Dr. Peter Hotez on COVID-19 Vaccine

Dr. Peter Hotez

[ Music ]

Marianne O’Hare : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthca re of the future.

This week Mark and Margaret speak with Dr. Peter Hotez, vaccine
scientist, pediatrician and founding dean of the National School of
Tropical Medicine at Baylor College of Medicine in Texas . Dr. Hotez
addresses the deadly consequences of a lack of a national public
health strategy to tackle COVID - 19 in the US, the rapid acceleration of
vaccine discovery for this particular Coronavirus strain, and the threat
of vaccine hesitancy and distribution timeline moving forward.

Lori Robertson also checks in, the Managing Editor of F act C heck.org
looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
that's improving health and well being in everyday lives.

If you have co mments, please e - mail us at [email protected] or find
us on Facebook , Twitter , or wherever you listen to podcast. You can
also hear us by asking Alexa to play the program . Now stay tuned for
our interview with Dr. Peter Hotez here on Conversations on Health
Care.

[ Music ]

Mark Masselli: We are speaking today with Dr. Peter Hotez, founding dean of the
National School of Tropical Medicine and Professor of Pediatrics at
the Baylor College of Medicine. He's the D irector of the Texas
Children's Hospital Center for vaccine development. He served as US
Science Envoy to the Middle East in North Africa under President
Obama and was President of the Sabin Vaccine Institute.

Margaret Flinter: Dr. Hotez is author of more than 400 published papers and several
books including the newly released Preventing the Next Pandemic :
Vaccine Diplomacy in a Time of Anti - science, and Vaccines Did Not
Cause Rachel's Autism . Dr. Hotez is a member of the National
Academy of Medicine, the National Institute of Health Council of
Councils , and he's also a fellow of the American Academy of
Pediatrics . Dr. Hotez, we welcome you to Conversations on Health
Care .

Dr. Peter Hotez: Many thanks for having me.

Mark Masselli: Well , thanks so much again , and you know you warned us many
months ago that things could get out of hand in the absence of a

Dr. Peter Hotez

national strategy. While there's been promising news about the
vaccine in recent days, I think it's fair to say your worst projections are
coming to pass infections a nd hospitalizations are skyrocketing, along
with the death toll. As someone who's on the front line of this
pandemic and major hotspot in Texas, I wonder if you can help our
listeners understand what we're facing here in America around the
pandemics trajec tory, as we are heading into Hanukkah Christmas and
the New Year .

Dr. Peter Hotez: Yeah, well, thanks. In this transition time, I had warned that things
could really get out of hand, because even when we had a functioning
White House, there was no real nat ional control program and it was
left to the States. Now it seems like everything is evaporated, we're
just seeing this very steep acceleration, getting 200,000 cases per day.
Remember what that number means, it means it's usually an
underestimate times fo ur or five. So we're upwards to a million cases
a day. This is starting to overwhelm intensive care units across many
parts of the country. That's when the deaths really skyrocket , is when
you start overwhelming health syst ems and piling people into ICU s o n
top of exhausted nurses a nd doctors and hospital staffs. And so in
some ways, it really is a nightmare scenario, some of the worst
affected areas in the world are in the United States and for most of
this fa ll, it's been the North Central US and Texas, b ut now it's
spreading outward.

Now Rhode Island is getting hit very, very hard , and we're hearing
news reports of what's going on in Rhode Island. Indiana's getting hit
very hard , so it's pretty much now going t o be a full - on national
problem. It was kind of confined in the middle mostly red states of
people defiant of mass and social distancing but it looks like it's just all
over the US and we'll hit 300,000 deaths probably next week and
probably 400,000 deaths by the inaugurat ion , which is a terrible
nu mber, the number of American GI s who lost their lives in World
War Two. And, and it' ll keep going for a while until, since without a
national strategy the approach now is to be relying 100% on
biotechnology solutions, meaning vaccines pretty much and that' s
where we're at. So until we can start vaccinating the population this
awful trend will continue. I tried to hold it off. I tried to work with the
White House over the summer to halt this fall surge because I knew
how horrible it would be , I just couldn't get any traction there.

