Speaker 1: My husband was exposed to a person who was later
Speaker 1: positively diagnosed with COVID nineteen, although that person has remained asymptomatic.
Speaker 1: My husband and I have been self quarantined in our
Speaker 1: home since we found out that person had tested positive.
Speaker 1: We are in our early thirties and are not worried
Speaker 1: for ourselves, but do not want to risk preading this
Speaker 1: disease to anyone else. My husband began developing mild symptoms
Speaker 1: two days ago and I began developing mild symptoms last night.
Speaker 1: We are both experiencing shortness of breath, chess congestion, cough,
Speaker 1: mild fever, and general body ache. Our case manager with
Speaker 1: the public Health Department spent most of the afternoon fighting
Speaker 1: to get test ordered for us. When we called urgent
Speaker 1: care to say we were coming, they told us to
Speaker 1: stay home. They agreed to see us when we explained
Speaker 1: that the Health department told us to get tested at
Speaker 1: our nearest urgent care. The Washington Post is reporting that
Speaker 1: sick people across the country are being denied coronavirus testing.
Speaker 1: If my husband had not been exposed to a confirmed case,
Speaker 1: I believe we also would have been denied. How will
Speaker 1: we know who has the sickness if testing is not
Speaker 1: widely available. Our urgent care appointment was incredibly frustrating. The
Speaker 1: nurse met us at a side door with masks. We
Speaker 1: were there for nearly two hours, and no one seemed
Speaker 1: to know how to treat us, what protective gear they
Speaker 1: were supposed to wear, what questions to ask us. The
Speaker 1: nurse took off her face shield while in the room
Speaker 1: with us to make it easier to see the computer.
Speaker 1: We overheard her say she has pneumonia. Why was a
Speaker 1: nurse with pneumonia assigned to us? We were there for
Speaker 1: nearly two hours, and the whole time could hear people
Speaker 1: outside of our room asking one another what to do.
Speaker 1: Someone was on the phone with what seemed to be
Speaker 1: the CDC. Their guidance appeared to change while we were there.
Speaker 1: The healthcare system is not prepared for a pandemic. We
Speaker 1: were first tested for flu. My results came back positive,
Speaker 1: my husband's negative. We were both written prescriptions for TAMA flu.
Speaker 1: We were also tested for COVID nineteen, but will not
Speaker 1: hear back until Monday or Tuesday, and maybe even Wednesday
Speaker 1: because labs are not staying open over the weekend. When
Speaker 1: you get tested for COVID nineteen. You have to sign
Speaker 1: a form saying that, among other things, you will self
Speaker 1: quarantine until you get your results back. Our doctor sent
Speaker 1: our tamiflu prescriptions to a pharmacy inside of a target.
Speaker 1: We had to point out to her that this would
Speaker 1: break our quarantine and maybe it would be a better
Speaker 1: idea to send it to the pharmacy that was literally
Speaker 1: next door and offer a drive through pickup. It still
Speaker 1: took over two more hours to fill our prescriptions there,
Speaker 1: as the one sent to target was not canceled properly.
Speaker 1: So now we wait under mandatory quarantine. We have enough
Speaker 1: food and other supplies, but worry for others who do not.
Speaker 1: I hope the government and healthcare system figure out what
Speaker 1: to do and quickly.
Speaker 2: Aaron, what date did we get that email?
Speaker 1: So we got that email on March thirteenth, oh Man.
Speaker 1: So this was an email that we received from someone
Speaker 1: who wanted to share their story, and we asked whether
Speaker 1: we could share this anonymously. They did not want their
Speaker 1: name to be shared. And we really appreciate you sending
Speaker 1: us this email because I think it's hugely important because
Speaker 1: it illustrates with a lot of people in the us
Speaker 1: are facing right now these challenges in getting tested.
Speaker 2: Absolutely.
Speaker 1: Hi, I'm erin Welsh, I'm erin Alman Updike and this
Speaker 1: is this podcast will kill you. Welcome to Chapter five
Speaker 1: of Anatomy of a Pandemic. This is our series on
Speaker 1: COVID nineteen.
Speaker 2: So far, what have we talked about. We have talked
Speaker 2: about SARS COVID two, the virus itself. We've discussed COVID nineteen,
Speaker 2: the clinical disease picture. We chatted about control strategies and
Speaker 2: also what we might expect from this epidemic curve and
Speaker 2: what we've seen so far. So in this episode we
Speaker 2: asked an expert all of your questions about vaccines and
Speaker 2: the development of a vaccine against SARS covy two. But
Speaker 2: we'll get to that in a minute.
Speaker 1: First, first things first, it's quarantine anytime, of course it is.
Speaker 1: How are we still managing to sound bubbly for that part?
Speaker 1: I don't know?
Speaker 3: Are we?
Speaker 1: Do we sound bubbly?
Speaker 2: I don't know?
Speaker 4: Do we? Okay, I don't know what are we drinking?
Speaker 4: In any case, I'm drinking water. But if you want
Speaker 4: a quarantine, you could make quarantini number five, which is
Speaker 4: essentially a tequila sunrise.
