WEBVTT - When Will We Have a Vaccine? 

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<v Speaker 1>Pushkin from Pushkin Industries. This is Deep Background, the show

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<v Speaker 1>where we explore the stories behind the stories in the news. Today,

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<v Speaker 1>we're going to talk about how to prevent the coronavirus. Specifically,

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<v Speaker 1>we're going to talk about vaccines and other approaches that

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<v Speaker 1>might enable your body to fight off coronavirus before you

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<v Speaker 1>get sick with it in order to understand this complex

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<v Speaker 1>set of issues. We're joined by doctor Akiko Iwasaki. She

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<v Speaker 1>is a professor of immunobiology at the Yale University School

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<v Speaker 1>of Medicine. She and her lab are heard at work

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<v Speaker 1>trying to understand COVID nineteen, and she's also been an

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<v Speaker 1>extremely effective public explainer of the science behind vaccines in

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<v Speaker 1>this current moment. Akiko, thank you so much for joining me.

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<v Speaker 1>I want to start deep in the weaths of vaccines.

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<v Speaker 1>This is your field. You've been crucial in explaining it

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<v Speaker 1>also to the general public. What are the approaches that

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<v Speaker 1>are being tried right now? Of the many approaches so

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<v Speaker 1>currently for COVID nineteen, there are over ninety different vaccines

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<v Speaker 1>that are in testing, so unfortunately very difficult to predict

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<v Speaker 1>what type of vaccines are going to work for particular disease,

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<v Speaker 1>and so at this point we just need to try

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<v Speaker 1>everything we can, and so there are many many platforms

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<v Speaker 1>that are vaccine uses. Some of the things that you

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<v Speaker 1>hear a lot in the media are these nucleic acid

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<v Speaker 1>based vaccines such as RNA or DNA vaccines, and these

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<v Speaker 1>are very fast to make because once you know the

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<v Speaker 1>sequence of the anergen of interest, you can clone these

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<v Speaker 1>sequences or synthesize these sequences to make RNA or DNA,

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<v Speaker 1>and you can just inject that material into humans and

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<v Speaker 1>once they're incorporated into the cell, the cell can then

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<v Speaker 1>themselves make the energens, and so that is a quick

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<v Speaker 1>way of generating a vaccine, whereas other approaches take chimeric

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<v Speaker 1>vectored vaccines, which means that the sequence of interest is

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<v Speaker 1>inserted into another viral genome to make a trojan horse

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<v Speaker 1>like vaccine where that virus can then be amplified and

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<v Speaker 1>given to people. And that's what the Oxford team is

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<v Speaker 1>doing with the anovirus vaccine. And then there are traditional

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<v Speaker 1>forms of vaccines like inactivated virus. So there are many

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<v Speaker 1>many ways to approach vaccine. That was a really good

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<v Speaker 1>three part analysis of the different approaches. Maybe let's take

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<v Speaker 1>them in the order that you gave them to me,

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<v Speaker 1>which is sort of the order of how much attention

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<v Speaker 1>they're getting at the moment. So, with respect to the

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<v Speaker 1>RNA DNA vaccines, has anyone ever made a successful RNA

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<v Speaker 1>vaccine for a disease that's been tested and verified and

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<v Speaker 1>actually worked. So there has never been a RNA based

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<v Speaker 1>vaccines that's approved for use in humans yet, So this

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<v Speaker 1>would be the first of such kind if it becomes

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<v Speaker 1>a successful vaccine. So if I understand, the upside of

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<v Speaker 1>the RNA approach is that it's one of the vaccines

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<v Speaker 1>that if we were able to make it, we could

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<v Speaker 1>then make it at very large quantities, very very quickly,

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<v Speaker 1>which will be a challenge for other forms. The downside

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<v Speaker 1>is it might not work. And this technology has been

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<v Speaker 1>known for a while, I take it, so the fact

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<v Speaker 1>that it hasn't worked yet is not because nobody's been trying. Right.

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<v Speaker 1>The vaccine research is expanding and evolving at such a

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<v Speaker 1>rapid pace, So just because it hasn't been approved for

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<v Speaker 1>use before this disease doesn't mean it's not going to work.