Margaret Flinter: Dr. Hotez, it is o bviously very sobering analysis, it speaks to the
challenges wrought by the lack of a national strategy. Here we are ,
you say we need to brace for some very traumatic days ahead of us ,
but you've also said that there are three things we have to do right
now, to at least try and curtail the outbreak until the vaccine becomes
widely available. So share what are those three things that you think
we just need to do right now to try and at least make a dent in this?

Dr. Peter Hotez

Dr. Peter Hotez: Well, to try to incentivize people, what I like to say is there is a reason
for doing this, if we can keep everybody alive for the next few weeks,
get them to the other side, and get them vaccinated, nobody has to
lose their life , and things will not be back to normal, but it will be in a
much better place in a few months. This is especially tragic to lose the
lives of loved ones during , over this period. The message is one
facemasks of course , and we've heard the President - e lect Biden
recommend 100 day wearing of masks and clearly if we get too close
to 100% mask wearing that can make the difference of whether
300,000 or 400,000 or 500,000 Americans have lost their lives by the
time of the inauguration , so that's really impor tant.

I think the other is implementing aggressive social distancing in areas
where we're starting to see surges in our ICUs are demonstrated by
positivity rates and hospital admissions and other measures . More or
less that's what the governor of Californ ia, Gavin Newsom’s
recommending is he's going to do surgical strikes in areas where there
are these deep surges and I wish other parts of the country would
adopt that. It's not the same as a national control program, but at
least it gives our healthcare pr oviders our heroes a chance to recover
and be able to manage patients to the best they can. Then of course,
continued diagnostic testing is still a cornerstone, I'm not sure how
effective contact tracing is at this point. It's just such a high level of
tra nsmission. These are all stopgap measures, but at least it'll help
limit loss of life to some extent, until we can really roll out
vaccinations in a more substantive way.

Mark Masselli: You know, I want to pull thread a little on vaccine development.
You'v e been involved in that your whole career and it's often very
long and arduous process. But I think you rightly noted that the road
to COVID 19 vaccine has been happening over 17 years since the SARS
outbreak. I wonder if you could talk to our listeners ab out the m ost
recent sprint and the incredible rapid mobilization that's come about
over this last year. But also, what should we keep our eye out in terms
of data? It appears we know about the efficacy of the vaccine, but we
don't know a lot about its effe ctiveness until it gets wider distribution
to the general population. What are you keeping an eye on in terms
of the data to give you some indication about its effectiveness or any
issues that might arise?

Dr. Peter Hotez: Well, you are right. I think, the se vaccines we often, it's pretty much
everything we know about these vaccines , unfortunately it is coming
from company press releases, as I often like to point out . When a CEO
releases a press release from a company it’s not written for you , it’s
not writ ten for me, it's written for the shareholders and sometimes
it's accurate but sometimes it's not. Fortunately, I think the new latest
ones from Pfizer and Moderna are roughly reflective of what the FDA
is actually before them when they're making decisions about

Dr. Peter Hotez

emergency use authorization.

I think, i f you look at the big landscape we'll have four or five
hopefully vaccines by the spring and that's going to be important
because I don't think we're going to be able to vaccinate a significant
percentage of th e US population with just with the two mRNA
vaccines alone . I'm not un certain that the technology is going to be
robust enough, at least this , for this pandemic , it’ll definitely improve
over time but I wouldn't want to rely totally on mRNA vaccines at thi s
point, even if in the early stages they look effective. So what I'm
looking at in the coming months is multiple vaccines, at least the two
mRNA vaccines probably to add no virus base d vaccines from
AstraZeneca Oxford and J&J , maybe a pa rticle of vaccine from
Novavax.

