WEBVTT - Lessons From Past Vaccines 0:00:05.120 --> 0:00:09.880 Welcome to Prognosis. I'm Laura Carlson. It's day two hundred 0:00:09.920 --> 0:00:13.880 and eighty two since coronavirus was declared a global pandemic. 0:00:14.560 --> 0:00:19.360 Today's main story. The US has begun a massive vaccination 0:00:19.440 --> 0:00:23.520 campaign to fight the coronavirus. It's not the first time 0:00:23.760 --> 0:00:27.520 the country has rolled out this kind of public health initiative. 0:00:28.120 --> 0:00:31.800 Today we look at what lessons we can learn from 0:00:31.800 --> 0:00:45.120 the past. But first, here's what happened in virus news today. Europe, 0:00:45.360 --> 0:00:48.480 as well as areas reaching from Canada to Hong Kong, 0:00:48.960 --> 0:00:52.800 suspended travel to the UK as a full lockdown came 0:00:52.840 --> 0:00:56.360 into force in London and Southeast England to contain a 0:00:56.440 --> 0:01:01.480 mutation of the coronavirus. The Europeans Center for Disease Prevention 0:01:01.520 --> 0:01:05.760 and Control said preliminary analysis in the UK indicates that 0:01:05.800 --> 0:01:11.080 the coronavirus variant is significantly more transmissible, with an estimated 0:01:11.319 --> 0:01:16.880 increased transmissibility of up to seventy The new faster spreading 0:01:16.959 --> 0:01:20.840 mutation of the virus has also been detected in Australia, 0:01:21.240 --> 0:01:25.880 Denmark and Gibraltar. The European regulator has said it is 0:01:26.160 --> 0:01:29.920 very likely the FISER and bio en Tech vaccine will 0:01:29.920 --> 0:01:34.080 offer protection against the new strain of COVID nineteen. The 0:01:34.160 --> 0:01:37.959 vaccine just won the backing of a key European review panel, 0:01:38.640 --> 0:01:41.920 clearing the way for inoculations in the region to start 0:01:42.040 --> 0:01:47.600 before the end of Marco Cavalery, chair of the European 0:01:47.680 --> 0:01:52.280 Medicines Agency Pandemic Task Force, said that while more evidence 0:01:52.480 --> 0:01:56.880 is needed, the antibody response seen from the shot suggests 0:01:57.200 --> 0:02:04.040 the new strain shouldn't compromise the vaccines effectiveness. Meanwhile, in 0:02:04.120 --> 0:02:08.000 South Africa, private hospital operators have warned that they are 0:02:08.040 --> 0:02:13.640 facing severe capacity constraints due to a resurgence in coronavirus cases. 0:02:14.280 --> 0:02:18.120 The COVID nineteen pandemic first peaked in South Africa in 0:02:18.240 --> 0:02:22.280 late July, before infections tailed off in the fall. The 0:02:22.320 --> 0:02:24.400 country is in the midst of a second wave of 0:02:24.440 --> 0:02:28.359 the disease that began shortly before the holiday season, when 0:02:28.480 --> 0:02:34.240 millions of people traditionally travel. Finally, congressional leaders in the 0:02:34.360 --> 0:02:38.000 US reached a deal on a roughly nine hundred billion 0:02:38.080 --> 0:02:42.120 dollar spending package to bolster the US economy amid the 0:02:42.160 --> 0:02:48.200 continued coronavirus pandemic. This gives lawmakers a short timetable to 0:02:48.280 --> 0:02:53.040 review and pass the second largest economic rescue measure in 0:02:53.080 --> 0:02:57.560 the nation's history. Senate Majority Leader Mitch McConnell, Howse Speaker 0:02:57.800 --> 0:03:02.160 Nancy Pelosi, and Senate Democrat Leader Chuck Schumer announced the 0:03:02.200 --> 0:03:06.600 accord on Sunday. The legislative text is still being written, 0:03:06.760 --> 0:03:09.760 but the House is expected to vote on it Monday, 0:03:09.800 --> 0:03:18.840 followed by the Senate. And now for today's main story, 0:03:19.240 --> 0:03:22.640 the US has begun a massive vaccination campaign to fight 0:03:22.680 --> 0:03:26.800 the coronavirus, but the effort will have plenty of challenges, 0:03:27.160 --> 0:03:32.000 including convincing people to get immunized. Of course, it's not 0:03:32.120 --> 0:03:34.440 the first time the country has rolled out this kind 0:03:34.440 --> 0:03:39.800 of public health initiative. Bloomberg's John Lawerman spoke with infectious 0:03:39.800 --> 0:03:44.560 disease specialist William Shaffner of Vanderbilt University to learn more. 0:03:54.240 --> 0:03:59.440 You've observed, lived through, and participated in some ambitious vaccine campaigns. 