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<v Speaker 1>And the mRNA platform, yes, you're right that it has

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<v Speaker 1>existed for a while, But for example, the delivery vehicle

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<v Speaker 1>for the RNA has been developed and made better. It

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<v Speaker 1>is much more stable and much more likely to be

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<v Speaker 1>taken up by cells to be expressed within the cell

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<v Speaker 1>than let's say, five years ago. So things are happening

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<v Speaker 1>very quickly. It sounds like you are actually a little

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<v Speaker 1>bit optimistic about the mRNA approach. Is that am I

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<v Speaker 1>reading you correctly that way? Vaccine is such an empirical

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<v Speaker 1>area of science that without testing in humans, we can

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<v Speaker 1>never really tell whether something is going to be promising

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<v Speaker 1>or not. But at this point, because of the severity

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<v Speaker 1>of the pandemic, you know, we just have to kind

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<v Speaker 1>of test many different platforms in the hope that one

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<v Speaker 1>of them will work. Let's turn then to the trojan

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<v Speaker 1>horse approach, which the Oxford team is using. They have

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<v Speaker 1>gotten attention in part because they've been saying that if

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<v Speaker 1>they get good results soon, they might be able to

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<v Speaker 1>actually have enough vaccine to use on medical professionals, even

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<v Speaker 1>by September, which is the kind of thought that makes

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<v Speaker 1>markets and people feel very optimistic. Say more about the

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<v Speaker 1>trojan horse approach and what its benefits are, and again

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<v Speaker 1>tell us whether that has worked so far because I

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<v Speaker 1>know that team started by working on malaria and that

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<v Speaker 1>hasn't totally worked out for them, and so they've then

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<v Speaker 1>shifted to working on COVID. Right. So the trogen horse

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<v Speaker 1>based vaccine is another area of vaccinology that has taken

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<v Speaker 1>off in the last decade or so because of our

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<v Speaker 1>ability to manipulate virus at every nucleic acid base resolution.

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<v Speaker 1>So these are approaches that are really being tried in

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<v Speaker 1>new war vaccines like HIV vaccines. A lot of the

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<v Speaker 1>trials that are done with HIV vaccines use this kind

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<v Speaker 1>of trogan horse approach of cloning in the energen of

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<v Speaker 1>interest into a viral vector that we know can infect

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<v Speaker 1>human cells but don't cause any disease. It's on their own.

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<v Speaker 1>And so this is another promising approach to vaccinology because

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<v Speaker 1>you know, we just know very well how the virus

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<v Speaker 1>enter our cell and can inject the material that we

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<v Speaker 1>want the cells to generate. And so, you know, while

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<v Speaker 1>the malaria and HIV vaccines have other problems and barriers

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<v Speaker 1>to overcome, the whope is that for the coronavirus, because

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<v Speaker 1>it doesn't mutate us as much and it doesn't have

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<v Speaker 1>many different life cycle stages as in malaria, that it

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<v Speaker 1>would be easier to implement such a vaccine. Have there

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<v Speaker 1>been successful viral vector vaccines trogan horse vaccines produced for

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<v Speaker 1>other drugs? I think they have, haven't there? Yes, hum

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<v Speaker 1>been for Ebola virus for example, there have been several

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<v Speaker 1>of these kind of trojan horse type of vaccines that

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<v Speaker 1>are pretty efficacious and safe. So I do have some

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<v Speaker 1>hope in this type of approach as well. Does anyone

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<v Speaker 1>try this approach for other Stars viruses? Yes? So the

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<v Speaker 1>Stars Covie one, the original Stars that you know, emerged

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<v Speaker 1>in two thousand and two. People have generated all kinds

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<v Speaker 1>of vaccine platforms. Unfortunately, when the epidemic subsided because of

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<v Speaker 1>public health control of that virus, there was no funding

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<v Speaker 1>or interest by sort of the public to pursue those

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<v Speaker 1>types of vaccines. So, unfortunately, we could have made a

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<v Speaker 1>lot more rapid progress this time around had we pursued

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<v Speaker 1>those original vaccine ideas for the Stars Covie one. And

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<v Speaker 1>this is a lesson to you know, the society that

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<v Speaker 1>we really need to invest in long term solutions to

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<v Speaker 1>come up with vaccines so that the next time there's

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<v Speaker 1>a pandemic of a new virus that we're much more

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<v Speaker 1>ready to deal with these emerging infections. That's sort of astonishing.

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<v Speaker 1>People were trying to produce vaccines for stars CoV one

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<v Speaker 1>and then they just stopped because there was no funding.

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<v Speaker 1>I mean, nobody thought, no foundation, no government, No one thought, well,

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<v Speaker 1>g this might be back or something similar might be back.