We're accelerating a vaccine now being scaled up across India and
tested, so that's very exciting. It's an older technolog y it is a
recombinant protein approach , they all work more or less by inducing
what are called virus - neutralizing antib odies. That's what our work
over the last 17 years more or less showed, if you can induce high
levels of virus - neutralizing antibody you get spike protein of the virus,
you'll get vaccine protection. So the key i s to for everybody to get
virus - neutralizing antibodies in their system and don't overthink
which vaccine you're going to take, though they all do that. What we
don't know is what the durability of protection is, how long will they
protect, will it be three months, 3 years, 30 years , and also whethe r
the same safety spectrum that we've seen in 30 ,000 40,000 person
clinical trials will continue to hold as we start vaccinating tens of
millions of people. But there is a good saf ety monitoring system in
place.

The hope is, as we move into the early spri ng, we will start vaccinating
a significant percentage of the population . It will keep you out of the
hospital and the ICU and then if enough people get vaccinated in the
country, we estimate now with a group at City University in New York
60 % to 80% of th e US population . P otentially we could achieve
interruption to the transmission as well, which would be fantastic , but
a lot of the stars will have to align. In order to achieve that we will
need to have vaccines that stop asymptomatic transmission and we
d on't know that yet from the performance spectrum of what we've
seen in the phase three trials. Hopefully we'll get an understanding of
that, we'll probably need adolescence and kids vaccinated. In order to
do that we’ll need a communication strategy to man age all the speed
bumps , all the bumps in the road because every day you're going to
be hearing something whether it's Bell's Palsy from the Pfizer vaccine,
or we heard about two allergic reactions in two people in the UK
that's got to be the message that we don't have a robust system of
communication in place to manage that.

Dr. Peter Hotez

We're hearing everything from the pharma CEOs , who more often
bungle the message and then we have to counter the anti vaccine
lobby. So far just no one has shown any appetite for doin g that. So we
still have a lot of work to do to get to that second piece of
interrupting transmission with widespread vaccination.

Margaret Flinter: Well, Dr. Hotez, one of the stars that has to align as you've indicated,
is trying to hold down the tide of vaccine hesitancy. Certainly, you
know that very well as a vaccine scientist , a pediatrician , and I know a
self described autism dad, which led you to perhaps write your book
Vaccines Did Not Cause Rachel's Autism . We have seen this around
measles in part icular but also some other vaccines and yet the entire
world does not have this shared experience in recent memory for
anybody dealing with a pandemic like this . What's your best sense of ,
will this be different , will people be more willing to accept the v accine
against COVID b ecause they've had this lived experience of seeing
such widespread death in their communities and in the country? Is
there a key message for people to be getting now to try and blunt
some of that vaccine hesitancy?

Dr. Peter Hotez: We ll, it depends which day you ask me . There are some days when I
am quite optimistic, we'll be able to overcome it , other days I'm not,
and that really does reflect some nuance of the new cycle. Most of
the surveys that we have are collected data prior to h aving the
efficacy results, knowing that we may have vaccines that are 95%
protective. I think, the numbers showing up to half of Americans will
refuse COVID - 19 vaccines, even if they're made available,. I think that
number will shrink, as the efficacy num bers are confirmed by the FDA,
as we already have done for Pfizer with the emergency use
authorization. As p eople see their colleagues and friends and family
get vaccinated with no untoward effect, I think the acceptance level
will increase.

Working again st us is the fact that there will be these bumps in the
road where we hear about allergic reactions or Bell's Palsy and
without an appropriate level of government scientists communication
to the American people that will be amplified . It will be amplified by
the media and of course amplified by the anti vaccine people. So you
know after what's happened today, I'm less optimistic than I was
yesterday, just on the basis because every adverse reaction that
happens is being put out there without any kind of eff ort to
contextualize it. I do the best I can as a medical school professor
talking on the cable news networks, but I don't have the
accountability. I'm not a government scientist , so that's a problem
and of course we've got this unfiltered, very aggressive anti vaccine
movem ent that dominates the internet. So hard to know how all this
is going to play out.