Speaker 1: Yeah, so tequila, orange juice, cherry, a little bit of
Speaker 1: cherry splash, juice grenadine.
Speaker 2: We'll post the recipe for this quarantini as well as
Speaker 2: our non alcoholic Placebrita on all of our social medias
Speaker 2: and our website.
Speaker 1: Every time, every time, every time. Okay, so a couple
Speaker 1: pieces that might be helpful to know before we jump
Speaker 1: into this interview, just so that we're all in the
Speaker 1: same page when it comes to vaccines. If you want
Speaker 1: a primer on how vaccines work and all the various
Speaker 1: types of vaccines, we have this in enormous detail in
Speaker 1: our two vaccines episodes, the first of which has a
Speaker 1: lot of detail on the types of vaccines and how
Speaker 1: your immune system responds to vaccines. So if you haven't
Speaker 1: heard it, or if you've forgotten entirely, which you know,
Speaker 1: I'm among those, it exists online for you. But for
Speaker 1: this interview, let's quickly go over some of the different
Speaker 1: types of vaccines. There are whole vaccines, so this is
Speaker 1: a vaccine that's made of an entire virus or bacteria,
Speaker 1: and those can either be killed or what we call attenuated,
Speaker 1: which means that they are less virulent and they can't
Speaker 1: really cause disease. There are component vaccines, which means the
Speaker 1: vaccine is made of pieces of the virus or bacteria,
Speaker 1: usually components of their surface, so that our body can
Speaker 1: make antibodies against these surface proteins that can help then
Speaker 1: fight off the virus if we ever get exposed to it.
Speaker 1: And finally, the newest kinds of vaccines, which I think
Speaker 1: are fascinating are DNA or RNA vaccines, and so that
Speaker 1: means injecting the DNA or RNA sequence or part of it,
Speaker 1: of the virus or bacteria into your muscle, and then
Speaker 1: your body has to use that sequence to make the proteins,
Speaker 1: and then your body makes animodies to those proteins, thus
Speaker 1: immunizing you.
Speaker 2: It's it's very cool, aren't it. It's beautiful, y awesome.
Speaker 2: And so having these different types of vaccines means that
Speaker 2: we have a number of different ways to target infectious diseases,
Speaker 2: including novel pathogens like SARS covy two. In the past,
Speaker 2: vaccine development relied heavily on creating attenuated versions of pathogens,
Speaker 2: so live strains of bacteria or viruses that don't cause
Speaker 2: disease but otherwise act a lot like real pathogens, or
Speaker 2: in other cases, we made vaccines out of whole killed cells.
Speaker 2: But both of these types of vaccines take a long
Speaker 2: time to produce, largely because they require first isolation and
Speaker 2: then culture of the pathogen in question, and then you
Speaker 2: have to grow that pathogen in large enough quantities to
Speaker 2: be able to produce a vaccine, So that whole process
Speaker 2: takes a long time and a lot of money too.
Speaker 1: So much money. Today, with the advent of molecular techniques,
Speaker 1: including gene sequencing, we can much more rapidly determine a
Speaker 1: protein or a gene sequence that could be used as
Speaker 1: a target for vaccine development. And we've seen this time
Speaker 1: and time again with every new pathogen that has emerged
Speaker 1: in recent years, from SARS to mers ebola zica. Groups
Speaker 1: rapidly try to identify potential targets that we can use
Speaker 1: to create a vaccine. But even though we can do
Speaker 1: this more rapidly than in the past, and even though
Speaker 1: genetic tools give us a kind of a head start
Speaker 1: on this, as you'll hear our guests explain, there are
Speaker 1: still very many steps to the development of an effective
Speaker 1: vaccine and they can't be skipped.
Speaker 2: So our guest today is doctor Maria Elena Botazzi. She's
Speaker 2: been working for years with her group in Texas on
Speaker 2: a vaccine against coronaviruses since the days of SARS, and
Speaker 2: so we brought her on to talk about her work
Speaker 2: on the development of a vaccine for SARS COVID two,
Speaker 2: the virus causing COVID nineteen. She'll answer all of your
Speaker 2: questions about what the steps are in vaccine development, looking
Speaker 2: at that timeline to development and whether we can hasten
Speaker 2: that process along while still maintaining safety standards. So the
Speaker 2: vaccine that her group is working on is a component vaccine,
Speaker 2: so it's made of that spike protein that you've probably
Speaker 2: heard a lot about in the news and if you've
Speaker 2: listened to the other episodes in this series. But we'll
Speaker 2: let her introduce herself and tell you all the details
Speaker 2: about the vaccine that she's working on right after this break.
