Stanford expert's bottom line on what a COVID vaccine means for you
It's been about a year as of our taping day today since this pandemic really started to seize and lockdown California where we're based and so much of the rest of the country and we have a lot of vaccines, both in terms of the choice of them and the volume of them now coming to the market all around the country, and yet.
There's still this general sense of uncertainty of how this is going to play out.
And is there really a light at the end of the tunnel?
Or is that just a moving target we see now what?
Dr. Yvonne Maldonado is gonna have a lot of good answers for us here.
She's professor of global health and Infectious Diseases at Stanford.
Doctor, I've heard you speak a number of times and you have the really great talent of making this all seem very digestible for those of us that don't have the background in it that you do.
So let me start with the big picture.
Where are we if you had to give a quick thumbnail status report, where are we in our progress against COVID-19 Well, thank you for inviting me, Brian.
So, just so you know, things can change dramatically overnight, but science is always the same.
I can tell you a little over a year ago, we walked into a new world, that world will not be different.
Over a very short period of time, but we are seeing some major and dramatic changes.
And in the last year, we've learned a tremendous amount about this virus.
We have had essentially a miracle happen in that we have, I have three Highly safe and highly effective vaccines that are now going to be available.
Our challenges are going to be several.
One of them is getting enough vaccine out to everybody who wants it.
The second is getting vaccine out to people who are resistant and the third is to be getting vaccine out to those around the world Who just don't have access unless we get herd immunity in the entire world, we are not going to be able to suppress this virus from circulating and large in large capacity.
We will continue I think, to see this virus evolve over time.
We're already seeing that happen.
And it may be that it will become a regular circulating virus but hopefully with less impact as we have seen over the last year.
So,in summary we`ve gone through it tumultuous year that probably none of us will never see again.
But in less that a year`s time we`ve seen a miraculous use of technology.
��To develop really good protective measures, and we need to make sure we know how to use those and how we inform people on moving forward.�� Let's dive into those three points you made.
Starting with the volume of vaccine available.
President Biden has been pulled up.
Is promised delivery date to have a shot available or a regimen I guess available for anyone in the country who wants it from I guess July to May that seemed pretty good to you.
You know it makes sense.
You know we have seen this number jump around Remember last summer operation warp speed under a different administration said If we would have 300 million doses by December 20 2020, we have about 10 million doses around that time.
But this is actually a little different.
First of all, we already have three vaccines that under emergency use authorization available to us now.
And we have seen a remarkable collaboration among the large pharmaceutical companies who know how to make vaccines know how to make them safely and rapidly.
And so for example, Merck and Johnson and Johnson will be working together to really amp up ramp up capacity to develop vaccines and we've seen that Pfizer imagers are also going to be working hard.
To ramp up their production.DSo I do think that may is a realistic target.
Obviously, I'm not gonna hold anybody's feet to the fire there but I do think we are going to see more capacity than we expected.
So having plenty of capacity is one thing sounds like we're on a pretty good track toward that.
Then you've got to get all those people who can get the shot.
To get the shot and this is absolutely befuddling me the numbers of people from surveys I've read who say, I'm not sure or I'm dead set against it are not in the one or 2% range.
They can run in the 10s of percents depending on what slice of population you're asking.
Are you as surprised as I am by these large swaths that say I don't or may not want it?
Actually, I'm not really surprised.
I've been working in the vaccine field as a pediatric infectious disease doctor for my whole career and I can tell you that the movement around misinformation about vaccines is only gotten stronger.
I don't think that the group of people who is against vaccines, as in as in principle has gotten extremely large, but they're extremely vocal and extremely well funded to spread misinformation and that is really a concern.
And so we especially because they are they prey on the vulnerable people who really are looking for answers and who may not think that they can find them in the mainstream scientific world.
So I am concerned about those groups.
And so we really need to make a lot of this education available to people at all levels and make sure that our providers who are still trusted in communities are able to message how safe and effective these vaccines can be.
I've also seen the other end of the spectrum and that is people who really, really want the vaccine For not able yet able to get it.
So it's coming from all sides.
Some people compare this to the Hunger Games and it's really unfortunate, but it does show you how this virus has changed our way of thinking and I do think that in the coming few months as you mentioned by May or June.
I think we will have settled down quite a bit.
There will be a lot more people with immunity, people will feel more comfortable.
And then the last point I want to make is the whole framework of vaccination was focused on equity and reduction of more death and disease and hospitalization.
And the populations that we have targeted that is those people over 75.
