Meaghan Kall is an epidemiologist at what used to be known as Public Health England but is now the UK Health Security Agency. She and her colleagues have been working flat out for two years producing some of the world's best COVID data. She has been a brilliant voice on Twitter. Follow her.

We speak about annoying and funny COVID myths.

She gives her view on COVID vaccine waning, Long COVID and risk in children; and how we are going to come to terms with COVID as an endemic disease (think about managing flu, although with different outcomes).

We dive into what it means to be an epidemiologist and think about the social determinants of health.  With the lens of looking at HIV epidemiology, we discuss how certain populations are more adversely impacted.

We discuss what caring for disabled children as meant for us and how that insight is another facet of what it means to be human.

We think about what “expected value” means and how science can not answer matters of policy which have to be decided also by thinking of our values and other trade-offs. 

Meaghan gives the advice she is currently giving family and friends and ends with some thinking on life career advice.

PODCAST INFO

• Apple Podcasts: https://apple.co/3gJTSuo

• Spotify: https://sptfy.com/benyeoh

• Anchor: https://anchor.fm/benjamin-yeoh

Transcript (this is mainly automated and so will have typos etc)

Ben Yeoh (00:00): Hello, and welcome to Ben Yeoh Chats. If you're curious about the world, this show is for you. What advice does an epidemiologist have on COVID today? On this episode, I speak to Meaghan Kall. Meaghan is a UK government epidemiologist, and we talk about the endgame for COVID as an endemic disease, vaccine waning and long COVID. We also discuss the social determinants of health. If you enjoy the show, please like and subscribe as it helps others find the podcast. Thank you, be well. Hey, everyone. I'm really pleased to have Meaghan Kall. Meaghan is an epidemiologist at what used to be known as Public Health England, PHE, but is now called The UK Health Security Agency. She and her colleagues have been working flat out for two years, producing some of the world's best COVID data. You and everyone involved in this public service have our great thanks. So thank you, Meaghan and welcome.

Meaghan Kall (01:03): Thank you. Thank you so much for inviting me onto your podcast.

Ben Yeoh (01:07): So, first question, what COVID myths do you find the most annoying or maybe even any that you kind of find amusing? I guess the annoying one I find is the myth of fertility and COVID vaccines, just because I kind of see that coming up a lot and obviously seems to be pushed. But do you have anything which you find really annoying about COVID myths?

Meaghan Kall (01:28): Yeah, there's a few. I think the most amusing one that I've seen so far has been that the vaccine turns people gay. So that was a new one for me. I mean, how would that work? What is the basis of that? And I think what's interesting about the vaccine myths is that it really highlights this idea of correlation does not equal causality. So two events can happen in time and space and a person that is linked, but it doesn't mean the one caused the other. And so I think we've obviously got a very hyper focus on the vaccines at the moment and what happens around the time of the vaccine and people will attribute things to the vaccine that aren't real. The other one that I saw recently was that the vaccine gave them nits. That was another adverse event. So there's things that are quite outrageous that are coming up. So to me, maybe I find those more amusing. I would say the more annoying one that I've seen, I feel like I've been battling for months and have spent so much of my time doing the misinterpretation of the vaccine and death data. So where people are now seeing that most of the people who die of COVID are vaccinated and people interpreting that as vaccines not working. And I think the is a message that we need to just keep reiterating until people understand it, but it is quite counterintuitive to tell people actually that means the vaccine program is working and people don't really, you know, it's very difficult to get that across and it's just based on the first assumption that no vaccine is 100% effective.

Meaghan Kall (03:42): There's never been a vaccine that is 100% effective against hospitalization or death. So if you start from that point, then there will be sadly, unfortunately, a small fraction of people who go on to be hospitalized and die of COVID and because in this country and because globally, there's such a strong age risk gradient for that, that sadly the people who we are vaccinating, we have really high uptake vaccines, some of them, particularly in the older age groups do go on to die. And it doesn't mean the vaccines aren't working because there's a whole lot of people whose infections were prevented and then onward from that, even who got infected, who then their deaths were prevented because of the vaccine. So we're just seeing a very, very tip of the iceberg now compared to what we saw before, but it's a very difficult thing I think it to communicate to people and get people to understand when they're just looking at basic numbers,

Ben Yeoh (04:48): That's a great deep dive into it. So I'll come back to a lot of COVID stuff in a moment and I think that's right, this whole data literacy has been really revealing, particularly for those who continued studying science or stats onwards, and those who sort of stopped at maybe 12, 13, 14 and didn't get into this type of thinking that reading of that stats has been quite counterintuitive like you said. But before COVID, you were quite an expert and continuing to be an expert on HIV and other infectious diseases. So I was reading one of your recent papers on HIV, and I was struck by the results that being gay or BI or being disabled in Romania led to much worse quality of life and obviously you looked at it in Romania, but this whole idea it seems to go across companies in the world, which is this intersectionality with so many what we might call the social determinants of health or socioeconomic and these other determinants. What do you observe happening here and how are you thinking about environmental, economic and some of these other determinants of health when you're thinking about epidemiology infectious disease or even health in general?

Meaghan Kall (06:06): Yeah, I mean, absolutely when we're looking at things-- So for example, so in people living with HIV and we are talking about now a lifelong chronic infection, people can stay well with HIV and live normal lifespans. So what is it that is perhaps determining worse outcomes in people with HIV, with excellent medication and I think what we're seeing is specifically with HIV it disproportionately affects marginalized populations and so you do have people from the LGBT background disproportionately affected, particularly gay and bisexual men and we have people who inject drugs, migrant sex workers and so you're dealing with this population that's marginalized in the first place, and then they have this additional burden of stigma with HIV. And so it can really have a huge impact on not only people's quality of life, but then onward to how well they stay on their medication. And so I guess the issue that we saw, particularly in that analysis is that being disabled, being gay or bisexual those are stigmatizing identities that in some countries are still a major, major barrier and these we're talking about structural barriers and this can also be a barrier to accessing healthcare and staying in healthcare. So, I like to consider myself actually particularly pre COVID a social epidemiologist.

Meaghan Kall (08:00): So thinking about these, as you say, structural determinants of health and how can we ensure that we can overcome those? Some of those are beyond public health, they're social issues that need to be addressed structurally within a country, within a culture. But some of those can also be overcome by the healthcare service. So for example, we don't see the same correlation in the UK. We have the NHS, we have a really amazing health system which is open access at the point of care. And so in many ways, that mitigates some of those additional barriers that people may experience, being able to access healthcare freely in that way.

