We Asked Top Vaccine Expert When COVID Will End | STAY CURIOUS #33

hey everybody it's steven from asian boss it's been a crazy week and all of us here at asian boss are super overwhelmed and grateful for all your support i'll make a separate video to thank you guys properly and explain our next steps so please stay tuned in the meantime let's talk about something that's much more pressing and that is covet this video is actually sponsored by bill and melinda gates who reached out to us to promote their annual letter the gates annual letter offers a perspective on social issues within the world and ways in which we as a global community can make a change and in their 2021 annual letter bill and melinda reflects on the impact of cloven 19 and how we can turn the hard lessons of this pandemic into a healthier and more equal future for all i personally read the gates annual letter every year so you should definitely head over to gatesletter.com and check out the letter for yourself now some of you might be wondering why should i listen to bill gates he's not a virologist or infectious disease expert well you're right that's why today in honor of the gates annual letter we're going to go speak directly with a world renowned infectious disease and vaccine expert who's dedicated over 30 years of his life to fighting deadly viruses just when can we expect to see the end of covet and take this damn mask off when will the next pandemic hit again let's go find out really good to see you again thank you for your time it's great to see you also just for the benefit of our viewers what's your credibility when it comes to infectious disease i'm an md a medical doctor and trained in internal medicine at duke and and trained in infectious diseases at duke for medical school actually i went to uh to yale and at the end of my time at duke i was called back into the military and so i worked with the army for most of my career doing hiv vaccine research so with the us military with the us military correct at the walter reed army institute of research walter reed is the person who established that yellow fever was transmitted by mosquitoes and it was such an important discovery because it allowed us to go after the mosquitoes and reduce the burden of yellow fever for people building the panama canal and you know so walter reed army institute of research is this army research institute that is dedicated to developing vaccines the us army did a huge amount of research on malaria on dengue on hiv and for a lot of the diseases that are really found in the tropics and you can imagine well why is the army doing that kind of research well where do we send soldiers you know we send them out into places that the average american wouldn't ever be so we had to have expertise in those diseases so all in all you've been fighting infectious diseases for how long 1989 was when i finished my fellowship so that's 30 years roughly let's talk about covid i mean did you ever imagine that we would be here in 2021 with the extent of devastation that covet has caused on a global scale is that something that you ever could have foreseen says an infectious disease person as a person actually as a history buff who really is interested in pandemics and things i mean we can go back in history and and you just need to look at the black death the bubonic plague the cholera and you know the cholera pandemic the one that we're in right now um started in 1960s so it's still going on hiv is a pandemic it started in 1981 we actually discovered it in 1980 when it was going on before that i mean there are a number of things that aren't as short and furious as covid but that have killed even more people and so you know when you take everything in perspective you know there are going to be additional pandemics there they may be very different from the covid pandemic i mean it could be another virus or it could be something that we you know don't even think about in the same way but we know that there's a looming crisis in antibiotic resistance so you know these antibiotics that we get when we go to the doctor a lot of the germs that we fight against are becoming resistant to the antibiotics and there are even some that are resistant to most antibiotics and you know by 2050 the studies have are suggesting now we will we could lose 10 million lives a year and a hundred trillion dollars a year to antimicrobial resistance so we know this is coming we have time to prepare and then the big question that everyone has is will we be able to do it and will back vaccines be an important part of that solution so basically just a lot of stuff that can kill us viruses germs and you know viruses are some of the most troublesome because you know as with this one you know we didn't see it coming people had long talked about the ability of these coronaviruses to jump from animals to humans and we've had previous smaller episodes the sars one outbreak in the early 2000s the middle east respiratory syndrome which is still a problem there's no vaccine against that that's right that's mers right which actually affected korea in 2015 very severely but it hasn't been as widespread as uh covet 19 and the reason is that it's just not as transmissible it has a much higher mortality if you get it but it's much less transmissible so there will be others and you know it's an important part of the research that people are doing to understand which viruses are the most likely to jump into humans from animals and you know what what types of viruses they are and what types of mechanisms we would have to be able to defend it against them could we have drugs would we need vaccines could we use this new class of agents called monoclonal antibodies all of these things have been developed and prepared for covet 19 and they would be an important part of any solution set in the future let's talk about the monoclonal antibodies is that kind of like the treatment that can be applied to to any other future viruses what is it exactly when you think about your body responding to a germ like a virus your body makes infection fighting proteins called