Those people over 65 and healthcare workers have and will continue to have impacts on reducing hospitalizations, deaths, and sickness and so that is really the founding start.
And then from there, we can go out and vaccinate additional individuals who are at lower risk, but who are still concerned obviously about getting infected or infecting their loved ones and friends.
So let's imagine if it was possible today to have a dinner party what you could if you have the right people that are you know, part of your family so people are sitting around the dinner table is your house.
They're chatting informally.
And one of them maybe a family member or an in law looks across the table and says yeah, look, Yvonne, I don't I just I'm not in a hurry to get this thing.
I don't trust this thing.
It was developed so fast and all the headlines tell me that things are changing so much.
I'm just gonna wait.
What do you say to that person about who has some kind of just gut reaction against getting the vaccine as soon as possible?
I think we have to have a lot of empathy and compassion for people's views at this point.
There's so much uncertainty here.
So many different things.
I really understand the confusion frankly a year ago I was very skeptical about a vaccine myself.
And the fact that I am fully on board here is because I've been in countless countless meetings since April of last year around vaccines.
We have been advocating to the federal government, all of the agencies around transparency, we I have looked at all the data, I've been to all the meetings, but not everybody has the time or the expertise or the energy to do that.
So I think that our ability to get people to understand and very, as you said in very straightforward terms is really critical.
The fact that they went so quickly is, was concerning originally to me.
But what we were allowed to do is have an open door access to the data and the methods that these vaccines were studied.
We understand the science we've seen the data, These are vaccines are incredibly safe They've been well tested.
They didn't just come up with them overnight.
they've actually been working.
Scientists have been working on this platform for a long time.
But as with other technological advances, they really got a rapidly scaled up because of a necessity.
These vaccines have been the platform's have been available for some time.
They just never had been licensed for use.
And so I think the other issue was investment.
So putting in billions of that just goes to show you if you put in billions of dollars into something promising it and you know it, it can easily work now we have seen failure.
So we know that the system is filtering out the vaccines that don't work.
So Merck has had some products that haven't worked AstraZeneca has pulled back on other products that don't work.
We don't hear about those in the mainstream, which is fine.
But we know that if they're not good enough, they're not getting out into the marketplace because the right regulatory agencies are doing the right job.
And many of us were not confident about that last year, but we have engaged very closely with those federal agencies, to make sure that they do follow The proper protocols.
And finally, the companies themselves know that a product that isn't going to be trusted is not going to be used and benefits no one.
So it is in their best interest and they understand that because it really is a market issue.
If they don't do a good job, we will call them out in this.
Private citizens and private societies we have made it clear to these companies if you make a product that we don't believe in We don't care if it was approved by the federal government.
We will not tell our stakeholders, our members, our families to get these vaccines.
And we have that bully pulpit of national independent academic societies and private societies.
Who know about vaccines and know how to get these messages out to our stakeholders.
I think that what you're saying there is, is key.
Two parts that I heard that I think are really under known by a lot of people.
And that is one you don't hear about the failures.
And that almost gives me more confidence that there have been failures that have been filtered out than to hear about the successes, because if it was all successes, I'd be a little suspicious.
Like really how low is the bar, but as you're reminding us.
A bunch of these have not made it because the system has worked.
And this idea that there this is a commercial system and for these companies to turn out a lousy or poorly functioning regimen is not in their commercial interest, right?
The federal government surprisingly to us initially, they were extremely responsive and they have continued to be so So let's turn to the third thing that you mentioned, which is we've the whole COVID situation is a global boat and if there's a leak anywhere, we've got a leaky boat.
Where are your concerns around the inconsistency that may occur with vaccine and immunity around the world?
How do we manage that?
That's huge and we're just we're just one country.
Well, I think that the World Health Organization, GAVI, which is a global alliance on vaccines and immunizations and others.
These are multilateral nongovernmental organizations that work in partnership with governments to help advance the health of the world.
And they're very trusted.
I mean, again, we've seen conspiracy theories arise around all of these things.
But you know, you have to just put those aside because they clearly, you're always gonna have fringe conspiracy groups, but let me tell you that the vast majority of scientists and healthcare officials around the world
Have confidence in these groups and work with them and in fact make up a large share of these groups.
I do think that the global approach has been a bit slow and starting.
I'm not quite sure why I think part of it may be lack of funding.
This has taken an economic toll on everybody and the ability to put money into global Approaches has been difficult.
And the other thing is everyone's working in their own countries to just put their fingers in the ****.
So I think we've had a chance now to settle down and start to think about this global approach.
But last year before any vaccine was approved by anybody, or the UK already had five doses per capita purchased.
