Hotez: We’ll be ‘close’ to normal by summer
During the coronavirus crisis, vaccine researcher Peter Hotez has become one of the country’s most trusted explainers of science. At the Texas Children’s Hospital Center for Vaccine Development, he and his team have developed a COVID-19 vaccine set to be manufactured in India. He’s also dean of the National School of Tropical Medicine at Baylor College of Medicine.
This interview has been edited for length and clarity.
Q: Could you give us an overview of the situation now with COVID-19, the variants and the vaccines?
A: In the U.S., we’re seeing a mixed picture. In some parts of the country, we’re seeing what some are calling “the fourth wave.” It’s hitting the upper Midwest pretty hard. Michigan is the worst-affected state. Also up in the northeast — New York, New Jersey, New England — those numbers are starting to go up. We might be beginning to see that in Florida now. There’s been about a 20% increase in cases over the last 14 days.
Most of that is due to one of the variants of concern, the B.1.1.7 variant that first arose in the United Kingdom. We all predicted this was going to happen; we just didn’t know how extensive it’s going to be.
The good news is we’re also vaccinating the American people. I think we’ll be vaccinated fully or close to it by the summer. So we know there’s an end to this fourth peak. It’s just a matter of how big the amplitude is — whether the peak is a small hill or whether it’s a mountain.
Q: With the B.1.1.7 variant, we’ve heard alarming news lately about children. Could you talk about that?
A: The B.1.1.7 variant first arose in southeast England in September. By December it dominated the British Isles. It’s a bad actor.
It’s more transmissible than anything we’ve seen before, with higher hospitalization rates and higher mortality rates.
To make things worse, we’re starting to see now,
in the upper Midwest, a number of young adults getting very sick. The COVID-19 narrative has always been that it affects older individuals. That was never entirely true, especially among African American and Hispanic populations. But we’re seeing now a lot of young adults get sick. That gives me pause for concern — as does its transmissibility among young people.
We have to think of
B.1.1.7 like a different virus. There are similarities to the one we know, and the good news is the vaccines work really well against the B.1.1.7 variant.
We’ll get to the other side and be in good shape by the summer, but I am worried about what happens to the country over the next two months.
Q: So far, no vaccine has been approved for children. Is that of concern with the B.1.1.7 variant?
A: It it does concern me. We now have safety data and even some efficacy data showing the PfizerBioNTech, could be used in 12- to 15-year-olds, but that vaccine has not been released yet for emergency use for that age group.
I think it will be. So probably pretty soon we’re going to start vaccinating adolescents, and I think by the fall school year, middle schools, junior high schools, high schools are going to have a very high percentage of both the students and the teachers and staff vaccinated. So we’re looking at a great fall school year, at least for the middle schools and high schools.
But I am concerned right now — until we halt transmission by the summer — about how we navigate everything from from now until the end of May.
Q: The CDC recently said that people who have been vaccinated can think about flying again, that they don’t need to fear for their own safety, as far as COVID goes, if they are masked and vaccinated. But is the equation going to be very different for parents traveling with small children? How would you advise a parent who’s making plans for summer vacation?
A: So here’s what we know. We know most of the vaccines that have been approved for release in the U.S. give very high levels of protection against symptomatic illness — as much as 95 percent — and new data shows that they seem to dramatically reduce asymptomatic infection. That’s because we’re stopping the shedding of virus in people who are vaccinated, even if they’re exposed to the virus. Based on the performance features of the vaccines, I’m optimistic we can vaccinate our way out of this epidemic.
That means that if you’re vaccinated, you can do normal things. The problem now is, until we get a high percentage of the U.S. population vaccinated, there’s still going to be a lot of transmission. That transmission is going to continue at least until the end of May.
So even though you’ve been vaccinated and can fly safely, there’s still a lot of transmission. I would avoid bringing the kids on a flight at this point. As we move into the summer and transmission goes way down, then it’s going to be a lot easier to think about doing family events and family travel.
Q: So you’re feeling good about where we are with COVID now?
A: We are going to be in a much better place by the summer. Our quality of life is going to improve dramatically. I don’t know that it’ll be completely normal, but it’s going to be pretty damn close to it by the summer.
It’s just a matter of being mindful for the months of April and May — not being reckless, having that situational awareness and trying to get everybody to the other side.
I actually thought we would be here, at this place, sooner. But then the B.1.1.7 variant really accelerated. And as I said, in terms of transmissibility and severity of illness, it’s like a different virus.
Q: Could you tell us more about those new studies showing that people who have been vaccinated don’t seem to be getting infected or shedding virus?