antibodies and also t cells killer t cells helper t cells and it's the body's way of making a strong response that will eventually contain the virus so antibodies are directed against basically any part of the virus that's kind of sticking out or uh that has the right qualities that allow the immune system to say that is something that i need to be aware of and and protect the body against but usually it's not a single antibody when a when a human being sees a virus the body's immune system makes antibodies against multiple different protein structures on the virus and sometimes those antibodies can be captured and what we can do is we can we don't have to make all of them we just have to make one and usually it's the one that we believe is going to be the most effective at neutralizing the virus that is and making it incapable of growing or binding or entering a cell so we call those neutralizing antibodies and we've done them for hiv um but we can do them for covid or other viruses as well so we make the single infection-fighting protein antibody that is the best at binding to this virus and inactivating it monoclonal antibodies are interesting because a monoclonal antibody can use be used as a therapy so for instance in covit a person comes in and is not feeling well and has to go to the hospital as soon as they enter the hospital they're given a dose of medical antibody the way president trump was if you have the right monoclonal antibody then maybe it will prevent progression to being ventilated the other way you could use a monoclonal antibody is to give it to people who've been exposed and we do this for other diseases and one of the other things people are thinking about well is you know once we get this under better control if kovid then were to come back into korea and you'd have a little outbreak maybe you could take the vaccine and vaccinate everybody but at the same time give them a shot of the coved monoclonal antibody to give them double protection but those are the kinds of studies that that would need to be done and and that would be a great use for potential monoclonal antibody prevented therapies the problem now is that you know monoclonal antibodies are fairly expensive um you know some of the treatments that are used in cancer are monoclonal antibodies and they can be ten thousand dollars of course and that's not something you can give to you know a hundred thousand people to prevent them from having covet but people have been working really hard in for instance the gates foundation uh in trying to lower the cost of monoclonal antibody production and it's through efforts like that that hopefully at one point in the future we will have accessible that is low-cost highly potent monoclonal antibodies that we can use to prevent disease as well as to treat uh serious elements so at this point where are we with covet because it's still not over um i think there's talks of like fourth wave and then you know before everybody can be vaccinated cases are rising in many different parts of the world when do you see this whole thing just going away and then we can just stop wearing masks yeah i think it's going to be a few years um actually in higher income countries we'll probably be in a much better position by the end of this year because for instance in korea but also by projection in the united states japan western europe you probably will have 70 to 80 of the population vaccinated and that's actually really important because you know some of what is driving the mutation in the coronaviruses is the amount of growth explosive growth in the number of infected people because the viruses require spreading growth in a population in order to change in order to mutate themselves and if you stop that you'll stop the mutation we get enough people vaccinated we wear masks and distance and avoid crowds we reduce the transmission of all coronaviruses that decreases the rate of mutation i think a lot of people will be disheartened to hear that just because you get a vaccine doesn't mean you can start taking your mask off and just you know back to the normal the way things were so taking the mask off is something that that may be possible when enough people in a country are vaccinated so and and what is that level and we we talked you've heard people talk about herd immunity in the beginning part in early last year it was hurt immunity achieved through infection which was a bad idea and we saw that um in some of the countries that didn't um try to prevent sweden like sweden um now we we might be able to achieve herd protection or herd immunity using vaccination the pfizer vaccine the pfizer biontec rna vaccine has been extensively used in israel and now there are enough people who've been vaccinated particularly among the elderly so that you are actually seeing an impact on hospitalization and that's what you want to know is there going is this going to decrease the demand for significant health care is it going to prevent people from going to the hospital from being ventilated from dying my father and my mother are in their late 80s and i want them to be vaccinated and you know they're going to continue to use masks after they're vaccinated until we have control we have to use a complete system of prevention and that includes the vaccine it includes masks it includes distancing and avoiding crowds it also includes the things in for instance in korea testing tracking isolating and treating the people who are infected because again we can't let any one thing go with with covet 19 you know as soon as we let our guard down and it doesn't matter whether it's in korea in china uh or in the united states the virus always seems to find the weakest point and and people suffer how do we get it so wrong from the beginning though like can we have done all this last year the year before that so this is the problem that we aren't really good at predicting which of the viruses um could make the jump you know and and it's actually it's interesting because a number of the viruses that are plaguing us today like hiv came from animals um so with the coronaviruses often