Francis Collins is the director of the NIH and former head of the Human Genome Project. Please support this podcast by checking out our sponsors:
- Ten Thousand: https://www.tenthousand.cc/ and use code LEX to get 15% off
- Allform: https://allform.com/lex to get 20% off
- SimpliSafe: https://simplisafe.com/lex and use code LEX to get a free security camera
- NI: https://www.ni.com/perspectives
- Magic Spoon: https://magicspoon.com/lex and use code LEX to get $5 off

EPISODE LINKS:
Francis's Twitter: https://twitter.com/NIHDirector
NIH: https://www.nih.gov
Human Genome Project: https://www.genome.gov/human-genome-project

PODCAST INFO:
Podcast website: https://lexfridman.com/podcast
Apple Podcasts: https://apple.co/2lwqZIr
Spotify: https://spoti.fi/2nEwCF8
RSS: https://lexfridman.com/feed/podcast/
Full episodes playlist: https://www.youtube.com/playlist?list=PLrAXtmErZgOdP_8GztsuKi9nrraNbKKp4
Clips playlist: https://www.youtube.com/playlist?list=PLrAXtmErZgOeciFP3CBCIEElOJeitOr41

OUTLINE:
0:00 - Introduction
1:18 - Lab-leak theory
4:26 - Gain-of-function research of viruses
16:35 - Bioterrorism
21:04 - Tony Fauci
31:15 - COVID Vaccines
37:20 - Joe Rogan
44:23 - Variants
49:05 - Rapid at home testing
53:18 - Animal testing
58:44 - Stepping down as director of the NIH
1:02:37 - Barack Obama
1:04:40 - Accelerating Medicines Partnership
1:15:18 - Faith
1:20:47 - Fear of death
1:23:49 - Meaning of life

SOCIAL:
- Twitter: https://twitter.com/lexfridman
- LinkedIn: https://www.linkedin.com/in/lexfridman
- Facebook: https://www.facebook.com/lexfridman
- Instagram: https://www.instagram.com/lexfridman
- Medium: https://medium.com/@lexfridman
- Reddit: https://reddit.com/r/lexfridman
- Support on Patreon: https://www.patreon.com/lexfridman

The following is a conversation with Francis Collins, director of the NIH, the National Institutes of Health, appointed and reappointed to the role by 3 presidents, Obama, Trump, and Biden.

He oversees 27 separate institutes and centers, including NIAID, which makes him Anthony Fauci's boss.

At the NIH, Francis helped launch and led a huge number of projects that pushed the frontiers of science, health, and medicine, including 1 of my favorites, the Brain Initiative, that seeks to map the human brain and understand how the function arises from neural circuitry.

Before the NIH, Francis led the Human Genome Project, 1 of the largest and most ambitious efforts in the history of science.

Given all that, Francis is a humble, thoughtful, kind man.

And because of this, to me, he's 1 of the best representatives of science in the world.

He's a man of God, and yet also a friend of the late Christopher Hitchens, who called him, quote, 1 of the greatest living Americans.

To support it, please check out our sponsors in the description.

And now here's my conversation with Francis Collins.

So for me, it's been difficult to watch, as it has during the pandemic, become at times a source of division.

What I would love to do in this conversation with you is touch some difficult topics and do so with empathy and humility that we may begin to regain a sense of trust in science and that it may once again become a source of hope.

You called for, quote, thorough, expert-driven and objective inquiry into the origins of COVID-19.

So let me ask, is there a reasonable chance that COVID-19 leaked from a lab?

I wish we had more ability to be able to ask questions of the Chinese government and learn more about what kind of records might have been in the lab that we've never been able to see.

But most likely this was a natural origin of a virus, probably starting in a bat, perhaps traveling through some other intermediate, yet to be identified host, and finding its way into humans.

Is answering this question within the realm of science, do you think, will we ever know?

I think we might know if we find that intermediate host and there has not yet been a thorough enough investigation to say that that's not going to happen.

And remember it takes a while to do this.

With SARS it was 14 years before we figured out it was the civet cat that was the intermediate host.

With MERS it was a little quicker to discover it was the camel.