Ben Yeoh (08:46): Yeah. I've always thought about that, that so much of what we might consider health or particularly when you're thinking about population health, the way of influencing that might be through an education or a social factor but because it falls under that, there's kind of, no, let's say budget for it. I mean, take something away from pre COVID times the education around say just the normal flu vaccine, particularly if you're in an elderly, a vulnerable population, the uptake was not where you might have it. Now, does the responsibility of that education rely on our health service or rely on the sort of education and awareness to get people around? And because it sort of doesn't seem to fall in either, it kind of slightly falls by the wayside and I was looking in the UK. So, like you say, some of our things don't have that correlation, but what seems really striking and this is also seemingly true of COVID is the outcomes on disabled people, whether that's actually learning disabled or other types of disability. So do you think it's this same structural health issue going through here and the social economic factors? And is there any thinking about helping this, because again, the stats on it would suggest that in the UK, something like about 20% of the population has some sort of disability and it just seems to me kind of a real miss that we haven't got that closer to what we see in an average population.

Meaghan Kall (10:13): Yeah. I mean, I think the point on education and awareness is an excellent one because you can have the best interventions in the world, but if people are not aware of them or are not able to access them or as we are seeing with the COVID vaccine there's a lot of misinformation also circulating around that then you won't see the impact that you could potentially have with that intervention. And so actually I think increasingly there's been a need to have a sort of parts of the healthcare service or the public health service to actually battle misinformation where maybe we didn't have that need before. And I think probably the internet has sort of helped that along because that is such a root for spreading misinformation, but you are kind of battling against the tide in a way, but I think there needs to be a public health response specifically against misinformation and messaging against misinformation. I mean, we saw what happened with vaccines and autism about 20 years ago, that has been completely debunked now, but even the damage that one single published paper by a fairly well respected academic made a massive dent in people's trust in vaccines.

Meaghan Kall (11:44): And so I think there is a need for that within the health system. I think I would also caveat though, there is a role for ministries of education and countries to actually do education for some of these wider structural issues as well. So I would say, for example, going back to the quality of life among gay and bisexual men. I think if you don't have sexual reproductive health and education about sexuality at schools in an accepting inclusive way I think that's where it starts. If you don't have that, then I think you're putting yourself at a disadvantage structurally in the population being able to understand and accept and have services that meet the needs of these people.

Ben Yeoh (12:35): Yeah. Talking about a lack of information or misinformation, but particularly a lack I knew nothing about ATR-X (syndrome) until speaking with you and I didn't realize how rare it is. So this is what we kind of call these rare genetic diseases. Would you like to tell us a little bit about that and maybe, I don't know how much intersection you've had, I guess, with the disability community or these communities, but maybe any sort of lessons or learnings that you've had in your life because of this?

Meaghan Kall (13:04): Yeah, I mean, this is a very personal journey for me actually. So whilst I have worked for a long time particularly in HIV, dealing with marginalized populations, I actually haven't had much exposure to the disabled community or health issues that affect them. But then four years ago, my son was born with this very rare genetic syndrome called ATR-X syndrome. It's an X-linked genetic mutation that mainly then affects boys. So women can carry, but boys are actually affected and it leads to moderate to severe learning difficulties and also physical difficulties. So for example, my son who's four is non-verbal. He still wears nappies. He's just learned to sit up on his own, but he can't crawl, can't walk. He's learned to clap his hands. So, he makes progress, but very, very slowly and at his own rate. So, for me, I guess rather unexpectedly in a way I joined this community of disabled people and their carers and had to learn really quickly about what it was to be disabled and not until I was actually part of it did I realize how hidden and invisible disabled communities actually are. Still in this day and age and the voice of disabled people I think and their carers is still not as mainstream, I think, as it should be. And so, I think for me where I've got a voice and I have quite a lot to say, I think I have felt that it has been something that I want to add to what I do and what I stand for to be able to speak up for people who don't have a voice and that includes my son.

Meaghan Kall (15:14): So yeah, I think it is difficult. It's a difficult place to be as a parent. I think there's a process to go through. I think you have a child and you don't expect them to have an illness or a condition or being permanently disabled and so accepting that and I think coming to the other end where actually you see this person for themselves and who they are and they have their own thing to add to this world and they have their own joy and their own personality and their own I don't know, […], the thing that they add and they bring to this world and it's maybe different, but it's just as valuable and their lives are just as valuable as everybody else's.

Ben Yeoh (16:04): Yeah. I think for me that all echoes really true and I hadn't realized until sort of being immersed in it and really deeply thinking about it, how much of the world is not designed for a lot of other people. In fact, across so many things, I feel sort of really ashamed that recently I hadn't realized how much of the world was designed for men, designed for able body, designed for, you know, you can go X, Y and Z, or not even talking about physical design but just how our social and cultural constructs and that actually if we design things for, well, for the everyone, or for some people who have these other needs, it actually doesn't bother the majority. Everyone can use an accessible bathroom for instance but we didn't really think about that and that has really sort of changed my world. And then that second element that you said that these are really without wanting to sound kind of mawkish about it, but really worthy, they're just as human as everyone else and therefore, if you think that being human is kind of special or about being humanity, then there is a lot to that, but that's on the challenging side as well as the joys, right. Everyone has rainy days and sunny days and that's just true of everyone.

Meaghan Kall (17:32): Absolutely. I think that you just picked up on is interesting as well, because I think seeing people and particularly-- so I'm thinking about my son who has a learning difficulty and is non-verbal, so he has certain ways that he can communicate and I think a lot of people say, "Oh, he's so smiley. Isn't he happy all the time?" Cause he is, he's a happy [kid], he's a smiley kid. He'll give you a smile if you smile at him. He is overall quite cheerful, but then you think, well, actually he's allowed to have bad days as well. He's allowed to have down days. He has his own personal feelings and I think I can't remember the term for it now. What's it called? Oh, sorry. This needs to be cut. What's the word? The, not a disability porn, what do they call this? It's sort of where people get-- You put a video on the internet, everybody goes, oh, that's amazing but it really actually diminishes--

Ben Yeoh (18:33): Yeah. kind of like pity porn, I think I've heard it called. [BY: I think it’s called inspiration porn]

Meaghan Kall (18:37): Yeah. So there's this thing called pity porn or whatever it is and I think that it makes people very two dimensional, I think. But actually people, even with disabilities, are three dimensional. They're humans. They're not here to be cured or fixed necessarily. They should be accepted just the same as everybody else. And I think I'm happy that I feel like we live in a time right now where that is actually being viewed and I think even I'm old enough to remember 20, 25 years ago when I was at school there was no talk about neurodiversity at all. I mean, that wasn't even really a thing. There was very little understanding about disabilities in schools and awareness about these things. So I think now we are, as you say, being more inclusive and I think there is a need, there is a drive to be more inclusive and make sure places are accessible and everybody's at a level playing field because if you don't do that, I think we don't realize how actually inaccessible the world can be for people without those small adjustments really.

