Coronavirus: A Vaccine, Then What? With Bill Nye
Below is an abridged version of the April 7, 2020, episode of the Science Rules! with Bill Nye podcast, Coronavirus Edition, featuring Dr. Bruce Gellin, President of Global Immunization at the Sabin Vaccine Institute. Listen to the episode.
Bill Nye: The World Health Organization says there are about 20 organizations racing to develop a vaccine and today we're joined by Dr. Bruce Gellin to understand what's going on. Dr. Gellin is the president of Global Immunization at the Sabin Vaccine Institute in Washington, D.C., and he's the former director of the National Vaccine Program Office. Dr. Gellin, Bruce, welcome to Science Rules! Coronavirus Edition.
Bruce Gellin: Thanks, I'm glad to be with you.
Bill: So what are you guys working on?
Bruce: So the key here is, now everybody in the world knows about this flattened curve. It's a curve that we actually drew 15 years ago as part of our pandemic planning at HHS (the U.S. Department of Health and Human Services), but there are two parts to this curve. The one that we are focused on now is flattening. The reason to flatten it, as everybody knows, is to keep people out of the way of the virus, so they don't get infected and find their way to the health care system, which is overloaded. Right now, the most powerful tool we have is social or physical distancing. The long term is really until there is widespread immunity in the population. You get that in two ways – by surviving the infection or by vaccination.
Bill: Ultimately, why does it take so long? Why are there so many steps to getting this figured out?
Bruce: Part of it is that with new ideas, you want to make sure they have some proof of principle. Usually those are done in an animal model to make sure your idea at least is feasible before you bring it into humans. So that's the first step. Many of the companies that have already begun testing in humans have already had experiences with similar types of vaccine development, so they already have a comfort level about how they perform both in terms of safety and effectiveness.
Bill: So when you guys talk about animal models, the rest of us would call them mice, is that right?
Bruce: It depends on the virus. Mice are not always the best animals. In this case it seems that ferrets, and maybe rhesus macaques and maybe hamsters, are the best ones. But the idea here is that you're trying to get an animal that mimics as much of the human response both in terms of the immune response and safety as you can before you get it into humans.
Bill: Are you trying to create antibodies from scratch?
Bruce: The vaccine's function is to stimulate an immune response in the person. And that can be antibodies, it can be T cells or other immune cells, but there is a whole spectrum of the immune response. That's what we're trying to do early on, both in the animals and in the early studies in humans, just to make sure before you get too far into this thing, you've got something that looks feasible.
Bill: Are there shortcuts? It's an urgent time.
Bruce: I think the most important piece here is to recognize that because there is a potential for risks, to make sure that we're following the general principles, but doing things, where feasible, in parallel. The other considerations as you're doing the testing is to try to think about the manufacturing, which is another key part of this. What would be really unfortunate is to go through this whole process, in 12 month have a vaccine that looks really promising, and then start to do the manufacturing. So the risk there is expanding or building the facilities and starting to make vaccine. That's a financial risk and as Bill Gates told Trevor Noah last week on The Daily Show, when there's a trillion-dollar hit to the economy, a few billion dollars is clearly a risk worth taking. The Gates Foundation is starting to go there, to develop some of these manufacturing facilities so you can make a vaccine at scale. There are separate discussions by the World Bank and others to try to do that, and therefore even that is done in parallel as much as possible.
You have the research and development going on, you're thinking about the manufacturing, and as you're doing this, you also have to think about the last mile of vaccine delivery and how that's going to work out, because you don't want to wait until you have a vial in your hand to figure this stuff out.
Bill: People of our age talk about, "if they can put a man on the moon, why can't they blank?" Do you think this is a worthy use of a moonshot-style investment, a federal effort?