The US Japan and the European Union already had two doses per person purchased and the rest of the world had less than one.
So we started off with lots of cash upfront, we'll buy in futures.
And we had our foot in the door already, which is I guess, you know this again, it's a capital system.
Capital market approach and that's what we're going to do.
But it does behoove us to watch out for our partners who don't have that kind of capital at because as you said, if we if we have virus somewhere we have virus everywhere.
So what are your milestones as you're looking forward to the rest of this year in terms of things we need to nail either hard indications or societal attitudes?
What keeps you busy right now looking forward?
Well, lots of things are keeping us busy.
On the one hand, I'm doing a lot of research around how this virus works, how it moves from person to person.
We can talk a little bit about the variance in a second, but how those are arising.
The other thing I'm spending a lot of time is on policy and implementation.
How do we pick?
Again, the Hunger Games analogy was not facetious.
So truly is, one of the sad decisions, who do we vaccinate first?
And every story is compelling.
Every single person deserves this vaccine.
But some people need it more quickly than others.
Those people who are more at risk of dying, [UNKNOWN] been hospitalised?
I'll tell you this last holiday season here in the US December through January.
I think we came as close as we ever have in our history to breaking our national healthcare system just because of the overwhelming number of hospitalizations.
The burnout among our healthcare staff, the lack of facilities, seeing patients in hallways, seeing patients in the street.
We were very close, and we don't wanna be there again, neither in this country nor anywhere else in the world.
And so, I think that rolling this thing out in a rational way, calming people down.
Cuz we have people on one side saying, No, this is a terrible idea and that's not vaccinate anyone.
We have people on the other side saying I really need it now, I have to get it now.
We're in fact, I'm a health care worker.
I've been seeing patients actively ill patients with COVID since July of last year.
I have been completely safe nobody on my staff has gotten infected.
Nobody in our hospitals have been infected when they've been following proper protocol.
Now that's a key you have to have PP, etc.
Now, because we're in the hospital we were more PP than others and we were at more often, but if you're out in public or when you should be or when you're allowed to be You're wearing a mask and you're distancing you are going to be really highly effective in preventing yourself from being infected or from infecting others.
So right now without a vaccine, we have spent a whole year seeing exactly what works to protect ourselves.
And if you can keep doing that, and until it's your turn to get a vaccine, I think we're going to be okay.
Today that we are talking is March 8th of '21.
And I believe this morning, some new CDC guidelines came out that people are scrambling for, saying once I'm vaccinated, what can I do?
Can you decipher that for us?
Yeah, well, unfortunately, I haven't had a chance to read through them very carefully because I've been in meetings all morning.
But the gist of what I've been able to see Which I think will be really important is going to drive people to want to be vaccinated even more is that the evidence is accumulating, that if you've had two doses of vaccine, we know that you are very unlikely to get sick.
You are very unlikely to be hospitalized or to die.
I mean, the data on hospitalizations death so far with the three vaccines that are Approved are you available for use in the US show 100% protection against hospitalizations and deaths.
Now, does that mean that nobody will be hospitalized or die?
No, there's probably a very tiny group.
But still these vaccines are extremely good and they're very safe.
So the CDC has said that if you have been completely vaccinated if you have your two doses if it's Pfizer or majorna.
Or your one dose of Johnson and Johnson, and you've waited this the two week window after your last dose.
Then you can get together indoors without masking and without restrictions with other completely vaccinated people.
That's a really big deal because your risk of infecting that other person or them infecting you is extremely low now is a zero.
No, it's not.
But at this point, I think it's fair to say that we can do that.
Now having said that, I think I will probably do that, but I'm probably not going to sit super close Initially, I want to make sure that we're still taking some, you know, if we can be outside that would be even better.
But they are also there's a big caveat there.
They've also said that when those people and everyone else Are outside or in public that they need to continue to mask and distance because the risk of a vaccine person to another vaccine person is very, very low.
But the risk to the rest of the world is not low.
And so we really need to make sure that when we're out on out and about in public, that we're still masking and distancing.
I think that's really frankly a small price to pay to avoid what we saw in December January of this year.
It was really devastating.
And helped me understand when I have completed my regimen of one or two doses of a vaccine.
Do I have equally modulated my risk of giving or getting,or does it mostly protect one or the other direction?>>That's a great question that we don't have the answer to.And many of us are in the process of starting to test that out.So we're following patients.I have a very large cohort of over 8,000 people that we've been following.
Many of whom have been vaccinated, many of whom have been infected.