Speaker 3: So I'm Marie Lena botazi and currently I co direct
Speaker 3: together with doctor Peter Hotis Center for Vaccine Development, which
Speaker 3: is based in Houston, and it's embedded with Baylor College
Speaker 3: of Medicine and Texas Children's Hospital. So it's a very
Speaker 3: unique vaccine center because we not only apply certainly business practices,
Speaker 3: you know, regulatory practices like any other big biotech or pharma,
Speaker 3: but we do it embedded in academic health centers because
Speaker 3: we have a lot of support through you know, collaborations
Speaker 3: with other I guess researchers. But at the same time,
Speaker 3: in the nonprofit sector, try to build these vaccine technologies
Speaker 3: with the ultimate mission that they can be affordable, reachable,
Speaker 3: and certainly be deployed to popular relations who really need them,
Speaker 3: you know, for the public good.
Speaker 1: Excellent talking now about stars COVID two, which is the
Speaker 1: virus that causes COVID nineteen. What about this virus makes
Speaker 1: it a good candidate for vaccine?
Speaker 3: So COVID nineteen as a coronavirus, and you know by
Speaker 3: that also any virus, you know, usually developing interventions to
Speaker 3: prevent them, you know, are not easy to do. So
Speaker 3: there's nothing particular about this virus that would make it
Speaker 3: easier or less easier to develop a vaccine against it.
Speaker 3: And you know, still with all the science advancements and
Speaker 3: technology advancements that we can't really predict when we would
Speaker 3: be successful at developing vaccines. And certainly now you even
Speaker 3: hear that most of vaccines are being developed in this
Speaker 3: new I guess era compared to maybe the old generation
Speaker 3: vaccines like you know, the measles, mumps, rubella. Is that
Speaker 3: new vaccines tend to becoming more and more that are
Speaker 3: not considered fully protective type of vaccines, but they are
Speaker 3: vaccines that are geared to reduce the severity of illness,
Speaker 3: maybe reduce the certain intensity of infections by different pathogens.
Speaker 3: And it's getting harder and harder to develop vaccines that
Speaker 3: are going to one hundred percent protect an individual. But
Speaker 3: that's still okay, right, I mean that you know that
Speaker 3: that's better than nothing. You know. Again, you know, I
Speaker 3: think the value of vaccines, whether they're fully protective or
Speaker 3: they are partially protected, ultimately is to try to again
Speaker 3: reduce deaths, reduce severity, hence reducing people to having to
Speaker 3: engage the healthcare systems by being hospital eyes or of
Speaker 3: course even going all the way to being put into
Speaker 3: intensive care units, and change the way that we therefore
Speaker 3: can manage these diseases by you know, being able to
Speaker 3: treat them like if you were getting a common call
Speaker 3: with you can basically maintain them through some simple at
Speaker 3: home type of containment or even just clinical management.
Speaker 1: So is the reason that it's becoming more difficult to
Speaker 1: create these completely protective vaccines? Is that Does that have
Speaker 1: something to do with the timeline of vaccine development or
Speaker 1: is it just sort of in the pathogens that we're
Speaker 1: talking about today, where we've kind of tackled all of
Speaker 1: the low hanging fruit of the infectious disease world.
Speaker 3: Well, maybe it's actually a little combination of both. Right,
Speaker 3: So again, if you think of how the old vaccines
Speaker 3: were originally generated, you know, we used to do them
Speaker 3: quite rudimentary, right, you know, use the entire pathogen and
Speaker 3: then you either kill the pathogen or inactivate the pathogen.
Speaker 3: And even though those vaccines are certainly still an approach
Speaker 3: that people occasionally evaluate more and more, now they're becoming
Speaker 3: much more sophisticated in the sense that we do them synthetically.
Speaker 3: Therefore we avoid also putting in any components of the
Speaker 3: pathogen that is really not necessary for us to confer
Speaker 3: protection in the human host, you know. So, yes, I
Speaker 3: mean the procedures, the ways that we produce vaccines, test vaccines,
Speaker 3: you know, have some level of impact of how quickly
Speaker 3: we can move them. But I think the second, which
Speaker 3: is the fact that pathogens, the ones that we consider
Speaker 3: the easy pathogen that we knew we could develop vaccines
Speaker 3: very rapidly, most likely we already did them. But now
Speaker 3: we're dealing with very complex pathogen is that even have
Speaker 3: very multiple transmission modes or that their cycle of survival
Speaker 3: is you know, inclusive and an intermediary vector or reservoir. Right.
Speaker 3: So you know, I just can give you an example,
Speaker 3: you know, the malaria vaccine, right, Why has it been
Speaker 3: so hard? Because what do you develop a vaccine against?
Speaker 3: Which stage of the parasite? You know, do you do
Speaker 3: it from the parasite that is in the blood stage
Speaker 3: or in the or or not do you look at
Speaker 3: you know, the parasite when it's inside the mosquito. These viruses,
Speaker 3: more and more are also quite intelligent in themselves, so
Speaker 3: they're very complex in the nature of how they not
Speaker 3: only find ways to infect but also where they come from.
Speaker 3: And therefore it makes it a little bit more challenging
Speaker 3: for us to find how we can tackle them and
Speaker 3: prevent them to not only infect us, but certainly cause disease.
