Pandemic: Coronavirus Edition

Is Novavax really better than the mRNA vaccines?

• Dr. Stephen Kissler and Matt Boettger • Season 1 • Episode 79

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Matt Boettger:

You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt Boettger and I'm joined with once again, just by one Kissler friend, Dr. Stephen kisser and epidemiologist at Harvard school of public health. Good morning to you find, sir, how are you doing on this lovely Monday morning? Good

Stephen Kissler:

morning. I'm doing pretty well. Really hot in Boston today. So we're just trying to keep it going.

Matt Boettger:

No, man, you were a, you were at the beach, weren't you?

Stephen Kissler:

Yeah. If, if you can call it that it's so, new England does have things that some people refer to as beaches. They're, they're pretty Rocky and the water is very cold. But but it was nevertheless, you know, since it is driving distance away, it was nice to just get out of the city for a little bit.

Matt Boettger:

That's awesome. Good, good, good. My weekend was spent dealing with sciatica. I was telling Stephen, this has been fun. I'm 43 years old. I'm getting old apparently. And so now I've got some sad. I got problem. I didn't do anything strange or crazy. I just got it. So I don't know how it happened. And so it's been fun. It's been a great, I just don't want to sit down. Don't want to lay down. I wish I could sleep standing up. That'd be a great, great thing to do. Or like a little bat upside down. So that's been mine but it's been beautiful here, beautiful weather. And it's good to go outside with the boys and do more things, all that great stuff. And I hope you guys are listening and having a wonderful summer as well. And can you ready for a wonderful 4th of July, for those of you who celebrate it here in the U S. But let's get going here. So a couple of things reviews, love them. We just got another one last week was awesome. Thank you so much. I wanted to read that, but I forgot to put it in the show notes. I'll do it next time around. Just has I'm remembering Stephen is going to be gone next week. So we'll probably either skip, just let you guys know ahead of time or if I can get this elusive, I don't know what his name is again. Mark Kissler. Is that Dr. Mark? If I get him actually on the show again, maybe we can, we can have another episode, but he is one heck of a busy man. This is. If you want to support us, we'd love it helps us just keep us going a cup, a cup, pick a few cents in our pockets, help to automate things and allow us to continue to move this forward. That's at patrion.com/pandemic podcast, or one-time gift PayPal, Venmo all in the show notes. So I want to start with this. This is kind of not necessarily COVID related Stephen, but I just want to get an idea of how. You know, global warming effects, your research and infectious disease. Cause the reason why I'm thinking about this is I just saw of this on the news. Like three days ago, I was like a record temperature. I couldn't believe like pork. I don't know if you saw this Stephen like predicted, I don't know if it hit it like 114 degrees and Portland, Oregon, and Seattle was supposed to get upwards of a hundred, which is this is not like 10 to 15 degrees is 30 to 40 degrees over their normal highs. And so this is got me thinking of how does an increase in temperature globally affect like disease, you know, in my mind, Does it make it worse? Does it make it less? I'm sure it's complicated. Like everything. Cause I'm thinking, oh, you know, winter time and it's when it gets really difficult for us. And so my goal when it gets cold or maybe it gets worse and when it gets warmer, maybe things will be generally better. But is that I'm a guessing everything is a nuance. There's no black and white, but what, how do you approach this when it comes to future disease?

Stephen Kissler:

Yeah. So there's this is a great question and something that a lot of epidemiologists are working on right now is the intersection between climate change and infectious disease. So, I think I, you know, there are a couple of different levels that we can take a look at this question, and I think I'll sort of step from maybe the most apparent ones down to some of the, maybe more surprising ones as well. So. Of course, one of the issues with global warming is as the name says, you know, places get warmer. And so one of the things that we we are already beginning to see and we'll probably continue to see is that the regions were Yeah. Basically the, the tropical bands of the climate tropical bands of the world that are generally the middle latitudes are starting to expand outwards. And that hasn't effect on a couple of different ways. So first of all, Different infectious diseases frequently behave differently in tropical versus temperate parts of the world. So flu is the canonical example where in temperate regions of the world we see major wintertime outbreaks of many respiratory diseases whereas in the tropical regions of the world where seasons are not so much spring, summer, winter, fall, but more rainy and dry. The, the whole. Pattern of flu outbreaks and other respiratory illnesses is just different. Tends to be a lot more sporadic. Still can be linked to the seasons, but again, the seasons look very different there than they do, for example, up here in Boston. And so what we're starting to see is, is there sort of, the latitudes where that region exists are starting to expand, and it's going to be interesting to see what effect that has on the overall seasonality of respiratory illnesses, the severity of respiratory illnesses. Cause In, in some ways having outbreaks asynchronous can be helpful in a way, because when everyone's susceptible and then gets infected in one big explosive outbreak that actually tends to cause more cases than it does when people are sort of getting infected at a low level over time. That's certainly not an argument to say that global warming is a good thing because we actually. No, what some of these effects are going to be. One of the other things that happens when you have this expanding latitudes of sort of tropical regions, is that a lot of the vectors that carry other infectious diseases that are especially problems in tropical areas of the world, especially in mosquitoes. They're starting to expand their habitats outward as well. So that's part of why we were able to see, for example, sort of more widespread outbreaks of Zika virus a few years back because the range where those mosquitoes that carry that virus can thrive are wider than they used to be. And so we're going to start to see outbreaks of infectious diseases like malaria, for example, in places that haven't seen them for many years, we we've started to see outbreaks of malaria in Southern Italy, for example, which had eradicated malaria for a very long period of time. So this is going to start to become a reality. We're going to see infectious diseases that certain parts of the globe have not seen in a very long time start to research. So that's, that's one key area that we're thinking about, but of course know global warming Yeah, we, we think about it in terms of warming and a place is getting hotter, but actually, you know, one of the biggest problems with global warming is not so much the increase in temperature, but the increase in variation in the types of weather systems that you get. So you generally get stronger storms, you get hotter hots, but you also tend to get colder colds as well. And so it just makes sort of the whole weather system a lot more variable. And so one of the issues there too, is that, of course for season. Infectious diseases in places where that, that do remain temperate, you might actually see much more severe winters and much more severe summers, which could actually drive that seasonality even stronger. Um Hm. And then. Digging one layer deeper into that. One of the things that I'm most concerned about is that we've definitely seen and we're beginning to see, and I anticipate that we'll continue to see big increases in the severity of tropical storms, hurricanes typhoons, cyclones, you know, things that can really devastate coastal community. And so, you know, one of the other big issues is that we're going to start to see infectious disease crises that follow along when these things hit short. So a number of years back we saw there was a major hurricane that hit Haiti and the Dominican Republic. And following on from that for years, they've been having a really difficult time controlling cholera because that affected their water treatment systems. And so there's been this huge color outbreak that has been spreading there as a result of a hurricane that, and so as we start to see coast lands, getting flooded, different infrastructures are going to cause you know, start to collapse. We're going to see people displaced, which also causes sort of the spread of pathogens. And so there's a lot of really big issues that are going to follow along from this that include. Diseases spread because of the changing weather, but also include the very humanitarian crises that are going to follow along from global warming as well. So it's, it's hard to overstate how huge of an issue this is and how it will touch infectious diseases and every other part of our lives in every way. But yeah, it's not to be you know, I, I feel bad starting off the podcast on this note, it seems so bleak. It is the, you know, there's, we have a lot of lecture to sort of get this.

Matt Boettger:

Yeah, I'm assuming Stephen did didn't do you work much with like climate change specialists there, or do you kind of your own bubble? Given that you know, what you do seems to touch almost every dimension of reality. Do you have like little groups by what you kind of talk about the future of global warming and how people are, how best to handle it? Or how does that work for you when it comes to

Stephen Kissler:

collaboration? Yeah. I currently I'm not working with any climate scientists. Although I've Back when I was studying for my PhD, I did a little bit more. So, many of my colleagues are for sure. There's a lot of crosstalk between climate scientists and epidemiologists economists and epidemiologists. That's one of the areas that I've been sort of doing more interdisciplinary collaboration behavioral scientists and epidemiologists. So oftentimes, it's really difficult. Have any sort of expertise in all of these rooms at once. So frequently epidemiologists will sort of pick one or two that I think especially related to the work that we're doing and, and try to dig into that and develop collaboration's there. But absolutely there, you know, since climate change is such a huge issue, there are a lot of us who have been who have been talking with climate scientists and really thinking deeply about yeah, about what these changes are going to mean for the landscape.