Ben Yeoh (19:52): Yeah. And it's unnecessary and I think that I picked up on something that's been slow, but in my more hopeful moments, I just noticed we've had in some ways enormous social progress. In some ways it's a little bit like life expectancy, slow and steady. We can do so much more because we see so many areas where it seems like, wow, this is just an obvious place that we could do better. But if you look at the overall stats, virtually everywhere, I know there's some populations now which are sort of suffering over the last two or three years but generally when you think about it globally or within countries every year, we are living a little bit longer. Things like death in childbirth are still going down. I remember speaking to a lot of my friends and allies 20, 30 years ago. So, slightly showing my age, but they thought they would never see gay marriage in their lifetime and now in a lot of places, it it's happening and it seems to be going in the thing. So that is, you can argue it slow and we have to do so much more and this is all completely correct, but you've also got to celebrate that we've had some wins. So I was thinking, you've come from Michigan to London. Do you miss anything about the US and maybe is there anything that the UK can learn from the US or a reflection about what the US can learn from the UK?

Meaghan Kall (21:13): Oh, that, I mean so much. Well, I moved over here a long time ago now though. So I moved over here in 2005, which is coming up on 16 years ago. So in a way I was never quite an adult in the US and I think also over that time period, a lot has changed. So I get the exposure of what's going on there from my friends online, but also from the odd visit here and there and I mean, unfortunately I do think that the US has become quite divisive, has become hyper politicized and I think it's a tricky environment over there at the moment. And you could argue in the UK, there is that to an extent as well. It's just not quite as polarized I think as it is over there. But yeah, I think one of the things that I think the US has an advantage is in terms of sort of resources. So coming back to my work, so they have this center for disease control and that is just incredibly resourced. I mean, they have so many different amazing programs that they're able to do in terms of public health there that we didn't, at least before COVID, quite have the same kind of emphasis and the same kind of backing to be able to do. I'm hoping, I think with COVID and then this really new enhanced profile of public health that actually we will be better resourced to be able to undertake these types of projects and one of the things that, for example stands out to me, is genomics, the genomic sequencing program. And I think some of those things like genomic sequencing, understanding variants and monitoring and tracking those has come to the fore of how useful that is and I think two, three years ago it made us seem very, very niche and very laboratory science but I think we can see how we can use that and the utility of that.

Meaghan Kall (23:28): So I think from the resource side of things, I think what the US-- Well, what the UK benefit has that the US doesn't again, in terms of public health is we have the NHS and what that again gives us and I'm a huge fan. I won't apologize. I will always talk about how amazing the NHS is that it also gives us sort of quite large scale administrative databases that we can use to analyze data at a population level. So again, with COVID, the analysis you've been doing, linking positive cases to their hospital records, to their vaccine status is something that's not possible in the states. All of those databases sit completely separately in the fragmented healthcare systems, private healthcare organizations. There's no national monitoring that's possible. So from that perspective, if I was doing my job over in the states, I think it would be really, really hard and also very, very frustrating at times to not be able to, with such a well-resourced public health system to still not be able to do that kind of analysis. So that's where the US is actually leaning very much on data from the UK and Israel and some of the European countries and east Asian countries to actually inform their policy on vaccines.

Ben Yeoh (24:59): Yeah. I mean, the UK COVID data to my view seems world leading, and to your point, I think the US lacks much of this granularity, which I'm really surprised the CDC hadn't managed to get something together, but like you say, there are structural issues. And I don't also know whether a lot of people know, but the NHS, because of our very unique NHS number gives us a data set and also the numbers because Israel is great, but it's a smaller kind of number set really, which is kind of extraordinary. I was, I don't know whether you might want to touch upon what's really great about the UK data and maybe sort of hopes for the future. I've put in my 2 cents, which is that I think for a lot of this, it's difficult for decision makers, particularly in politics, cause you've always got a kind of a now need. If I spend more money on a diabetic nurse now, I'm going to get immediate diabetic outcomes. Whereas things like infectious diseases, particularly that, it's sort of in-- A decision maker's mind is kind of an insurance type thing. Like, well, I could stockpile 20 million masks, but if I don't need them for 10 years, that particularly in my political cycle might seem a little bit of a waste. I could see that from their point of view. I'm not going to get any credit. It'll be the person who's on another watch who can then benefit from those masks.

Ben Yeoh (26:20): So some sort of institutional framework or organization, which can pivot and react very quickly and gather that kind of almost just in time in a way that PH&E have done over this time, but being prepared so that you don't have to necessarily have huge stack piles, but you can react very quickly because also we don't know in what form it would take, maybe whatever form it will happen, masks aren't going to be your thing. It's going to be some other thing, whatever it is that you want. But I guess circling back is maybe a couple points about what's really great about the UK data and what you'd hope for what we could do in the future.

Meaghan Kall (27:03): Yeah. I mean, I think one of the-- So as you mentioned PHE has sort of changed and parts have been split up and the pit that I work on looking at infectious disease is part of the UK health security agency. So there's two points I think to make. One is that the health security agency, one of the key aims of that is to build in a workforce that is very reflexive and able to respond to emergencies. And I mean, I would say data needs, but you know, this is sort of to inform policy very, very quickly and again, that's a capacity that's built up really well over the course of COVID and that within this health security agency is aiming to retain that ability. So as you say, if there's quite a rapid need for modeling data or just sort of surveillance data or outcomes data on anything that perhaps comes up that the health security agency then is able and resource and staff to be able to provide that. I think the flip side of that, as you say, so there's the immediate need which I think in the UK we have as we've got these amazing data sets, we actually-- it's more of an operational challenge in terms of getting data linkage and permissions to be able to bring all these data sets that we have together because they're owned by different organizations. And I mean there actually is quite important data protection that we have to follow and patient safety and patient privacy laws that we do have to follow.

Meaghan Kall (28:59): So that can take two or three years, again, pre COVID to get to two databases to link up and talk to one another. So I think the health security agency is meant to have a framework. We're able to make sure that everything is talking to each other so we can do these analysis rapidly in a secure and safe environment. So that's that. The other point that--

Ben Yeoh (29:21): Wow, two or three years. That just kind of blows my mind and I kind of think this cause there is, I think sort of rightly so the public's kind of worried about their data, but on the other hand, essentially we give it to Twitter, Facebook, Google not only for free, like the opposite and we don't give it to sort of health authorities who could really save people's lives with it. And it really frustrates me that I think, you know, but essentially cause I think we can trust the NHS and I think we can trust the NHS with our data and we would do so much better for it and cause you've got to trust NHS more than Facebook and you've given it to Facebook, Google, Amazon and all of that and what is that letting them do, sell you more cat memes, if that's what you were into as opposed to directing your population health. They're giving you ideas about where you are. So that frustrates me and this is the kind of the public imaging education bit, because I think if people really, really knew, I'm hoping that they would be more like, Oh no, you know what? This is a really good thing, I would give my credit card and all of that data because I really see that there could be a huge benefit with that and particularly in the UK.