Dr. Peter Hotez

Mark Masselli: We'r e speaking today with Dr. Peter Hotez, founding dean of the
National School of Tropical Medicine at the Baylor College of
Medicine . Dr . Hotez in your new book, Preventing The Next Pandemic ,
you note that we should already be preparing for the next wave of
deadly pathoge ns that are certainly to emerge. It seems like maybe
every 10 y ears we've had SARS and MERS the n we have COVID - 19.
Some nations have effectively thwarted bad outcomes with the
pandemic largely through effective public health strategies.
Obviously, the United States has not. How do we move beyond this
instructive moment to better prepare policymakers and global health
practi tioners for the next pandemic? Tell us more about your call for
vaccine diplomacy in this time of anti science to address this and
really future challenges?

Dr. Peter Hotez: Yeah, within the US, I think this concept of a Coronavirus Task F orce , if
nothing else, we've learned as a discredited concept . It’s too
politicize d. You can't manage a pandemic or an epidemic out of
Washington DC . I have an article that's been published now in
Microbes and Infection and it basically says it's got to be taken out o f
Was hington. It’s got to move to Atlanta, it's got to be put firmly in
control by the Centers for Disease Control. They're the professional
set up to do that and if there have been lapses this year because they
did miss the entry of the virus from Europe into New York and the
debacle with the testing. There are some instructional issues that
have to be fixed. But that needs to be prioritized and running out of
Atlanta and not Washington . I think that will help quite a bit and really
create a national response a nd stop this nonsense of, h ey, we just
have to let the states be in the lead and with some backup , FEMA
support and supply chain management, that that's a failed strategy .

Globally we have a lot of repairing work to do . The US has pulled out
of the World Health Organization and the COVAX sharing facility for
equity around COVID - 19 vaccines. We have the President's executive
order this week saying it's America First , which has no teeth to it
anyway, because the contracts are already signed by the
multinatio nal companies. We're going to have to fix that because right
now in that gap, you have now the Russians and the Chinese making ,
bypassing usual vaccine governance mechanisms with WHO and
negotiating one on one bilaterally with the country. So it's got this
kind of cold war smell to it, working wit h the Latin American countries
and African countries for influence. So there's a lot of damage that
has to be un done. It's all doable, but we're going to have to be a
different type of country, really taking on con trol of our own epidemic
and providing better leadership globally.

Margaret Flinter: But Dr. Hotez, you introduced me to a new acronym NTDs, for
Neglected Tropical Diseases. It is something that you've put a lot of
very important focus on and seen just so much suffering and harm

Dr. Peter Hotez

come from a variety of preventable illnesses that have impacted some
of the world's most marginalized and vulnerable populations. I know
you have a deep concern for health inequities here in the United
States and certainly during th is pandemic, we've had the concerns
about disproportionate impact , higher death tolls in certain
populations. There are questions of whether some of the most
privileged COVID victims are getting access to better or earlier
treatments, while others may not. What are your thoughts on how we
move forward from here beyond COVID to address these systemic
disparities in health care and outcomes in our own population here at
home?

Dr. Peter Hotez: Well, it 's no secret that the US is one of the leaders in health
dis parities u nfortunately . We have one of the world's most expensive
health systems and yet the one of the worst in terms of inequities and
inefficiencies. So there's that larger structural issue . I think, we
haven't done enough to recognize the impact of COV ID - 19 on lo w -
income neighborhoods, and particularly the essential workers tha t
comprise the Hispanic African - American, Native American
communities, even basic stuff, with guidelines, saying 65 and older
t hat was based on non - Hispanic whites with only 13% w ere under the
age of 65. But it's 35% among the Hispanic community. It's men and
women in their 50s and early 60s . Even simple thin gs that don't cost
as much more, we can fix to save lives, and yet, we just can't seem to
kee p all this on the radar screen.