Matt Boettger:

Sure. You know, this is we're gonna change subject now, but I feel like it's kind of related. I kinda, it's kinda hard to put my finger on this, but there's this other article and it talks about, but it's it kind of maybe in a metaphorical way it's related this man believed to have longest COVID 19 infection had virus for 300 days. So why do I think this is related? Because I feel like in some sense with global warming, no matter how much the world begins to have its own ecosystem in the end, And how it corrects itself in the end, there is. Dependency and responsibility on us to be able to help it be able to not go into an extreme weather cycle or whatever. And so the same thing for this, where this is what's fascinating to me because this guy had it for 300 days. It was like, whoa, that's insane. How did that happen? The article, obviously right away. Pop that bubble from bill, you got freaked out about, oh my gosh, can people just spread it for 300 days? No, this was just an individual person who had a severe immune compromised body cancer, that kind of stuff. So that kept the virus alive for a long period of time. And I want you to speak in this for a second, because this was like a revelation to me on maybe at least the current technology that's give that's provided for us that no matter how much medicine future technology that we have to have. Bring health to someone who sick. In the end, the buck stops with us because I realized, oh, this person just couldn't receive the treatment because their body, the body itself, wasn't able to work with the treatment. Like, wow. At some level we can really put our hope in technology that it's going to cure every disease, but at least, at least at this moment, this is a perfect case by which the body has to have at least a baseline by which to negotiate and work with the future technology to bring about health. That just was kind of road leverage to me the, again, going back to the public health mandates of the future technology is great, but at the same time, we've got to keep ourselves as healthy, as possible to work with technology and not have it be kind of like a substitute for our bad behaviors and bad.

Stephen Kissler:

Yeah. And to be clear, like certainly being immunocompromised does. Relate to necessarily bad behavior or like any person's fault. People are certainly born with these conditions. Cancer is cancer is no one's fault. And, and so, you know, certainly, you know, maintaining our health. Is a good thing to do and, and helps, you know, not just with, with the standard things of preventing you know, reducing our risk of cancer and obesity. But also then the downstream conditions that follow along from that, which included that outcomes from infectious diseases. So I, I do have a lot of hope for the technologies, the medical technologies that will develop in the future. And, and that hopefully, you know, we will find ways to help people with who are immunocompromised too. To improve their immune systems to, to have, you know, immunotherapy to to find vaccines that work for them. There's been some recent studies that suggest maybe a third dose of the MRN vaccines actually do provide a substantially higher immunity for people who are, have certain immunocompromised conditions. So that might be an approach is to just sort of keep exposing them repeatedly to to the vaccines and that, that, that might help. So I think this is a really active area of research. You're right as well, that that on, on sort of the population level too. And I think we'll probably get into this in some of the topics that we'll talk about in a few moments as well, but we can we can play so much of our trust in technology. And I've seen this, especially around the vaccine, sort of like seeing the vaccine as this magic bullet that will get us out of the COVID problem. And that's clearly not the case, too. Right. We're seeing spikes in cases, in places around the world and. Again, since people are vaccinated, these rises in cases don't matter, certainly mean what they meant six or eight months ago. They're not translating into hospitalizations and deaths at nearly the same rate that they did then. So the vaccines are definitely doing. What they were intended to do, but they're also, you know, COVID is still clearly here and there are other things, including, you know, basic prevention measures that are still important alongside the vaccine. And you're right. You know, like in the long-term one of the things we talked about on a previous episodes was just like how the United States in particular does have really high rates of obesity, heart disease, diabetes Some of these things, which are, you know, are genetically linked, but are also to some extent behaviorly linked. And so, you know, what can we do to maintain a healthy society, to the extent that we're able, if you're predisposed to diabetes and obesity how can we help those people out a little bit extra? Because they're going to have an especially hard time keeping their weight down and then. You know, make, make them especially vulnerable to future infectious diseases, to, you know, how do we you know, treat, treat the whole person and the whole body and not just rely on sort of these technologies that come through and save us in a time of crisis. I think that that's a huge, huge thing that we're gonna, I have to think about for the future of public. Yeah.