Some of them have been both infected and vaccinated.
We're all wanting to follow those people over time and see what is that risk exactly?
Who is likely to get reinfected following vaccination and how long is immunity going to last now?
We have a you know, we're very helpful but the sad truth is that coronavirus generally don't provide lifelong immunity.
As opposed to something like measles where if you get a two dose regimen of measles vaccine, you can be pretty sure that you will never.
Be infected with measles virus and more importantly or as importantly, you will not infect other people with measles because you just we have what we call sterilizing immunity Coronavirus is just don't give you that they are respiratory viruses that we know we get the colds every year.
So that tells you right away That there's some limit to the immunity that you might get, we just don't know what those limits are.
But we do know for example that people have had natural infection with SARS CoV 2, whether they're symptomatic or asymptomatic.
We know that there are many case reports now of those individuals becoming infected again.
Within 90 days or so, so that's the lower limit.
We think people can be protected for up to, say 90 days after they've been infected with the virus.
But we don't know much more after that.
And that's a big question that we need to answer.
Okay, so that's the story once you've had the disease and supposedly have generated your own immunity, that's a different story than the story around the vaccines, right?
Well, but even with the vaccines, we still we it would be the same question How long is the vaccine going to be better?
Then natural disease or not.
I suspect that it could be better.
But the other issue is, all of the studies that were done with these vaccines were done to look at prevention of disease that is, symptoms.
Not to look at whether you're infected and asymptomatic and we need to figure that out cuz If you are infected and asymptomatic as a vaccine, but you don't have symptoms and you don't end you're not gonna get you're not gonna be sick yourself.
That's great news.
But there might be a risk that you could still be infected and transmit to others.
There are some indirect data that suggests That the vaccines do provide between 50 and 75% reduction in actual infection overall, but those data needs to be confirmed.
If that's the case.
That means that and that's the fully vaccinated person, unfortunately could still be infected but not sick But that risk is actually substantially reduced than the than among those people who haven't been vaccinated.
So that means that you might still be infected but not sick if you have been vaccinated.
So again, the idea that when you go out in public or see other people.
That are not vaccinated you should be wearing a mask and distancing because of that risk that you could still make them infected.
So those are all things we are trying to understand better.
And I think this work that you and others you're doing is so interesting because this is what will help from what I'm hearing you say clarify the story around these many points.
These are all a lot of good bright points.
And yet there's a lot of variance and nuance in there.
And that's where the lay person says, I don't understand it.
I'm not sure where this is going yet.
Well, and that's a great point and that's why we try to keep the guidance simple.
And the guidance has been keep masking and keep distancing because we don't know so rather than get into all the details of the latest study And who knows if it's better than another study.
The idea is really let's just keep masking and distancing.
But let's open up, we can open up we can go out and eat some places.
Now pudding here in my county we're allowed to eat indoors, but at a reduced capacity with better ventilation etc.
So just remember the basics, keep masking, keep distancing.
Follow what your county tells you because they are following the same guidance that I'm looking at, and they're trying to keep it simple.
When you're vaccinated, you will be protected against getting sick and getting hospitalised and dying, but the risk is not zero.
And the risk is definitely not zero that you could infect other people.
So until we have better data and until more and more people are vaccinated.
Remember we have about 340 million people in this country so we think about a third of this people might already have been infected.
If we can get another one third of the people in the country vaccinated or more then we get to the point where we have reduced circulation of these viruses and actually reduced Likelihood that we will develop variants.
Now that brings up two points.
One is we need to learn more about the variance and the second is, children under 18 make up 25% of the US population.
We need to work very quickly and safely to build out vaccine trials for children so that they can have access to the vaccines.
For themselves as well as for their family members and others.
That brings us to the variants, as you just mentioned.
We hear, again, in the mainstream media, us laypeople here, that some variants are more transmissable, some have higher morbidity, some seem to have both, and we're not sure about either.
It seems like a lot of inconclusive Stories of unbacked around variants that have some cryptic names as well.
How are we all out here supposed to sort of get our arms around the variant story?
Well, I think we don't need to don't really know I was just listening to a pretty complicated story of the looking at the several 100,000 genotypes and how they've been evolving And it's quite fascinating but the bottom line is, we don't really have a lot of answers yet.
We do know that all viruses mutate, that's normal.
For some reason this virus is mutating faster.
Now what we think might be happening but we don't know is that it may be amplified.
Those mutations may be amplified
Certain high risk populations that somehow allow the virus to mutate faster.
And then those viruses because they the mutation, some of these mutations make the virus more infectious.