they start in bats they go through some we call them intermediate or secondary hosts another animal species so at one point we thought for covet 19 it might be spiny anti-years and then it made the leap from them from that other species into humans for for the middle east respiratory syndrome or mers it starts in bats goes to camels and then to humans it's difficult to predict which coronavirus is going to for instance for coronaviruses is going to make them the leave next will it be a cousin of covet 19 so we have coveted 21 which is 80 percent similar to covid19 the same way that sars one is 80 similar to sars2 there was actually a us government program looking at exactly this question and transmission from animals to humans and it was and it was defunded in 2018. why why was it defunded so you know again it's hard to to know um what every each administration's priorities are i guess that there was a concern that this wasn't generating useful information you know but it's interesting to know that um back in the early 2000s while i was still in the military if you looked at the and this is public information so i'm not revealing anything top secret the national security strategy in included pandemic diseases including hiv so one of the reasons that they started this president's emergency program for for aids relief pepfar was around the national con security concerns about the impact of hiv and aids on destabilizing countries and regions and on on transmission to different parts of the population you know in some of the countries aids had a devastating impact on the people who were very important members of the bureaucracy senior members of the army uh teachers so you know the ability and there were lots of aids orphans and some of them unfortunately ended up in some of the rebel groups so again the impact of infectious diseases on society are sometimes difficult to predict and the benefit of being able to identify them or at least be ready to take care of them um is really critical i mean you the the difference in korea was you know the government learning from mers had planning sessions you know um tabletop exercises they were they would go through the you know what would it take in order to track people and to test them and so you know when covid19 happened they were ready they'd actually done a tabletop exercise on a respiratory virus ill viral illness coming from china in december and then of course in january they had copen 19. so they were better prepared even countries that people considered well prepared like the united states were we're not ready and this gets to the idea that every pandemic is different every infectious agent is capable of doing different things and you need to be able to look at the data make decisions based on those data and change what you're doing and the inability to do that contributes to delays and response and those delays in response you can you've seen sometimes had really dramatic and devastating consequences so is it fair to say that most viruses come from animals we had pigs birds bats mouths what's what's going on here it's like animals they carry a lot of viruses so all species have viruses and um and one of the odd things is some of these viruses don't make their host species sick it's like bats like why is it that bats have sars and mirrors and v2 and and bats are very unusual and it may be that that bats are more unusual than we think um and and no one quite understands why but they don't react to the virus the same way that we do their bodies manage to control it they you know it keeps the infection from killing them and it kept and their body's immune response doesn't overreact it does just enough to keep it under control the virus is still there you know people speculate maybe it's related to you know the amount of energy that they expend when they fly because you know bats are you know one of the few mammals that truly can fly um but no one really understands why bats but you know there are other examples the hepatitis e that i talked to about how that has a 30 mortality in pregnant women it doesn't harm the pig at all siv simulator immunodeficiency virus in the species that it comes from doesn't make them sick the monkeys and the virus exist peacefully it's when it makes a jump into a different species that you start to see in even different species of monkeys so in the host monkey species the virus is fine but an siv virus that jumps to a different monkey species can cause significant disease even death in those monkeys so again it has something very peculiar to do with the way our immune system recognizes and attacks diseases and what you want to avoid and what unfortunately happens at least in in covet 19 is there appears to be an overreaction certain parts of the immune system are making are doing too much and and that exuberance i guess of the immune system actually causes some damage so how is it that you know the scientists and experts were able to develop this mrna vaccine this fast i think that's part of the reason why people are skeptical like you you see nurses like refusing to take vaccines like what exactly is a mrna vaccine and is it like easier and and cheaper to manufacture now right and you know um we don't do a good job of communicating we think you know when we're scientists we come up with the prize and we figure everyone's going to be happy it's not like we just started working on them you know we've been working on rna vaccines for at least two decades so just taking a step back then to biology you know you start with the genetic genetic information or dna dna has to find a way to relay its message all that information in order to make the things that that your body needs in order to function so it creates us an rna message so dna goes to rna that rna message makes its way outside the nucleus which is where the dna sits in a cell in your body and it's translated into protein and the proteins then you know become muscles uh or other parts of the cell or in the case of a virus it becomes a part of the virus outer code or some of the proteins that the virus needs in order to