A: The first hint of this came from a study in Israel that was published in the New England Journal of Medicine. It was the PfizerBioNTech vaccine, and by the way, it was going out in an area where the B.1.1.7 variant was dominant. So now we have a pretty good glimpse into what it’s like to vaccinate a population where you have the B.1.1.7 variant, which is our situation currently.
Number one, it confirmed the high levels of protection seen in the Phase Three trials in a real-life situation. So that was that was exciting.
But also, it was highly effective — 92 percent — in stopping documented infection, PCR positivity from both symptomatic and asymptomatic infection, and roughly about 90 percent from asymptomatic transmission. So it’s everything you’d hope for in a vaccine — really outstanding performance characteristics.
I’m guessing the Moderna and the Johnson & Johnson will be similar. That means that if you can achieve high levels of vacand cine coverage — upwards of 80 percent — you can start looking at halting virus transmission.
We’re not there yet. We’re still in the early stages of vaccination. But now we’re vaccinating 3,000,000 to 4,000,000 people a day in this country. Do the math: Within two months, we should be able to get a really, really high percentage of people vaccinated. That’s good news, at least for the U.S.
The news is not so good from our neighbors to the north and south. Canada is not doing well in terms of rates of vaccination, and Mexico is doing even worse.
Europe is very spotty. The U.K. is doing the best, but there’s a lot of variability across Europe right now.
Q: What about the rest of the globe? How are we doing with things like new vaccines coming online and the ability to deliver them?
A: The rest of the globe is in bad shape. In Africa essentially nobody is vaccinated. Latin America is not doing a lot better.
As good as the vaccines are in the U.S. program, they’re very innovative in their design. That was great in terms of getting early vaccines out there for the American people. But because they’re innovative in their design, our ability to make lots of them is slowed. It’s still a young technology, and we don’t have capacity to produce the number of doses that we need.
And the number of doses is daunting. Look at sub-Saharan Africa: You have 1.1 billion people. You have 650 million people in Latin America. So just in Africa and Latin America alone, that’s 1.7 billion people times two doses. You’re talking close to 4 billion doses of vaccine.
We don’t have that capacity for mRNA vaccines, I don’t think we have that capacity for adenovirus vaccines. That’s not their strength. The science policymakers didn’t put enough attention into expanding that portfolio to make available simple, durable, low-cost vaccines.
That’s where we come in at Texas Children’s Hospital and Baylor College of Medicine. We’ve done just that: We use an older technology, the same one used to make hepatitis B vaccine, and there’s no upper limit to the amount you can make. You can make lots of it.
In fact, our collaborators at Biological E are now making 1.2 billion doses of this vaccine. It’s finishing Phase One/Phase Two clinical trials and going to move into Phase Three trials soon. We hope it’ll be released for emergency use in India no later than the summer. Then assuming that it does well in performance and Phase Three trials internationally, potentially it could be released by the World Health Organization for pre-qualification as we head into the fall. We’re really excited about making that contribution.
Q: What do you think the world will look like as we begin moving out of this hunkered-down phase? Will the floodgates just suddenly open and we’ll be back to normal?
A: Let’s look at the U.S. By later in the summer, I think quality of life is going to look something that’s close to normal. We may not need masks. I think we’ll have restaurants and bars fully open. I think we’ll be able to do sporting events and concerts. I think flying domestically will not be an issue.
As people start flying and using cars, I think you’re also going to see the oil and gas industries pick up. That’s important because my youngest son is in the oil and gas industry, and we want him to do well. [Laughs.]
I think we’re gonna see all of those things pick up, but with some asterisks, right?
We’re going to be a bit isolated because Canada and Mexico are proceeding at a much slower rate.
Israel will be fully vaccinated. The U.K. will be fully vaccinated. But I don’t know where else in Europe — maybe some of the Western European countries. Africa will still be treacherous to travel to, and Latin America as well. That will have an impact on our economy — especially here in Houston, which is such an important gateway city.
Q: Any closing thoughts?
A: I’m extremely optimistic for the country. I can’t say this enough. I think that by the summer, we’re gonna have something that resembles a normal quality of life. It’s really a blessing to live in the United States, where we use science to get our way out of this. That’s a lesson too.
When the U.S. has been faced with a crisis, time and time again, science and scientists have come through for this country. The invention of radar and the Manhattan Project helped get us out of World War II. Science got us out of the Cold War. It’s what put humans on the moon. When we’ve needed to do big things, science and scientists came through.
Q: Do you have plans to celebrate when the pandemic is over?
A: I don’t have plans to celebrate. I’ll tell you what I do have plans to do: sleep. I haven’t had a good night’s sleep in 14 months, so that’s what I look forward to more than anything.