That virus then becomes the the alpha virus, if you will, it takes over.
It's just like anything else.
Survival of the fittest.
If you have 1000 viruses and you kill off 999 of them, but that one healthy super virus is not just because of some mutation of chance that are able to withstand your immune system that of course that one virus will then take over because it's the only The last virus standing and then of course they replicate.
So the key to variances to keep those viruses from getting to new people because that's how mutations occur, is from going to one person to another.
Back to the simple message, masking and distancing.
If you do that you keep those viruses from mutating.
Creating even more variants.
Now until we understand those variants better, that's the best we should, we should we can and should do.
So each of us is a little lab unknowingly for a potential variant.
As it comes to a new body.
A new host is where it can be re tinkered a little bit to become a new version.
That's a great way of putting it.
We're all each of us a little laboratory, a little home for a virus to start to experiment and frankly, to see how well it can overcome our immune system and go on to the next person.
These viruses, of course, don't have feelings or thoughts but the idea of life is to propagate.
If they can propagate in you, the only way they can keep going is to propagate and a new person.
You need to fight that and the only way to fight that is a mass and staying apart.
It's amazing how so many roads travel back to the same place for us in the population.
Where a mass maintain the distance it accomplishes so many things.
It's not just to one end, it's to a lot of different ends.
And I think that's hard for people to think about because it seems so easy and simple.
It doesn't seem like that would be able to help.
And it's also tiring.
We've been doing this for a long time.
Now everyone's tired of wearing those masks.
They're tired of distancing.
But I think with vaccines now and given that most people who are vaccinated are over 65, the younger crowd, who is the crowd that most likely wants to go out there probably say what When do I get to go out and do things?
Well, we're going to get there and I can guarantee that by summer, there will be more access to vaccines for all people in the US.
Hopefully to more people around the world, I was talking to my colleagues in India, they're just starting to get the vaccine role out there in India as well.
So the more we can vaccinate people, the better off we are, but it doesn't mean you can't go out now it just means you have to be careful when you go out.
So it shouldn't be an all or nothing.
I'm either going to go stay in my house and And hide under the covers or I'm going to go out and have a rave party.
You can do something in between you can go out, have dinner with your friends to stay up distanced and just make sure you're careful.
So I think we're just going to have to be patient a little bit longer.
And frankly, when you're talking about a pandemic of, as we say biblical proportions, I think we've done pretty well and without these vaccines, I think things would be much more dire at this point.
So they truly are, in my view, a scientific miracle because they gave us hope for this year that we just wouldn't have had otherwise.
Yeah, the the story of these vaccines is going to go down.
I think any of us can see that as one of the great stories in medical history.
How rapidly they were developed, and to be honest, how rapidly they're being distributed.
I know everyone's grousing about, when do I get my shot, and a lot of unevenness around the world.
But what an incredible lift has happened in just 12 months.
Let me finish by asking you a question about your prospects on this.
In your Line of work, you didn't see this coming until it suddenly did.
It's so big, it has a lot of legs left yet to conquer and then interesting questions to look into once we get our arms around it more.
Is this become almost a defining medical situation for the rest of your career or do you think you'll ever move into a post COVID phase?
In your sector of medical research?.
Well, you know, this wasn't I think this particular virus at this particular time was unexpected, but many of us knew and have been saying this for a long time.
Just like we've talked about global climate change and other issues.
The problem is it's very hard to react to something that's not here, yet.
I think being prepared is always difficult, especially at a global scale but we knew the situation was right to happen anytime.
And frankly, if you look at some of these areas around the world where we interface with animals that we're not generally used to, there are plenty of other opportunities.
So I will be working on this virus myself for some time I'm going back to working with other viruses, actually, my area of research was understanding how viruses move from person to person.
So I was already doing that.
I'm trying to go back to some of the viruses I was working with before, so that I can try to learn from that and maybe apply to this virus as well.
The but the question I have in my mind for those evolutionary biologists out there is how do we keep those next viruses from entering the human, the human population again, and how and if they do, how do we stop them from spreading?
Because we know I mean, I've seen the papers.
There are several viruses out there that are great candidates to start doing this as well.
And the more we populate areas of the world that we haven't been in before we're animals carry these viruses.
They're not affected by them but we can be or they might be affected but they mutate when they get into us and they cause an unintended consequences.
That needs to be dealt with one way or the other.
And we need to set up our technology to be able to try to track and predict and respond to those.>> Dr. Yvonne Maldonado is professor of global health and Infectious Diseases at Stanford.[bbb]
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