Ben Yeoh (30:37): Anyway, I stopped you there from your second point, but just that's--

[…]

Ben Yeoh (30:42): I thought it could be more. I thought it could be a challenge, but two or three years of multi-agency just seems like that. And I think, we've got very high data protections and I was going to ask a little bit about day in a life and things like that. We've got freedom of information and all of this as well and if you compare it to what you have in other things, it's just-- Again, we've just put the emphasis, in my view, slightly wrongly about how we could do that.

Meaghan Kall (31:12): Yeah. Like I say, some of these private companies like Google and Facebook have just trillions of data points that they get to fit in. But I mean, I don't want to undermine, it's actually a very, very important step that we do carefully consider data release and who gets access to data and that is very, very carefully managed, I think because there is an element to public trust and we need to make sure that people can opt out if they need to and we have, in this country, very few who actually take that option. That is possible but I would say that--

Ben Yeoh (31:49): But our safeguards are really strong. That's the kind of--

Meaghan Kall (31:53): And they need to be there, but there is also a bureaucratic element there that just take it's paperwork and it's red tape and it takes a long time and it's almost just the human resource required to get something through to be able to, you know, like I say, link two databases across or get a memorandum of understanding you can pull some data, an extractive data and link that up. And some of these databases are very, very sensitive of course. And so that is something that I think could be improved massively. I hope it will be now and it actually has even over the past 10 years. A lot of the cross working has been very good, so that's positive. Yeah.

Ben Yeoh (32:39): Great. Okay. So we're going to go more into the epidemiology section and all of the COVID stuff, but I thought maybe it'd be good to have an understand of-- What do you think people most misunderstand about being an epidemiologist or maybe you can get a glimpse into sort of a day in a life of Meaghan. I mean, I got an impression there's spreadsheets, maybe there's paperwork, like freedom of information, they're speaking. You do this kind of comms role but I guess a few years ago, people […] oh, what do they do? Are they tracking stats and things? So I don't know, maybe what's misunderstood about what you can or can't do, or a glimpse into your kind of day in the life.

Meaghan Kall (33:18): Well, I mean for me, when I used to tell people that I was an epidemiologist, they thought I studied skin or armadillos. I mean, there was almost zero recognition of what that term was. And so, wow, that has really changed over the past two years. Now, pretty much everybody knows what an epidemiologist is but breaking it down to its basic points, it's people who study a disease in a population. And I think what maybe people don't realize is there's lots of different types of epidemiologists. So there are infectious disease epidemiologists, which is where I work, but there's also, as I said, there's social epidemiologists that look at the impact of social factors and social determinants of health on outcomes of people. There are psychological epidemiologists that look at say-- they might look at anxiety, depression, and mental health issues. They might look at things like suicide and look at the demographics around that. There's people who will look at substance abuse, alcohol and smoking. I mean, the actual profession of epidemiology is actually really, really broad and covers almost any area that might affect health. So I think that's one thing that I think is important to highlight, these other roles in epidemiology that are being done that aren't just looking at an infection. But yeah, I think the actual day to day, it is quite-- I mean, I'm a government epidemiologist and there's epidemiologists who work in lots of different sectors, including academic and the commercial sector and things like that.

Meaghan Kall (35:11): In the government sector we're asked to do quite a lot around surveillance. So the routine monitoring of particular infections understanding the demographics, the factors, risk factors for acquiring these infections looking at the outcomes of people with the infections. Also looking at prevention measures and evaluating those. And so for HIV that could be looking at a pre-exposure prophylaxis, that could be looking at condom use. For flu and COVID, that's looking at vaccines. So these preventative measures. So it's quite broad in how we're understanding how disease impacts the population. And so, we do analysis to inform policy. We do some of them as more in depth analysis to better understand factors associated with these diseases. We do a lot of interworking with other government agencies depending on what the topic is to engage with COVID in particular. We're doing a lot of working together with policy makers and ministers because so many of these decisions are very high profile at the moment and being made at the top levels of government and are changing so rapidly. And then, yeah, we also do day to day response to freedom of information requests and parliamentary questions and things like that. And just to say all those freedom of information requests that come in, they get dealt with just as in the same level of scrutiny that would be if a member of parliament asked it.

Meaghan Kall (36:50): So we have a certain statutory duty to respond to all of those with the best information that we can. So it's quite a mixed bag, lots of different things that we deal with on a day to day basis. Oh, also there's quite a lot at the moment dealing with sort of individual management of certain settings or certain outbreaks and things like that. So there's actually quite a lot of instant meetings where we deal with and look at the epidemiology of what's happening--

Ben Yeoh (37:16): In the local areas.

Meaghan Kall (37:17): --At Local level. Exactly.

Ben Yeoh (37:18): On a particular population. Wow. Keeps you really, really busy. And so I guess we've had a lot of these kinds of armchair epidemiologists that we said and actually it's interesting. Some with the computational mass background have shown quite a good sort of short to medium, some accuracy with some of their modeling actually using kind of the stats and the mass. Others have actually been kind of quite off base and I think this is interesting for how we started off this conversation with some of the myths, because I'm always very interested about whether we think we have a biological or scientific mechanism behind something. I always thought to start with a theory and then check the data rather than just mind through the data and come up with things. And then on the other hand, some scientists have been quite protective of what's perceived to be their own sort of relatively narrow domains. A lot of social scientists will say economic thinkers and things have stressed a lot of work around kind of this thinking around so-called expected value and interdisciplinary thinking and it all comes out to be sometimes quite argumentative, well, particularly on social media. I'm just wondering how best we should think of this and is there any learning kind of you've surmised on all of this area?

Meaghan Kall (38:34): I mean, I think I'd like to start with a positive that's come out of all this and I think one of the most amazing things of having so much resource and energy on a single infection, on a single disease has meant that we've been able to draw resources from probably the most unlikely areas that you may not expect. So, like you say, we've got people who normally work as actuaries, people who work in forecast modeling for insurance companies, people who work in-- I mean, just so many different sectors, actually all looking at the same problem. And even when it comes even down to people who are very good at like data visualization, they're getting in the mix and it's actually maybe me and my small team at PHE who work on some of epi may not have the resources to be able to do all that. So I actually love going on Twitter and other places and seeing what other people can do with the data when it's done in a robust and sort of an independent sort of way, just really as a research question, they're trying to answer and I've just been a really big fan of open access to data and putting APIs, for example, on the dashboard and letting people draw down the data and play with it and do these amazing analyses. I mean, I'll be quite honest, some of the analyses that show up on Twitter and in the broad sheets make it into some of our incident management meetings where we're using, because it helps us to visualize and it helps to communicate that to the stakeholders that we're talking to. So I think that's been amazing. I think I'll really miss that when things die down and people go back to their day jobs and then we're not able to draw from that resource.