With SARS-CoV-2 there's been some looking but especially now with everything really tense between the US and China, if there's looking going on we're not getting told about it.

Do you think it's a scientific question or a political question?

It's a scientific question, but it has political implications.

So the world is full of scientists that are working together, but in the political space, in the political science space, there's tensions.

What is it like to do great science in a time of a pandemic when there's political tensions?

My whole career, in genetics especially, has depended upon international collaboration between scientists as a way to make discoveries, get things done.

Scientists by their nature like to be involved in international collaborations.

The Human Genome Project, for heaven's sake, 2,400 scientists in 6 countries working together, not worrying who was going to get the credit, giving all the data away.

I was the person who was supposed to keep all that coordinated.

That was sort of their first real entry into a big international, big science kind of project.

Continue on the line of difficult questions, especially difficult ethical questions.

In 2014, US put a hold on gain of function research in response to a number of laboratory biosecurity incidents including anthrax, smallpox, and influenza.

NIH lifted this ban because, quote, gain-of-function research is important in helping us identify, understand, and develop strategies and effective countermeasures against rapidly evolving pathogens that pose a threat to public health.

All difficult questions have arguments on both sides.

Can you argue the pros and cons of gain of function research with viruses?

And first let me say this term, gain of function, is causing such confusion that I need to take a minute and just sort of talk about what the common scientific use of that term is and where it is very different when we're talking about the current oversight of potentially dangerous human pathogens.

As you know, in science, we're doing gain of function experiments all the time.

We support a lot of cancer immunotherapy at NIH.

Right here in our clinical center, there are trials going on where people's immune cells are taken out of their body, treated with a genetic therapy that revs up their ability to discover the cancer that that patient currently has, maybe even at stage 4, and then give them back as those little ninja warriors go after the cancer.

You gave that patient a gain in their immune function that may have saved their life.

So we gotta be careful not to say, oh, gain of function is bad.

Most of what we do in science that's good involves quite a bit of the hat.

And we are all living with gains of function every day.

I have a gain of function because I'm wearing these eyeglasses.

Otherwise, I would not be seeing you as clearly.

So that's where a lot of confusion has happened.

The kind of gain of function which is now subject to very rigorous and very carefully defined oversight is when you are working with an established human pathogen that is known to be potentially causing a pandemic and you are enhancing or potentially enhancing its transmissibility or its virulence.

We call that EPPP, Enhanced Potential Pandemic Pathogen.

That requires this very stringent oversight, worked out over 3 years by the National Science Advisory Board on Biosecurity.

That needs to be looked at by a panel that goes well beyond NIH to decide are the benefits worth the risks in that situation?

Most of the time, it's not worth the risk.

Only 3 times in the last 3 or 4 years have experiments been given permission to go forward.

So I will argue that if you're worried about the next pandemic, the more you know about the coming enemy, the better chance you have to recognize when trouble is starting.

And so if you can do it safely, studying influenza or coronaviruses like SARS, MERS, and SARS-CoV-2 would be a good thing to be able to know about.

But you have to be able to do it safely, because we all know, lab accidents can happen.

I mean, look at SARS, where there have been lab accidents, and people have gotten sick as a result.

We don't want to take that chance unless there's a compelling scientific reason.

That's why we have this very stringent oversight.

The experiments being done at the Wuhan Institute of Virology as a subaward to our grant to EcoHealth in New York did not meet that standard of requiring that kind of stringent oversight.

I want to be really clear about that because there's been so much thrown around about it.

Well, in the standard use of that term that you would use in science in general, you might say it was.

But in the use of that term that applies to this very specific example of a potential pandemic pathogen, Absolutely not.

So nothing went on there that should not have happened based upon the oversight.

There was an instance where the grantee institution failed to notify us about the result of an experiment that they were supposed to tell us where they mixed and matched some viral genomes and got a somewhat larger viral load as a result, but it was not EPPP.

It was not Getting into that zone that would have required this higher level of scrutiny.

So they didn't cross a threshold within that gray area that makes for an EPP P They did not

And anybody who's willing to take the time to look at what EPP means and what those experiments were would have to agree with what I just said.

What is the biggest reason it didn't cross that threshold?

Is it because it wasn't jumping to humans?

