Smallpox, Dr. Angela Rasmussen, New York discussed on Science Friday
This is science Friday. I'm Ira Plato. It's a new week in a new year, And that means there's a whole slew of covert news to take a look at all this new information about vaccines and mutations. It can be pretty overwhelming. Right, So we're here to fact, Check your feet with our gas. Dr. Angela Rasmussen favor ologists at Georgetown University's Center for Global Health and Security. She's based in Seattle. Welcome back, Angela. Always great to have you. It's always great to be here, IRA. Thanks for having me you're quite welcome. Let's start with distribution of the vaccine for a minute. We've seen a lot of coverage that the U. S fell very short of its goal. Vaccinating 20 million people by the end of 2020. In fact, we hear that just over three million doses were administered. Why did we fall so short? Well, I think one of the reasons we fell so short and it is really complicated in this I should add, is a disclaimer that I am not involved in any way in the distribution, so I only know about this from a sort of bigger picture level. But I think that one of the big problems that we've had with distribution is the fact that there really is no centralized vaccine distribution plan. Operation works speeds involvement in that really ends at the point where they allocate the vaccines to the different states. And at that point, it becomes each individual state or localities responsibility to distribute that vaccine and some states are doing better than others, for example. Some states have implemented policies that actually make the vaccine much more difficult to access for some people such as New York, in which the vaccines are only to be given out at hospitals right now, when we have an unprecedented number of covert patients going into hospitals that makes using that environment to also distribute vaccines to healthy people. Very challenging, So it's a really complex problem. It has a lot to do with logistics, and it also has a lot to do with all the different rules in the different places where the vaccines are actually being distributed on the ground. Yeah, We have no national policy. That would be the same for everybody. That's exactly right. And this was a problem that we also saw with with really testing each state And sometimes local health departments are predominantly involved in doing these tests and collecting the data and then reporting it to a centralized federal data call later, and this has also really lead to a lot of confusion, trying to look at the national numbers. Rather than the numbers by states on DSA. Now we're seeing the same thing with vaccine distribution. It really does argue that for really important public health measures that affect all of us in the U. S. They're really does need to be a federal national plan to unify us and to make sure that these things run smoothly. Do you think now that we're getting a new president in a couple of weeks that things could speed up with the new administration? I really hope so. And certainly President elect Biden has made it clear that he does. Plans to have more of a federal plan. He plans to provide more federal leadership and I really do think that's what's needed because we shouldn't be able to access Really critical public health measures like vaccines based on the politics of who our local governor or leaders are you know a few years ago when Tony Fatty was on the show talking about vaccinations because we used to have him on regularly? Hey, he related a story that when he was a young child, I think he was six or seven and he was living in New York. And there was an outbreak of smallpox in New York City, but because everybody used to get inoculated with smallpox. Remember when you were a baby? They don't do that anymore. Yes, the infrastructure. I'm actually not that old, but I know the story. Well, the infrastructure was there so that they could inoculate what eight million people in two weeks. I mean, doesn't that speak to us? Hey, we've learned a lesson. We should create a permanent infrastructure because we're going to have more outbreaks of viruses. Absolutely. And you know, smallpox is a great example of that. That was the first vaccine in fact. Vaccines are called vaccines because the virus that you used to inoculate somebody against smallpox or very old virus is vaccinia virus or cowpox. Virus s O. Technically, a vaccine is on Lee really? A smallpox inoculation because most vaccines are not based on vaccinia virus. Now, of course, we now use the term generally to mean an immunization. But I think that that's ah great reminder that we should maybe go back to basics that sometimes we need to be able to rapidly and dynamically and flexibly start vaccinating a lot of people, especially if there's an outbreak of a re immersion virus or if there is a new outbreak of a new virus. Now we have all these different vaccine technologies, and we've shown During this pandemic, at least that we can rapidly approve them for for human use, and that they're actually quite efficacious. We need to start thinking about how we can do that. As part of a larger, longer term pandemic and epidemic preparedness plan. We now have two approved vaccines here in the U. S one from Fizer. One from Oh, Derna. These are both two dose vaccines and you know we have been hearing talk about whether not both doses are necessary. Just try to stretch the vaccine supply out what's going on here so that that was first proposed before we started to realize what serious issues we were having with vaccine distribution. The idea there was when those vaccines were submitted to the FDA for evaluation for emergency use authorization. Both of them showed a certain level of protection after the first shot. And after about 14 days after you get your first shot, there's really measurable protection conferred by that one shot now, the caveats There is that. That we don't know how long that protection would last after just one shot because, of course, the clinical trials were evaluating them as two shot regimens. So knowing that we would only have about 20 million doses of each by the end of 2020 people have proposed. Maybe we can give people one shot and that will confer some protection. And then either we could leave it at one shot. Or maybe we could give them a second shot. Just later on. We have more vaccine supplies. Now I think that there is married to some of those arguments. But the real caveat. There is that we don't have any efficacy data on changing up the dose in regimen so right now, given that we aren't able to get the vaccines that we do have into people's arms. I think it's really premature to be suggesting that we just change the dose and schedules. Without doing any research to see if that would provide the same level of protection as the dozing schedules that were actually evaluated and the U. K. I understand is trying this one dose method right now, The UK is actually recommending a delayed second dose. So there is a difference with that. Now it may be, You know, we do get many vaccines and what's called a prime boost regimen where you get the first dose and then you get a booster shot later on. And for some vaccines, we know that you can get that booster shot over a large range of time. And in fact, one of the trials for the AstraZeneca vaccine did give the second dose up to 12 weeks later and didn't see measurable decrease in efficacy..