Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day one and
Speaker 1: fifty four since coronavirus was declared a global pandemic. Today's
Speaker 1: main story. Despite the fact that COVID nineteen has disproportionately
Speaker 1: affected black, Latino and Indigenous Americans in major drug trials,
Speaker 1: the participants are overwhelmingly white. But first, here's what happened
Speaker 1: in virus news today. Russia rushed aside international concerns about
Speaker 1: the safety of the world's first COVID nineteen vaccine. The
Speaker 1: country will start mass inoculation this month before clinical testing
Speaker 1: is completed. According to Russian Minister of Health Mikhail Murashko,
Speaker 1: authorities planned to start inoculating medical workers and other risk
Speaker 1: groups within two weeks on a voluntary basis. The vaccine
Speaker 1: will be available to the wider population from October. President
Speaker 1: Vladimir Putin's announcement on Tuesday that Russia has cleared the
Speaker 1: vaccine for use was a propaganda coup for the Kremlin,
Speaker 1: but many questions remain in the West about this vaccine's
Speaker 1: safety and efficacy given the scant details about its development.
Speaker 1: New Jersey is the latest US state to retreat from
Speaker 1: plans to send kids back to classrooms. Governor Phil Murphy
Speaker 1: will now give public schools the option of all remote
Speaker 1: teaching when classes resume in September. Earlier, Murphy had required
Speaker 1: that all districts offer some level of in person instruction
Speaker 1: with safety precautions in place. On Tuesday, the state's largest
Speaker 1: teachers union issued a joint statement with groups representing administrators
Speaker 1: saying classroom instruction quote is not safe yet. Finally, the
Speaker 1: pandemic will likely make the gender pay gap worse after
Speaker 1: the US economy recovers, but it could ultimately improve opportunities
Speaker 1: for women. A paper from the National Bureau of Economic
Speaker 1: Research said that in a regular recession, the pay gap
Speaker 1: between men and women shrinks by two percentage points because
Speaker 1: men tend to get hit harder by job losses. But
Speaker 1: according to the report, in a pandemic recession like the
Speaker 1: one we're in now, that gap increases by five percentage points.
Speaker 1: And now, for today's main story, in the rush to
Speaker 1: develop a vaccine or treatment for COVID, nineteen drug companies
Speaker 1: are fast tracking clinical trials, but those trials have a
Speaker 1: major diversity problem. Participants in major drug trials range from
Speaker 1: seven to eighty nine white. This is a big problem
Speaker 1: considering it's a disease that disproportionately affects people of color.
Speaker 1: Kristin V. Brown reports that failing to account for minority
Speaker 1: groups could potentially impact how well a drug eventually works
Speaker 1: for those that the virus has harmed the most. COVID
Speaker 1: nineteen is not an equal opportunity threat. Over the past
Speaker 1: six months, black little you know, and Indigenous Americans have
Speaker 1: suffered more from the virus than anyone else. The statistics
Speaker 1: here can be shocking. For example, in cases where race
Speaker 1: is known, black lives have accounted for more than of
Speaker 1: the national death toll, even though they make up about
Speaker 1: of the population. So I was surprised when I took
Speaker 1: a look at who has participated in clinical trials for
Speaker 1: COVID nineteen vaccines and treatments. It turns out that, at
Speaker 1: least so far, most of them have been white. You
Speaker 1: might wonder why this matters, after all, race is not biological.
Speaker 1: It's a social construct. But the more we understand about
Speaker 1: human biology, the clearer it is that a person's individual
Speaker 1: biology can influence certain things, like whether they are more
Speaker 1: susceptible to certain diseases, or if certain drugs work for them.
