Commissioner Scott Gottlieb, United States, Flu Vaccine discussed on The Munk Debates
To reflect on what our world will look like after covid nineteen this week former. Fda Commissioner Scott Gottlieb on the future of pandemics public health and their effects on the economy. Let's go to another audience question. I'll read it out for you. And we can go from there. And president trump is threatened to withdraw the United States from the WHO the World Health Organization is your position so Scott. What's your view on the? Who there's been a pretty strong debate about whether they were as neutral as they should have been vis-a-vis China and whether they were a slow off the bat here to declare global pandemic and touring the five alarm bell. That states around the world needed to get a headstart on preparations to try to reduce the effects of covid nineteen. I think the WHO here was far less effective than it could have been and should have been. I think it was less effective in the setting of the Ebola outbreak in western Africa than it could have been should have been and demonstrated the shortcomings of the W. H. O. I think they were too late to really speak with a clear voice about what was going on. In China this the scope the risks to press China to make more information available. So I I think it's an organization where we have to do a lot of evaluation on how to make sure this doesn't happen again and make sure we have more functional World Health Body but I don't agree with you be defunding it and this is a wrong time to weaken you. Organization still further especially with the risk that covert is going to become now in the Southern Hemisphere. Allow those nations lack access to public health infrastructure? Neighbor rely more on the. Who you'd think about parts of Africa? Parts of South America and so weakening the WHO setting when this could become epidemic in southern hemisphere. This isn't the time to do it. I think we need to reexamine. Who after this public health emergency passes and do the best? We can right now to press them to do a better job in a setting of the current epidemic. But I think a lot of this should be done after this epidemics past try to really reform that organization. Thanks got a great questions from the audience. So let's let's keep going here on this monk dialogue with Scott Gottlieb the former commissioner of the Food and Drug Administration a board member of Pfizer the drug maker and someone who's really distinguished himself as one of the most astute and thoughtful commentators and analysts on the covid nineteen pandemic so this question. Scott is from Sheldon this week to companies announced results with respect to preliminary testing Vaccine do these milestones mean. The chances of developing a vaccine have gone up or just that testing can continue and Scott. It's interesting maybe we can talk a little bit about one of your other hats the aware which is an analyst on CNBC. We've seen some very big market reactions to the Gilead Therapeutic. And now the Madonna vaccine a very preliminary study. I guess or test that they conducted in both instances very small samples. You could say that these are not even the first inning. It's maybe the first batter at bat in the first inning yet. This huge reaction response that. Do you think the two things are commensurate? Should we be as optimistic about talk about Madonna result past week? Well look I think it's encouraging I. I wouldn't necessarily say that we should be tremendously optimistic about any one of these vaccines but I think that what we see now is a number of early sets released about different vaccines that demonstrates that it should be possible to develop a vaccine against coronavirus. I think that's the real takeaway here we've now seen a number of different vaccine constructs some very novel constructs in case in return in. Marta contract which we haven't used before develop a licensed vaccine visors taking the same approach. We've seen a number of these constructs be able to in both animal models as well as now people induce the production of antibodies that should provide some level of protective immunity. And so that is statement. We couldn't make six weeks ago or two months ago. And so that's why. I think we should be more encouraged with respect to the Madeira data in particular. It's early. It was only forty five patients in all forty five. The data shows that the different vaccines that they use have three different doses of two hundred and fifty gram doses hundred microgram dose and twenty five granddaughters but in all three doses they able to generate the production of antibodies and people were what we call binding antibodies me. They bound the virus. What we don't know is where they neutralizing antibodies. Did they bind the virus and destroy the virus testing for neutralizing? Antibodies takes longer. Because you have to expose the antibodies to the virus in a special lab. It'd be a cell three lab a secure lab because this is now a special pathogen needs to be dealt with carefully. They only looked for the first eight patients on whether or not the vaccine was generating neutralizing antibodies. In fact it was in those eight patients and so I think a lot of people assumed well if it worked in the first eight patients. It's probably likely to work. In some proportion of the next thirty seven we don't know all neutralizing antibodies same. We don't know what level of protection is going to afford but we infer that. Oh probably afford some level of protection these these vaccines any of them probably aren't going to provide protection like we think of smallpox vaccine or measles vaccine where you're vaccinated and you can't get infected. Would this is probably GonNa be more like the flu vaccine? You can get infected. But it's going to reduce the severity of the infection and limit your ability to get Cova the disease. What about Scott. Are you concerned that the DNA sequences that were using now for a lot of this vaccine research is going on right now or primarily those that came out of the initial clusters on in Europe and viruses do mutate? Is there a risk here that we create a a series of vaccines that are based on kind of Kovin? One point zero and we move onto Cova two point zero and three point zero and four point. It's unlikely in a short period of time. So all mutate this virus mutating just because it's mutating doesn't mean that it's getting more dangerous or less dangerous more contagious less than pages. Or that's going to obviate technology. So we've looked at a lot of sequencing data now with this vaccine eylau this work comes lavish Trevor Bedford in the Hutch in Washington State. And what we see is the viruses undergoing drift but the part of the viruses genetic material that