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Transcript
Fred Goldstein
Get Started.
Nick van Terheyden
We need to fix the Facebook thing as well.
Fred Goldstein
Yes. Okay, welcome everyone to this week’s COVID insights to Action Group. Got an interesting topic. I’m glad to be joined again by Dr. Louis Saldana and Dr. Nick van Terheyden, we will be discussing vaccines. So thanks so much for joining us. Let’s begin guys and talk a little bit about I know we now have three of them with the latest announcement. Maybe Luis you could give us some insights into the three vaccines and what they’ve got.
Luis Saldana
Well, the ones were I think heard heard most on for kind of in order of the where the news came out was first Pfizer vaccine, which actually looks like it’s probably going to be the first to get probably get the FDA approval there first to apply for it. And it’s a messenger RNA delivery system, which are fairly new technology for vaccines, all of them kind of leverage the fact of the the spike protein that’s unique to to COVID. But but that’s the first one the the issues that have come out, you know, it’s, of course, they’ve announced over 90% efficacy rate. But and then, but the issue with it is the distribution due to the fact that it has to be ultra cold storage, which is like minus 70. I don’t remember the specific number, but it’s very cold. If it’s ultra cold, it’s not something that most places have for ongoing storage. And then you know, that gets into the vials you reconstitute the vials, how long does that last? So there’s issues in terms of that, I think there’s some promising things that came out today about the military has been is kind of involved with this. And I think they have kind of seems like the first round of doses kind of pretty much they feel ready to go maybe even as soon as a week after FDA approval. So So that’ll be interesting to watch that. And, you know, I think would be very impressed if we pulled out that kind of logistics to get the doses of that. healthcare and people’s arms. Of course, that requires two doses, just like all the ones that have so far been in the news. The second one is the Madura, which is through the operation warp speed, and that is similarly messenger RNA virus vaccine, also, but it does not work in the differences, it does not require the ultra cold, it requires cold storage, not ultra cold storage. So a more typical, or doable storage. So that may, you know, allow for even more distribution to more places, like there’s concern about rural places getting it and things like that. So, so I think this allows that allows for for more of that. And so will you know, it has very similar the vacancy rates for it were again above 90 very impressive. As far as that goes with fairly low side effects. two doses, there is some mention about people that were in the trial that was second dose actually had moderately significant side effects for 2436 hours. So it’s kind of one of those things, and it seems to be more after the second dose than the first dose. So that’s something to kind of watch as we get as we started vaccinating people. The third virus, and the third vaccine that we’re hearing the most about is the AstraZeneca. From the Oxford trial, and that’s probably the best candidate for global distribution, because it does not require the cold storage. It’s an ad no virus based vaccine. So they actually use the Add no virus, which is a common cold virus to kind of as is kind of a vector to kind of deliver it to the body. And and then still take advantage of the same mechanisms and things. So that’s that’s that that’s technology. It’s been used quite frequently in the past. And so very, very much more typical. The issue was they reported 70 to 90% efficacy rate. The 90% is getting some, you know, some doubt cast upon it just because of the fact that it required for a smaller first dose, which they said happened by accident, which is kind of there’s a lot of scientists that are kind of raising eyebrows around this kind of sense of the first dose was kind of a half dose given and it actually had a higher efficacy rate than than the standard two similar doses. So So I think there’s there’s, that’s one to watch as far as that. I think it’ll be in terms of FDA approval for the US. It’ll probably be the last but I think it’s going to be probably The biggest globally, that’s going to get I probably have more doses around the world, I think. Certainly the the also the Russians have already had went out there. And that’s also an add no virus delivered vaccine that they claim over 90% as well. So, so those are kind of the main ones that are out there. And China’s either got one or very close, as well. But that’s kind of the that kind of the summary of where we are kind of at this point with the vaccines.
Fred Goldstein
So a quick question on that. Regarding your you’re just your statement about the half dose to begin with. And whether that was it. If that was in fact an error that would lead me to be concerned about delivery? You’re getting a half dose? The second one by mistake? Is there something up with that to be worried about or not?