0:04:00.400 --> 0:04:03.200 Is it fair to say that the small pox imnization 0:04:03.280 --> 0:04:07.880 effort was the biggest and most successful on record? I 0:04:07.880 --> 0:04:11.960 would think that that's the case that in polio, smallpox 0:04:12.000 --> 0:04:17.520 of force was eradicated the global campaign against polio. We 0:04:17.680 --> 0:04:23.359 now have polio confined really to Afghanistan and Pakistan. They're 0:04:23.440 --> 0:04:28.480 the last holdouts for the wild poliovirus. Both of those 0:04:28.520 --> 0:04:34.200 have been extraordinarily comprehensive, and both of them lasted years 0:04:34.240 --> 0:04:39.440 around the world, but both very very successful public health 0:04:39.520 --> 0:04:44.240 interventions against two very dreaded diseases. Well, let's talk about 0:04:44.240 --> 0:04:49.800 smallpox first, because smallpox was effectively eradicated. Is that the 0:04:49.880 --> 0:04:53.120 only disease that we've been able to eradicate? And if so, 0:04:53.400 --> 0:04:56.920 why was that possible? It's the only human disease we've 0:04:56.960 --> 0:05:00.120 been able to eradicate. Yes, it was possible for or 0:05:00.120 --> 0:05:04.320 a number of reasons. One, the smallpox virus actually spread 0:05:04.640 --> 0:05:08.919 relatively slowly. It has this reputation of spreading rapidly, but 0:05:09.040 --> 0:05:13.640 it actually spreads rather slowly. You need rather close contact 0:05:14.000 --> 0:05:18.440 for transmission to occur. You knew where every case of 0:05:18.520 --> 0:05:25.520 smallpox was because we didn't have any asymptomatic or subclinical infection. 0:05:25.839 --> 0:05:32.040 Smallpox was a dramatic, serious, easily recognizable disease, so you 0:05:32.040 --> 0:05:36.120 could find it. And then we had a brilliant strategy 0:05:36.160 --> 0:05:40.920 of vaccinating. We first tried to just vaccinate everybody, and 0:05:40.960 --> 0:05:45.280 you know that went halfway there, But the real strategy 0:05:45.480 --> 0:05:48.880 was to find out where the cases of smallpox were 0:05:49.240 --> 0:05:54.360 and then to vaccinate everybody around them so the smallpox 0:05:54.440 --> 0:05:59.240 virus couldn't spread any further and that snuffed out the 0:05:59.360 --> 0:06:04.440 transmission and of smallpox. So what about with polio. We've 0:06:04.440 --> 0:06:09.040 had an excellent polio vaccine for years, I guess almost 0:06:09.040 --> 0:06:10.960 as long as we've had a small pox vaccine, perhaps 0:06:11.000 --> 0:06:14.800 even longer. We don't even use smallpox vaccine really anymore 0:06:15.760 --> 0:06:19.640 because we don't need it. But polio, there's still some 0:06:19.680 --> 0:06:23.279 pockets of polio, right, what's the obstacle there, Well, there's 0:06:23.279 --> 0:06:26.520 several obstacles to polio. Polio is a much more subtle 0:06:26.560 --> 0:06:32.000 infection because it's an intestinal virus. And for every hundred 0:06:32.080 --> 0:06:36.240 people who are infected who have this virus in their intestines, 0:06:36.600 --> 0:06:41.480 usually without symptoms, without symptoms, John there's one case of 0:06:41.600 --> 0:06:47.160 paralytic polio, so it's much harder to trace. But however, 0:06:47.680 --> 0:06:52.279 the vaccine was so easy to administer. Remember you could 0:06:52.360 --> 0:06:55.560 