Is it because it did not have a sufficient increase in virulence or transmissibility?

EPPP only applies to agents that are known human pathogens of pandemic potential.

These were all bat viruses derived in the wild, not shown to be infectious to humans.

Just looking at what happened if you took 4 different bat viruses and you tried moving the spike protein gene from 1 into 1 of the others to see whether it would bind better to the ACE2 receptor.

And let me also say, for those who are trying to connect the dots here, which is the most troubling part of this, and say, well, this is how SARS-CoV-2 got started, That is absolutely demonstrably false.

These bat viruses that were being studied had only about 80% similarity in their genomes to SARS-CoV-2.

They were like decades away in evolutionary terms.

And it is really irresponsible for people to claim otherwise.

Speaking of people who claim otherwise, Rand Paul, what do you make of the battle of words between Senator Rand Paul and Dr.

Anthony Fauci over this particular point.

I don't want to talk about specific members of Congress, but I will say it's really unfortunate that Tony Fauci, who is the epitome of a dedicated public servant, has now somehow been targeted for political reasons as somebody that certain figures are trying to discredit, perhaps to try to distract from their own failings.

Here's a person who's dedicated his whole life to trying to prevent illnesses from infectious diseases, including HIV, in the 1980s and 90s.

And now, probably the most knowledgeable infectious disease physician in the world, and also a really good communicator, is out there telling the truth about where we are with SARS-CoV-2 to certain political figures who don't want to hear it and who are therefore determined to discredit him.

So with politicians, they often play games with black and white.

They try to sort of use the gray areas of science and then paint their own picture.

But I have a question about the gray areas of science.

So like you mentioned, gain of function is a term that has very specific scientific meaning, but it also has a more general term.

And it's very possible to argue that the, not to argue, not the way politicians argue, but just as human beings and scientists, that there was a gain of function achieved at the Wuhan Institute of Virology, but it didn't cross a threshold.

I mean, there's a, it's a, but it could have too.

So here's the thing, when you do these kinds of experiments, unexpected results may be achieved, and that's the gray area of science.

You're taking risks with such experiments.

And I am very uncomfortable that we can't discuss the uncertainty in the gray area of this?

Oh, I'm comfortable discussing the gray area.

What I'm uncomfortable with is people deciding to define for themselves what that threshold is based on sort of some political argument.

The threshold was very explicitly laid out.

Everybody agreed to that in the basis of this 3 years of deliberation.

If that threshold needs to be reconsidered, let's reconsider it, but let's not try to take an experiment that's already been done and decide that the threshold isn't what it was because that really is doing a disservice to the whole process.

I wish there was a discussion even in response to Rand Paul.

I know we're not talking about specific senators but just that particular case, I'm saying stuff here.

I wish there was an opportunity to talk about, given the current threshold, this is not gain of function, but maybe we need to reconsider the threshold and have an actual, that's an opportunity for discussion about the ethics of gain of function.

You said that there was 3 studies that passed that threshold with influenza.

That's a fascinating human question, scientific question about ethics.

Because like you said, there's pros and cons.

You're taking risks here to prevent horribly destructive viruses in the future, but you also are risking creating such viruses in the future.

With nuclear weapons and nuclear energy, nuclear energy promises a lot of positive effects and yet you're taking risks here.

With mutually assured destruction, nations possessing nuclear weapons.

Well we're not, but a lot of people argue that that's the reason we've, nuclear weapons is the reason we've prevented world wars.

And yet they also have the risk of starting world wars.

And this is what we have to be honest about with, with the benefits of risks of science that you have to make that calculation.

I'm totally with you, but I wanna reassure you, Lex, that this is not an issue that's been ignored.

That this issue about the kind of gain of function that might result in a serious human pathogen has been front and center in many deliberations for a decade or more, involved a lot of my time along the way, by the way, and has been discussed publicly on multiple occasions, including 2 major meetings of the National Academy of Sciences, getting input from everybody, and ultimately arriving at our current framework.

Now, we actually, back in January of 2020, just before COVID-19 changed everything, had planned and even charged that same national science advisory board on biosecurity to reconvene and look at the current framework and say, do we have it right?