Speaker 1: This can be connected to genetics or environment you grew
Speaker 1: up in, and both of those things can be connected
Speaker 1: to race. So if you know that a disease especially
Speaker 1: impacts minority populations, it's really important to make sure that
Speaker 1: those populations are represented in clinical trials. I talked about
Speaker 1: this with John Bagel, a researcher at the National Institute
Speaker 1: of Allergy and Infectious Diseases who has worked on multiple
Speaker 1: or lea stage clinical trials for COVID nineteen. The way
Speaker 1: I would frame it is that the diversity should match
Speaker 1: the scientific objective. If the objective is determining efficacy and
Speaker 1: understanding how the vaccine prevents disease in different populations and
Speaker 1: how effective it is in different populations, then that diversity
Speaker 1: is very critical. Uh. The last thing that you would
Speaker 1: want to do is roll out a public health intervention
Speaker 1: and not understand the impact that it had for the
Speaker 1: different populations that you're trying to cover. Now it should
Speaker 1: be clear race is not the only variable that could
Speaker 1: be connected to why a person responds to a vaccine
Speaker 1: and another one doesn't. Age can also matter, so can
Speaker 1: other underlying medical conditions. You could also give the exact
Speaker 1: same vaccine to two different white men in their fifties,
Speaker 1: and the vaccine might work for one of them but
Speaker 1: not the other. Biology can just be mysterious. Sometimes there
Speaker 1: is still so much we don't know, but we do
Speaker 1: have clear examples of where race is a factor. The
Speaker 1: classic examples would be for hypertensive where that in the
Speaker 1: hypertension guidelines there are clear recommendations based on race because
Speaker 1: we know that as a class, even though there is
Speaker 1: individual variation that as as a class of drugs, UH,
Speaker 1: they will have different effects on different populations. Another example
Speaker 1: that comes to mind is asthma. Black and Latino children
Speaker 1: are known to not respond as well to abutyroll, which
Speaker 1: is the most popular medication on the market to treat
Speaker 1: asthma attacks. There's been some compelling research to suggest that
Speaker 1: a genetic variant maybe what's responsible here, and knowing someone
Speaker 1: might have that variant because save their life since abutyrol
Speaker 1: is the medication that most emergency rooms keep on hand
Speaker 1: to treat severe attacks. But much of this we have
Speaker 1: really only started to understand over the last decade or so.
Speaker 1: It is an increasingly recognized phenomenon and the whole field
Speaker 1: of personalized medicine is revolving around this idea that there
Speaker 1: are subtle variations in our immune response, subtle variations in
Speaker 1: multiple genes that might not be a parent but but
Speaker 1: will affect our ability to respond to different medications. Now,
Speaker 1: one thing that John mentioned is that it's important for
Speaker 1: a trial's patient population to match the scientific objectives of
Speaker 1: that trial. So he said it's less critical that early
Speaker 1: stage trials be diverse because the main objective is to
Speaker 1: test a small number of people and make sure that
Speaker 1: drug or vaccine is safe. I looked at the data
Speaker 1: for six trials that had published results, and only one
Speaker 1: of them, elite stage trial for the drug Room Disapvere,
Speaker 1: had anything approaching diversity. But most of those trials were
Speaker 1: early stage. It's in phase three trials, which seek to
Speaker 1: test how well a drug or vaccine actually works, that
Speaker 1: diversity is absolutely critical. Congress actually passed legislation acquiring publicly
Speaker 1: funded medical studies to include more women and minorities. The
Speaker 1: f d A also encourages the inclusion of diverse populations
Speaker 1: and its guidelines for developing COVID nineteen treatments and vaccines.
Speaker 1: Part of the problem is that can be hard to
Speaker 1: recruit minority populations to participate in a trial. There is
Speaker 1: a lot of mistrust in our healthcare system among them,
Speaker 1: but in the past drugmakers also haven't necessarily tried hard
Speaker 1: enough to recruit them. That may be changing. Every single
Speaker 1: drugmaker I talked to for the story told me that
Speaker 1: they had plans in place to make sure that there
Speaker 1: are more diverse participants in later stage vaccine trials. Plans
Speaker 1: like working with community organizations to help recruit participants. I
Speaker 1: noticed these efforts in place when the NIH launched its
Speaker 1: Phase three trial for a vaccine produced by Maderna. They
Speaker 1: hosted a Facebook live Q and A in which the
Speaker 1: heads of Maderna, the NIH, and the n I A
Speaker 1: I d All fielded questions from a participant in the
Speaker 1: phase one trials. That participant was a black woman named Robin,
Speaker 1: and she got right to the tough questions about race.
Speaker 1: I have to say that when I told my friends
Speaker 1: and relatives that I was going to participate, they were
Speaker 1: absolutely adamant that it was a bad idea. They tried
Speaker 1: to discourage me because they were concerned about my health
Speaker 1: and about my safety. And the reason for that was
Speaker 1: because in the African American community, we are all familiar
Speaker 1: with the Tuskegee experiments. The Tuskegee experiments are often cited
Speaker 1: as one of the reasons there is mistrust of our
Speaker 1: healthcare system in the black community. Beginning in the thirties,
Speaker 1: public health researchers conducted an experiment which they sought to
Speaker 1: observe untreated syphilis in black men, but lied to participants
Speaker 1: and told them they were eaving a treatment for bad blood.
