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Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning again, everyone. As with so many days this year, there is good news and bad news today about the COVID vaccine rollout. A piece of good news from New York City that provides evidence for vaccine effectiveness, the city announced that COVID-19 hospitalizations among senior citizens have dropped by 51% since mid-January when seniors started getting vaccinated. The drop is nearly twice the reduction in hospitalizations among New Yorkers younger than 65, which has only decreased by 29%. Younger people, of course, have been vaccinated less so far. More than 60% of adults over 65 in the city have received at least one shot. Good evidence, and good news.

The bad news of course is on the complexity of the Johnson & Johnson and AstraZeneca vaccine situations in the US and around the world. The CDC announced last night that the J&J pause in this country will last at least a week as they investigate the handful of serious blood clots that women under 50 have gotten within two weeks of their shots. The connection to the vaccine remains inconclusive. What to do next with that risk if it's real, but only one in a million, remains a policy challenge. Globally, the EU and South Africa, for example, have stopped buying AstraZeneca or Johnson & Johnson doses because of the clotting concerns.

There are concerns in developing countries about the richer whiter ones dumping more dangerous ones on them. Vaccine hesitancy could be exacerbated everywhere by these few cases. In life and death terms, it's starting to look possible that many more people will die from COVID because of vaccine hesitancy than would ever die from the very rare blood clots. Human psychology, the way we process risk, can sometimes be not in the interest of our bodies. With me now, Dr. Peter Hotez, MD and Ph.D. He's a professor in the pediatrics virology and microbiology department at Baylor University in Houston, Dean of their National School of Tropical Medicine, and co-director of the Texas Children Center for Vaccine Development.

He's author of a new book called Preventing the Next Pandemic: Vaccine Diplomacy in a Time of Anti-science. It's largely about his amazing career bringing attention to diseases common in the developing world but mostly ignored because not a problem in the richer countries. He's been a champion of getting people in the at-risk countries vaccinated against those things. With that as background, he is also perfectly positioned to understand the global science, politics, and psychology of today's COVID vaccine moment. Dr. Hotez, I've been learning a lot from you and your TV appearances during the pandemic. We're so thrilled to have you on the radio. Welcome to WNYC.

Peter Hotez: Thanks so much for having me, and good to be back in New York, even if it is virtually.

Brian Lehrer: If I might start on the news. Do you support the pause and using the Johnson & Johnson vaccine in this country or do you think it's an overreaction?

Peter Hotez: I think the FDA and CDC really had no choice, they had to put it on pause to get their arms around it and to find out what the full extent of this is. Remember the context here, this also seems to be happening with the AstraZeneca Oxford vaccine, that it's this rare complication that the adenovirus vectored vaccines, which both are the AstraZeneca Oxford and the J&J, it may be happening that because of this addenda virus vector, that they're inducing a certain type of antibody that's activating platelets and causing these clots to form, and it's not just blood clots, it's cerebral thrombosis, so it's happening in the veins that drain the brain. That is highly lethal and causes a lot of neurologic impairment.

Given the serious nature of it, even if it's rare, the fact that it may be common to the adenovirus vector technology, I think they needed a pause to get their arms around it, talk to the European regulators, talk to the regulators in the UK, and see how we're going to move forward. Let me stop there and then we can continue talking.

Brian Lehrer: Assuming that the connection turns out to be real, but as rare as it appears to be, how do they bring it back?

Peter Hotez: this is an important question. There's a few options. Again, this is reason for the pause, to compare notes with the various regulators, because they may be able to do a surgical strike. By that I mean it may be that this is occurring exclusively among premenopausal women. If that's the case, then you can continue the program, continue vaccinating with the proviso that it's going to be contraindicated or against medical advice to give it in premenopausal women. Once you collect information, maybe it's occurring in women who are postpartum because we know women who've just delivered babies are at higher risk of thromboembolic events.

It could be occurring in women who smoke because that could also cause thromboembolic events or it could be happening in young women who are on birth control. If they can identify specific at-risk population and take them out of the pool for getting adenovirus vectored vaccines, that's probably the best possible outcome because then you can recommend it with a pretty robust feeling that you know it's going to be safe in the other groups. The consequences are dire because, while the US, the Western European countries and the UK have access to the two mRNA vaccines, that's a brand new technology that can't be scaled yet.

Maybe in a few years it can, but it can only be produced in modest quantities. That means we don't have much to offer for people in low and middle-income countries in Africa and Latin America and low-income countries of Asia, and that's a full-on crisis if we can't do that. It's really important to get our arms around it as quick as possible.

Brian Lehrer: Your whole career has been focused on global public health equity, bringing attention to neglected diseases in the developing world. In this case, I heard a characterization by a public health official from an African country, I think Uganda, but I'm not sure, it went by fast on TV this morning, but it concerned that the richer wider countries are hoarding vaccines. Would you describe the relatively robust availability of supply here compared to many developing world countries in general as hoarding?