replicate to grow nobel prize winner said a virus is a piece of bad news wrapped up in protein and in a way that's extraordinarily apt the beauty of rna is as soon as you publish the sequence of a virus so as soon as the covet sequence was published a person who's interested in an rna vaccine could say okay this is the sequence we want it codes the outer spike you know that the little club-like things that right the spike proteins that are on the outside of the virus you can say well this is the spike region we'll just take it out we'll turn it into rna and you can do that overnight or within a few days so you can then take that rna vaccine the initial one and test it in mice and if you're lucky then you'll see a response it'll make the right infection fighting proteins that you can measure and you're off and running and you can do that in a very short period of time if you were doing a more traditional approach say making a protein you would take that genetic sequence which everyone needs to have and you put it in to a you do some genetic engineering of a plasmid you'd insert that into a cell then you have to grow it and grow it and you have to wait sounds time consuming yeah and then you know then you have to take that protein that's now floating around in a flask and you have to purify it and when you purify it you have to make sure that you don't do anything bad to it because if you happen to change the way the protein folds on itself it could change the vaccine so there are all these steps in a traditional protein vaccine that are a cause for delay compared to an rna vaccine the rna vaccine you get the rna you inject it into someone and you what you know is that the person's cells will automatically fold that rna pro so the protein that comes from the rna the right way one of the other vaccines that got out really quickly is a whole inactivated virus vaccine so two vaccines from china one from india what they did is they as soon as you can isolate covet 19 and grow it up in a culture you can use that that culture to infect other cells and pretty soon you'll have lots of virus floating around in the in the cell culture and you don't want to inject live virus so you use formaldehyde or you use heat and you kill it or a chemical a different chemical and you kill it and then you purify that that killed virus you mix it up with alum which is an aluminum salt and you inject it and that's you know we have lots of vaccines that are based on very simple old-fashioned technology a little less fast than rna but still very quick i mean the cytopharm vaccine 79 efficacy was announced in december so around the same time frame as the rna vaccines that was my question too when you say efficacy level why do all these like different brands of excellence have different level of efficacy yeah and so that's that's a really important so for instance pfizer 95 right but they're in a 94.5 percent is there a big difference between 95 and 70 percent you know 70 percent is a good vaccine the us fda said and the who said anything over 50 percent they would consider licensing so you know the johnson johnson vaccine it was tested under some very unusual circumstances the mutant coronavirus was emerging in south africa at the same time that they were testing the johnson and johnson vaccine and it protected against that in the united states the johnson and johnson vaccine was 85 of course there wasn't a lot of the new variant circulating but the important part was that the johnson johnson vaccine protected against severe infection and hospitalization and those are the things that you're really interested in so they actually were able to provide a significant amount of information about severe disease regular people like us we don't we we panic when we hear oh it's only like 55 you know effective it's like that that does that doesn't sound very good compared to like 98 efficacy right and you know and and all of these are amazing vaccines um and you know anyone that's approved by ministry of food and drug safety in korea or fda in the united states or ema you know i would be happy to take and give to my family the important thing is that we vaccinate as many people as possible as quickly as possible again continue to wear masks and all the other distancing and tracking tracing and treating but we really need to control uh the explosive growth of uh infections one of the the good things and the bad things about this pandemic has been the infra amount of information that's available has been enormous i mean things are being published on the internet before they're actually fully reviewed in scientific journals so sometimes they're going to be changes in in some of the data that when you're reviewing a paper for a journal you you make recommendations to the authors that they may need to change this they may need to rephrase the way they talk about talking about peer review basically peer review exactly peer review um and that's you know right now you're you're putting peer review out onto the internet and the first set of peers that you get are actually you know whoever wants to download it from the internet um and that's been uh remarkable uh for those of us who are you know working in the field because we actually get to see the data i think it's a double-edged sword it could be a misinformation or it could be really fast that's the flip side that unfortunately we aren't able to control the misinformation and and the misinformation is really rampant and you know what do governments need to do well they you know governments need to make vaccines um accessible so you have to make it easy to get you have to positively socialize it you have to talk about the vaccine to the same extent that the naysayers are talking about the vaccine and you have to talk and emphasize why it's so important in some countries in in low and middle-income countries they have national vaccination days where you know it's everyone goes out and the ministries out in force and they're trying to vaccinate as many people as they can find you know we haven't gotten to the point yet where we have enough vaccine to do