Speaker 1: Even after a cure for syphilis was discovered, most of
Speaker 1: them did not receive it. And so many people are
Speaker 1: in the African American community are familiar with it, and
Speaker 1: when you asked them about participating in clinical trials, they'll
Speaker 1: give you two words, Tuskegee and no. I was curious, though,
Speaker 1: just how Maderna had recruited Robin and others for the
Speaker 1: early stage trials. According to Maderna, of those trial participants
Speaker 1: were white. I talked with Ian Hayden, a twenty nine
Speaker 1: year old Seattle resident who participated in the trials. He
Speaker 1: was actually one of just a few people who had
Speaker 1: a bad reaction to the vaccine. Ian is white, by
Speaker 1: the way. I first learned about the study from a
Speaker 1: co worker who posted about it in slack Um he
Speaker 1: shared a form basically where people who are interested could
Speaker 1: could express their interest. Um that was the first that
Speaker 1: I learned that the trial was taking place here in Seattle,
Speaker 1: where I live, and that they were recruiting in the
Speaker 1: Seattle area looking for healthy people under fifty five like me. Um. So,
Speaker 1: I filled out that form really without much forethought, because
Speaker 1: I didn't expect to hear back. To be honest, I
Speaker 1: just figured I'd throw my hat in the ring and
Speaker 1: we'll see what happens. A couple of days later, I
Speaker 1: did get a call back from the clinic asking me
Speaker 1: to come in for a screening visit. Ian works in
Speaker 1: the world of vaccine development as a science communicator at
Speaker 1: the University of Washington. In other words, he heard about
Speaker 1: the trial because it's in his field of work. He
Speaker 1: also said that he was comfortable volunteering in part because
Speaker 1: he works in this world and knows what to expect.
Speaker 1: You know, it seems clear to me that we need
Speaker 1: a coronavirus vaccine. I think that's clear to a lot
Speaker 1: of people now. It's it's how we're going to put
Speaker 1: this all behind us at the end of the day,
Speaker 1: and we're not going to get a vaccine without clinical trials,
Speaker 1: and clinical trials need volunteer. You know, I came in,
Speaker 1: I guess with uh, I don't know on on the
Speaker 1: side of science, you could say, and of course with
Speaker 1: a lot of trust in that system, something that I
Speaker 1: was familiar with. I'm somebody who happens to know scientists.
Speaker 1: I know people who work on vaccine design, and undoubtedly
Speaker 1: that color is my thinking to this. This whole process
Speaker 1: is probably going to look very different to someone who
Speaker 1: who doesn't know a scientist, and you know, you only
Speaker 1: hear about these things through the news. For her part
Speaker 1: in that Q and A, Robin said she decided to
Speaker 1: participate because she wanted to help her community. I felt
Speaker 1: that if those people who conducted the Tuskegee experiments were
Speaker 1: allowed to succeed, not only because of what they did,
Speaker 1: but because future generations of African Americans were still too
Speaker 1: afraid to participate in trials that would benefit us, then
Speaker 1: those people would really have one twice and I was
Speaker 1: not going to let that happen. With so many vaccines
Speaker 1: in progress now it does seem promising that one of
Speaker 1: them will work, and eventually we will be able to
Speaker 1: put this terrible year behind us. But it will take
Speaker 1: significant effort to achieve the diversity necessary to make sure
Speaker 1: that vaccine works for everyone. That was Kristin V. Brown
Speaker 1: and that's it for our show today. For coverage of
Speaker 1: the outbreak from one bureaus around the world, visit Bloomberg
Speaker 1: dot com slash coronavirus and if you like the show,
Speaker 1: please leave us a review and a rating on Apple
Speaker 1: Podcasts or Spotify. It's the best way to help more
Speaker 1: listeners find our global reporting. The product No sis Dale
Speaker 1: Edition is produced by Topher foreheads Jordan Gospore, Magnus Hendrickson
Speaker 1: and me Laura Carlson. Today's main story was reported by
Speaker 1: Kristin V. Brown. Original music by Leo Sidrin. Our editors
Speaker 1: are Francesco Levi and Rick Shine. Francesco Levi is Bloomberg's
Speaker 1: head of Podcasts. Thanks for listening.