Speaker 2: Excellent, So, in the case of SARS CoV two, this
Speaker 2: new coronavirus. How is the vaccine that your group is
Speaker 2: working on being made, what is it targeting, and how
Speaker 2: is it going to work against this new virus.
Speaker 3: So if we look at the vaccine that we currently
Speaker 3: are developing, as I mentioned, since our mission is really
Speaker 3: to always find ways that would lead to a technology
Speaker 3: that is already using a proven platform, so that's always
Speaker 3: been our case. So like proven platform, I mean in
Speaker 3: our case it is a recombinant protein based vaccine. And
Speaker 3: the reason we select that is because we know there
Speaker 3: are already many vaccines that are license and being used
Speaker 3: that use that same technology. So the backbone therefore of
Speaker 3: the way that we want to make the vaccine, it's
Speaker 3: proven and already has a lot of safety and as
Speaker 3: well as data on how you can rapidly produce it
Speaker 3: and how good are they by scaling them, and certainly
Speaker 3: even the amount of costs. You know that these types
Speaker 3: of platforms costs. So recombin and protein based vaccines are
Speaker 3: in general quite affordable and more importantly, they don't need
Speaker 3: to have very sophisticated manufacturing plants, and even in low
Speaker 3: middle income countries that do have capacity to develop their
Speaker 3: own vaccines could rapidly adopt them. That is certainly one
Speaker 3: consideration that we want is that you know, we don't
Speaker 3: develop something that is too much of a high cost
Speaker 3: or it has too much complexity in the technology that
Speaker 3: then we can only make it in the US and
Speaker 3: then nobody else is able to adopt it because it's
Speaker 3: just too expensive or too labor intensive. So that's one aspect.
Speaker 3: The second aspect, specifically for COVID nineteen is that everybody
Speaker 3: is trying to attend and to develop a vaccine targeting
Speaker 3: what they call the spike protein, which is the protein
Speaker 3: the virus uses to infect the human cells. But even
Speaker 3: within the spike protein, there are a lot of components
Speaker 3: that maybe it's they're not necessarily useful in the induction
Speaker 3: of this protective response. So we with a group of
Speaker 3: partners from the New York Blood Center as well as
Speaker 3: the University of Texas Medical Branch here in Galveston, we
Speaker 3: were kind of like picked apart the spike protein and
Speaker 3: we narrow down what we think it's the most essential
Speaker 3: piece that we need for us to be able to
Speaker 3: induce our response in humans that is protected but at
Speaker 3: the same time evaluates the safety of using it. So
Speaker 3: it's it's actually a small piece that it's called the
Speaker 3: receptor binding domain. So amongst the spike protein, the like
Speaker 3: uses this domain to specifically target this component in our
Speaker 3: human cells that needs to be bound on and therefore
Speaker 3: used to be to infect the cells. So we therefore
Speaker 3: engineered in our lab a recombinant protein that specifically just
Speaker 3: expresses this receptor domain, and when you put it in
Speaker 3: the right formulation, we know that in animal models it
Speaker 3: does induce a strong and certainly efficacious response and protects
Speaker 3: against a challenge of the SARS virus. Now there's a
Speaker 3: disclaimer here that you know, our vaccine was developed back
Speaker 3: in twenty eleven, so the engineering of this vaccine was
Speaker 3: really based on the SARS virus that was circulating at
Speaker 3: that time and not COVID nineteen virus. But there are
Speaker 3: several evidence and strong scientific evidence that the two viruses
Speaker 3: are very similar to each other. So we believe that
Speaker 3: we should evaluate it to see whether there may be
Speaker 3: a potential of cross protection.
Speaker 1: That's wonderful kind of giving you a jump start on
Speaker 1: the SARSKOV two vaccine potentially.
Speaker 3: Right, And you know, we will not know if it's
Speaker 3: a perfect fit. It may not be a perfect fit.
Speaker 3: But you know, I think, if anything, at this point,
Speaker 3: I know there are many efforts trying to develop very
Speaker 3: specific COVID nineteen vaccines, and they certainly all use different
Speaker 3: strategies and even different platforms. Some may be more favorable
Speaker 3: than others. Again, we probably are the only ones focusing
Speaker 3: on this small domain. We also are, in parallel trying
Speaker 3: to engineer a brand new vaccine that is against specifically
Speaker 3: the RBD of this new virus. But in the meantime,
Speaker 3: you know, since we are already so advanced with the
Speaker 3: prior vaccine, because we already even have it in our freezers,
Speaker 3: manufactured with a grade that can be used in the clinic,
Speaker 3: we think that we should not just wait for us
Speaker 3: to develop a new one. We should, you know, in parallel,
Speaker 3: start evaluating the one that we already have designed.
Speaker 1: Do you mind walking us through that timeline for vaccine
Speaker 1: development and then testing and then deployment, and then maybe
Speaker 1: how soon you think we could expect to see an
Speaker 1: effective vaccine for SARSKOV two.