Bruce: I'm clearly biased because I've been working on vaccines my whole life, but I think that Bill Gates summarized it. When you look at the current situation when everyone is locked in their houses until we can be freed up, you see how crippling that is to this society – the movement of the society, the functions of society – seems to me that's a pretty good investment. Because unless you have immunity – and you don't want to have that from the virus, because you can see the consequences of that already in terms of the hospitalizations and deaths. Without that immunity, I think we're going to be crippled for some time.
Bill: Do we social distance until a vaccine is available? Another year and a half or what have you?
Bruce: I wish I had a good answer. That clearly is a question everyone is trying to grapple with because there's no way we can maintain this as we're doing now. Even early on when we were doing our pandemic planning, when we thought about what was called community mitigation, these various things that you do – close schools, close theaters, stay home, and the rest of it – the underlying question is, how long could you do this? Because clearly not everybody and probably most people can't do that.
To me, another piece here that we need to really look at seriously and urgently is immunity in another way. We know that lots of people have been infected but we don't know who is now immune. So while we're still trying to understand the immunity to this virus, if we believe the people who survived the virus are now immune, if we know who those people are, they should be able to go back to work - particularly if they're health care workers, providing community services and doing other things.
Bill: And truck drivers.
Bruce: So I think we'll be seeing more about another test. A test for immunity. Again, the science isn't fully there but I think it's a place that, if I was going to do another moonshot, it would be on this. In the near term, to understand immunity now until we get to immunity then, from a vaccine.
Bill: So how would you test for immunity?
Bruce: Again the assumption is that this is antibodies. This is a test that has been developed for lots of other diseases. In fact we've already heard of some of the therapies that are being developed by siphoning off the antibodies from people that have been infected and giving those to people. That's really called passive immunity, which is giving them the antibodies that we hope will protect them.
Bill: How do you do it?
Bruce: This is called plasmapheresis. It's essentially taking the antibodies out of the blood, the plasma – we've often heard about this as plasma therapy – and taking that fraction off.
Bill: What's the hype on hydroxychloroquine?
Bruce: I wish I understood that. I think it begins by observations. In this situation, my understanding is that there has been an observation that in some people, there may have been some effect.
Bill: Correlation is not causation.
Bruce: And anecdotes are not data. Which is why it's important that we give these a thorough examination, because if they work, great. If they don't work, get them out of the way and don't waste your time or your money and potentially put people at risk.
Bill: I am of an age also where I got the polio vaccine by going to the big junior high school, as they were called back then, and getting the sugar cube with the red liquid in it, and that was also an enormous government investment, right? So this seems like a solvable problem.
Bruce: That certainly is the hope. And anyone who has worked on vaccines, either the private sector, the academic sector, the public sector, is now trying to see if the approach that they have taken to other vaccines, can you apply that to this situation. There is no question that people can make a vaccine. The key, then, which is why it takes as long as it does, is its evaluation. To make sure that what you're going to put into people, has the effect that you want.
Bill: How do you roll it out? Do rich people get it first? Do old people get it first? Do kids get it first? How do you roll out this vaccine, and when is it going to happen? A year and a half, do you think?
Bruce: This is large-scale production. Because if you're going to do this in your kitchen, you're not going to have enough for everybody. But when you start to do it in large-scale facilities, then you're going to have much more. But you're right. When it's first available, there's not going to be enough for everybody. So we need to start talking about that now. Not just here, but we also need to look at the global nature of this and the global equity, and how are we going to ensure that those that don't have the wherewithal to be able to invest in vaccine research and development have access to vaccines as well. And even in those countries, they'll have to be thinking through, if they get a limited supply, who gets it.
Bill: As I like to ask, if you were king of the forest, if you were running the whole show, Bruce, what would you do? What's the priority?
Bruce: I think the priority is to do as many things as possible at the same time. While we're doing the research and development, we need to think through how we're going to manufacture. As we're thinking about the manufacturing, we need to think through who's going to get it and in what order, because not everyone is going to get it at the same time. And to have that conversation now and not only when the vaccine is out there and there is a clamoring for it.