Peter Hotez: Well, in a sense, yes, but not at probably as this person thinks of it. Here's the deal. There's more than a billion people in Sub-Saharan Africa, 650 million people living in Latin America, 400 million people living in low-income countries of Asia, it's 2 billion people. We need between four and 5 billion doses of COVID vaccine. Where does that come from? The problem is focusing only on brand new technology vaccines that have never been scaled at anything close to that level, that we don't know about the safety profile, was a very high-risk strategy.

The problem is that I see is a little bit different that the policymakers were so obsessed with innovation and using this epidemic as an opportunity to accelerate in new innovative platforms that nobody took a step back and say, "Hey, let's balance the portfolio with a simple, easy, breezy low-cost recombinant protein vaccine." We did that. We've now made that and we're accelerating it now with Biological E, they're one of the big vaccine producers in India, they're producing 1.2 billion doses of it. So far, it's looking great in clinical trials, but the sad part was I had to spend the first five, six months of this pandemic snoring.

Looking for funds to get it going because we adopted a Coronavirus program about 10 years ago, we know how to deliver the spike protein through recombinant proteins. We made a SARS vaccine, a MERS vaccine, but nobody wanted to help us with a low-cost easy, breezy recombinant protein COVID vaccine. We wound up, fortunately, being down here in Texas, we moved out here about a decade ago. I did my MD, Ph.D. in New York, by the way, at Cornell and Rockefellers and I met my wife in New York, so we feel like New Yorkers. Being down here in Texas is a great philanthropic environment, we're able to get funds from the Clayburgh Foundation from Tito's Vodka of all places.

If you have a vodka cocktail tonight, make sure it's Tito's. The JPB Foundation, which is in the New York area, and got about $4 to $5 million, we're able to make the vaccine and then transfer the technology to Biological E in India. The sad part was, I should never have had to do that. This should have been a priority from day one, and that's the problem. Had we been able to get funding sooner, we could have been rolling this out by now potentially. I think that's where the failure was. We had a good COVAX sharing facility in place, there's a mechanism ready to go by the WHO and the GAVI Alliance, and CEPI to ensure equity of the vaccine that are there, but the problem is the vaccines aren't there and that's where the problem is.

Even if the US were to drop off all of its stockpile tomorrow and into Latin America and Africa, it would still be a drop in the bucket compared to what's actually needed. That's what we need to fix.

Brian Lehrer: You don't think there are global distribution policies that could make it more even? If there was a world government instead of 180 competing ones, a rational global system could be developed where people have an equal chance, no matter where they live, of getting a vaccine in the face of limited supply. Short of that, what?

Peter Hotez: Well, so that's what COVAX is designed to do. The problem is the doses aren't there. The problem occurred upstream from the distribution that there were policy decisions focused exclusively around innovation, not sufficiently considering which vaccines are going to be needed in resource-poor countries. Now there's support. CEPI, which is linked to the Gates Foundation, is coming in to help us through Biological E and that thing but it would have been great if it had been in place sooner. Hopefully, a few things have to happen.

Hopefully our vaccine can get up, but also the AstraZeneca vaccine does have the ability to scale. AstraZeneca, Oxford began working with Serum Institute of India, which is another big vaccine producer and they are scaling it up, but then there's been a hold up in India as well. There's been a prohibition against exporting vaccines in India because India is having a COVID issue as well. We need to fix that. Assuming that it does, and assuming that we understand better what populations are at risk for cerebral thrombosis, hopefully then AstraZeneca vaccine and some extent, J&J vaccine will be made available for Africa and Latin America, and the poor countries of Asia as well.

Then we have another problem to get around, which is that by pausing and trying to understand what's going on, and I think that was a good decision to protect the public. If they did that 10 years ago, I think we could resume without any big issue but now, of course, we've got this very aggressive anti-vaccine empire, which first accelerated down here in Texas back in 2015 and is now, unfortunately, become a globalized enterprise. Now in guess what? People in Africa and Latin America have iPhones and access to the internet like never before. They're downloading this stuff coming out of the anti-vaccine groups in the US and as well as Russia. We can talk about Russia in a minute.

That's also making things really complicated. I'm worried now that even if a vaccine is made available and the regulators figure out how to get around the cerebral thrombosis issue, we've got to do something about the anti-vaccine aggression, which is mounting daily.

Brian Lehrer: We'll continue in a minute with Dr. Peter Hotez. We can take some phone calls for him at 646-435-7280. His book is called Preventing the Next Pandemic. The subtitle is right on the point that he was talking about just now, vaccine diplomacy in a time of anti-science. We will keep going there. With your calls right after this.