Meaghan Kall (40:34): So I think that's amazing. I think, as you say, then the converse is that there are people also out there who maybe don't have such a robust approach to the data. They may have an agenda or something. Confirmation bias is a huge thing I think, and people have something that they want to say. People can usually change and manipulate the data to make it say whatever they want it to say and that's the unfortunate side of things is that there's no accountability and there's no responsibility for people drawing any manner of conclusions from the data. And sometimes it does make me want to tear my hair out thinking, oh my God, that's not what it says. But somebody with a high profile will say it and then it becomes the gospel. So again, that kind of comes back to what I said before about constantly having to counter misinformation out there and it's a difficult thing. I mean, it's a difficult thing, even UK HSA, to do that. We're a government body and so sometimes there's already kind of a base skepticism about what we're saying, if we're trying to manipulate, but that's-- I mean, in this country, that's not the case of what we're trying to do. So yeah, I think it's a bit of a mixed bag.

Ben Yeoh (41:55): Yeah. That's fair. That's sort of my impression too. Oh, one bit I am interested in, I guess we can follow the science to a certain degree, but there have to be social political decisions made by politicians at some point. I guess there's been a lot of talk by some areas of I guess, economists about what they would call expected value hasn't necessarily been taken into account. So, one example would be speed in some countries. So it doesn't even necessarily be the UK thing, but for instance, speed to approval of a vaccine or you could talk about boosters and things, just the delay in decisions. So where you're talking even a few weeks or a few months, when they translate that into statistical lives, they're going, well, this statistical life would be really, really saved. And what makes me perhaps a little bit unhopeful is when you broaden that out to sort of a global stage. So you're talking about global stats, but you could see for X billion investments, so quite large numbers, like a hundred billion, but very doable for nation states to do this, you would get potentially trillions in reward because we did invest in say vaccine infrastructure in Africa, and suddenly those life saves are there. And that there seems to be no kind of what they would call an expected value calculation on that that would just be quicker and spend more money.

Ben Yeoh (43:24): And from their point of view, it's sort of win-win because you're saving lives, which is also helping everything on the economic front and that sort of thinking, I think has felt very frustrated by, and some of it, I think you've mentioned there's a kind of a bureaucratic hurdle, obviously there's different stakeholders with different things. But I've still been surprised that there couldn't have been and there still isn't a quicker expected value. I mean, thinking about it on the global stage, if I was a benign dictator, I could definitely siphon off seemingly 200 billion and get trillions of outcomes, which would be a great reward seemingly on that, but obviously we're not set up to do that. Do you think we haven't paid or in general we're not thinking enough about expected value and is there anything we can do on that or do you think it's more of a, I don't know, if there's any other things we need to sort of consider in that type of thinking?

Meaghan Kall (44:21): Well, I mean, I think it's a really interesting area of thought at the moment in terms of where's best to invest, I think. I think a lot of countries, particularly developed countries are in the thinking that let's sort our patch out first and then we'll be better able to help others who have less resources basically. However, the risk there, as you say, is that the time that you spent sorting your own part, sort of putting your mask on first, like on the airplane is kind of that sort of analogy, so put your mask on first before you can help others, is that you lose time and you lose lives and you lose sometimes also momentum particularly around vax. Like we'll say vaccine rollout is kind of one of the key areas for this and me, my own personal worry is that what may happen is that all the high-income countries sort themselves out so to speak and then okay COVID is over for us, it's endemic and we're fine now. And then it comes out of the news media, it starts dropping down the agenda and down the priority list and perhaps there's just less momentum and less sort of drive to continue pouring resources into helping other countries with their vaccine supply and rollout. And I think the problem with that is that, especially with COVID yes, my belief, it will become endemic everywhere, but we have variants that are constantly posing problems and could in future pose problems as vaccine efficacy and in severity of outcomes. And I think sort of, none of the countries are going to be fine until all of the countries in the world are fine, unless we close borders everywhere, which is never going to happen.

 

Meaghan Kall (46:42): So there's going to constantly be this movement. We don't live in a vacuum and we don't live like in isolation from one another. So I think there is an incentive even for the UK to make sure that other countries are in order to be able to move on from where we are right now. But to an extent, I also have sympathy with policymakers because we can produce the data from within PHE, from UK HSA and give really compelling evidence for why a policy is needed, but it's then the government minister's job to actually consider all the other pieces that will be affected by that, which include economic impacts and others. So I don't envy that position because there's a lot of different factors that need to be weighed up when making these decisions and that's what politicians are for, that's their job is to weigh all these cost benefits up and make a decision on the balance of that. But I think, yeah, it can feel kind of frustrating if you feel something should be happening in your patch and it's not.

Ben Yeoh (47:59): Yeah, I saw that particularly with say the regulators, which again, I have quite a lot of sympathy because it's quite complicated and I can see individual nation states needing to take a view in different populations and different actually we can get on to this, that countries data because of their populations, the way they do their data often really not comparable, which is probably one of the other things which kind of annoys me when people look at their status. Like, well, do you actually know when you go and look into it, it's just a completely different number, but I did feel with everything like, you know, particularly with Europe versus UK, or even to some extent Japan and then the US, you're talking about clever scientists with other clever scientists. There should have been better, I guess, regulatory arbitrage, where if a decent amount of consensus scientists are saying, look, this is safe and effective for us. It's kind of going to be obviously safe and effective for most of these other populations given what we know in those months delays we're very costly. And I know there's all these other stakeholders in the round, and there's a kind of this behavioral agency problem, because you take the blame for when things go wrong, but you hardly get the credit. If you've done something three months quicker, no one goes, ooh, the expected value of that was millions of life saves, well done. It's like, oh my God, you had a one in a billion side-effects, which was dramatic. So I can see that, but it was really frustrating.

Ben Yeoh (49:28): In fact, you can see this now that it seems obvious if this bunch of scientists are saying it, and that's where consensus is, it's got to be true in these other countries, but that's where it is. So, [we are] not really talking about anything official or official policy, but I was wondering when you're speaking to friends or family and they ask you advice about COVID what do you say to them and maybe people who are being a little bit vaccine hesitant? Maybe because there'd been an underserved community or they've had some misinformation. Do you have any overall advice about COVID or vaccine hesitant people?