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<v Speaker 1>I mean that same sort of mind blowing in a

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<v Speaker 1>bad way. It is mind blowing to most of us

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<v Speaker 1>scientists working in these areas as well, and so, you know,

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<v Speaker 1>I really think that we need to take this unfortunately

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<v Speaker 1>an opportunity to really ensure more funding for basic research

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<v Speaker 1>and vaccine research, especially because of the change in the

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<v Speaker 1>world environment and ecology and so on that promotes the

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<v Speaker 1>emergence of new viruses that we're hearing about all the time,

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<v Speaker 1>like zeka virus and nibola and many other virus says

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<v Speaker 1>that we will be facing in the future, and we

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<v Speaker 1>can't just drop a vaccine trial or vaccine approach just

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<v Speaker 1>because something is contained for the time being. That brings

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<v Speaker 1>us to the traditional vaccines, the ones that we were

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<v Speaker 1>all taught about as kids in school, cowpox in order

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<v Speaker 1>to fight smallpox, or the polio vaccine in its classic form,

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<v Speaker 1>where you use a reduced or a weekend form of

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<v Speaker 1>the virus. What are the paths forward for COVID nineteen

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<v Speaker 1>with such a vaccine? Are there? Of the ninety that

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<v Speaker 1>are out there are a bunch of them trying to

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<v Speaker 1>use the traditional approach. Some of them are certainly trying

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<v Speaker 1>to use the traditional approach. You know. I teach immunology

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<v Speaker 1>to medical students every year, and one of the things

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<v Speaker 1>I talk about during vaccine lectures is that the live

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<v Speaker 1>attenuative vaccines are the most potent an effective vaccine because

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<v Speaker 1>it is the closest to the original infectious version of

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<v Speaker 1>that virus. And so even though it's a very traditional

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<v Speaker 1>vaccine approach that's been used for hundreds of years, I

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<v Speaker 1>think we need to, you know, not forget that those

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<v Speaker 1>are also approaches that we should pursue. Even though they're

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<v Speaker 1>not the cool latest technology approaches, they might work the best.

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<v Speaker 1>There's been a fair amount of attention to the theory

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<v Speaker 1>that one of the classic tuberculosis vaccines seems to provide,

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<v Speaker 1>at least in some studies, more general protections against things

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<v Speaker 1>that aren't TB and I understand that that is a

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<v Speaker 1>somewhat disputed view among immunobiologists. I wonder if you would

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<v Speaker 1>tell us what we ought to think about this theory

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<v Speaker 1>and whether it pulls water, and if so, whether this

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<v Speaker 1>is something worth pursuing, and if not, whether it's as

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<v Speaker 1>leading and dangerous. So that is the thinking that BCG vaccine,

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<v Speaker 1>which as you mentioned, Noah, that is traditionally, I mean

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<v Speaker 1>it is currently used actually in some countries still against

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<v Speaker 1>TB and there is actually an interesting statistical sort of

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<v Speaker 1>correlation between countries that still are using the BCG vaccine

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<v Speaker 1>to the rate of COVID nineteen and mortality. And so,

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<v Speaker 1>for instance, countries like Japan who are still using the

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<v Speaker 1>original BCG vaccine in children, they have very low rate

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<v Speaker 1>of infection as well as death compared to some other

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<v Speaker 1>countries like the US, which has stopped using the VCG

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<v Speaker 1>vaccine a while ago. And other experiments have led to

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<v Speaker 1>this idea that BCG vaccine gives a person a kind

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<v Speaker 1>of trained immunity, which means that our innate resistance against

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<v Speaker 1>these viruses are elevated as a result of receiving these

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<v Speaker 1>types of vaccines. And currently there are countries like Netherland

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<v Speaker 1>who have begun to immunize healthcare workers with BCG in

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<v Speaker 1>order to determine whether trained immunity is indeed elicited in

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<v Speaker 1>those volunteers and whether that would prevent against non TB

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<v Speaker 1>related diseases like viral infections. And there was even a

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<v Speaker 1>study done to demonstrate that BCG vaccination induced certain types

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<v Speaker 1>of innate immune resistance genes to be elevated in human volunteers.

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<v Speaker 1>So you know, right now it's unknown how long such

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<v Speaker 1>trained immunity lasts and how exactly that is working. It's

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<v Speaker 1>still under investigation. We'll be back in just a moment,

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<v Speaker 1>Like you go, I want to turn now to the

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<v Speaker 1>question of probabilities and time. These are huge challenges under

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<v Speaker 1>the intense economic and health pressures that were currently facing.