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Brian Lehrer: Brian Lehrer, on WNYC with Dr. Peter Hotez from Baylor University and author of Preventing the Next pandemic: Vaccine Diplomacy in a Time of Anti-science. On preventing the next pandemic, what kinds of pandemics are you mostly referring to there?

Peter Hotez: I'm referring to both neglected tropical diseases, which are not necessarily pandemics, but they are widespread diseases of the poor diseases of poverty. That's actually our major activity, making vaccines for diseases such as female genital schistosomiasis, which affects 40 million girls and women in Africa,

One of the things that we're trying to do in our center for vaccine development, National School of Tropical Medicine, is see if we can create some type of sustainable model for making vaccines for diseases that the pharma companies won't make because there's no financial return. There's a huge market, but not a commercial market. The truth is, we need as much innovation in the business sector and the sustainable financing sectors we do in the science.

Brian Lehrer: Would you, for listeners, pick any one of the neglected tropical diseases and tell everybody a little bit about it and about your efforts over time with respect to a vaccine for it? We're all focused on COVID-19 for obvious reasons right now, but I want to respect the breadth of your work and your career.

Peter Hotez: Let's look at a disease like female genital schistosomiasis. Probably very few people have heard of it. It's probably the most common gynecologic condition on the African continent. It's particularly devastating for adolescent girls. They get it by standing in contaminated, freshwater that has the parasitic larvae, and they have to be in tributaries or lakes, places like Lake Victoria or Malawi, in order to wash their clothes, do all of their daily activities. They get exposed to these larvae. Then the larvae turned into adult worms in the blood vessels that deposit these spine-shaped eggs that get into their cervix, uterus, lower genital tract.

It's usually not a killer disease, but it causes pain, bleeding, discomfort, pain on intercourse, and very socially stigmatizing. Even community health workers or teachers will accuse these adolescent girls of sexual promiscuity when in fact what's happened is they've gotten it by standing in contaminated water. If they're married, it's grounds for marital discord. Some of my colleagues including Jennifer Downs at Cornell has found that it's linked to depression as well, unipolar depression. We made a vaccine for this. We developed it starting around 2004, so we're almost 20 years into it. It's now finishing phase two clinical trials looking really promising.

There's a lot of cool science behind it. We used RNA inhibition to identify an essential role for the target of the vaccine, which is a surface protein of the parasite. We did RNAI. We did a lot of investigative work to uncover the mechanism, showed it's safe in phase one clinical trials inducing a good immune response and now it's in phase two. We could have potentially had this as a licensed vaccine by now if there had been greater financial support for it. We're really excited. We think we can roll it out but now what we find is because we're a modest size research institute based in Texas we can get as far as phase two.

Then what you need is you need an industrial-scale producer that's going to make it for enough for 40 million girls and women, or basically, a hundred million girls that

Brian Lehrer: Which can only come from the wealthier Western governments?

Peter Hotez: I think so, although now we're starting to work with some interesting people to see if we can build vaccine, manufacturing capacity in Africa. Right now, no vaccines are made on the African continent. Actually, very few vaccines are made in Latin America, very few in the Middle East. The world tends to underachieve in low and middle-income countries on where vaccines are made. We're trying to see if we can build capacity in South Africa for producing their own vaccines. They should be able to have them. For instance, they should be able to make our recombinant COVID vaccine. It's not that complicated, it's just that there's no infrastructure.

That's the other piece that we do. We do a lot of capacity building. We invite scientists from all over the world into our labs and we teach them how to make vaccines. Not just the academic science, but the quality control, quality assurance, how to do batch production records, because you can't walk into Merck or GSK or any of those places and say, "Teach me how to make a vaccine," but what we can. We're trying to build that capacity as well. I started doing that and the Obama administration, invited me to serve as US science Envoy for Muslim majority countries in the Middle East and North Africa.

I loved it because it was an opportunity to really practice vaccine diplomacy and build that vaccine development capacity now, and slowly, I think we're making some progress, but this needs to be done in Africa. It needs to be done in poor countries of Latin America and in Asia as well.

Brian Lehrer: Jonathan, in Sunset Park, you're on WNYC with Dr. Peter Hotez. Hi, Jonathan.

Jonathan: Hi. About the idea of vaccine distribution in poorer countries. I think nobody is surprised by the fact that the wealthier countries have ordered the most vaccines. It's what one would have expected. There obviously is a issue of some of injustice and inequity, but on the other hand, if you look at it from a public health point of view, if you look at where the most cases of COVID have occurred, by far the largest number of cases have been in the wealthier countries, primarily in Europe and in the United States. Africa has been not very hard hit by it for whatever reason, we don't know.