give it on a sugar cube to a child and 0:06:56.200 --> 0:06:59.200 it would go down into the intestinal tract and then 0:06:59.480 --> 0:07:02.760 do it's work, So we could vaccinate. In this case, 0:07:03.040 --> 0:07:07.400 we had a different strategy to just vaccinate very comprehensively 0:07:07.960 --> 0:07:11.560 and they're The trick is to be accepted in the 0:07:11.680 --> 0:07:17.560 population to vaccinate each and every child, and that becomes 0:07:17.560 --> 0:07:22.520 the great challenge in areas where there is civil unrest, turbulence, 0:07:22.680 --> 0:07:28.480 and indeed UH guns are blazing, so the last challenges 0:07:28.560 --> 0:07:33.280 are very severe. So this situation that you mentioned with 0:07:33.800 --> 0:07:39.080 many many asymptomatic people along with some who actually become symptomatic, 0:07:39.840 --> 0:07:42.960 that sounds kind of familiar. So what kind of lessons 0:07:43.000 --> 0:07:45.360 do you think we can learn from polio that could 0:07:45.400 --> 0:07:50.760 be applied to, you know, coronavirus to covid vaccines. Yes, 0:07:50.880 --> 0:07:53.880 it is familiar, isn't it, because we have many people 0:07:53.920 --> 0:07:58.440 who are without symptoms who can transmit the COVID virus 0:07:59.480 --> 0:08:03.160 the same. The most important lesson I think has to 0:08:03.240 --> 0:08:08.440 do with actually the business you're in communication, communication, communication. 0:08:08.960 --> 0:08:12.560 You have to provide a goal, you have to enlist 0:08:12.640 --> 0:08:17.320 the population to achieve that goal, and then you have 0:08:17.440 --> 0:08:22.520 to tell them very explicitly, very honestly, and very repeatedly, 0:08:23.080 --> 0:08:25.840 how we're going to get from here to the goal. 0:08:26.360 --> 0:08:29.760 What about the vaccine, who will get it, when will 0:08:29.800 --> 0:08:33.200 it be available, how many side effects will it have? 0:08:33.920 --> 0:08:36.560 And then you have to put down all the rumors 0:08:36.600 --> 0:08:40.640 that come up, all those falsehoods uh related to the 0:08:40.720 --> 0:08:44.199 vaccine that people out there managed to conjure up all 0:08:44.240 --> 0:08:48.760 the time. I chuckle, But it's very serious business because 0:08:48.880 --> 0:08:54.160 it can have a very dampening influence on the acceptance 0:08:54.200 --> 0:09:06.800 of the vaccine. Over the years, you've seen various campaigns, 0:09:07.360 --> 0:09:10.320 for example, just the annual effort to try to get 0:09:10.360 --> 0:09:12.720 people to take flu vaccine. I know you're a huge 0:09:13.280 --> 0:09:17.120 supporter of flu vaccine, right. What can we do to 0:09:17.240 --> 0:09:22.319 actually make the messaging better and overcome these obstacles that 0:09:22.360 --> 0:09:25.360 we've seen in the past. Well, if we're speaking about COVID, 0:09:25.960 --> 0:09:28.840 and this is a public health statement, not a political statement, 0:09:29.120 --> 0:09:32.960 but there's been so much mixed messaging about COVID and 0:09:33.040 --> 0:09:36.679 we have not had, at least to date, a single 0:09:36.920 --> 0:09:41.880 national campaign. We haven't had a single national coherent response. 0:09:42.160 --> 0:09:44.680 It's been left to the states, and now we have 0:09:44.760 --> 0:09:47.840 a crazy quilt, if you will, of different approaches in 0:09:47.960 --> 0:09:51.719 different states. Is it any wonder that people are confused? 0:09:52.320 --> 0:09:55.600 What I would like to see as regards the COVID 0:09:55.679 --> 0:10:00.160 vaccine is the public health people and the clinici and 0:10:00.280 --> 0:10:03.959 such as myself out in front, with our political friends 0:10:04.000 --> 0:10:09.160 behind us. Supporting us, but let us do the messaging, 0:10:09.760 --> 0:10:13.559 take the politics out of it as much as possible, 0:10:14.040 --> 0:10:18.079 and let us do our job in a coherent, straightforward 0:10:18.120 --> 0:10:22.400 fashion with their support, making sure that we are all 0:10:22.600 --> 0:10:27.560 part of a national effort to dampen the spread of COVID. 