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<v Speaker 1>So let's start with the time question. Assuming that one

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<v Speaker 1>of these ninety vaccines or several start to be proven

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<v Speaker 1>to work, what sort of time frame will it take

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<v Speaker 1>to generate them, and what are the barriers to making

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<v Speaker 1>billions Because we're talking about billions of doses quickly, right,

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<v Speaker 1>so there are multiple barriers at each checkpoint. First, the

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<v Speaker 1>vaccine has to be not only effective but safe in people,

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<v Speaker 1>since the vaccine will be given to millions, if not billions,

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<v Speaker 1>of people, we need to be absolutely sure about the

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<v Speaker 1>safety of the vaccine itself. The second barrier is the

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<v Speaker 1>safety with regards to infection from Sarscovie two, and that

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<v Speaker 1>refers to this idea that there are some vaccines that

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<v Speaker 1>unfortunately enhance the disease as opposed to protect the person

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<v Speaker 1>against the disease. That has been seen with vaccines like

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<v Speaker 1>dengi virus vaccines, and so we really need to ensure

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<v Speaker 1>that not only is the vaccine itself, but is it

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<v Speaker 1>safe for people who are going to encounter the virus,

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<v Speaker 1>you know, following the vaccination. And so that safety and

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<v Speaker 1>efficacy issue is absolutely key in going forward with any

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<v Speaker 1>vaccine candidates. Let's say we find such a safe and

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<v Speaker 1>effective vaccine, then the challenge will be manufacturing and scale.

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<v Speaker 1>So we go from a couple hundred doses of vaccines

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<v Speaker 1>in phase one and two going into a large phase

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<v Speaker 1>three trial with tens of thousands of people, and then

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<v Speaker 1>after that, the efficacious and safe vaccine needs to be

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<v Speaker 1>generated in the you know, millions or millions if we

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<v Speaker 1>want to cover the entire world. And so that is

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<v Speaker 1>a huge challenge for manufacturing because imagine having to generate

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<v Speaker 1>you know, billion vials to contain the vaccines or even

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<v Speaker 1>the stoppers for the each vile needles that have to

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<v Speaker 1>be distributed. I mean, you can imagine the challenge in

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<v Speaker 1>just generating that kind of doses of not only the

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<v Speaker 1>vaccine but its containment as well as a needle, and

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<v Speaker 1>the healthcare workers that are needed to deliver those vaccines

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<v Speaker 1>to billions of people. So it's not as trivial just

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<v Speaker 1>having a vaccine that's safe and efficacious. It needs to

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<v Speaker 1>also be scalable to that level of distribution, because if

0:15:34.516 --> 0:15:38.196
<v Speaker 1>we don't have enough ultimately to cover a large portion

0:15:38.276 --> 0:15:42.316
<v Speaker 1>of the human population, then there'll be inequity in terms

0:15:42.396 --> 0:15:45.996
<v Speaker 1>of who's going to be protected going forward, and that's

0:15:45.996 --> 0:15:49.276
<v Speaker 1>something we need to be very careful about distribution and

0:15:49.796 --> 0:15:53.516
<v Speaker 1>equity in vaccination. No one's ever done anything like this

0:15:53.636 --> 0:15:55.996
<v Speaker 1>at this scale before, so it sounds from what you're

0:15:56.036 --> 0:15:58.996
<v Speaker 1>saying like there is a possible scenario where you could

0:15:59.036 --> 0:16:01.316
<v Speaker 1>win in the sense that you've got a vaccine but

0:16:01.476 --> 0:16:03.276
<v Speaker 1>lose in the sense that you didn't get the vaccine

0:16:03.316 --> 0:16:08.596
<v Speaker 1>two people fast enough to actually substantially affect the course

0:16:08.596 --> 0:16:12.356
<v Speaker 1>of the pandemic. Is that a plausible scenario that is

0:16:12.396 --> 0:16:16.196
<v Speaker 1>definitely a plausible scenario, and that's why we you know,

0:16:16.236 --> 0:16:19.876
<v Speaker 1>just because we have a vaccine, we cannot immediately relax

0:16:20.156 --> 0:16:23.756
<v Speaker 1>all the physical distancing measures that we're taking, because you know,

0:16:24.076 --> 0:16:26.956
<v Speaker 1>first of all, we need to wait till you have

0:16:27.076 --> 0:16:31.036
<v Speaker 1>enough vaccines to administer to the population, and we need