Speaker 3: Certainly so developing vaccines, and be quite honest, any biologic
Speaker 3: it's a long process. So if you start from scratch,
Speaker 3: like for example, we're starting from, you know, looking at
Speaker 3: the genetic code of the virus, identifying what we want
Speaker 3: to target. I mean, at least for this, we already
Speaker 3: have a heads up because we already had an idea
Speaker 3: of what to target. So let's let's take the example.
Speaker 3: We know we want to target the receptor binding domain
Speaker 3: of the spike, so rapidly we clone that. We have
Speaker 3: to look for the process for making it at laboratory scales.
Speaker 3: But then that laboratory scale has to be scaled up
Speaker 3: to the point where it becomes not only a pilot
Speaker 3: scale in manufacturing agencies, but eventually even what we call
Speaker 3: industrial scales. That's just that sole process of from the cloning, engineering,
Speaker 3: to scaling and producing usually can take from six months
Speaker 3: all the way to maybe eighteen months to even twenty
Speaker 3: four months. And of course it depends on is it
Speaker 3: easy to make it? Is it not easy to make it?
Speaker 3: Are the processes very complicated? Since we already know four
Speaker 3: stars that we already had developed was a very simple approach,
Speaker 3: and it ended up being quite an easy process. Instance,
Speaker 3: think that, you know, we could have a new process
Speaker 3: for the stars to RBD or the COVID nineteen RBD
Speaker 3: in probably the next six months, so that's one piece. However,
Speaker 3: after that, of course, you know, producing something doesn't tell
Speaker 3: you whether it's usable, or if it's going to be safe,
Speaker 3: or if it's going to be protected. So we before
Speaker 3: going to humans, you have to start a whole pre
Speaker 3: clinical plan where you have to have an animal model
Speaker 3: of course, that has to be suitable for the pathogen
Speaker 3: that you want to test your vaccine against. We know
Speaker 3: that there are currently several groups that have been developing
Speaker 3: these COVID nineteen animal models. They probably are not ready
Speaker 3: one hundred percent, but you know there are already a
Speaker 3: few that people are using to be able to evaluate
Speaker 3: any kind of vaccine or even even drugs for example.
Speaker 3: So that process of evaluating your produced vaccine candidate usually
Speaker 3: can take again another six maybe to another nine months,
Speaker 3: So there goes a year, right, and that's just only
Speaker 3: pre clinical. After that, when you decide that yes you
Speaker 3: can make it, yes you have indication in some model,
Speaker 3: then is the critical activity start. And by critical activities
Speaker 3: mean what we call the regulated the activities that then
Speaker 3: you can provide as evidence to a regulatory body, in
Speaker 3: our case the United States Food and Drug Administration. So
Speaker 3: that they can evaluate that information, and those include three
Speaker 3: main components, so a formal manufacturing campaign, a formal toxicology studying,
Speaker 3: an animal model, and then of course a plan of
Speaker 3: how you're going to do the first in human safety evaluation.
Speaker 3: And those three activities generally take another year or a
Speaker 3: year and a half, so you already have one year
Speaker 3: for that what we call research and development, one year
Speaker 3: maybe two years for the initial critical path activities, and
Speaker 3: after you finish that first, then you design a long
Speaker 3: term plan where eventually you evaluate in larger populations, you
Speaker 3: look at efficacy, you look at safety, and so as
Speaker 3: you can see, it can be a two to three
Speaker 3: year program, or it can become a ten year, twenty year,
Speaker 3: thirty year. As you have seen for many other vaccine programs,
Speaker 3: there is never an assurance that we will find one.
Speaker 3: But of course you have to do the studies to
Speaker 3: be able to evaluate if there's even the feasibility of doing.
Speaker 1: So in a situation like this where there's increasing need
Speaker 1: for the development and deployment of a vaccine. You know,
Speaker 1: I've seen a lot of news articles talking about shortening
Speaker 1: those steps, and so which of those steps would be
Speaker 1: shortened to them? Maybe you know, get an early release
Speaker 1: of a vaccine.
Speaker 3: So I think that it's not really a shortening of
Speaker 3: the steps as much as trying to instead of doing
Speaker 3: them linearly and one after the other. That there's been
Speaker 3: some I guess and consultation with the regulatory bodies that
Speaker 3: you can stagger and maybe do things in parallel. So,
Speaker 3: for example, as you're already developing this process, you rapidly
Speaker 3: already engage the manufacturer and you could already have them
Speaker 3: do some what we call engineering runs, and therefore you
Speaker 3: don't have to wait until you have a process fully
Speaker 3: developed before you already engage a manufacturer, right, so you
Speaker 3: condense it that way. In the area of pre clinical testing,
Speaker 3: you may be able to while you're doing some of
Speaker 3: these pre clinical tests, you already ramp up to have
Speaker 3: a design for your toxicology study. And then on top,
Speaker 3: as you're doing your toxicology you don't have to wait
Speaker 3: for the end of it while as if you release
Speaker 3: the safety data as it comes out, I guess educates
Speaker 3: how you can then start your clinical study. So normally
Speaker 3: they like you to do one thing and then get
Speaker 3: all the data and review it and then plan for
Speaker 3: the next step. In these kinds of emergencies. They're allowing
Speaker 3: you that you can unblind some of the information so
Speaker 3: that you can start things in parallel and not necessarily
Speaker 3: wait until you have a study totally completed. And that's
Speaker 3: how they're trying to condense the timelines. But definitely one
Speaker 3: thing that you cannot do is you cannot skip steps, right,
Speaker 3: I mean, I think even though maybe in the news
Speaker 3: there's this perception that, you know, how could have they
Speaker 3: done this? You know, we haven't seen any data because ultimately,
Speaker 3: you know, we in the scientific community, we get access
Speaker 3: to the information because people publish it or make it available, right,
Speaker 3: I mean, right now, I think either there's been no
Speaker 3: time to sometimes see all the data that is kind
Speaker 3: of around, or sometimes we do see data, but it
Speaker 3: hasn't really been evaluated by peers. So it's at the
Speaker 3: same time, it's quite struggling, right because these agencies, I assume,
Speaker 3: have purview of information that maybe not all of us have. Uh.
