the highest privacy-protection standards in the world.

And Germany, over the course of the last few weeks,

has articulated an approach that definitely picks up

several of these elements.

So there are ways of building in privacy structures

that are meeting the standards of the German privacy framework,

and so I think for us, that's a really important place to look to,

and learn from them how they're structuring it,

to achieve those privacy protections.

CA: Danielle, you're an ethicist, among other things,

as well as a political theorist,

and is it, as you think about how to apply ethical questions to this,

is it inherent in a situation like this that there are going to be trade-offs,

that there is no "perfect solution" that we just, you know --

These things are fundamentally --

You've got two goods that are fundamentally in conflict with each other

or if you like, avoidance of two evils that are going to clash.

And that we're not going to get away sort of untainted to some extent,

we just have to try and make the least bad choice?

DA: It's a great question, and I think,

I tend to formulate things as being about hard choices and judgments,

rather than being about trade-offs.

I think trade-offs often suggest that you can precisely quantify

this degree of monetizable harm against that degree of monetizable harm,

and I think that's actually not as helpful to us in this current moment,

to be honest.

So in effect, I think the most important thing

is that we clarify our core values.

And so the way we've tried to articulate that

is to say we have a fundamental value in securing public health.

We have a fundamental value

in securing a functioning, healthy economy.

We have a fundamental value

in securing civil liberties and justice and constitutional democracy.

And so then the question is, given that set of fundamental values,

what are the policy options

that actually do secure all of those things?

So in that regard, at the end of the day,

you know, there's a bunch of libertarians in the group that we work on,

and a lot of us come out very strongly,

sort of, privacy protecting, liberty protecting point of view.

And so we're not here to sacrifice those things.

We're rather here to find a solution that aligns with the values

that we bring in to this problem.

So that's how we think about the decision making.

CA: Talk a bit more, actually, about the group

that you've pooled together over this.

I know that there's a TED speaker Paul Romer,

an economist at Stanford, who's, I think, a key member.

Who else is in the group?

DA: Well, Paul was a key member.

I'm afraid we parted ways to some extent, because he's advocating random testing,

so the sort of 100 million tests a day direction,

and he's not a fan of the contact-tracing approach,

so he does have, you know,

he's sort of at one end of a kind of libertarian spectrum on that

and my view, however, is that testing 100 million a day

is far more intrusive

than smart testing supported by privacy protective contact tracing.

I also think it's really important to throw into the mix

the fact that collective social distancing

is a huge infringement on our civil liberties.

We keep forgetting that.

The alternative is not contact tracing versus nothing,

it's contact tracing versus social distancing.

We can't go out,

we can't form associations where we get to be together in person,

churchgoers can't go to church right now.

You know, political parties are having their conventions postponed.

If that's not infringement on our civil liberties,

I don't know what is.

So from my point of view,

the civil liberties conversation is one about the contrast

between the kind of infringement that is produced by social distancing

versus the kind of infringement or reshaping

that would be imposed by contact-tracing regime.

I didn't answer your question about our group.

CA: Go ahead, it's just amazing this thing is moving so fast in real time.

Talk about some of the other people who are in your group.

DA: Sure, so Glen Weyl is an economist at Microsoft,

a political economist,

he's a really key figure

and he is really an innovative mechanism design thinker,

who is really good at kind of,

figuring out how to craft incentive structures and so forth

that help people make choices in socially productive ways,

in ways that are also freedom-respecting, and so forth.

So he's really been helping us think about the design of the policy pathway,

Rajiv Sethi is another economist,

Lucas Stanczyk is a philosopher at Harvard

who has been scrutinizing the civil liberties and justice questions.

I mean, that is his line of work,

those are the things he's most committed to,

and that's what he's doing.

We've reached out to a number of public health groups

for regular consultations,

so they're not as directly part of our group

in the sense of advancing a policy,

but in terms of informing our epidemiological understanding,

we've relied a lot on folks at the Chan School of Public Health at Harvard.

So lawyers as well,

Glenn Cohen, who directs the Petrie-Flom Center for law and bioethics

has been a critical member,

Andrew Crespo also at Harvard Law School,

Rosa Brooks at Georgetown Law school,

I could go on, I'm missing key people, critical scientists.

Actually, there's a great paper on solidarity

by Melani Cammett and Evan Lieberman that people should check out too.

CA: It's exciting that one of the impacts of this,

and I've seen it in other areas as well,

this crisis is really breaking a lot of cross-disciplinary lines

and bringing people together in unexpected combinations,

which is good.

DA: Yes.

CA: So how, if this plan got general acceptance, how --

I mean, obviously, the clock is ticking, this is urgent,

what would it look like to move this forward?