Luis Saldana
I don’t think we know I think there’s like I said there’s some, some scientists that are that are are looking at with raised eyebrows and kind of wanted to say, okay, that if an error like that can happen in into the trial that that’s somewhat somewhat concerning as far as that goes, but so I think that one’s TBD. We’ll see what happens with that.
Fred Goldstein
Uh huh. And, Nick, you want to come in some more on what some of these side effects are that people are seeing that Louise mentioned? And how concerned should we be about that?
Nick van Terheyden
Yeah, before I do, I want to ask the question, what’s the similarity between the Russian virus, a Russian vaccine and all the vaccines that we currently have? in play the three that Luis covered, they all share one common trait. And that is we haven’t seen the data yet.
Oh, my gosh,
Nick van Terheyden
to say, Now, to be clear, I want to sort of lump everything up into the Russian virus category, because we’ve literally seen nothing on that we have seen some other stuff, but we’ve still waiting on actual release of data, which I know everybody is keen to see but has yet to come about. When it comes to side effects. It’s interesting. We have this discussion earlier on talking about this. It is not. So number one, it sounds like on the second dose, some people got actually pretty severe side effects. And by that I mean, you know, they got as if they were getting a flu like symptoms, because Coronavirus is very like flu like symptoms. shivers, aches pains. The good news is it only lasted for a very short period of time. But it probably means that folks that are getting that second dose may actually have to take some time off a day off just to you know, be sure. And it’s also something that people have to be prepared for. Now, I haven’t seen that for all three, I think that was certainly for the first two. I don’t know if I’ve seen anything on the AstraZeneca. But we may see that. And, you know, that’s part of the expectation. But let me just ask or answer before the question even comes up? Well, if I’m going to get those symptoms, why should I take the vaccine? The reality is you want the immunity from the vaccine, not from the virus, because you don’t want the long term sequelae of having actually suffered COVID-19, which is causing some challenges with this long COVID. So you want immunity through a vaccination program? And yes, it may cause some interesting, there’s a whole discussion about this. Should you mute that. Side effects, give people Tylenol. And there is a whole group of physicians that suggests that actually allowing the body to raise its temperature is a good thing and you get a better immune response. So sweat it out, as our grandparents and grandmother used to say,
Fred Goldstein
Do you see any reason to think and obviously there’s no data yet? So it’s just all speculation that people may want to choose one over the other?
Nick van Terheyden
I think that’s a almost an irrelevant question. I think you’re just going to be glad to get one or other of them. You know, I think Luis Absolutely. Nails the whole point on distribution. And you know, it’s funny, we’ve got the spectrum, everything from super cold, very challenging all the way to, well, pretty cold to regular fridge. And also that last one, I don’t think you mentioned this, Louise, but I haven’t seen any pricing on the maternal the Pfizer’s but I have on the AstraZeneca about $4 a dose which is very, very low. And they have targeted this to make it extraordinarily affordable. And, you know, that’s going to determine the distribution as well, some of the economics I suspect.
Fred Goldstein
Yeah, I think they announced it was definitely much cheaper than the others. Yeah. But by how much who knows as you said, Would that then tend to see particularly both from a distribution a price standpoint that that specific vaccine goes to Africa, and suddenly other countries? And maybe we end up with more Pfizer? Madonna?