I testified to the Congressional Hispanic Caucus over the summer and
basically made that statement that we're experiencing historic
deci mation of Hispanic communities. Here in Houston, we get a death
report from the people who've died the day before , the week before
and, every day , it doesn't provide names it provides age, race,
ethnicity, and sex , and it's every day Hispanic, Hispanic, Hispanic,
Hispanic going down the list , and this more or less goes on without
comment. It's not just Houston, it's acros s the southern cities and up
into Chicago and places like that, that have large Hispanic
communities. This is largely unknown. We're going t o have to finally
address this. I know the Biden Ad ministration has appointed someone
to manage racial inequalities on the Coronavirus Task Force , and I
hope that we can elevate that kind of thing to greater importance.

Mark Masselli: We hope so as well , and our thoughts are with all those who've lost
their lives , and certainly, the black indigenous people of color have
been significantly impacted by the U . S . bungling of our response to
the pandemic. But we have to figure out a strategy moving forward
and we will shortly have a new administration , and President Elect
Biden has set some ambitious goal s. You men tioned 100 days of
wearing mask and also this effort to vaccinate 50 million Americans in
his first 100 days that's given that two are needed for each individual.

Dr. Peter Hotez

I guess I ask the question, is this possible? I ask that in part because
the current administration hasn 't developed a delivery system, the
supply chains in disarray. Everything has been left, as you said earlier
to 50 states. It's terrible strategy. What keeps you up at night, to get
all people in America vaccinated , to really implement this very
important goal that t he President Elect ha s laid out?

Dr. Peter Hotez: Well, I do think it is doable. Remember, every year we do a carefully
orchestrated dance of vaccinating 85 million Americans against the
flu , and that starts around August and goes to the end of the year.
Now, it's fewer people over a longer period of time, but it's not – in
terms of scope and magnitude, it's not that much different. I mean, it
is more ambitious and you have the problem , the fact that the first
vaccines coming out have these onero us freezer requirements that
make it more challeng ing, but it's certainly doable.

I think, though, we're going to have to fix our deficits and
communicating about vaccines, we just don't have good mechanisms
for it. I know there's a plan to pay $50 millio n for public service
announcements, and that'll help but it's not enough, we're going to
need government scientists on the lead. And then we have to do one
other thing, which no one right now has an appetite for , and that is
launch a counter offensive agai nst the anti - vaccine groups that are
deliberately targeting African - American communities. Especially in
academia that makes people very uncomfortable or in governments
to do something like that , but treat it like we would terrorist
organizations. I mean, a ctually it's killing a lot more Americans than
terrorist groups ever have.

So for that, I've recommended now creating an Interagency Task
Force to look at what are our levers that we have to do this. In the
past, we've left it to the Health and Human Serv ices agencies that
don't want to get involved. They've not seen the urgency of doing
this. I think it means bringing in Homeland Security it means bringing
in the State Department because a lot of it's coming from Russia and
Russian bots and trolls , it mea ns de partment of commerce . If we put
our mind to it, we can put – and our political will to it , we can do a lot ,
and that's going to be necessary as well.

Margaret Flinter: We have been speaking with Dr. Peter Hotez, the Founding Dean of
the National Schoo l of Tropical Medicine, and the Director of the
Texas Children's Hospital Center for Vaccine Development. Learn
more about his work by going to www.peterhotez.org , or follow him
on twitter @PeterHotez or @ TexasChi ldren's. Dr. Hotez, we want to
thank you so much for your dedication to advancing the science of
vaccines, for your dedication to global health inequities , for your
thought leadership during this pandemic, and for being such a steady
and compassionate voic e of reason and information throughout these

Dr. Peter Hotez

many very difficult months. Thank you for joining us today on
Conversations on Health Care.

[Music]

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to t he facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what ha ve you got for us this week?