0:10:27.880 --> 0:10:31.040 And we can do that with a combination of masking, 0:10:31.160 --> 0:10:35.559 social distancing, avoiding large groups, and now adding the vaccine. 0:10:35.920 --> 0:10:39.120 We'll have to do all of those together for a 0:10:39.160 --> 0:10:42.320 period of yet many months, but next year in the 0:10:42.400 --> 0:10:46.440 holiday season could be back to normal or close to 0:10:46.520 --> 0:10:50.439 it if we could do all those things together. The 0:10:50.559 --> 0:10:53.760 vaccine alan won't be enough, not for a long time. 0:10:54.240 --> 0:10:57.560 We'll have to do all those things together. Can you 0:10:57.760 --> 0:11:00.160 can you think of any times in the past US 0:11:00.880 --> 0:11:04.520 when we've had that kind of messaging, very direct messaging 0:11:05.160 --> 0:11:08.200 about vaccines. One of the one of the things that 0:11:08.240 --> 0:11:11.400 I recall, and I'm sure you recall very vividly, was 0:11:11.440 --> 0:11:14.760 back in two thousand four when the US was trying 0:11:14.760 --> 0:11:18.000 to roll out smallpox vaccine and I think to a 0:11:18.040 --> 0:11:24.200 degree anthrax vaccine for certain populations healthcare workers. And that 0:11:24.320 --> 0:11:27.360 was very difficult, and I think there were some issues 0:11:27.400 --> 0:11:30.800 with messaging there, right, and some issues also with with 0:11:30.880 --> 0:11:35.360 side effects. Do you remember that as a particular episode. Oh, yes, 0:11:35.400 --> 0:11:39.800 I remember both of those. And we had vaccines, both 0:11:39.880 --> 0:11:43.680 of them, the smallpox vaccine and the anthrax vaccine that 0:11:43.800 --> 0:11:48.960 had substantial side effects associated with them, and as a consequence, 0:11:49.440 --> 0:11:55.080 acceptance was kind of dicey. And that also had political 0:11:55.160 --> 0:11:59.960 overtones because there were concerns that particularly the smallpox vacs 0:12:00.000 --> 0:12:05.199 a nation campaign was perhaps was perhaps more politically motivated 0:12:05.520 --> 0:12:11.600 than scientifically motivated. So that complicated both of those campaigns. 0:12:12.760 --> 0:12:16.440 I'm in mind of another one, John, Back in two 0:12:16.480 --> 0:12:20.360 thousand and nine, we had the pandemic swine flu come 0:12:20.440 --> 0:12:26.520 upon the scene. It affected principally children as opposed to adults, 0:12:26.600 --> 0:12:30.360 and there I think we made one blunder, uh in 0:12:30.440 --> 0:12:35.200 that we overpromised when the vaccine would be ready, and 0:12:35.360 --> 0:12:38.520 for a number of technical reasons, it took longer to 0:12:38.679 --> 0:12:41.840 make the vaccine and get it out and when it 0:12:41.920 --> 0:12:46.600 was finally ready. Instead of the public health messages being oh, 0:12:46.679 --> 0:12:49.880 we've got a vaccine here it is, here's who should 0:12:49.920 --> 0:12:52.560 get it, and here's where you where you should go 0:12:52.679 --> 0:12:56.080 to get it, the message was in the news media 0:12:56.600 --> 0:13:00.840 the vaccines here and it's late. Look at that, huh, 0:13:00.880 --> 0:13:04.560 and so we stepped on our own message. We've done 0:13:04.559 --> 0:13:08.560 a little bit of that this time too, and it's 0:13:08.640 --> 0:13:13.199 made me grumpy because I always prefer to under promise 0:13:13.679 --> 0:13:19.160 and then over deliver. Then everyone's happy and enthusiastic. There's 0:13:19.160 --> 0:13:23.840 been too much over promising here. Any other cases in 0:13:23.880 --> 0:13:28.240 