In Nigeria, which is the most populous country in Africa, there has been 164,000 cases. I'm looking at New York Times map right now, which is one in 1,200 people. In many European countries and the United States it's one in 10 people, one in 12 people, one in 15 people.

Brian Lehrer: Let me get an answer to that question. Is it really unjust if the concentration has been first of all in the United States, I think more than anywhere therefore that's where the vaccines are, Dr. Hotez?

Peter Hotez: He's actually partially right, but there's a bit more nuance to it. A couple  

I think the other point to make is one of the books that are written a few years back, it's called Blue Marble Health. It's an interesting finding, and for full disclosure it's not widely accepted in the global health community yet, but I think there's something here. That is that when you add up where the world's poverty-related diseases are, yes, they're in fragile nations in Africa and Latin America, but on a numbers basis the most of the world's poverty-related diseases are actually in the G20 countries, the 20 wealthiest economies, accounting for 85% of the global economies. It's the poor living among the wealthy that account for that illness.

I call it Blue Marble Health just to be provocative and give it a different name because the paradigm is always poor countries versus wealthy countries. I think with the millennium development goals, the sustainable development goals, the world has changed a little over the last 20 years. Now it's more the poor living among the wealthy. We've even seen this in the United States. When you look at who's mostly affected by COVID, this virus has raced through low-income neighborhoods and Black and brown communities across the country. Those are the ones who've been disproportionally affected by COVID-19.

It's the same in Brazil. It's the same in India. It's the same in all the G20 countries. That's important from a policy perspective also, because it's not always a resource issue. It's an awareness issue. It's caring about our own vulnerable populations. For instance, I thought being in New York for so many years, and then in Washington DC, I was chair of microbiology at George Washington University. I thought I knew what poverty looked like. Then I moved down here to the Gulf coast. It's a different animal. The depth and breadth of poverty down here is stunning and said, "I'll bet there's neglected tropical diseases here based on my experience globally."

Sure enough, wherever we began to look in the Southern United States, we found disease. We found hookworm in Alabama, working with Catherine Coleman Flowers is an environmental justice activists and MacArthur winner in Alabama. We found Chagas disease in Texas, and transmission. When we first start talking about these diseases, you can imagine everyone says, "We got to build that wall higher." I point, "No, there's actual transmission of these diseases here." I estimate, Brian, that there are about 12 million Americans living in extreme poverty with a poverty-related neglected tropical disease. Hookworm Chagas disease, toxocariasis.

Interestingly, had a lot of success raising awareness about neglected tropical diseases for these drug packages that are being given in Africa and elsewhere, was able to work with USAID and the US Congress on that. When we talk about poverty-related diseases in the US, the lights go out. Finally, we were able to work with

That's a big statement because I'm also a parent of an adult daughter with autism and intellectual disabilities and wrote a book a few years back called Vaccines did not cause Rachel's Autism, which puts me up against the anti-vaccine lobby. Robert F. Kennedy Jr. Now publicly has labeled me the OG villain, which I had to look up the original gangster villain. Now Laura Ingram has been going after me on Fox news. It's been nuts.

Brian Lehrer: Let's end with this. Our time has gone so quickly. We've spent about a half-hour and we're just about out of time. Maybe you could end by talking about what you think the best ways are to fight what I think you called it earlier, the anti-vaccine empire. Did you say empire, globally? Is it different around the world than in the United States in the different media environments to be effective against it?

Peter Hotez: There is, but the thing that's new is now that American-style anti-vaccine movement has been exported. I spent so many years debunking the vaccines causing autism because I have my daughter and wrote the book Vaccines did not cause Rachel's Autism and made some progress. That was taking the wind out of the sails of the anti-vaccine group. They re-energized by connecting themselves with the Republican T party down here in Texas under this concept of health, freedom, and vaccine choice. They were able to get a lot of T party money, and reorganize. Then what happened in the last year, they glommed on protest against mass and social distancing.

That's why the COVID-19 returned to the Southern States with such a vengeance last summer than in the upper Midwest in the fall. As a result, it's become an anti-science movement, not just an anti-vaccine movement. Now, unfortunately, it's become mainstream in the Republican party. You have now Tucker Carlson night after night on Fox news doing anti-vaccine rants and Laura Ingram. It's been really damaging and scary for me and the family because I start getting these weird email that sound very QAnon like.

Brian Lehrer: We have 20 seconds.

Peter Hotez: Now, unfortunately, the Russian government has piled on and they're launching this whole program of weaponized health communication to add onto that. It's a whole ecosystem or empire.

Brian Lehrer: The book is called Preventing the next Pandemic: Vaccine Diplomacy in a Time of Anti-science Dr. Peter Hotez, thank you so much for your work and for your time.

Peter Hotez: Thanks so much, Brian.

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