Lori Robertson: A recent study in Denmark found that facemasks did not have a large
protective effect for wear er s. It did not find that masks provide no
protection at all or don't offer benefits to others, which is how some
wro ngly interpreted the results. The Randomized Controlled Trial
evaluated whether giving free surgical masks to volunteers and
recommending their use safeguarded wearers from infection with the
Coronavirus in addition to other public health recommendations. The
study didn't identify a statistically significant protective effect for
wearers , but the trial was only designed to detect a large effect of
50% or more, and the study didn't weigh in on the ability of mask to
prevent spread of the virus from wear er s t o others, which is thought
to be t he primary way that masks work.

As a result, the most that can be said is that this particular study
under the conditions at the time in Denmark didn't find that the
facemask intervention had eight large protective effect s for wear ers.
Social media posts nevertheless latched on to the study to wrongly
claim that the trial , “ Proves masks offer no protection from COVID. ”
Or that masks, “ Don't work. ” Again , the study published in November
only assessed the personal protective effect of a mask intervention,
not the potential for masks to hamper spread of the virus to others.
Around 6 , 000 people who left their homes for at least three hours a
day participated , with approximately half being given a box of 50
surgical masks and be ing told to wear a mask w henever outside of
their homes.

The other half was not given masks or such a mask recommendation.
The study was conducted at a time when Danish authorities were not
recommending masks to the general public. So most people those
gr oups would encoun ter were not likely to be masked. After a month
1.8% of the people in the mask group had been infected with COVID -
19 compared with 2.1% in the control group, the difference was not
statistically significant. That's my FactCheck for this we ek. I'm Lori
Robertson , Managing Editor of FactCheck .org.

[Music]

Dr. Peter Hotez

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsy lvania. If you have a fact that you’d
like check, email us at www.chcradio.com . We’ll have FactCheck.org’s
Lori Robertson check it out for you here on Conversations on Health
Care.

[Music]

Margaret Flinter: Each wee k Conversation highlights a bright idea about how to make
wellness a part of our communities and everyday lives.

Mark Masselli: When Jennifer Staple - Clark was a sophomore at Yale and internship at
the ophthalmology office turned out to be a life transformi ng
experience , she realized that many of the patients who had limited
access to medical care were coming into the office with serious eye
conditions that had gone past the point of reversing, leading to
unnecessary blindness. What she launched from her dor m room 11
years ago, was a local initiative to improve access to preventive eye
care to the neediest population in her local community. Her vision
quickly grew. Within two years , she took her organization Unite For
Sight worldwide, and has since turned it into one of the leading
providers of global eye care in hundreds of commu nities around the
world.

Unite For Sight brings social entrepreneurs , public health experts,
local eye surgeons , and volunteers together to bring eye care into
some of the most under served areas of the world. The motto at Unite
For Sight is that local problems need local solutions, so they use each
country's existing pool of ophthalmologist s and eye surgeons to treat
their l ocal patients. They also train community health workers in ea ch
area they serve thus removing traditional barriers to eye care
experienced by many in extreme poverty , and also ensuring a
continuum of care for all of the patients they serve. The community
health workers provide education and transportation to get doc tors
to the patient's communities and patients to the hospital if surgery is
indicated . Since its inception, Unite For Sight has served 1.4 million
patients worldwide and restored eyesight to roughly 55,000 people ,
restoring not only their sight, but their dignity and ability to be
productive membe rs of their communities as well, identifying a
pressing medical need, using global health delivery models and
improving the quality of life by offering basic preventative eye care to
those who had previously gone without. Now that's a bright idea.

[Music]

Marianne O’Hare : You've been listening to Conversations on Health Care.

Mark Masselli: I'm Mark Masselli.

Dr. Peter Hotez
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health.
[Music]
Marianne O’Hare: Co nversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or
wherever you listen to podcasts. If you have comments, please
email us at [email protected] or find us on Facebook or
Twitter. We love hearing from you. This show is brought to you
by the Community Health Center.
[Music]