0:16:31.076 --> 0:16:35.796
<v Speaker 1>testing to see who's being exposed before and who has

0:16:35.796 --> 0:16:40.276
<v Speaker 1>a virus still replicating in their respiratory system in order

0:16:40.316 --> 0:16:43.636
<v Speaker 1>to know who can safely go back to society and

0:16:43.676 --> 0:16:46.876
<v Speaker 1>who needs to be quarantined. So testing and tracing and

0:16:47.596 --> 0:16:50.956
<v Speaker 1>containment is still going to be important even when the

0:16:51.036 --> 0:16:54.236
<v Speaker 1>vaccine is made. That brings me to a question that

0:16:54.276 --> 0:16:58.836
<v Speaker 1>I've really been troubled by in recent days. I feel

0:16:58.836 --> 0:17:03.036
<v Speaker 1>as though we've all heard public health officials and immunobiologists

0:17:03.076 --> 0:17:06.276
<v Speaker 1>and others vaccinologists saying to us, as soon as we

0:17:06.316 --> 0:17:10.076
<v Speaker 1>could have a vaccine is eighteen months, and then from

0:17:10.116 --> 0:17:12.196
<v Speaker 1>that point, I think we've been making, at least I've

0:17:12.196 --> 0:17:15.596
<v Speaker 1>been making the cognitive error of thinking that that means

0:17:15.716 --> 0:17:19.476
<v Speaker 1>that we will have a vaccine in eighteen months. Those

0:17:19.516 --> 0:17:21.996
<v Speaker 1>are not at all the same thing. The ideas best

0:17:22.036 --> 0:17:24.756
<v Speaker 1>case scenario is very different from what's actually going to happen. Right.

0:17:24.756 --> 0:17:26.596
<v Speaker 1>I invest in a company and someone tells me, best

0:17:26.596 --> 0:17:28.756
<v Speaker 1>case scenario, will become a billionaire, but the most likely

0:17:28.796 --> 0:17:32.996
<v Speaker 1>scenario is that I will not. I am worried about

0:17:32.996 --> 0:17:37.676
<v Speaker 1>our collective almost belief at this point that we're going

0:17:37.756 --> 0:17:39.436
<v Speaker 1>to get a vaccine. So I want to ask you

0:17:39.476 --> 0:17:42.196
<v Speaker 1>about probabilities. Do you have the sense that I have

0:17:42.276 --> 0:17:46.636
<v Speaker 1>these ninety approaches that the probability is relatively good that

0:17:46.796 --> 0:17:50.116
<v Speaker 1>one of them will work, or do you think that

0:17:50.156 --> 0:17:52.676
<v Speaker 1>we still can't say with great confidence that we're going

0:17:52.716 --> 0:17:57.276
<v Speaker 1>to have a success. Yeah, it's like predicting the stock market.

0:17:57.836 --> 0:18:00.796
<v Speaker 1>I just I won't be able to say, yes, there

0:18:00.836 --> 0:18:03.996
<v Speaker 1>will be a vaccine that's going to be successful. But

0:18:04.636 --> 0:18:07.716
<v Speaker 1>my prediction would be that there will be a handful

0:18:07.716 --> 0:18:10.276
<v Speaker 1>of vaccines out of the night indeed that's being tested

0:18:10.756 --> 0:18:14.596
<v Speaker 1>that will provide the level of protection we need to

0:18:15.076 --> 0:18:20.716
<v Speaker 1>reopen society. Let's not forget there are non vaccine related

0:18:20.836 --> 0:18:24.076
<v Speaker 1>interventions that we can take at the same time, such

0:18:24.116 --> 0:18:29.996
<v Speaker 1>as development of effective antivirals and monoclonal antibodies that can

0:18:30.076 --> 0:18:34.396
<v Speaker 1>be generated against the energens of the COVID nineteen virus.