codes for the protein on its surface. That is the target of our vaccines particularly this spike protein. Which is the protein. The virus uses to invade ourselves the genetic material that codes that spike protein isn't undergoing as much change and it changes at. Its undergoing aren't changing that spike protein in a way that it should evade our antibodies to it and so it's undergoing drift and so we have a vaccine we might want to reformulate the vaccine every two or three years to get it more precise to what the current composition of spike protein is. But it's unlikely to be the case that we see such rapid mutations in the engines the things on the surface of the coat of the vaccine we target without antibodies that we do with the flu vaccine or with influenza. Where in a single season influenza? Sometimes we've seen undergoes so so many significant mutation so many significant changes obviates the vaccine for that season that that vaccines no longer effective. We're unlikely to see interest seasonal mutations happened so rapidly that this would operate a vaccine. But I think it's probably the case that when we do hopefully get a safe and effective vaccine. We're GONNA WANNA reformulate it on some semi regular basis to get it more precisely aligned with what the current predominance sequences for the parts that code for the region. The vaccines is targeting fascinating stuff. Scott do we know one hundred percent that this virus was not genetically engineered in a lab. I think we feel pretty confident that this virus wasn't manipulated and certainly wasn't like a bio weapon that was deliberately released and engineered and released to Epidemic causing an outbreak. I think there are still some question is we know there was a lab will Han. That was a high security lab. We know they were doing. Experiments with Corona viruses have been isolated from bats other species. We also know that lab didn't have good procedures and well before this well before this episode. You can go back two years ago. There was articles in science magazine. Some of the leading academic journals calling into question the safety procedures in that lab saying that they didn't have good controls in place the special pathogens and calling into question whether they should have been allowed to handle the pathogens. They were handling so I think there's some doubt in people's minds is. Could this have been an accident? Could it have been a lab accident? Where patient zero if you will wasn't someone who came into contact with an animal in sort of inadvertent way but someone who was doing an experiment and accidentally infected themselves maybe became as symptomatic didn't know they had the infection went out and became patient zero and spread it. We might never have an answer to that question. We're going to have to look at the store strain to some of the original infections to really get a sense of that and have much more information about what was going on in that lab and look at some of the strange that they were working with and we might never get that information. I mean it doesn't seem like China's making a lot of that available so I think liveliest theories in doubts gonNA persist maybe perpetuity. But when you sort of hear about people saying well Clinton's have been elaborate could have been something deliver. I think most reasonable people are saying. It's not something that was deliberate net someone releases deliberately by could have been a lab accident and I don't know that we can fully discharge that possibility. It's less likely I mean I think we think it's the less likely scenario may be far less likely scenario. But I don't think we can fully discharge it. Then I guess. Part of this dialogue is thinking about the future. How do we get controls internationally? In place to ensure that countries that maybe are not at the standard of candidates the United States in terms of lab infrastructure lab technology. Don't advertently or inadvertently release another virus. I mean are you optimistic that we have the international consensus to do that? Well no I'm not. I mean this isn't the only lab where has been questions raised in the scientific community out procedures in certain labs. There's been questions about labs in the United States where there were concerns that they didn't have proper procedures in place so we need strong international bodies to overseeing this we have them the World Health Organization. I think that they're not functioning as stringently or aggressively. They could be or should be and we allow certain countries to hold certain special pathogens. Who probably need to reexamine that and make sure that there is a better set of universal procedures in place for ensuring lab safety for the labs that are going to handle. The most dangerous pathogens now is going to be a lot of people who don't want to use this episode as he sort of rallying cry for that. Because there's a lot of people still pushing back on the notion that this could ever have been lab mistake. Miss had to have just been sort of a natural occurrence that this virus jump species went from a bad or another animal into humans. Probably that's the case. But you know. I think we're never going to fully discharge that doubt and I think we should reexamine Lab Safety more generally. It's an important call to be making. Okay let's get some more questions. This has been a great discussion digging in a lot of issues. That were certainly top of mind for me and for you. The Viewing Audience Mark. Warren is asking. How important is a national testing strategy for the United States? And why is it so hard for us to mobilize strategy and Scott can ask the same thing here in Canada? The scaling up of testing has been a persistent challenge. And I would say baby doubly so the scaling up of any large scale contact tracing system whereas Scott you know this better than most you look at countries like Taiwan South Korea China. Frankly they seem light years ahead on on both fronts. I think the reality is that allow these tasks gut are going to be largely. Left to states is certain things. The federal government can do to support these activities. But they're going to be largely left to states. Some states are doing a better job than others at getting in places infrastructure. I think getting into the fall least in the United States. The challenge isn't necessarily going to be on the back end the platforms running tests. Which was a challenge. This go around. We just didn't have enough labs in PC are based machines to run the tests. Scale that up. We've gotten a scaled up dramatically now running about four hundred thousand tests a day but initially running about ten thousand test a week and so has been scaled up dramatically in a very short period of time..