Nick van Terheyden
I think it’s entirely plausible. I mean, you know, this is about distribution. It’s about access. And also, we haven’t talked about this, you know, when might you or I get this vaccine? Well, I’m pretty sure I’m very low down on the list. I’m not in the frontline healthcare workers or anybody that’s on the frontline. They’re all at the top of the list appropriately. So. But along with that is all the people that are additional high levels of risk over 65 co morbid conditions, so other conditions. So, you know, in terms of timing of all of this, it’s going to be a while before any of this flows through, even if they started delivering it today. Yet, it’s
Fred Goldstein
fascinating that I saw they announced they were going to distribute to the states based on the state’s population, and not their health status. And when you think about that, that means a place like Florida where I’m at is going to get a fair chunk of this, but maybe places like North Dakota that have some really burgeoning high infection rates, or risk up, they’re not going to get as much to begin to help their healthcare workers. I don’t know what the proportion ratio will look like. But the fascinating thing to consider,
Luis Saldana
no, you kind of wonder if the politics of that have led to the big spike there also would lead to not taking wanting the vaccine, you know, I’m saying no, we’re just things kind of dovetail to where you send it to them. And they don’t they don’t take it. And so So yeah, I in terms of different vaccines for different purposes, I think that’s what you’re going to see I think you’ll see things directed towards like some of the, you know, Indian Reservation areas, more difficult rural areas to reach are going to probably get the AstraZeneca vaccine probably, you know, unless they can easily get to one of those urban centers are somewhere where they have the ultra cold storage or, or cold ability to do the cold storage. So I think you will see, kind of all three here in the US, I think plus the j&j there’s a there’s a j&j vaccine that we should maybe be hearing something about very soon as well, which initially was thought to be going to be one dose. But there they have started doing two dose trials. So So makes you think that they have you know that they think that to really get the numbers that they need, they’re gonna need a two dose.
Fred Goldstein
Is there is there an underlying biological basis for why the single dose is not kicking up enough immunity? Or something that we know of as to why you need two doses with these?
Nick van Terheyden
i? I’m sure there is. I don’t know that we know what or, you know, the precise mechanism of this. You know, to me, it’s linked closely to this whole issue that, you know, Luis talked about, which, you know, I think you described as a mistake, I described as serendipity. Because that mistake led to this insight. And now it’s raised this question of why that’s the case. Why does this lower dose and I’ve seen some good explanations or good thoughts around that. But you know, this is part of our continued scientific exploration, one of the challenges is, we’re going to lose data as people jump in and take the vaccine, and that’s going to be true of the the trials. So a lot of the people that are in the placebo arm that got you know, nothing didn’t get the vaccine. I don’t know that this is true, but I think what I’ve heard is that they may well Now jump into the vaccine arm and we’ll lose that data from a long term basis, which is unfortunate, but obviously, you know, you respect that because those people put themselves out there so that maybe they’re getting an earlier dose as a result of it.
Fred Goldstein
Mm hmm.
Luis Saldana
Yeah, I think the other thing to remember is there’s a there already is a two dose vaccine shingrix and there might be some others for sure. So, so that requires two shots as well and, and I think it’s, it’s determined that to really get the antibody response, robust antibody response to it, that the two doses just the more effective first one, kind of Prime’s the pump and then the second one really, really provides safe and they’re worried they would be worried about giving that much in the in single dose. And you know, that I think it’s very soon it’ll be very similar to people’s experience with shingles vaccine as far as that goes,
Nick van Terheyden
good. But I you know, a couple of things to note on that is, if you have Pfizer for number one, you can’t go get Madonna for number two, and you know, equally You can’t mix and match. This isn’t like going to the supermarket for your candy, which by the way, we can’t do any more. Because that’s, you know, too much of a health risk. So you get it all prepackaged, but you can’t mix and match. And they’re a different time. So this is quite a logistical problem to say, Okay, you
Fred Goldstein
got this now you have to come back at this point, because that’s what we understand to be the requirements. And we’ve talked about this, both of you this, right now we’ve got data, I think in the Pfizer, one, it’s 160 infected in that group and 95% efficacy or whatever. And modern is the same kind of thing. But and I think you’re going for the EU and the 10th, we may get it of December is what I’ve heard the committee may meet and vote on this or something. What other data what what sort of questions do you have in your mind about what you’d like to see, in terms of the other data points?
Luis Saldana
Well, I expect that the data that that will be seen by the panel that looks at these is going to be they’re going to be looking very closely at the side effects panels and see if they can, can sort or see some patterns in terms of like, you know, is it a certain type of side effect that that’s noted? You know, are they do they come late, even the data may or may not be now maybe after a week, a couple more weeks, even that two weeks of extra data may be significant to them as well, I think they’re going to be looking for patterns, I think is what they will be most most likely to really look for. These are smart people that have committed their lives to looking at these things. And I think they can they have a they know how to really sort through the data and really hone in to find the insights that that, you know, otherwise might not be picked up with just general data, data analysis.
