COVID expert worries U.S. is at ‘last arrow’ with vaccine
Since March, bow-tied vaccine researcher Peter Hotez has worked to convey a scientist’s view of COVID-19 to everyday Americans. This week, he agreed to answer readers’ questions about vaccines.
Hotez is a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, and co-director of the Texas Children’s Hospital Center for Vaccine Development — where he and his team are working on a COVID-19 vaccine .
This interview has been edited for length and clarity.
Q: You were vaccinated yourself in mid-december?
A: I just got my second dose last night. [Laughs.] I’ve got my get-out-of-jail-free card.
Q: How long does the vaccine take to work? You and your family were taking extreme precautions. Could you relax after the first does? Can you relax now?
A: Even after you get the second dose, we still don’t know if you can transmit asymptomatic infection. So until a high percentage of the population gets vaccinated, you still may need to take precautions.
So for instance, my wife and daughter don’t have their complete vaccine. That means if I go out or go to work, I could still bring home the virus. I think that probably doesn’t happen — that people who’ve been vaccinated carry the virus — but we don’t have the evidence base to be sure.
My big concern now is whether the nation and the state of Texas have put in place what we need to vaccinate our way out of this. We have not done a good job in the state of Texas of controlling COVID. We lead the nation — we’re either No. 1 or No. 2 — in deaths and the number of new cases per day.
We’re at this screaming high level. We’ve had close to 2 million confirmed cases in the state of Texas. And remember, that’s an underestimate by a factor of five. That means we’ve had roughly about a third of the state infected already. That’s why we have close to 30,000 deaths. We’re among the worst in the country.
There are reasons for that. We
refused as a state to do the shutdowns — the lockdowns, as they like to call them — and there really hasn’t been much in the way of COVID containment. So we’re backed into a corner.
The only way we can get out of this and protect everyone is to get everyone vaccinated. I’m not confident we have that infrastructure in place. I mean, look at the numbers. We have roughly 30 million people in Texas. We have to get 75 to 80 percent vaccinated in order to interrupt transmission, according to studies we did with City University of New York last year. That means we have to vaccinate 24 million Texans, right? And if we want to do that over a period of eight months, that’s 3 million Texans a month. We’d have to vaccinate 100,000 people a day.
Some of the vaccines require two doses. So 100,000 Texans means roughly 150,000 immunizations a day.
We’re not set up right now. We don’t have that infrastructure in place. We’re not going to do that with people calling around to H-E-B and Kroger’s and asking if they have vaccine for their mother or father, brother and sister.
The pharmacies are doing a good job. H-E-B is getting geared up. The hospitals are also. The health systems and the physicians’ offices are doing the best they can.
So it’s not as if they’re failing. It’s just that all those things together will not be sufficient to immunize 150,000 Texans a day.
Q: Reader Marrie Richards asks this: “It’s been argued that, in order to have enough vaccine to get more people immunized at least once, we should skip the booster shot. Is this a good idea?”
A: Several things have been proposed to stretch the vaccine supply: delaying the second shot; or cutting the dose in half for both the first shot and the booster; and even just giving a single shot, one and done.
The data is not robust enough to support implementing any of those. All those proposals are based on post hoc analysis of the Phase Three trials or looks at only Phase One data. To my mind, it just puts an added risk to the program without adequate evidence of benefits.
Let’s take the proposals one by one, starting with the single dose. All we know, right now, today, is that a single dose of the Pfizer vaccine will give you a modest level of protection for three weeks. It’s not very much protection. Looking at the virus neutralizing the antibody data, I would have said none, because it’s really between none and modest. So that proposal is a non-starter.
With delaying the dose, there’s the same risk. You’re just going to get people who get COVID.
Halving the dose is based on not a lot of data, from the early Phase One and Phase Two trials, that shows, “Yeah, there may be some merit to it, but it won’t be as good as the current vaccine.”
So my question is, why would you do that? All you would do is take a dysfunctional, unworkable vaccine infrastructure, which is what we have now, and instead of a least giving people hope that it’s delivering a good vaccine, you’d give them a crummy vaccine. A crummy vaccine on top of a crummy infrastructure is a nonstarter. The answer’s no.
If you look at most of the people who are tossing out these ideas, they’re not vaccine scientists. They’re smart immunologists and infectious disease docs. They like the intellectual challenge of looking at the data and sort of speculating out loud. But from my perspective, it’s not a viable approach.
So what do you do? Well, one, you have to fix the infrastructure. And also, we’re going to need more vaccine.