0:18:34.436 --> 0:18:38.476
<v Speaker 1>And so it is a huge challenge to distribute vaccine

0:18:38.516 --> 0:18:41.396
<v Speaker 1>to everyone. But there are other measures that we can

0:18:41.436 --> 0:18:44.356
<v Speaker 1>take in the meantime, so we don't have to rely

0:18:44.476 --> 0:18:48.156
<v Speaker 1>only on vaccines to reopen society. Would you say more

0:18:48.156 --> 0:18:50.956
<v Speaker 1>about the monoclonal antibodies and how they work. Yeah, So

0:18:51.036 --> 0:18:56.876
<v Speaker 1>monoclonal antibodies, unlike vaccine, kind of sidesteps all the process

0:18:56.956 --> 0:18:59.916
<v Speaker 1>that the immune system has to generate in order to

0:19:00.556 --> 0:19:06.516
<v Speaker 1>make a antibody. So monocloe antibodies are great for blocking

0:19:06.836 --> 0:19:10.996
<v Speaker 1>viruses and other pathogens because you know, once you clone

0:19:10.996 --> 0:19:13.916
<v Speaker 1>these monoclone antibodies from let's say a person who has

0:19:13.956 --> 0:19:17.476
<v Speaker 1>already recovered from the disease, they are a sort of

0:19:17.516 --> 0:19:22.836
<v Speaker 1>precision tool that the immunologists can use to give someone

0:19:22.876 --> 0:19:26.876
<v Speaker 1>a passive immunity. So you don't necessarily have to generate

0:19:26.916 --> 0:19:30.916
<v Speaker 1>that anybody. You're just getting the antibody directly into your

0:19:31.276 --> 0:19:35.796
<v Speaker 1>bloodstream in order to protect yourself from further encounter with

0:19:35.876 --> 0:19:39.596
<v Speaker 1>the virus. And so you hear on TV lots of

0:19:39.596 --> 0:19:44.036
<v Speaker 1>commercials that use the monoclone antibody for let's say, psoriasis

0:19:44.156 --> 0:19:48.556
<v Speaker 1>or arthritis, and so many many companies now have a

0:19:48.756 --> 0:19:53.956
<v Speaker 1>great capacity and expertise to generate a very effective monoclone

0:19:53.996 --> 0:20:00.356
<v Speaker 1>antibody against variety of things, including viruses and bacteria. So

0:20:00.596 --> 0:20:05.076
<v Speaker 1>I think that leveraging the existing capacity as well as

0:20:05.196 --> 0:20:10.076
<v Speaker 1>expertise of the pharma and biotechnology, that we can quickly

0:20:10.156 --> 0:20:15.916
<v Speaker 1>generate and hopefully distribute safe and effective monoclonal antibodies. How

0:20:15.956 --> 0:20:17.596
<v Speaker 1>long do those last in the body? I mean, do

0:20:17.636 --> 0:20:20.076
<v Speaker 1>you need to take them relatively frequently? They're not a

0:20:20.116 --> 0:20:22.196
<v Speaker 1>vaccine in the sense that you haven't taught your body

0:20:22.196 --> 0:20:25.316
<v Speaker 1>to generate them yourself. If I understand correctly, this is

0:20:25.316 --> 0:20:27.316
<v Speaker 1>just you're giving the body the thing it needs to

0:20:27.356 --> 0:20:29.756
<v Speaker 1>do the fighting off, so they must wear out at

0:20:29.796 --> 0:20:33.956
<v Speaker 1>some point, that's right. So monoclonal antibodies don't last as

0:20:33.996 --> 0:20:37.676
<v Speaker 1>long as if you had generated the antibody yourself, but

0:20:37.876 --> 0:20:40.196
<v Speaker 1>you know it can last up to you know months,

0:20:40.476 --> 0:20:42.836
<v Speaker 1>you know, maybe up to six months or even longer

0:20:43.436 --> 0:20:48.396
<v Speaker 1>with these like highly engineered monoclonal antibodies. And not only that,

0:20:48.516 --> 0:20:53.836
<v Speaker 1>some monoclonal antibody have vaccine effect, meaning that once the

0:20:54.156 --> 0:20:57.836
<v Speaker 1>monoclona antibody binds to the surface of the virus, that

0:20:57.876 --> 0:21:01.636
<v Speaker 1>can sort of educate the immune response to generate more

0:21:01.796 --> 0:21:05.676
<v Speaker 1>These antibodies against the virus by sort of vaccinating a

0:21:05.756 --> 0:21:09.956
<v Speaker 1>person that way, so you know, the monoclona not only

0:21:10.276 --> 0:21:15.236
<v Speaker 1>confers transient protection, but potentially can vaccinate you against the

0:21:15.316 --> 0:21:19.716
<v Speaker 1>virus when the virus enters the body of that person.