Give a sense of what you think it would cost,

give a sense of who might own it,

like, what would it take to actually activate this giant idea?

DA: Alright, so it's a big price tag, so I hope you're sitting down --

I'm glad you're sitting down.

So over two years,

based on conservative estimates of what you would need,

that is to say maximal estimates for testing and things like that,

it's got a price tag of 500 billion,

which includes both the production of the tests

and the personnel of test administration,

contact tracing and all of that.

So it's important to remember though,

that that production ramp up and the contact tracing ramp up

are employment possibilities,

so in that regard, they would counteract the negative impact on employment

of the social distancing.

So it's a big price tag,

but it would be multipurpose in that regard,

contributing to jumping up the economy,

as well as the testing program itself.

It would be important that it be phased in,

and phasing it in would actually give us a way of testing out the paradigm

as we went.

So for example, for a first phase of rollout,

probably what you would want to do,

ideally by the end of the next month,

would be to have a full range of testing

for a combination of everybody in the health care sector

and everybody who might fill in

and substitute for any health care workers who test positive.

So in other words, your health care worker pool

and a substitute pool, say a national service corps,

of folks who can fill in for health care workers who test positive.

If you can get those two groups, those two sectors

fully under testing, contact-tracing regime,

so you know that every health care worker is not positive,

and anybody who is is immediately quarantined and so forth,

we would stabilize our public health infrastructure,

and that would already get about 30 percent of the workforce

under this kind of testing and tracing regime.

And then you'd move on, with that stabilized,

to other critical and essential workers, etc.

So the bad news, Chris, is you know,

who would be the last people to be folded into this?

It would be you, it would be me,

the people who can actually telecommute for work, OK.

Because we would have the least call on social needs

to pull us back out into the workforce.

So we'd be the last ones out.

But that's a good thing,

I think that's a part of making the point that we're all in this together

and that there are sacrifices in different places,

and service workers, care workers and so forth

would be able to get out faster.

CA: And that addresses what is definitely one of the most shocking

and painful aspects of the current moment,

which is, you know, for those of us working from home

it feels traumatic,

but it's nothing like what others are experiencing,

whose livelihood depends on being out there,

doing, you know, physical work.

And so I think it's excellent, obviously, that the plan focuses on them first.

How applicable is this to other countries?

You're obviously talking -- The plan is developed for the US.

It's inspired by what's happened, in some ways, in some Asian countries.

Is it applicable to other countries as well?

DA: It absolutely is,

and we're already seeing Europe move in this way.

So Europe and the UK are ahead of the US on this point,

I mean, the rough shape of the plan that we're proposing

seems to be pretty much the rough shape of the plan that's emerging

in Europe and the UK.

So I think it's a really important moment

to bring together those policy conversations,

bring together those modeling conversations

and help each other out on this one.

CA: And I guess the reason I'm delighted that you're engaged in this

is that it's --

You know, it's fundamentally framed here

as this is a discussion that society has to have.

There are ethical choices we have to make here

as part of this.

And so we can't just leave it up to the scientists,

as brilliant as they are.

And the politicians, for goodness sake.

We all need to understand what is at stake here,

what the choices are, what the hard choices are

and know that any direction is tricky,

but we, you know --

This really matters.

DA: Absolutely.

I think you've put it so well.

I think that's what makes this kind of question different in a democracy.

It really is important that we all collectively achieve understanding,

have clarity about the directional options

and have a sense of collectively moving in a direction that we desire, right.

That we consent to, in a sense.

CA: Corey.

CH: Hi, I just wanted to come back

and give you a little feedback on what people are saying online

in terms of the testing,

to be able to go back to work,

you know, how people feel about that.

Obviously, there's lots of questions about the app and privacy.

Some people are hesitant about it,

they're wondering whether it will be mandatory,

which you touched on.

Maybe you will opt in to be able to go back in the office.

I'm in, I would test to be able to go back in the office myself,

but I think people are wondering about that.

But the general consensus is it seems like a reasonable possibility.

There are a couple of questions.

One I think you just touched on

in terms of the global possibilities.

Do you see some collaboration on the global landscape,

do you see people talking to each other?

Obviously, if we want international travel to come back,

that seems like a key piece of it.

DA: Yes.

So I think travel is one of the hardest pieces of this,

and actually I don't think that there are good,

clear answers on that yet.

Scientists are talking to each other across international boundaries

without any questions.

I think the scientific community is really well

and at work, really connected, trying to think about these things.

It's not clear to me how well-networked the policy-making community is,

in all honesty.