Meaghan Kall (50:08): I mean, I think the way I've been talking about COVID has definitely evolved over the time that it's been around, I think. Actually at the very start I was thinking, oh, it's just like-- I'm talking about early, early first couple of months though, oh, maybe it's another flu or like a bird flu and then I think as we get more information about what coronavirus was and how it was affecting populations and how severe it could be in terms of outcomes, but also sort of long COVID and things like this, yeah, I think then my advice would adapt and I think now we're in a vaccine era and I think I could maybe call it post vaccine. Are we there? I think nearly especially for adults. I think it's adapted again. So my current advice for people is that I believe that coronavirus will become a globally endemic infection. I think that a great deal of the poor outcomes we're seeing down to COVID is because people are immune naive, have been immune naive and have lacked any kind of immune response. And so it's a completely foreign pathogen and then the body reacts. I think, in the presence of some immunity, whether ideally through vaccines, but even if you've been infected before, that gives you immunity, then your chance of having poor outcomes is just much, much, many, many times lower. Although as I said before, it can happen, but I think then again we're looking at a particular risk and it's not really something you would see in a younger and otherwise healthy population.

Meaghan Kall (52:00): So to that end, I think there will come a time when we have to live with it and we have to get on and we can't continue having a myopic focus on a single disease for much longer because other diseases, other conditions, other health problems, other economic problems are also in the mix and need attention as well. So my current advice, I say, if you can avoid crowded indoor areas and wear a mask indoors, I think that's your best you know, your safest way of doing it. It's an intervention that takes almost very little effort, a mask basically and could be quite impactful, I think particularly if you are infected and you don't know it. But other than that, I think we're not going to see the end of coronavirus, I don't think in our lifetime. And I think probably a lot of people are going to be infected more than one time, but going forward, I think the severity will reduce. There's also so much we don't know yet and I think we still need to continue maybe in the background, maybe not at the forefront of the headline news every day, but we need to continue monitoring things vaccine waning and long-term vaccine effectiveness. We need to continue monitoring things like variants and how those impact on changes to the virus and we need to continue pushing vaccination in these hesitant populations to ensure everybody's is protected as they can. So I think there's still a lot of work in the background.

Meaghan Kall (53:52): To your second question though, about vaccine hesitancy, to me, I have had people in my life who've come to me for advice on the vaccines and whether it's like you say, some particularly marginalized populations who have very little trust in the health system, it could also be pregnant women who are just concerned about the impact on their unborn child. It could just be people who've had misinformation. I think for me, kindness and patience is always the best way forward. I think combating people, making them feel silly and making them feel as if they're a mug for believing something or not understanding is the absolute worst tactic to take. I think giving people time and patience and the correct information, signposting them and also maybe not expecting people to change overnight or change their minds in a heartbeat because people have a lot of really deeply felt beliefs and a lot of deeply felt fears and those don't just change overnight. So, yeah, I think it's so important not to see vaccine hesitant people as some sort of enemy or some people who are doing something to the rest of us to harm us. I think these are people who most of whom, many of whom have genuine fears that really need to be worked through and need to be assuage before they'll feel comfortable. So I think that's my opinion. I think also countering the just general population of misinformation is just going to be so important because unfortunately there seems to be a bit of a wave at the moment of anti-vaccine sort of protests and movement that's gaining a bit of ground at the moment, which I think is really unfortunate. And for that, I think we need higher government level messaging that needs to come in to combat that.

Ben Yeoh (55:56): Yeah, that makes a lot of sense. Well, I'm just going to pick up on two or three things you'd said there. I don't know if we'd be able to cover them briefly, but one was I guess the endemic state, second was on sort of long COVID and the third one was on vaccine waning. I guess on the endemic state, I was listening to a pharmaceutical company recently and they were essentially saying that the end game for COVID in post vaccine sort of world, which some nation states are probably in, was sort of an endemic disease, sort of normalizing low friction interventions, crowded place with masks. Why not? Doesn't really cost you anything, but for everything else, if you're double vax or some people might need boosters and things like this that you should really be thinking of beginning to be a sort of a more normalized state living of its endemic disease and that wild mutations were also very likely. They also said that to your point, if we keep up with the surveillance and everything, that the technology should be able to match whatever we see on the mutation side. So obviously this kind of [Inaudible:00:57:02] away, but your base case would be that you would cope with it. And then that becomes another endemic disease. I mean, it's not quite likely, but that's what most people would kind of think about. Would that be a sort of reasonable base case and thinking about the end state here?

Meaghan Kall (57:21): Yeah and I think it's just something to clarify, I don't think anybody thinks that the disease of course, COVID is like the flu. What we're saying is how we manage it will be like the flu, I think. So thinking about it from that perspective where yes, we have a potentially deadly virus circulating in this population is actually quite scary, but we've had that with flu for hundreds of years and for several decades we've had flu vaccines. So I think we manage that through surveillance, like you say. So we constantly monitor the number of infections and particularly in populations like in hospitals and young people, for example, and we also monitor and we will be monitoring much more closely variants so that we can adjust and tweak the formulations of vaccines if, and when that becomes necessary. So if we're able to do that, then what we're also able to do is interventions like preventive interventions. Like the vaccination campaigns, that's an intervention. That's a huge, huge intervention for us and again, we use that for the flu. Every winter we come through with a vaccination campaign and we target vaccines and the people who are at most at risk. Normally it's very young children, very elderly, healthcare workers, for example, carers. So I would always have my vaccine. And so we have these vaccination campaigns, that's a huge intervention. And then some of the non-pharmaceutical interventions as well, if those stay up to a certain extent will make all the more benefit in terms of preventing the spread and preventing impact of illness basically that we might see.

Meaghan Kall (59:17): So this is where I think all this background work needs to continue to be able to see, okay, well, will coronavirus become more of a seasonal virus? At the moment we're not seeing that at all, but it could become that way once it becomes more endemic. So we need to continue to watch the patterns, looking at waning cause again, we don't have a really good concept of what that means in an endemic state. What it would normally mean is that a of certain amount of people immunities are sort of reducing and people are coming into the susceptible pool at a certain rate, then people are being vaccinated coming out of the susceptible pool in a certain rate and where that sort of levels off in terms of the numbers of infections that we're seeing is a big question mark. We don't really know and then I think the third point is really variants. And I think it's really important to note actually that when you have a new virus, actually from an evolutionary perspective after a few years, it tends to kind of settle down. So you don't really have massive divergence in terms of variants and different strains coming out after a certain point. So I think the hope is that the same will hold for coronavirus. We're seeing alpha strain, delta strain and lots of unique strains coming out. We're hoping that actually after a few years, that will settle down in and of itself and you might see different strains merging slightly like you do with flu, but not to the same level where it could completely evade a vaccine, for example.