0:21:20.116 --> 0:21:22.116
<v Speaker 1>Why do you think that we're getting a lot of

0:21:22.156 --> 0:21:27.876
<v Speaker 1>public attention to antiviral therapies and a lot of attention

0:21:27.916 --> 0:21:33.156
<v Speaker 1>to vaccines and comparatively much less public attention to the

0:21:33.196 --> 0:21:37.396
<v Speaker 1>monoclonal antibody approach. Is that just because it doesn't present

0:21:37.436 --> 0:21:40.796
<v Speaker 1>itself as permanent or I mean, tell me why, because

0:21:40.796 --> 0:21:43.236
<v Speaker 1>it seems, in a sense it has an advantage that

0:21:43.276 --> 0:21:45.996
<v Speaker 1>neither of the other things has, namely, you don't need

0:21:45.996 --> 0:21:49.796
<v Speaker 1>a new discovery to do it. Yes, that's correct. I'm

0:21:49.836 --> 0:21:54.516
<v Speaker 1>also puzzled as to why there isn't more attention paid

0:21:54.556 --> 0:21:58.436
<v Speaker 1>to the monoclonal antibody therapy. To me, it's one of

0:21:58.476 --> 0:22:03.556
<v Speaker 1>the most promising area to pursue. Maybe it's, as you say,

0:22:03.596 --> 0:22:07.516
<v Speaker 1>people assume that it's a transient protection or that it's

0:22:07.596 --> 0:22:13.556
<v Speaker 1>just the challenge of generating large doses is insurmountable. But

0:22:13.956 --> 0:22:16.116
<v Speaker 1>both of these things may not be true. If we

0:22:16.196 --> 0:22:19.156
<v Speaker 1>have a concerted effort to do this. It's your view

0:22:19.196 --> 0:22:21.996
<v Speaker 1>generally that the ramping up process that we're engaged in

0:22:22.076 --> 0:22:26.356
<v Speaker 1>now is sufficient. I mean, ninety different approaches sounds good

0:22:26.396 --> 0:22:29.756
<v Speaker 1>to the general listener. We know that this is costing

0:22:29.836 --> 0:22:31.956
<v Speaker 1>us so much money that there's really no limit to

0:22:31.956 --> 0:22:34.196
<v Speaker 1>how much money we could throw at the problem of

0:22:34.636 --> 0:22:37.276
<v Speaker 1>COVID nineteen and have it still be cost effective, assuming

0:22:37.316 --> 0:22:38.916
<v Speaker 1>any of these things that works, and even if it

0:22:38.956 --> 0:22:40.956
<v Speaker 1>doesn't work, it's still cost effective to be trying it.

0:22:41.396 --> 0:22:43.076
<v Speaker 1>Do you think we should be doing much more than

0:22:43.076 --> 0:22:46.436
<v Speaker 1>we're doing. Do you think our efforts are roughly appropriate?

0:22:46.556 --> 0:22:50.716
<v Speaker 1>What's your gut sense of whether we're throwing enough resources

0:22:50.796 --> 0:22:55.276
<v Speaker 1>at the disease right now? We are not throwing anywhere

0:22:55.276 --> 0:22:59.236
<v Speaker 1>near enough resources at the problem right now. For instance,

0:22:59.516 --> 0:23:03.516
<v Speaker 1>we still don't have enough testing throughout the country, and

0:23:03.596 --> 0:23:07.836
<v Speaker 1>that is key in trying to reopen society. We also

0:23:07.916 --> 0:23:13.436
<v Speaker 1>don't have enough resource as being allocated for research and vaccines.

0:23:13.876 --> 0:23:16.756
<v Speaker 1>For instance. You know my lab is working on immune

0:23:16.836 --> 0:23:20.436
<v Speaker 1>response to COVID nineteen, but you know there is no

0:23:20.556 --> 0:23:26.436
<v Speaker 1>centralized funding mechanism to rapidly support such effort, and the

0:23:26.676 --> 0:23:32.596
<v Speaker 1>NIH has announced several emergency funding mechanisms and I'm hoping

0:23:32.636 --> 0:23:35.676
<v Speaker 1>that some of these will come through, but I feel like,

0:23:36.196 --> 0:23:39.756
<v Speaker 1>as you say, the economic impact of this pandemic is

0:23:39.796 --> 0:23:43.996
<v Speaker 1>so large that no amount of you know, this sort

0:23:43.996 --> 0:23:46.716
<v Speaker 1>of ramping up of the resources, it's going to be

0:23:46.796 --> 0:23:49.876
<v Speaker 1>a waste, because if even one in a hundred of

0:23:49.876 --> 0:23:53.356
<v Speaker 1>these things work, then it's it's totally worth the investment.