So I think there's probably a lot of room for building

a tighter international network of policy makers on that front.

And the hardest part is going to be the travel piece.

And honestly, we haven't even talked about parts of the globe

like Africa or India, South America,

where they're not yet getting towards this policy paradigm.

So the virus is going to live in the world, without any question.

And live in the world probably in quite significant ways

for a considerable period of time.

So I think the role of travel restrictions

is probably going to be with us for a spell.

And so it really does matter that we get the design of those right.

I think it's Hong Kong that has a particularly,

what looks to me like a sort of, useful regime,

where anybody who is coming into Hong Kong for longer than two weeks

has to go into 14-day quarantine when they arrive.

But for anybody who is coming for a shorter time,

they have to be tested when they arrive

and then they have to also go through active monitoring

during the period of their time in Hong Kong,

which means having temperature checks and so forth reported.

So I think that's a reasonable thing to do

in order to keep business travel up and running,

even as we're all trying to deal with controlling the virus.

CH: And you also mentioned solidarity

and I think that touches on another question

that someone brought up online

about some of the social impacts after the 1918 epidemic

and the fear,

and the, you know, the fear of the other,

and foreigners and all that.

And how do we get through this

without that kind of fallout

and you know, how do we, kind of, keep ourselves together

and looking out for each other?

DA: I think that's such a hugely important question.

And I mean, in one sense it's easy,

because the virus is an adversary to every human being equally, right.

We are all completely equal in relationship to it.

And so what we are really all aspiring to here is

sort of transformation of our basic socioeconomic infrastructure

in a way that puts us all on a footing to be pandemic-resilient.

So I've been using the metaphor

we need to put ourselves on a war footing

to mobilize the economy to fight the virus,

and I stand by that in a sense that we do need to mobilize the economy.

But really at the end of the day,

it's not a war against a human adversary or anything of that kind.

And so what we're really talking about

goes back to the questions about the health infrastructure,

health care.

We're really talking about achieving a transformed peace situation

where our economies and our societies are pandemic-resilient.

That's the real goal here

and it really does require an investment,

so because of the 2003 SARS experience,

Asian nations have been investing over the last five years or plus,

in pandemic-resilient equipment and infrastructure.

We haven't done that in the US,

so we find ourselves in a position where we have to accelerate

in a matter of months,

something that has taken other people years to build and develop.

So I think really focusing on that,

and the goal is an economy that's not vulnerable to pandemic, right.

I mean, because we don't want to leave this pandemic

and have the economy be just as vulnerable to pandemic

at the end of the pandemic as we were at the beginning of it.

We don't want to be vulnerable this way.

And so in that regard,

the job is to build in that infrastructure for pandemic resilience ASAP.

CA: Wow.

CH: Thank you.

CA: Danielle, given the price tag you're talking about on this,

half a trillion dollars, basically, up to.

That's significantly less than some of the multitrillion dollar numbers

that are getting thrown around,

so, I mean in terms of the scale of the problem,

it's probably an appropriate number.

But it sounds like, to have any chance of doing this,

this would have to be a kind of federal initiative

at some level.

DA: Yes.

CA: We have a problem that more than half the country

fundamentally doesn't trust

key parts of the administration,

let's say.

How could this be framed in a way that could build trust

and make it feel like this is the country as a whole,

that there's this coalition of trusted voices

who are the final decision makers on this?

DA: So we have this incredible federalist system,

and we need to see it as an asset.

It's modularized and flexible, and we need to activate that.

We do need all the parts of the system working,

so we do need the federal government working on behalf of this,

we need the state governments working and municipal governments.

On the federal end of things,

we need Congress to fund.

So in the first instance,

there's a really big need for funding legislation,

and also, Congress can really help by directing investment,

not just in the testing program itself,

but in the national service corps,

probably flowing through state governments,

through the national --

The reserves in every state.

That would be sort of health reserves.

You know, really expand that program

with a combination of employment program and backing up that sector.

So there's a lot for Congress to do as a part of this.

For the testing program, we really do need the kind of procurement order

to produce capacity

that the Defense Department is the best example of.

So in the ideal, a sort of testing supply board

that brought in leading figures who are masters of supply chain logistics

from the private sector,

working in close coordination with the federal government

would be great.

The White House has recently, in the last week or so,

begun to put in pieces of architecture that goes in this way,

sort of a testing supply czar, for example,

an admiral, I believe.

So we need people of that kind

who are really superb masters of logistics, procurement,

contracts and that sort of thing,

to be able to ramp up an active, functional supply chain

for testing to deliver at the order of tens of millions of tests a day.

So we do need [unclear], absolutely is a key part of that,

key driver of that.