Let's look at the experience over those 3 years and say, is the threshold too easy, too hard?

COVID came along, the members of the board said, please, we're all infectious disease experts, we don't have time for this right now.

But I think the time is right to do this.

And that should be just as public a discussion as you can imagine about what are the benefits and the risks.

And if somebody decided, ultimately, this came together and said, we just shouldn't be doing these experiments under any circumstances, If that was the conclusion, well, that would be the conclusion, but it hasn't been so far.

If we can briefly look out into the next hundred years on this, I apologize for the existential questions, but It seems obvious to me that as gain-of-function type of research and development becomes easier and cheaper, it will become greater and greater risk.

So if it doesn't no longer need to be contained within laboratories of high security, It feels like this is 1 of the greatest threats facing human civilization.

Do you worry that at some point in the future, a leaked man-made virus may destroy most of human civilization?

At the moment where we have the greatest control, the greatest oversight, is when this is federally funded research.

But as you're alluding, There's no reason to imagine that's the only place that this kind of activity would go on.

If there was an evil source that wished to create a virus that was highly pathogenic in their garage, the technology does get easier.

And there is no international oversight about this either that you could say has the same stringency as what we have in the United States.

It would take a seriously deranged group or person to undertake this on purpose, given the likelihood that they too would go down.

We don't imagine there are going to be bioweapons that only kill your enemies and Don't kill you.

Sorry, we're too much alike for that to work.

There's lots of scary novels and movies written about it.

But I do think it's something we have to Consider what are all the things that ought to be watched.

You may not know that if somebody is ordering a particular oligonucleotide From 1 of the main suppliers and it happens to match smallpox They're gonna get caught So there is effort underway to try to track any nefarious actions that might be going on.

Is there an international collaboration of trying to track this stuff?

This is a general issue, Lex, in terms of do we have a mechanism, particularly when it comes to ethical issues, to be able to decide what's allowable and what's not and enforce it?

I mean look where we are with germline genome editing for humans, for instance.

There's just bully pulpits and governments that get to decide for themselves.

My dad, a physicist, worked at Chernobyl.

I was, I don't know what word you want to put it Maybe incompetence is too harsh.

Maybe it's the inherent incompetence of bureaucracy I don't know but for whatever reason there was an accident.

Of course it does We know that SARS for instance did manage to leak out of a lab in China 2 or 3 times, and at least in some instances, people died, fortunately quickly contained.

All 1 can do in that circumstance, because you need to study the virus and understand it in order to keep it from causing a broader pandemic But you need to insist upon the kind of biosecurity the BSL

framework under which those experiments have to be done and Certainly at NIH we're extremely rigorous about that But you can't count on every human being to always do exactly what they're supposed to.

So there's a risk there, which is another reason why, if we're contemplating supporting research on pathogens that might be the next pandemic, you have to factor that in.

Not just whether people are gonna do something that we couldn't have predicted, where all of a sudden they created a virus that's much worse without knowing they were gonna do that, but also just having an accident.

That's in the mix when those estimates are done about whether the risk is worth it or not.

Continuing on line of difficult questions.

We're gonna get to fun stuff after a while.

Just like you did already in this conversation.

It is painful for me to see division and distrust but many people in politics and elsewhere have called for Anthony Fauci to be fired.

When there's such calls of distrust in public about a leader like Anthony Fauci who should garner trust, do you think he should be fired?

To do so would be basically to give the opportunity for those who want to make up stories about anybody to destroy them.

There is nothing in the ways in which Tony Fauci has been targeted that is based upon truth.

How could we then accept those cries for his firing as having legitimacy?

They've decided they don't like Tony, so they make up stuff and they twist comments that he's made about things like gain of function, where he's referring to the very specific gain of function that's covered by this policy, and they're trying to say he lied to the Congress, that's simply not true.

They don't like the fact that Tony changes the medical recommendations about what to do with COVID-19 over the space of more than a year.

And they call that flip-flopping and you can't trust the guy because he says 1 thing last year and 1 thing this year.

You don't want him to be saying the same thing he did a year ago, that would be wrong now.

People don't understand that or else they don't want to understand that.