0:23:53.956 --> 0:23:57.516
<v Speaker 1>So I am a little frustrated as to how little

0:23:57.636 --> 0:24:01.596
<v Speaker 1>resource has been poured to research as well as development

0:24:01.716 --> 0:24:04.676
<v Speaker 1>of drugs. Thank you so much for taking time out

0:24:04.676 --> 0:24:06.876
<v Speaker 1>of your super busy schedule of saving the world to

0:24:06.876 --> 0:24:08.756
<v Speaker 1>talk to me, and thank you for the great, great

0:24:08.756 --> 0:24:11.756
<v Speaker 1>cloud of your analysis as well. Thank you very much.

0:24:11.836 --> 0:24:16.156
<v Speaker 1>Though speaking to doctor Akiko Iwasaki was really eye opening

0:24:16.196 --> 0:24:20.796
<v Speaker 1>for me on several dimensions. She's extremely forthright about the

0:24:20.876 --> 0:24:25.156
<v Speaker 1>challenges and bottlenecks that face the process of producing vaccines

0:24:25.436 --> 0:24:28.356
<v Speaker 1>on any of the three approaches that she described, yet

0:24:28.356 --> 0:24:31.236
<v Speaker 1>at the same time she has an underlying optimism that

0:24:31.356 --> 0:24:35.716
<v Speaker 1>we will eventually make our way to a functioning vaccine.

0:24:36.236 --> 0:24:38.916
<v Speaker 1>What was also very striking to me is her emphasis

0:24:38.956 --> 0:24:43.796
<v Speaker 1>on monoclonal antibodies. The antibodies would help the body fight

0:24:43.876 --> 0:24:48.316
<v Speaker 1>off COVID nineteen and Although they don't confer a permanent immunity,

0:24:48.676 --> 0:24:51.876
<v Speaker 1>they would in the short run, potentially enable millions of

0:24:51.916 --> 0:24:55.916
<v Speaker 1>people to avoid getting the disease. The most significant difference

0:24:56.236 --> 0:25:00.716
<v Speaker 1>between the monoclonal antibodies and either the anti viral treatments

0:25:01.196 --> 0:25:04.556
<v Speaker 1>or alternatively, the vaccines is that they do not require

0:25:04.676 --> 0:25:09.036
<v Speaker 1>any new science. We will continue to follow the monoclonal

0:25:09.116 --> 0:25:12.916
<v Speaker 1>antibodies story and the vaccine story going forward, and we'll

0:25:12.956 --> 0:25:14.956
<v Speaker 1>try to figure out how it comes to be that

0:25:14.996 --> 0:25:17.396
<v Speaker 1>we haven't yet had the degree of emphasis on the

0:25:17.436 --> 0:25:21.196
<v Speaker 1>monoclonal antibodies the doctor Awasaki thinks we ought to have done.

0:25:21.876 --> 0:25:24.396
<v Speaker 1>Until the next time I speak to you, be careful,

0:25:24.796 --> 0:25:30.836
<v Speaker 1>be safe, and be well. Deep background is brought to

0:25:30.836 --> 0:25:34.196
<v Speaker 1>you by Pushkin Industries. Our producer is Lydia Jane Cott,

0:25:34.476 --> 0:25:38.116
<v Speaker 1>with research help from Zooie Wynn. Mastering is by Jason

0:25:38.156 --> 0:25:42.116
<v Speaker 1>Gambrel and Martine Gonzalez. Our showrunner is Sophie mckimmon. Our

0:25:42.196 --> 0:25:45.276
<v Speaker 1>theme music is composed by Luis GERA special thanks to

0:25:45.316 --> 0:25:48.916
<v Speaker 1>the Pushkin Brass Malcolm Gladwell, Jacob Weissberg, and Mia Lobel.

0:25:49.316 --> 0:25:52.196
<v Speaker 1>I'm Noah Feldman. I also write a regular column for

0:25:52.236 --> 0:25:55.236
<v Speaker 1>Bloomberg Opinion, which you can find at bloomberg dot com

0:25:55.276 --> 0:25:59.556
<v Speaker 1>slash Feldman. To discover Bloomberg's original slate of podcasts, go

0:25:59.676 --> 0:26:03.356
<v Speaker 1>to Bloomberg dot com slash Podcasts. You can follow me

0:26:03.396 --> 0:26:07.356
<v Speaker 1>on Twitter at Noah R. Feldman. This is deep background