And so it's a time for all the parts of our government

to come together and do their respective pieces.

CA: So I'm kind of in awe at the scale at which you're thinking.

I guess as we wrap up here,

if I might, I'd love to just go to a bit more personal place.

Like, I'm just curious about you

and what is it in your past

that is, sort of,

is providing the fire right now,

the drive to try to do this?

How are you?

How are you feeling about this?

Tell us a bit about you, please.

DA: Well, that's a very generous question.

You know, I love this country.

I'll admit that's where the motivation starts from,

in the sense that,

like, lots of people would say that I'm a global humanitarian,

and watching the world succumb to the disease motivates me.

I think of Paul Farmer for example, as an example.

And I respect that and I get that,

but at the end of the day, I love my country.

And it hurt, just hurt, in the beginning of this,

and what hurt particularly,

was I was very clear, early on, that I was getting better information

as a member of the Harvard faculty

than my fellow parishioners,

than the people who were serving me in restaurants and cafes,

and it just like, that made me angry, in all honesty.

As a combination of those two things, I was like,

A, I want to understand this,

and B, I want to share what I understand

because it's not fair that people like me get it,

and that's not being shared with other people.

CA: Wow, that's powerful.

I think all of us, we all feel this weird mixture

of almost guilt at how fortunate a position some of us are in.

Certainly a lot of gratitude, anger.

Were you persuaded, Whitney, by this idea, by the possibility of it?

CH: Sorry, you're meaning me.

CA: Sorry! (Laughs) Did I say Whitney?

CH: Totally OK.

Whitney's your usual pal.

CA: I'm the world's worst person on names,

and Whitney and I have been hanging out here the last few weeks.

Corey.

CH: It's absolutely fine.

Being mistaken for Whitney is a huge compliment.

It's very persuasive,

and I think so hopeful to hear a constructive plan

and a feeling that there is a path out of this that is both possible for us

as humans,

to get back to being together,

but then also as an economy and as a country.

I'm really inspired by your work

and so grateful to you for sharing it with us.

DA: I appreciate that, thank you.

I'm really glad to get a chance to talk about it

and share the knowledge that our group has acquired

over the last month.

So thank you.

CA: So if someone wants to keep in touch with the progress of this idea,

what should they do?

DA: OK, so now I should know our website URL by heart,

but of course, I don't, I'm afraid.

If somebody googles "COVID,"

"Safra," "Allen," that's my surname,

our website will come up.

So if you just remember those three words, "COVID," "Safra," "Allen,"

and Google that,

you should get to our white papers,

op-eds, things like that.

We are hoping to have our full policy road map

published by the end of the week.

That's our target goal.

CA: Yeah. It's: ethics.harvard.edu.

DA: OK.

Exactly, that takes you to the main landing page,

and then to the COVID site.

CA: And then to the COVID-19 from there, yeah.

DA: Exactly.

CA: Alright, well, thank you so much, Danielle,

I found this absolutely fascinating.

DA: Thank you.

CA: It's going to take --

I mean, this is not an ordinary idea.

We don't often at TED have someone come and say,

"Yeah, I've got this idea for how to spend half a trillion dollars,

and it could make a difference between the US

and other places around the world actually getting the economy going again.

That's not usual, so this has been a gift to us today, thank you for that.

DA: Thank you.

CA: To everyone listening, this is an important debate.

And it's not finished yet,

there will be many other contributions to ideas like this, I think.

DA: That's for sure.

CA: Yeah, chip in, chip in.

Thank you all so much for being part of this today.

We're back again tomorrow.

Corey, do you have details on that?

CH: I do.

And also, you can listen to this conversation

on our website TED.com or on Facebook,

and you can also listen to the recording of it

through TED Interview.

So if you missed any parts of it or you want to pass it along to a friend.

We have some more amazing speakers coming up

I might glance at my cheat sheet,

but tomorrow we have Esther Choo,

who is an emergency physician and professor

and she is going to share with us what she's seen

on the front lines of this crisis.

On Wednesday, Chris and I will be speaking with Ray Dalio,

the founder of Bridgewater,

and he is going to address

the market and economic implications of this pandemic.

And on Thursday, we have two speakers,

Gayathri Vasudevan,

who is going to share with us what's happening in India,

and Fareed Zakaria, a journalist.

Friday, we'll wrap things up with a musician and artist Jacob Collier.

So we have a lot of amazing things coming up.

CA: We do, so calendar it if you can,

apart from anything else, we just like your company here every day.

We'll get through this together.

Thanks so much for being part of this.

Danielle, thanks again.

DA: Thank you, goodbye.

CH: Bye.