that yeah i mean right now we there's just a terrible shortage of vaccine and you know countries all over the world are asking why they don't have more i mean you saw the european union temporarily slapped a ban on exports about the astrazeneca vaccine because their supply was being cut because of problems in the manufacturing you know low and middle income countries you know by comparison haven't gotten many doses at all just exactly as you weren't remember we talked about this whole inequality problem yeah it's you know and you know we have this covax mechanism we have this thing that was set up by world health organization by gabby the vaccine alliance in seppi to provide 2 billion vaccines by the end of 2021 to 189 countries around the world the who feels now that they have adequate guarantees that they will have 2 billion doses the problem is not having enough but when vaccines are actually a fairly complicated biological product this is something that's actually grown and has to be made and at every step if you fail quality the whole batch gets just could be discarded and so and and you'd want that i mean these are biological products they have to be safe and effective they're given to healthy people and and so the standards are are very high around vaccines and you'd want them that way we say expedited you know people think oh they're cutting corners well in fact you know the fda completely redoes the statistics to make sure that the vaccine does what the company says that it does you know astrazeneca didn't submit its data to the us fda if there's another trial that they're doing for operation warp speed which is a u.s program that will be submitted again you know this gets to the expectation of these what we call stringent regulatory authorities uh for the quality of the information that's provided and the level of safety and efficacy that they're going to demand what's the most important thing for us to be prepared then for the next pandemic surely we've learned something out of this whole whole thing so what's that one thing we could be doing to prepare ourselves for the next pandemic so this is going to disappoint you but it's not one thing it's many things so one thing is we need better surveillance we need to be able to know where in the world these viruses are jumping we also need to study the viruses that can jump or might jump in in greater depth so that we know what to expect which means also that we need to have the kinds of you know diagnostic platforms that will be able to identify very rapidly uh viruses that are making the leap into humans testing is another very important thing then open transmission of information you know as soon as a country finds out about this it can't say well this is ours because of intellectual property concerns we're not going to share the sequence with anybody for something like this we have to make information available publicly as quickly as possible so to the credit of the chinese government and the chinese researchers you know by the first week in january we had sequences which were then used to develop the first set of vaccines so one of the reasons we could do that was that we knew the genetic information we had the sequences which allowed us to generate vaccines so that's one part the second part is actually also i would say prophylactic a preventative measure and that is um having organizations whose job it is to develop vaccines rapidly for outbreak diseases emerging infectious diseases and so for for many countries in the world that's coalition for epidemic preparedness innovation so sepi had practiced they used mers as an example they used nepa virus which nope probably most people haven't heard of and that loss of fever which is a fever an illness that is found in west africa those are the initial ones now chikungunya has been added also and a rift valley fever but these platforms were very important because it allowed sepi to a experiment to understand what was working and what didn't work it allowed them to have relationships with different companies so that when stars cov2 happened before they actually made an announcement that they were taking applications they could actually query companies very quickly to ask them if they'd be interested because they already had relationships they already had contracts in place with some of these companies the next part is also preparation and this gets to preparing for a pandemic you know does a country have the right means to control pandemics through testing tracking isolating and treating which they did in korea very well but also practicing it you know having a tabletop exercise going through the motions finding out if you know for instance if you're in the united states can the center for disease control which is a federal government agency communicate rapidly and get good information from each and end of each of the 50 states and it turns out the answer to that question was no but we didn't really figure it out until this whole thing was on was in the united states and causing huge problems so again you know we have to be ready to act quickly and and it's always health night this is an old army person talking if you practice i i think that the other part is you know a uniform set of communication i mean you know the united states you got conflicting messages you know people were pointing fingers no it's not my job or yes it is a problem no it isn't a problem we're in korea for instance or in australia you got one consistent message you know this is a problem this is what we're gonna do everyone has to follow the rules that you know these are the rules i mean the united states had vaccine they they were woefully behind their own schedule in terms of being able to vaccinate and every state was left to devise its own plan there was no individual there was no you know single national plan right um so again you know hopefully these are all going to be lessons that many countries will learn as they've rolled out vaccination i guess i'm just concerned about the scenario where let's say the whole country is vaccinated but then they start allowing