the past that sort of offer object lessons for how 0:13:28.280 --> 0:13:30.880 to move forward in this case, well, I can think 0:13:30.920 --> 0:13:33.840 of a couple of other vaccines that have been introduced 0:13:33.840 --> 0:13:39.920 into routine practice that were so good that either pediatricians 0:13:40.280 --> 0:13:44.840 or in my in another case, internists and family doctors 0:13:45.200 --> 0:13:51.000 accepted the vaccines immediately, and we're very enthusiastic about them 0:13:51.080 --> 0:13:54.440 and got the moms who brought in the children and 0:13:54.679 --> 0:13:58.120 older persons to really accept the vaccine. One had to 0:13:58.160 --> 0:14:02.719 do with a vaccine again, a bacteria called the new Macoccus. 0:14:02.800 --> 0:14:06.600 We had a really great new macoco vaccine that eliminated 0:14:06.600 --> 0:14:10.800 bloodstream infections and meningitis and children. It was so good 0:14:11.280 --> 0:14:15.080 that the pediatricians all wanted to give it immediately and 0:14:15.240 --> 0:14:18.679 there were shortages. The same thing happened with the newest 0:14:18.800 --> 0:14:23.040 version of the shingles vaccine. It's also a spectacularly good vaccine, 0:14:23.560 --> 0:14:26.920 and among people who knew about shingles, they all went 0:14:27.000 --> 0:14:29.240 out and wanted to get it right away. And once 0:14:29.280 --> 0:14:32.400 again the company was in the public health community were 0:14:32.480 --> 0:14:36.480 surprised at the demand. Uh. And it took a while 0:14:36.760 --> 0:14:40.480 to catch up, but we had two brilliant vaccines, and 0:14:40.520 --> 0:14:44.760 the messages were clear. These are great vaccines. No wonder 0:14:44.800 --> 0:14:48.720 then that people lined up wanting them. When you look 0:14:48.760 --> 0:14:51.680 forward to this effort, are you excited about it? I mean, 0:14:51.680 --> 0:14:53.480 this is this is going to be the most massive 0:14:54.040 --> 0:14:57.640 I suppose you know, on a timescale, this really dwarfs 0:14:58.280 --> 0:15:02.520 the smallpox, any other vaccination effort we've ever had. I 0:15:02.560 --> 0:15:05.040 think that that's right, John. And if I'm not excited, 0:15:05.080 --> 0:15:10.400 there's something wrong with me. Covid is a really nasty virus. 0:15:10.720 --> 0:15:14.440 It does awful things. And here we have what we 0:15:14.560 --> 0:15:19.920 think are going to be two vaccines, extraordinarily effective, really 0:15:20.000 --> 0:15:26.800 quite safe. Yes they hurt, but no serious adverse reactions. UH. 0:15:26.920 --> 0:15:32.880 And the opportunity to provide this prevention to our entire 0:15:33.000 --> 0:15:38.280 population and reduce COVID to very, very very low levels, 0:15:38.760 --> 0:15:42.480 that's an extraordinary opportunity. We don't get a chance to 0:15:42.520 --> 0:16:00.920 do that in medicine very often that was John Lowerman, 0:16:01.200 --> 0:16:03.400 and that's it for our show today. For coverage of 0:16:03.400 --> 0:16:06.080 the outbreak from one hundred and twenty bureaus around the world, 0:16:06.440 --> 0:16:10.560 visit bloomberg dot com slash Coronavirus and if you like 0:16:10.680 --> 0:16:13.000 the show, please leave us a review and a rating 0:16:13.200 --> 0:16:16.360 on Apple Podcasts or Spotify. It's the best way to 0:16:16.360 --> 0:16:20.680 help more listeners find our global reporting. The Prognosis Daily 0:16:20.840 --> 0:16:25.480 edition is produced by top foreheads Jordan Gaspoure, Magnus Henrickson 0:16:25.600 --> 0:16:29.320 and me Laura Carlson. Today's main story was reported by 0:16:29.400 --> 0:16:33.960 John Lowerman. Original music by Leo Citrin. Our editors are 0:16:34.080 --> 0:16:38.160 Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head 0:16:38.200 --> 0:16:40.440 of podcasts. Thanks for listening.