This gets to the problem of the MRNA vaccines. We were never supposed to rely solely on the MRNA vaccines. It’s not a mature technology. It doesn’t have the capacity to do the job. We’ve known that for the whole year of 2020.
That was the whole rationale behind Operation Warp Speed: The MRNAS would be the first to get up, but then we would have later vaccines come along that are more robust in terms of production and the ability to vaccinate large numbers of people. That’s why you have the two adenovirus-based vaccines and the particle vaccines: They were they were supposed to be the worker bees on this. The MRNA was to get started, and then the others would follow it.
Our lab has a recombinant protein vaccine, and we’re scaling up to a billion doses. If the U.S. needs vaccine, you could bring our vaccine in from India, to do this. But don’t play games with the MRNA vaccine.
Q: An anonymous reader asks, “What are the risks of taking a vaccine prior to getting pregnant or receiving the vaccine while you’re pregnant? Since the MRNA vaccines deal with genetic material, are there any risks to the baby?”
A: Because the Phase Three trials are so large, even though they excluded women who knew they were pregnant, a number of women actually got pregnant during the trials. They’re being followed, and so far there are no adverse outcomes that we’ve heard about.
So you have to balance that against the known risk of getting COVID if you’re pregnant. The morbidity/mortality among pregnant women is really high. So if my daughter were pregnant right now, with this screaming level of COVID-19 transmission, I would want her to get vaccinated.
The American College of Obstetrics and Gynecology has basically said that: that the risks of getting COVID while pregnant far outweigh anything we’ve seen from the vaccine. The ACOG, the American College of Obstetrics and Gynecology and I think also the Maternal Fetal Medicine Society have also come out with a similar type of statement: Get vaccinated.
So have that discussion with your obstetrician.
Now, about the RNA vaccines: RNA isn’t going into the nucleus of the cell. The way an MRNA vaccines work is, it gets taken up by the cell in the cytoplasm. Remember cytoplasm? You had to learn about it in high school biology when you were learning about the nucleus. This is why you had to learn it.
The MRNA goes into the cytoplasm. There it’s made into protein. It doesn’t go into the nucleus, and it doesn’t get incorporated into DNA. There’s no genetic risk to the baby.
Q: Randy Pace asks, “Will current vaccines work for the new strains of the coronavirus?”
A: That’s being studied now. For instance, our lab is testing our vaccine for that now in collaboration with a group at Duke University, where they have all of these various viruses or pseudoviruses.
So yes, we have to confirm this, but I think the vaccines will work. Most of the mutations in those variants are not in the business end that the vaccines address — the receptor binding domain on the coronavirus’ spike protein.
But we need to continue to monitor for variations.
I’m profoundly disappointed that we’re not really looking for variants in the U.S. The CDC program for that, like so many things this past year, has underperformed: The U.S. has sequenced only 50,000 virus genomes. In the UK, they’ve already done 200,000. Here we should have completed between a million and 10 million virus genome sequences.
The U.S. has that capacity. There’s no greater genome sequencing capacity in the world. We have the New York Genome Center, and the Broad Institute of MIT and Harvard. Here in Houston, Baylor College of Medicine is a national resource for genomic sequencing, with a lab headed by Richard Gibbs; it’s one of the premier genomic centers in the world. And Methodist has a lot of capacity. Plus there’s the University of Washington; and Washington University in St. Louis; and the Stanford genome center.
We should have a governmentsupported program in place so those robotic sequences are running day and night. We should have 10 million virus genome sequences. That’s not even that much: It’s the equivalent to a couple or just a handful of human genomes. We do that all the time. It’s not even that hard.
Q: What else should we be thinking about? What should we watch for?
A: The next big milestones, other than getting more and more people vaccinated, will be getting some of these other vaccines up. The adenovirus-based vaccines, I think those will be next — the Johnson & Johnson, the Astrazeneca-oxford, which is now being used in the U.K.
I’d like to see those vaccines in the U.S. They’re a little more robust in terms of production, and you can make a lot more of them. They only need simple refrigeration.
My big worry is that, as a nation, we’re backed into a corner. We failed on everything. We failed on the diagnostic testing. We failed genomic sequencing, We failed to halt the entry of the virus from Europe into New York. We failed to halt the Southern surge across the Southern states. We failed to halt this big mammoth fall surge.
U.S. strategy always came down to the same thing: “Vaccines are coming.” That’s all we have left, our last arrow, and we’ve got to shoot that one straight. If we don’t, it’s catastrophe — and we’re already having a lot of missteps in the beginning.