international travel again and all these maybe people from the countries that haven't been vaccinated they come over yeah i suspect the government is going to probably require either vaccination or quarantine still and and that system has been relatively effective how the vaccination certificates are going to roll out or if vaccine passports are going to be necessary really not clear i seems that who may not be completely supportive of that idea on the one hand on the other hand you know there isn't going to be travel because if a businessman is coming here for a three-day trip and has to quarantine exactly it's going to make it impossible and now you have to quarantine when you get back to the united states evidence of vaccination will be very important but what is going to be the standard is it going to be an electronic standard or is it going to be the yellow who immunization card um and so you know there has to be a system that we can verify i mean the countries can verify and there has to be an international standard and you know hopefully as vaccines being rolled out you know the people who can afford to travel will be able to to get vaccinated this whole idea of like vaccine passport is that something that you just thought of or is it something that already exists oh no people are talking have been talking about it i think that organizations are looking into it um it gets to be a part of a actually bigger question in global health you know is it possible to make an electronic medical record and you know the problems with electronic medical records more broadly are around privacy and security but there have been a number of small companies um and maybe some larger ones as well that have been thinking about what it would take for a set of governments to recognize a common standard for uh vaccination so a country that i'm making this up the uk is keeping track how does the uk let korea know that joe smith has been vaccinated right and how does korea verify that and so all of these things still need to be worked out but there are lots of companies um you know lots of smart people in these startups and things thinking about this kind this exact question and i just hope that the governments are doing the same if you had to take a guess as to when the next pandemic is coming can we predict the next one we can tell you what types of viruses might be likely you know like coronaviruses were early target because we know they jump back and forth what about things like dengue fever and so these would be emerging or re-emerging diseases so dengue is all over the world the thing is about dengue though it doesn't actually kill many people so i mean annual deaths from dengue are in the few thousands the same would be true of um and zika for instance spread very very rapidly in in south america and then kind of stopped and and so again you know we have some vaccines that we think might work in zika but we are unable to test them fully because it's um it's at this point it's kind of difficult um because you need remember in order to test a vaccine you need to have uh enough evidence of infection in order to begin the testing dengue would be another potential candidate and there's another virus called chikungunya and actually ivya is doing a study with chikungunya vaccine now in colombia panama and thailand i've heard of that what is that so chikungunya is another virus disease and it really causes severe aching in the joints again chikungunya probably doesn't won't kill you it's like dengue right you get sick you feel awful you feel like you're you know every joint in your body is aching and in the past we thought well it's probably more tropical disease it doesn't but you know we've seen spread of chikungunya now in south america um it there are occasional cases in europe and there are cases now in the southern united states and you know whether this is related to global warming or or just you know the normal tracking of mosquitoes and mosquito vectors you know these are diseases that are all potential and for instance sepi the coalition for epidemic preparedness innovation actually has a chikungunya vaccine program you know seppi is for instance concerned about some viruses there's one in west africa called loss of fever but it involves a particular type of mouse species and so there's it's probably less likely to spread outside of that region but again you know we can always be surprised the thing is that and we always forget pandemic flu is something that that does happen you know every a little bit longer than every decade or so so i think flu highly likely another major pathogen like an hiv you know out of the blue comes to shock us you know those occur much less frequently and the good news is that in general you know diseases don't escape from vaccines flu would be one example where there are new mutants being generated that require new vaccines to be to be made most of the other vaccines that we have have been relatively stable despite their prolonged use and very extensive use again controlling pandemics with vaccinations easier than dealing with one without a vaccine i think we've learned that with covet 19. we rely on you to be that ultimate communicator of science we really hope that people listen to you and take you seriously and then don't see you as that political figure you're just doing your job right we just hope that people get that no thank you and you know your questions are always really insightful and and they really get to the heart of the big questions that um not only we have but but that people have you know are the vaccines safe do they actually protect what's the difference between 95 and 50 um and you know when will we be able to be vaccinated all these are very critical questions let's just hope that you know the world will will get together and will allow or provide funding for all the people in this on the planet to be vaccinated as quickly as possible thank you so much for your time thank you

Channel: Asian Boss

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Length: 38min 3sec (2283 seconds)

Published: Tue Feb 09 2021