Meaghan Kall (01:01:01): We're very, very fortunate with our vaccines. We have incredible vaccines that we think so far look like it would take an awful lot of mutations to completely evade a vaccine. And again, that's different to the flu. So it would not take a big change in a flu virus to evade a vaccine. Coronavirus looks to be behaving quite differently. So we think we're quite hopeful, we're optimistic, but there's a ton of things we need to keep monitoring very closely for at least another couple of years, I think.

Ben Yeoh (01:01:32): Yeah, I think from what I can see as well, that's one of the differences within the flu. Like flu often you'd have to adjust. This one looks like we won't have to and then even if it does come with our surveillance, it's very likely we'd be able to adjust on time. I guess a lot of people are thinking about long COVID as well and I guess a lot of it-- obviously it's impacting adults, but a lot of the queries around the risk in children it seems my reading of the data particularly I put some weight on this ONS study is suggesting that the risk is pretty low, there's difficulties because it's not very well-defined. We know what it is and everything and that, but it does look-- given that a lot of children are unvaccinated so that's why it's sort of come up as a thing. Do you have a view on what you're seeing in the data and whether it is true to say that long COVID risk in children is lower and then I guess we can also speak to-- It is obviously an issue in adults and we see post virals syndromes quite often in type of infectious diseases. So it's not surprising and actually that's been an understudied area in general for all sorts of post viral infectious diseases of which we're hoping I guess we're going to see more research in that, but yeah, any views on long COVID risk in children and any thoughts on long COVID in general?

Meaghan Kall (01:02:51): Well, I think, like you say, the post viral syndrome, which we do see in other infections has been really poorly understood, like you say. So I think one thing that's really good is that there's a lot of effort and a lot of resources now going into trying to characterize this and understand what's happening when these things happen. Again, not just for COVID, but other infections. So I'm hoping actually that will help us to understand some of these disease areas that actually previously have been very kind of fuzzy and ill-defined and have been very difficult to diagnose and don't really have specific diagnostic criteria and then that means it's difficult to treat them and understand how to treat them. So I think, again, that's just a positive with this awareness of long COVID and emphasis and the numbers who are affected due to the sheer scale, I think that hopefully we will come sooner rather than later to some much better understanding of what's causing that. At the moment, it looks like a multi-system sort of inflammatory reaction that's happening that's causing a long-term effect. I have to say long COVID isn't my area that I work on very in depth, but the evidence that I've seen so far has indicated that long COVID is quite less common in children compared to adults. And I think our quite rational explanation for that is children are much more likely to either be asymptomatic or have very mild symptoms and I think there probably is some correlation with how severe your illness is and how bad it hits you and causes an immune response to then how likely you are to experience a long COVID reaction.

Meaghan Kall (01:04:43): So I think that's good news because I think that children are largely protected from this additional sequelae but of course no parents want their child to have long COVID or even have a severe reaction to COVID. I think when it comes to kids, we actually have to be even a bit more sensitive and even more vigilant, I think, because it's really important to protect our children as much as we possibly can. So I think even if there's-- I think it's important that we continue to do research in this area so that we can really characterize this and really understand if there are particular risk groups. Are there any risk factors that we can look out for to try and help protect our kids even more? I think even with a rare condition, I think that's really important. To do

Ben Yeoh (01:05:39): Yeah. That makes a lot of sense. And I don't remember the details, but I have seen a couple of plausible biological mechanisms for why this should be. Like you say, if there's an inflammatory mechanism and children in general are not getting as inflamed because their reactions are [smaller], it would make sense. And so maybe then on the vaccine waning question, I guess here again, we don't actually have that much data. The UK has some, Israel has some. Very difficult, I think, to compare, although a lot of people have been trying to do these comparisons. I think there was a PHE study on vaccine waning as well. So you probably might be a little bit more knowledgeable about this. Do you have any thoughts on vaccine waning? And I guess people are thinking, well, you know, boosters, but that's not such an issue as well. So yeah, any thoughts on vaccine waning?

Meaghan Kall (01:06:34): Yeah, I mean, I think when it comes to understanding the extent of waning in my view, you need real life data, and that's as opposed to sort of laboratory data. So measuring antibody responses and T-cell responses in a lab setting can give you this first early indication of what might be happening but I think ultimately we need to know on a population level, we need information on infections and re-infection and information in the context of vaccines to really understand the extent of waning because immune waning again, you'll have vaccine immunity, but you also have what we would call the natural immunity or infection induced immunity. So both of those types of immunity play in, they can boost each other. I think they're additive. And so I think there's quite a lot to unpick. What we're seeing so far is that when we look at population data and from this PHE report, we see not surprising results. I mean, it's showing us that you have a greater level of vaccine waning as you get older. So especially amongst the oldest age groups, 80 plus you see higher rates of vaccine waning over six months. Also, in immunosuppressed populations and clinically extremely vulnerable. So people who may have underlying health conditions have higher rates of vaccine waning. This is not surprising. This is exactly how and why we do annual boosters. Well, we're doing boosters now, but I'm even thinking about the flu. So we have targeted populations who just need that extra boost of immunity on an annual basis.

Meaghan Kall (01:08:30): Again, the frequency could vary, but in flu, for example, we do an annual booster that we bring people forward, the people who are most likely to need that boost of immunity to need that additional protection that they get offered that, and then it just mitigates the impact in those high risk groups who are most likely to be hospitalized, which adds to the NHS pressure and sadly die. So that's exactly how a targeted booster program would work going in the future and I think the evidence we're looking at now is probably pointing to that. However, I think the jury is still out in terms of the duration of time it really takes to see meaningful immunity loss and it could be as well, we're still so early on-- We've kind of pinned our hopes to these two dose vaccines and even with Johnson Johnson, it's one dose, but there may be the need to make it a three dose regimen, for example, or adjust the dosing interval schedule. And rather than having it be an annual dose, maybe you actually just need three doses and after that point, your immunity will stick around for a lot longer. These are the questions that we need to answer and we need more time and more data to answer that. So I think it's great that the booster program is happening now because that will help us to understand these factors. But I think the jury is still out in terms of what that will look like going into the future.

Ben Yeoh (01:10:07): Yeah. That seems really fair. I think it's completely plausible that you have three shots and you're sort of what we'd call the T-cells, your immune system essentially remembers that as it does for some other things like chickenpox and things. You can remember it for a long time. What level that reaches, we don't know. So a friend of mine asked who was very interested in that global vaccine equity question that we raised earlier, should they take the third shot as a booster? And my advice was, well, you can't do anything on a systems level. You can't do anything about Africa, but you can do something locally about yourself if you're on one of these populations, which would benefit. I said my recommendation is I think you should take the booster because it's going to help you and we can't do anything on the systems level. This is a sort of political thing. Would you agree with that advice or have any other thoughts on that?