Speaker 3: And it's the key to have experts in whatever communities
Speaker 3: they're set up to make sure that they try to
Speaker 3: make the most safe and appropriate decision. And that said,
Speaker 3: you know, it's it's it's a strong, big pressure on
Speaker 3: people right to make these decisions when you on top
Speaker 3: have this urgency behind you, right.
Speaker 2: So, I know a lot of the focus has been
Speaker 2: on the development of vaccine, and in general we are
Speaker 2: better at developing vaccines than we are anti virals, it seems.
Speaker 2: Do you know if there are antivirals that people are
Speaker 2: working on, or maybe why it might be easier to
Speaker 2: develop vaccines than it is antivirals.
Speaker 3: So in fact, I think you got it the other
Speaker 3: way around. So usually what we call either small molecule
Speaker 3: drugs or even sometimes these types of imminotherapies tend to
Speaker 3: be have a little bit more unaccelerated process for moving
Speaker 3: forward towards you know, eventually use the usability. And the
Speaker 3: reason is the following vaccines, at least the ones that
Speaker 3: generally are being developed, they're what they call preventive vaccines.
Speaker 3: So the intention is that you use them in normal,
Speaker 3: healthy populations. So the risk benefit of giving something to
Speaker 3: a healthy person that eventually can then lead to something
Speaker 3: that is of high risk, the bar is a lot higher, right,
Speaker 3: you know, you're a little bit more cautious of what
Speaker 3: you use to give to a healthy person. Therapy is
Speaker 3: as you know, and they're intended to be therapeutics, and
Speaker 3: therefore you're already tackling and supposed to use them and
Speaker 3: already sick people. So the bar it may be a
Speaker 3: little bit lower, right because being sick and being certainly
Speaker 3: severely sick, and with the option of death, you know,
Speaker 3: there's a lot of protocols that you can use with
Speaker 3: the argument of compassionate use, where you know you are
Speaker 3: trying to really evaluate that this is going to not
Speaker 3: only extend the life or certainly improve the quality of
Speaker 3: life in an event that you know you can, you know,
Speaker 3: totally prevent the ultimate death. Right for now, as you
Speaker 3: can see the level of urgency as you've heard in
Speaker 3: the news. First, have the deal diagnostics right, because you
Speaker 3: need to know who is infectant and who's not. Second is,
Speaker 3: if you already have those infected, how can you really
Speaker 3: prevent these people to have severe disease and therefore avoid death.
Speaker 3: And so here is where a lot of therapies are
Speaker 3: being rapidly evaluated and even even repurpose some therapists that
Speaker 3: may be used for something else. They are evaluating them.
Speaker 3: But ultimately, in the long term, you want to if
Speaker 3: you can't avoid infection, through the either containment or other practices.
Speaker 3: You eventually will need to have a preventive vaccine, right,
Speaker 3: because even if this outbreak or pandemic disappears, if there
Speaker 3: were to be something in the future, you don't want
Speaker 3: to scramble again just to try and to find therapies.
Speaker 3: You want to have a full toolbox, right, good diagnostics,
Speaker 3: good preventive measures for those who haven't gotten the disease
Speaker 3: yet there and also already have therapy for those who
Speaker 3: are unfortunately do get it.
Speaker 1: Gotcha? That makes sense. Just as in our first episode
Speaker 1: on coronaviruses, we ask the people that we interviewed, what
Speaker 1: about this disease concerns you and or is cause for concern?
Speaker 1: And what about it is maybe not as much of
Speaker 1: a cause for concern as the media has made it
Speaker 1: out to be, or something maybe about the vaccine development
Speaker 1: stages that reassures you.
Speaker 3: Well, I think, to be quite honest, I think it
Speaker 3: is a concern, right, And I think that concern stems
Speaker 3: from the rapid transmission that we are seeing from people
Speaker 3: to people, right. And as you have noticed, you know,
Speaker 3: there's been some really enormously drastic attempts to try to
Speaker 3: even reduce our social connections to try to minimize is
Speaker 3: the transmission of this virus. And it's been quite interesting
Speaker 3: even compared to the other coronaviruses that we have seen before.