Bill: Ok, we'll put you in charge. So, what do we do? Let's say the worst of it is in the next two weeks, here in the U.S. especially, the peak of the curve. The number of people getting infected and the number we all focus on, the number of people dying, reduces by the end of April, and by the end of May it's reduced quite a bit. What do we do? Do we go out of our houses? Do we go out of our houses wearing masks? Or do we find friends who tested positive but didn't get especially sick and hang out with them, hoping their antibodies will find their way into us? What do we do?
Bruce: Of those options, the one absolute not to do is to have a coronavirus party because that is going to be a death sentence. This is not about differences in the virus and somebody had a "safe" infection and somebody had a disastrous infection. It's the same virus that manifests differently in different people. We don't know who is going to have a horrible disease and who is going to be asymptomatic. So don’t go to a coronavirus party, whatever you do.
So I think the medium-term here is treatments. There is a whole other enterprise going on looking at what might be helpful. There are some drugs that are more promising than others, there is this idea of using antibody therapy or even designing antibodies rather than sifting them off of people that have been infected.
Bill: Is this the analog to Tamiflu?
Bruce: It is, and maybe a better analog is the investment in the research of AIDS drugs. AIDS was a fatal illness. It was a huge effort in developing therapies and now I don't know the number – 20, 30 – there are a number of treatments now and HIV has become a chronic illness for the most part. So while we're working on a vaccine there is the same level of effort – another moonshot, maybe – on the therapies. Because we want to be able to treat people who are infected, maybe give people a drug that might prophylax them, which means protect them, short of a vaccine. But there is a lot that's going on in that area as well, and I suspect we're going to be seeing something coming out of that even before we get a vaccine.
Bill: This is fantastic. Is there anything else that we left out? We got vaccines, distribution, manufacture of vaccines, year and a half, animal models, stay home, don't go to a coronavirus party, and we may have a drug before we have a vaccine. Is that right?
Bruce: One other thing is a little bit of expectation setting. Again, when I last looked at the World Health Organization's list of vaccine candidates there were over 50 of them, two or three were already in clinical trials, and they tell me there's dozens more that they're now learning about. Not every good idea is going to work its way through the system and we should be prepared for the disappointment that things that look promising early on don't fulfill that promise. Which is why it's important that there be many horses in the race because they're not all going to finish that race. But we shouldn't be disappointed when "leading candidates" drop out. That's just the nature of the way this works. The fact that there are many more ideas gives me some promise that some of them will work their way through and give us a vaccine that we can safely give to billions of people around the world.
Bill: The old saying, "the way to have a good idea is to have a lot of ideas." Thank you so much for enlightening us. I really appreciate you taking the time. This has been great. Our guest today, everybody, has been Dr. Bruce Gellin who is now working at the Sabin Vaccine Institute in Washington, and you used to be at the National Vaccine Program Office, and you understand this problem as well or better than anyone.
Something that's on my mind, everybody. You know I have another day job, I'm CEO of The Planetary Society and this summer, because of the orbits of the Earth and the planet Mars, we, human kind, is planning to launch a rover to Mars in July. July 17 is the nominal launch date. And I just remind you guys, everybody, that the orbit of the Earth and Mars are not affected by the pandemic, but the name of the rover is perseverance. And that to me is the message of Dr. Gellin today, that we have to stick with this. We have to stick with social distancing, we have to stick with discipline, wearing a mask when you have to go somewhere in public, and respecting the science and keeping in mind that everybody is in this together. This virus, as the astronauts say, has the overview effect. It affects everybody on Earth.
Keep in mind, the Spanish Flu was a horrible thing in 1918, a horrible thing. But humankind got through it. Life goes on. We built roads. We feed more people than ever before. Extreme poverty is lower than it's ever been. As screwed up as things seem to be, life for more people is better, so we're going to get through this. We have to persevere.
Thank you to Bill Nye and to the team at Stitcher that produces Science Rules! with Bill Nye. Listen to the interview here.