So when you basically whip up a largely political argument against a scientist and hammer at it over and over again to the point where he now has to have 24-7 security to protect him against people who really want to do violence to him.

For that to be a reason to say that then he should be fired is to hand the Evil forces the victory.

Yet there's something difficult that I'm going to try to express to you.

There's a humility to you that garners trust.

And when you're in a leadership position, representing science, especially in catastrophic events like the pandemic, it feels like as a leader, you have to go far above and beyond your usual duties.

And I think there's no question that Anthony Fauci has delivered on his duties But it feels like he needs to go above as a science communicator And if there's a large number of people that are that are distrusting him it's also his responsibility to garner their trust, to gain their trust.

As a person who's the face of science, are you torn on this?

The responsibility of Anthony Fauci, of yourself, to represent science, not just the communication of advising what should be done, but giving people hope, giving people trust in science, and alleviating division.

Do you think that's also a responsibility of a leader, or is that unfair to ask?

I Think the best way you give people trust is to tell them the truth And so they recognize that when you're sharing information It's the best you've got at that point and Tony Fauci does that at every moment?

I don't think him expressing more humility would change the fact that they're looking for a target of somebody to blame, to basically distract people from the failings of their own political party.

Maybe I'm less targeted, not because of a difference in the way in which I convey the information, I'm less visible.

If Tony were out of the scene, and I was placed in that role, I'd probably be seeing a ratcheting up of that same targeting.

I would like to believe that if Tony Fauci said that when I originally made recommendations not to wear masks, that was given on our best available data.

So admit with humility that there's an error.

That's not actually correct, but that's a statement of humility.

And I would like to believe despite the attacks, he would win a lot of people over with that.

So a lot of people, as you're saying, would use that, see that, here we go, here's that Dr.

I believe if he was Display that public display of humility to say that I made an error That would win a lot of people over.

That's my that's kind of my sense to face the fire of the attacks on politics, you have to, like politicians will attack no matter what.

But the question is the people, to win over the people.

The biggest concern I've had is that there was this, this trust of science that's been brewing.

And maybe you can correct me, but I'm a little bit unwilling to fully blame the politicians.

Because politicians play their games no matter what.

It just feels like this was an opportunity to inspire people with the power of science.

The development of the vaccines, no matter what you think of those vaccines, is 1 of the greatest accomplishments in the history of science.

And The fact that that's not inspiring, listen, I host a podcast.

Whenever I say positive stuff about the vaccine, I get to hear a lot of different opinions.

The fact that I do is a big problem to me because it's an incredible, an incredible accomplishment of science.

And so I, I'm sorry, but I have to put responsibility on the leaders, even if it's not their mistakes.

You take responsibility for the situation.

I wonder if there's something that could have been done better to give people hope that science will save us as opposed to science will divide us.

I think you have more confidence in the ability to get beyond our current divisions than I do after seeing just how deep and dark they have become.

Tony Fauci has said multiple times the recommendation about not wearing masks was for 2 reasons, a shortage of masks which were needed in hospitals, and a lack of realization early in the course of the epidemic that this was a virus that could heavily infect asymptomatic people.

No, he was making a judgment based on the data available at the time But he certainly made that clear over and over again It has not stopped those who would like to demonize him from saying, well, he just flip-flopped.

He says 1 thing today and 1 thing tomorrow.

Early on, I'm a co-author on a paper, 1 of many, but this was a survey paper overlooking the evidence.

It's a summary of the evidence we have for the effectiveness of masks.

It seems that It's difficult to do rigorous scientific study on masks.

There's a lot of philosophical and ethical questions I want to ask you.

But within this, it's back to your words and Anthony Fauci's words.

When you're dealing with so much uncertainty and so much potential uncertainty about how catastrophic this virus is in the early days and knowing that each word you say may create panic, How do you communicate science with the world?

It's a philosophical, it's an ethical, it's a practical question.

There was a discussion about masks a century ago and that too led to panic.

So I mean I'm trying to put myself in the mind, in your mind, in the mind of Anthony Fauci in those early days, knowing that there's limited supply of masks.

See all Lex Fridman transcripts on Youtube

Francis Collins: National Institutes of Health (NIH) | Lex Fridman Podcast #238