Speaker 3: So that's definitely a distinction. I think the unpredictability, right,
Speaker 3: you know, that you cannot really predict, you know, even
Speaker 3: how these curves will be looking how you know, certainly
Speaker 3: what happened in China and what's happening in Europe. We're
Speaker 3: trying to make a lot of inferences of what's going
Speaker 3: to happen maybe in the Americas. So there's a lot
Speaker 3: of unknowns and and I think it's it's the stress
Speaker 3: that everybody has, not only personally as an individual, but
Speaker 3: as a community, but you know, including all the first
Speaker 3: responders and certainly the medical and researchers that are you know,
Speaker 3: more in the trenches about this. It's it's very hard
Speaker 3: to predict, right, So we should take this seriously and
Speaker 3: try to as Mutch we you know, are not very happy,
Speaker 3: you know, to try to really contain our social connectivity
Speaker 3: at this point. And it's it's tough now, I think,
Speaker 3: you know, the other challenge that I see is and
Speaker 3: I appreciate that a lot of media is trying to
Speaker 3: push information is it's still you know, again to be
Speaker 3: very conscious of the quality of the information that is
Speaker 3: being pushed out and who who is using reputable sources,
Speaker 3: Where are the reputable sources to look at, and not
Speaker 3: get totally blindsided by the noise that it's really trying
Speaker 3: to disrupt, you know, where the real information is and
Speaker 3: people are just getting distracted. So I hope that we
Speaker 3: can figure out a way and this is a lesson
Speaker 3: learn of the power, of course of media and social media,
Speaker 3: but that at the same time it's it's making our
Speaker 3: lives a little difficult because people are just getting distracted
Speaker 3: by information that is just absolutely not useful. And then
Speaker 3: I think in the area of again developing vaccines, if anything,
Speaker 3: I hope that this just that the population understands that
Speaker 3: ultimately those of us who are working on these types
Speaker 3: of interventions, we don't take this lightly. That the way
Speaker 3: we do this is you know, to ensuring first and
Speaker 3: foremost the safety of anybody that will eventually use them,
Speaker 3: and so that they can reinvigorate again their their acceptance
Speaker 3: that vaccines work. That even in the context of COVID nineteen,
Speaker 3: there are so many other diseases that are certainly potentially important.
Speaker 3: There are a lot of them already have vaccines that
Speaker 3: clearly either one hundred percent protect or even partially protect,
Speaker 3: and we should therefore continuously ensure that we are up
Speaker 3: to date with our vaccinations because I think, you know,
Speaker 3: we're also seeing that there was a little bit of
Speaker 3: disconnect about you know, the value of vaccines and how
Speaker 3: it brings value as a public health tool, and that
Speaker 3: this is really a public health you know that all
Speaker 3: communities have to engage and needs to support these types
Speaker 3: of initiatives.
Speaker 1: Thank you again so very much to doctor Batazzi. We
Speaker 1: really really appreciate it.
Speaker 2: Yeah, thank you so much for spending the time to
Speaker 2: talk to us and explain all of those things.
Speaker 1: Also, we're very excited that she's working with doctor Hotees,
Speaker 1: our friend Hodi, Our friend Hodi.
Speaker 2: He probably hates that I say that, I don't know,
Speaker 2: let us know.
Speaker 1: I love it, and that's more important.
Speaker 2: So what have we learned from this episode? First of all,
Speaker 2: there are a lot of different strategies to vaccine development,
Speaker 2: So we learned a lot from doctor Botazi about the
Speaker 2: strategies that her group is using. So developing a component
Speaker 2: vaccine based on the platform that they had been using
Speaker 2: for mers. But one thing I really want to point
Speaker 2: out is that there are a number of different strategies
Speaker 2: that groups can use, like we said in the intro,
Speaker 2: and they're all doing this simultaneously. So there is a
Speaker 2: group that has started safety trials, so phase one trials
Speaker 2: of an RNA based vaccine, and I think this is
Speaker 2: pretty exciting because this is the first of its kind
Speaker 2: in humans that's actually being tested in humans. There are
Speaker 2: DNA based vaccines that are being used in animals right now,
Speaker 2: but this one, it's the first RNA based vaccine that
Speaker 2: I know of, and it's the first one being tested
Speaker 2: in humans. So it's going to be very interesting to
Speaker 2: see how that trial goes. And if you want to
Speaker 2: know even more details about the work that doctor Botazi
Speaker 2: is doing, as well as what other types of vaccine
Speaker 2: trials are going on, remember that you can check clinicaltrials
Speaker 2: dot gov to see all of the registered human clinical
Speaker 2: trials for vaccines and drug treatments. So yeah, point two.