Fred Goldstein
Anything from your perspective, Nick?
Nick van Terheyden
Well, I mean, clearly the side effects but, you know, obviously, I assume that they continue to expand the, the data and the numbers, because they’re they’ve been recruiting, they haven’t stopped recruiting, as far as I know. So they’ll add to that, if there’s any changes in that. And we did see to at least two suspensions, and I can’t recall precisely, not unusual, so that happens. What’s unusual about it in this instance, is that everybody knows about it. Now everybody goes, Oh, my God, there was a suspension in the vaccine trial. And, you know, you think, really, that’s the topic of conversation, we’ve all sort of elevated everybody. But I’m sure that they’re going to look at that specifically, and and focus in on any other recurrence or associated instances where they look at the side effects and go, gosh, there’s something to be concerned about it. So I mean, I, you know, the best analogy I can come up with is, you know, with the magnifying glass, they’re going to be going over that with a fine tooth comb, to really understand the detail of the data because they don’t want to make a mistake, it would be terrible to do so.
Fred Goldstein
So obviously, everyone’s excited. They’re looking at this thing’s coming out. I think we got 20 million potential doses from Pfizer by the end of the year 15 million from Madonna. So you’re cutting that in half? Because it’s two doses? At what point do you see us getting back to where we’ve got enough people vaccinated, that perhaps things go back to a little bit further towards normal?
Nick van Terheyden
How I’m going to point to Louis season.
Luis Saldana
I think this has been a set of folks that might have modeled it out in terms of looking at the doses and and the number of people you need to reach the probably, probably the herd immunity kind of threshold, they probably would use 60%, maybe 50% from the vaccine, but but you know, probably 60% I just kind of depends. So it really is gonna depend on the the uptake and, and delivery I I think I’ve seen some optimistic things that say by the end of the first half of 2021, though I probably a little less optimistic about that. I really think it’ll probably be third quarter 2021. The reason I think that’s important, is I think one will still probably be wearing masks through 2021. I think even folks that probably received the vaccine, we’ll be wearing masks, because you’re not, you’re not there. They’re not there to protect only you protect others as well. So, so that that that’s something but but also, when we’re going to have a way right now we’re all you know, kind of bracing for the winter wave. And I think we’d be looking at that in the fourth quarter of 2021. And that’s going to happen I think, we will have a wave hope we had such a smaller wave of COVID And I think COVID will stay in the population in some form or fashion, they’ll just be much, much smaller waves that would that we’ll see. Until it, you know, more or less, maybe maybe plays out over time.
Nick van Terheyden
Yeah, I can’t disagree with that. The thing about the, the waves and the mitigation of that one of the things that I’m hopeful around here is that we’re starting, you know, it’s a little bit sad that we’re so far behind the curve in this country to get the testing capabilities, right. And the reality is that, you know, until we can test people on a daily basis at home, even, you know, as suggested by Michael meaner and others, you know, we’re doing our best, but ramping that up as much as possible is going to be part of that targeted strategy to Louise’s point, so that you, you focus on those small outbreaks and minimize them as much as possible. But we’re going to be dealing with that certainly through next year, in towards the end of the year. And masks, I think they’ll become part of our world and the way that they did in Japan, and other places. You know,
Fred Goldstein
we’ve been pondering this one for quite a while. And it was a question that came in from one of the registrants, which was why are some effective measures not being taken in the US? Would you like to chime in on those?
I will say, Oh, sorry. Sorry. No, no, go
Nick van Terheyden
ahead.