Meaghan Kall (01:11:01): Yeah, absolutely. I mean, I think there are two really important issues. One is that the global vaccine supply and the other is the individual level of the offer that's happening to you when you get a text that says come for a booster. By the time you get that text, the dose is sitting in a fridge somewhere near you. So the acquisition supply is already there and if you don't take it up, then it will probably go to waste is the question. There is some work to share leftover vaccines and things, but there are expiring dates. It's a tricky situation and I think ultimately when you've got a vaccine sitting in a fridge, I'd rather have it in somebody's arm than just sitting there with an unknown destination. So the way that the program is working is still looking at these priority groups, if you're falling in the priority group and you get invited, I think you should go get that vaccine, definitely. Even if you think you might be fine, I think every little helps in terms of getting these vaccines and these boosters and the immune response for you. The work-around vaccine supply, that is very much more structural, that is much more needs government engagement and planning. And cross international working that absolutely needs to be at the 400%, because there's a limited supply. So that absolutely needs to play into these discussions, but on an individual level, I think that decision has to be a yes, go get your vaccine.

Ben Yeoh (01:12:45): Great. And then the last question on the data side, which would be-- So I mentioned this earlier, one thing I've learned on data when I've looked at country by country comparison, particularly when I try to look at some health care data, was that in reality, the data were not comparable. They were just too many different assumptions or how the data was collected and things and you often see it-- When you sit in papers, it's kind of one line. Sometimes there's a footnote saying, well, we can't really make these comparisons and then we go ahead and make them anyway cause it's the best that we've got, but in actually such a high profile area, I feel this is kind of misled, well, has been very misleading because you really have said apples and oranges and pears comparisons, and then try to draw some conclusions and really you can't. So I don't know whether you feel this is-- have I overstated the case or what have you learned from country to country comparable data and then everything which has happened there.

Meaghan Kall (01:13:44): That actually would have been a good answer for that very first question you asked me about what's the most annoying thing. That could have been it, because again, I have actually the very first and it was on Facebook, but the first sort of long post, I guess, into the world that I made about coronavirus was for people to please stop making comparisons between different countries. And I think when you're working on the data, you can see how nitty-gritty it is but even a simple definition difference can make two countries completely different in terms of comparisons. You've got population denominator issues, you've got vaccine issues, you've got healthcare issues, you've got population demographic issues. There's so many things that can affect the comparability. I can see why people want to do it but it's not a league table. Setting countries out like a league table, I think can be very, very misleading and very, very actually quite harmful and I don't think it's a very helpful thing to do. So yeah, I find that very tricky, I think. To an extent it helps to inform people understanding what's happening in a context, and in some places you can see that there is no healthcare system and there is no testing, you can see what's happening there. But yeah, I struggle. I've been banging this drum for a very long time. Please stop making international comparisons because they're just not valid. They're just not valid.

Ben Yeoh (01:15:34): Okay. That's fair and then, is there anything else on COVID you'd like to say.

Meaghan Kall (01:15:41): Oh, I don't know.

Ben Yeoh (01:15:43): We covered most of the important kind of-- I'm not dwelling too much on the past, but kind of like you say, because things have changed about where we are now. I don't know if there's anything else you'd want to add. There might not be anything.

Meaghan Kall (01:15:55): Well, I think as sort of a parting thought and it's looking into the future, I think, but what I'm a little bit worried about is when everything quote, unquote goes back to normal that we will lose a lot of the momentum that we've gained so far and a couple areas I think are really important are as you say, the global vaccine program. I'm worried that that could fall by the wayside and get deprioritized really, really quickly by high-income countries. And so I really just encourage governments to keep going with that. I think that's really, really crucial, COVAX and other vaccine sharing programs really need to keep going and that's from a global health security perspective. The other thing I think that's really, really important is concentrating on inequalities and disparities in health outcomes. And I think there has been some attention brought on that with COVID, but I think we need to do so much more to address these underlying inequalities the drivers behind poor access to healthcare and keep pushing on with interventions and information programs and other sorts of programs that can help reduce disparities in health outcomes and continue funding NHS and other health programs and social care programs that will allow these disparities and these gaps in health outcomes to be narrowed. So I think it would be a really shame to get through the whole COVID and then forget all of the things that we've learned about that. I think we really keep focusing on those.

Ben Yeoh (01:17:51): I agree. I felt we did a little bit when the swine flu hit. We didn't really take the lesson from that. So, the final question. What advice might you have to maybe particularly to young people today that might cover having gone into kind of stem and science, or it might be sort of more of an outlook about what you've learned through life or moving or anything? If there's anything you'd like to say as advice and life thoughts from Meaghan?

Meaghan Kall (01:18:17): Oh gosh, that sounds very, well, not say patriarch. I don't want to patronize people because I think everybody has their own sort of journey that they need to go through. I think just from a career perspective, I think we do live in a world where instant gratification is something that we desire, but I think patience and don't expect everything to come together in terms of your career and your life aspirations overnight. I think you need to work. You need to be patient. You need to keep your head down and graft. You need to do some work that actually you believe in, that you think is important because if you don't think it's important you'll be super demotivated and nobody will be onside with you. You'll find it difficult to gain any traction with anybody else, because when you do something you don't enjoy, it's so obvious. So I think you need to find that sweet spot of something that you do really enjoy and that you're good at and if you can't find that right away, you can try moving around and try different types of careers and jobs and areas and topics and I think I'm a really big fan of mentorship. And actually, if you can find somebody who you look up to in a topic area, whether it's even on Twitter or you get their email address from somewhere, you see a presentation somewhere, reach out to them and I think you can gain a lot from getting some mentorship from people who've been there before and who can probably save you quite a lot of time and energy and pain imparting their wisdom to you that they had to learn themselves. And then it can help you to understand and help you to plan and really see what's important to you, I think, in terms of your own trajectory and your own path.

Ben Yeoh (01:20:14): That sounds great. So work hard and graft, do something that you believe in and find a mentor. Excellent. Okay. So Meaghan, thank you so much for talking to me. I learned an awful lot and thank you once again for the great public service that you and your team are doing.

Meaghan Kall (01:20:31): Thank you so much for having me, Ben. It was a lot of fun. Really enjoyed it.

Ben Yeoh (01:20:35): Bye.

Meaghan Kall (01:20:36): Bye.

Ben Yeoh (01:20:37): If you appreciate the show, please like and subscribe as it helps others find the podcast.