Speaker 1: We also learned that while you could in theory at
Speaker 1: least create a vaccine for nearly any pathogen, it seems
Speaker 1: that a lot of the pathogens that we are seeing
Speaker 1: emerge have complexities that makes them super difficult to target,
Speaker 1: and whether that's a complex life cycle or complex components,
Speaker 1: so it's difficult to know which component of the pathogen
Speaker 1: to target, or maybe whether it's just completely novel pathogens
Speaker 1: that we know nothing about. So we're starting from scratch
Speaker 1: in a lot of these cases, and that can make
Speaker 1: the creation of a successful vaccine much more challenging.
Speaker 2: Absolutely number three, and this I think is a really
Speaker 2: important point to take away from this interview. Although we
Speaker 2: can try and do some of the steps of vaccine
Speaker 2: development in parallel, we can't skimp on safety and nobody
Speaker 2: is trying to, so there isn't a way to drastically
Speaker 2: shorten the time course of vaccine development. So the fact
Speaker 2: that there were groups like doctor Batazzi's group already working
Speaker 2: on vaccines for similar viruses means that they already had
Speaker 2: platforms in place which could be built upon, and that's
Speaker 2: unbelievably helpful in trying to hasten the development of vaccines
Speaker 2: for novel pathogens.
Speaker 1: The other big takeaway that I think was super interesting
Speaker 1: from our conversation with doctor Botazi is that one of
Speaker 1: the big challenges in vaccine development is in ensuring safety,
Speaker 1: since vaccines are something that we inject into otherwise healthy
Speaker 1: people to prevent them from getting a disease, rather than treatments,
Speaker 1: which are something that we use when someone is already sick.
Speaker 1: And so this is a difference in way the risks
Speaker 1: of a particular vaccine versus a particular treatment. And this
Speaker 1: is interesting because honestly, we don't have a lot of
Speaker 1: specific treatments for most viruses, but we'll hopefully talk in
Speaker 1: a future episode about how many different treatments are out
Speaker 1: there that are already trying to help people currently infected
Speaker 1: with SARS CoV two.
Speaker 2: Yeah, which is awesome. Number five and what I think
Speaker 2: my favorite takeaway from this episode is to underscore just
Speaker 2: how important it is, even in times when it seems
Speaker 2: like everything is fine and there's no scary disease coming
Speaker 2: after us, we need to be funding research into vaccine
Speaker 2: development because we never know exactly what disease might emerge next.
Speaker 2: But having systems and platforms in place that we can
Speaker 2: build upon is really useful in ensuring rapid access to
Speaker 2: potentially life saving treatments and vaccines. And so I think
Speaker 2: We've kind of touched on this in almost every episode,
Speaker 2: but funding science research is really important.
Speaker 1: Yeah, absolutely, And I think, you know, one of the
Speaker 1: things that kind of occurred to me as we keep
Speaker 1: saying these things. As we keep saying, oh, social responsibility
Speaker 1: for social distancing, and you need to keep funding this,
Speaker 1: we're kind of preaching to the choir. I don't know
Speaker 1: if there are many people. I don't know if there
Speaker 1: are many of our listeners that need to be convinced
Speaker 1: of these things, especially now, But these things are still
Speaker 1: an issue. And so if you want to make an impact,
Speaker 1: if you want to spread the word, you can just
Speaker 1: spread it by talking about it, or you can contact
Speaker 1: your congress person if you're in the US, make your
Speaker 1: vote matter with these sorts of issues and topics, and
Speaker 1: so this is something that you can make an impact
Speaker 1: on and it you know, I kind of feel like
Speaker 1: we're just shouting into an echo chamber a little bit,
Speaker 1: but you know, let's get the message out there.
Speaker 2: Yeah, that's all we can try and do. Man, really, Yeah,
Speaker 2: voting good point erin.
Speaker 1: Okay, sources sources, So.
Speaker 2: If you'd like to know more about the study that's
Speaker 2: going on right now with that RNA vaccine. We'll post
Speaker 2: the details to that clinical trial, and then if you'd
Speaker 2: like to know more in general about the different strategies
Speaker 2: that groups use to try and develop vaccines for emerging viruses.
Speaker 2: There's a great paper by afro at All that was
Speaker 2: published in Clinical and Experimental Immunology last year, so we'll
Speaker 2: post that on our website as well.
Speaker 1: Awesome. Thank you so much again to doctor Batazzi for
Speaker 1: taking the time to chat with us about the work
Speaker 1: that she's doing on a vaccine. We really really appreciate it.
Speaker 2: And thank you to Bloodmobile for providing the music for
Speaker 2: this and all of our episodes.
Speaker 1: And thank you to you listeners. We really appreciate you
Speaker 1: listening chapter five.
Speaker 2: Did you make it this far? That's amazing.
Speaker 4: I feel like people should get a prize if they
Speaker 4: actually listen to all of this.
Speaker 1: Definitely, what's a prize? I think the prize is the
Speaker 1: next episode, chapter six. Yeah, chapter six will be your prize.
Speaker 1: That's that's exactly right. Okay, that's this is exactly right.
Speaker 1: This is exactly right. We're losing it, okay, so before
Speaker 1: we lose it completely, wash your hands.
Speaker 2: You filed the animals m