Luis Saldana
I was gonna say, I will say one of the things was probably, and I think even Dr. pouchy would admit this inconsistent and not clear communication from our public health officials is part of that there is a part of it. I think the politicization of a public health message is another part of it. Those are I think, too, too big, two big components that have kind of led to that. And the fact that we never did deliver what we said, we talked about delivering test whenever you want one, has anybody seen that? I mean, I think we’ve seen very much people’s experiences, frontline people not get it be able to get a test. So so I think we’ve fallen way, way, way short on testing. We were a little late to the masking game. And then it became politicized, I think so those are our two big, big things. But I do want to say one thing is, I think we can’t marginalize the significance of this public health, the fact that we got a vaccine, and in a year, it’s like, I think, and nobody’s wildest dreams. Would anybody have seen that? So and that’s astounding, I think. So.
Nick van Terheyden
Yeah, I’d be the first to say I certainly didn’t see that happening. And I wasn’t pass on moderner with, you know, what is essentially a novel approach to vaccination using messenger RNA, incredibly unstable yet here we are with not one that to have that particular form and another with really very promising data based on what we’ve been told, and what we hear. So you know, that’s all good news, in my mind.
Fred Goldstein
Is this something based on how we understand it so far, that you think 18 month booster? Something like that may be needed? Because we just don’t know yet?
Nick van Terheyden
Well, to be clear, we don’t know. So this is speculation on my part, for sure, unless Luis has anything additional to add to this. But the early indication that I’ve seen and heard from folks that I trust, seems to imply that this may not be a recurrent theme, and certainly not the order of the flu vaccine, which is annual because it shifts so much and we have these different variants. You may be able to get this and be good to go. Maybe for five years, like shingrix, maybe for 10 years, like tetanus. Who knows, but I don’t think it’s going to be, you know, an annual event, which Wow, that’s a pretty substantial thing to vaccinate the population annually for this, but we want to do that for flu, but we don’t seem to do that just based on uptake. Mm hmm. Yeah, I agree.
Fred Goldstein
Fantastic. Well, I as you said, it’s really good news. We’ve got this virus, this vaccine now three of them, and they’re more on the way obviously there. tons in the hopper, a number one phase threes section in phase three parts of the trials. So I do know also that we’ve got some, you know, information on surveys. How many people retake this and one of the things I just like to bring up I know you both it’s physicians are very concerned with this one is the new study by Blue Cross Blue Shield, which did a claims analysis and found that 40% of the parents and guardians report that their children didn’t get their appropriate vaccines this year. Obviously, that’s something we’ve got to figure out how to fix as well.
Nick van Terheyden
Yeah, I and some of that may be people’s resistance. So we’ve had a vaccine resistance problem that is based on, you know, comes back to Louise’s point of communication, we’ve done a poor job communicating, we, as human beings have very, very poor at assessing risk. And, you know, the risk reward ratio, and all these things is really quite clear, but we’re not communicating that for that to be the case. But the other is, like all these other things, diabetics, half heart disease, you name it, they’re not getting care, they’re not getting screened, because essentially, we shut down systems for fear of what was going to happen. And people avoided care and they’re still doing it. So all those are contributory elements, we’re going to be playing catch up to this and paying for that impact, I think for a considerable period of time.
Any additional thoughts? Luis, no, I
Luis Saldana
I agree, I think we’re gonna be playing catch up for quite a while on this kind of all these preventative care things, especially with kids returned in person school, I think there’s been kind of lacks, you know, we’ve kind of relaxed all the enforce rating for enforcement of, of the, you know, the regulations around the vaccines. So who needs to be vaccinated before coming to school and things and so, with a lot of virtual teaching, that’s, that’s kind of gone by the wayside and things and so, so Yeah, I agree with Nick. It’s, it’s, it’s, I think it’s really more a function of we’re falling behind on cancer screening, maybe diabetes care, a lot of different things. There’s gonna there’s gonna be a cost I think he took to the national you know, now our national health and wellness.
Fred Goldstein
Well, fantastic. We’re coming up on the end of the half hour, we try to keep these 230 minutes. So I’d like to thank you both and those who attended as well. We’ll be doing the next one next Wednesday at 4pm and sending out what the topic will be for that and appreciate it. Hope you all have a fantastic holiday break. Thanks, Luis, Nick, appreciate it.
Thank you. Bye