Matt Boettger:

Yeah, no, thank you for correcting my oversimplification. Yep. Totally. With the immune compromise. That is not anybody's fault. I'm just thinking about back in my nineties days. I We're trying to lose weight and there was these, these pills you could take that actually would make you feel full. So you don't have to eat. I'm like, that's like the cheap way, right? It's not trying to actually work and actually being healthy, but taking some kind of chemical pill to make you actually feel full. So then you don't overeat them. These are the things that we need to really work on general health. No, thank you for that clarity. Okay. So let's, let's, let's get into this now. So, with the Delta, the variant we're seeing now, I last week I saw a lot of articles about this kind of, I a little bit of dramatic stuff going on and maybe not fear-mongering, but just showing a lot of rising cases everywhere. We're seeing the Delta COVID the Delta variant being really taken over California. Not necessarily in the sense of like surges, but just that it's, it's dominant. It's now I've thought it was like 1% now it's like 15% or more than that. Within California being the Delta variant, Missouri seen a surge of the Delta. It seems like the Delta variants contributing to that. We're seeing Africa now. Or you said you're mentioning even the UK is starting to see Israel, you know, at 87% vaccinated is starting to see, you know, quota, surge. Now we can talk about that right now, or in a little bit about how the a hundred cases that they've received a day. Half of those coming from children who are vaccinated, but surprisingly the other half Lisa's one article is saying is coming from vaccinated adults. You know? So these are these breakthrough occurrences, you know, maybe you can. On all of this had one level of where you see things both as the Delta variant kind of taking over certain areas and how we're going to continue seeing these hops. But also this idea of the breakthrough hot pockets. Oh man. I'm 43. Those were the most delicious thing ever. That's a, yeah, that's a good use of hot pockets by the way to talk about that. If those hot spots, right. And as well as this Israel dealing with these a hundred cases, 87% vaccinated. So it's going to land on a few and what that means for the brain.

Stephen Kissler:

Yeah, right. So, I think that we can sort of think about this on two different levels where, you know, one there at many countries around the world where vaccination rates remain very low. And so in those contexts, you know, then it's there's not so much a question as to, you know, why, you know, why, why is it spreading there because it's sort of the same. Song and dance in a way where it's like there, it just happens then. And, and we, you know, we, we do have the Delta variant on our hands, which is as we mentioned, I think in the last episode far more infectious potentially is able to get around some level of underlying immunity anyway. And so it makes a lot of sense that places who don't really have much immunological protection from the vaccine or from a lot of previous spread would be susceptible to rises in cases right now. So that's one thing. Then we w we certainly have the example, places that have higher vaccination rates as well. The, you know, wha why is the Delta variant starting to spread there too? So, sort of ticking these off w w one by one, if, if we're able I think also, as we've mentioned before, you know, vaccination rates It matters a lot on, it matters a lot, sort of what geographic scale you look at them on. So across the United States, we have, I think on the order of almost 50% of people fully vaccinated, something on that order. And and more than that, who have received at least one dose, but of course that varies hugely from community to community. So a lot of places where we've seen outbreaks of the Delta variant now are still hovering around 15, 20% vaccination rates. And so there's still a lot of susceptibility there too. And of course there's still COVID circulating in the community. Like there are still cases spreading around. And so when it finds a place where it's able to. It's going to spread. And so that, that makes some sense, but of course, you know, there's, as you said, there's, we are still seeing cases, even in vaccinated people. We are still seeing cases in places where we do have high rates of vaccination. And so what's going on there? On the one hand it's, again, still, it seems like the vaccines are working as, as we would expect, right? Like the, the vaccines are highly effective, but again, they have 95% of effectiveness against symptomatic disease. Against the sort of vanilla variant, you know, pre this was even pre-alpha variant that most of the MRN vaccines were tested. And so we will see some breakthrough infections it's going to chip away at that effectiveness against symptomatic disease. It will chip away probably even more against the effectiveness against asymptomatic disease, which was already a little bit lower in the first place. And so we're going to start seeing breakthrough infections. We're going to start seeing the Delta variant takeover, even in places that do have higher rates of vaccination, including California. No matter what your rates of vaccination are, the Delta will start to displace whatever was there, because it's just so much more that. That's just the way that evolutionary biology works. It's, it's going to start making it more and more of those cases, even if it doesn't necessarily cause surges. And that sort of brings us to the UK, which has had a pretty good vaccination rollout program, but is starting to see both, you know, the majority of cases made up by the Delta variant and a rise in cases in many places. Nope. The UK similar to the U S has a lot of heterogeneity in vaccination rates within the country. Some places are very highly vaccinated. Some are still have very low rates of vaccination. But we're starting to see rises in cases, again, I think the, the main point to underscore here is that it's not totally unexpected, although it's something that we're watching. You know, very closely. I want to see how this sort of plays out, but by and large, you know, again, people who are vaccinated are very well protected against severe disease. And so even if the variant is able to gain a foothold, even if it's able to spread, it's not translating into hospitalizations and deaths at nearly the rate that that previous variants were in the pre vaccine era. So, you know, this is, this is kind of something that we've been saying for over a year now, which is that, you know, we're, we're going, we're going to be living with COVID for a very long time. And we're sort of in this awkward transition period where hopefully it's transitioning from this pandemic, awful disease to something that is more like a wintertime respiratory virus. And we're still going to see these sort of surges of infection at different times of year until things sort of settle out. It's going to take a little while for that system. Settle into its normal, you know, pattern of, of, of seasonal outbreaks, which is what I imagine will probably happen. We could be surprised it might be able to spread outside of the winter and for a long time to come, but it's, we're, we're still in that transition period. So, so none of what we're seeing is super alarming to me. Although it is, you know, something we need to pay close attention to because, you know, if we do start. Really big rises in cases, for example, in the UK or in Israel. And if those do start translating into hospitalizations and deaths, which I don't anticipate that it will, but if it does in that remote possibility that it does, then, then we got some more work on our hands, you know, we've, we've got to continue figuring this out. But for right now you know, watching it with curiosity, but definitely not paying.

Matt Boettger:

Yeah. Yeah. Great. And to put things in the context, just to say from the CDC, if this is like 4,100 cases, total so far in the U S that have led to breakthroughs and hospitalization and, or a death. And now those, like, I think it was 3,900. Have been hospitalized in a thousand, it was 3,900 were asymptomatic and really unrelated to COVID-19. The CDC says as well as 750 fully vaccinate people have also died. I think most were the age of over 65 in that situation of those seven hundred fifty, a hundred and forty two of those were again, asymptomatic and not really. Directly court, you know, correlated to covet. So just shows how small the percentage seems to be going quite accurate with what we think of between 94 to 90 and 88% with effective with the Delta variant, with Pfizer and Madonna.

Stephen Kissler:

Right. And ever since that part with all that. Yeah, that's perfect. I. Amend the previous statement where I said that I'm not particularly concerned and that, and that really pertains to highly vaccinated. I am deeply, deeply concerned about it may happen in places that don't have higher rates of vaccination yet. Because, you know, especially with the Delta variant, we know that it could potentially be more severe as well. So I think this really underscores the super urgency. Sharing vaccines of getting as many places around the globe vaccinated as quickly as possible, both for their own sake, for the sake of the global picture. Because again you know, and you know, I'm, I'm sitting up here in Massachusetts where we have very high vaccination rates and cases are very low right now. So, so in that context I'm not particularly concerned for this local community, but we do have a massive global problem on our hands. And I just want to underscore that and not be too blessing about any of that.

Matt Boettger:

Yeah. That's important. Yeah. But yeah you know, we were talking about just like Africa is that 1% vaccinated right now. And they're seeing a pretty big surge in this could be really. Destructive for Africa and a lot of these countries who don't have the resources like we do to be able to roll out such a vaccinated effort across the country. So let's keep going with this Delta thing. What do you think about this? I read this, I read this article kind of got me, got me really interested about Delta Varian. Can spread within five to 10 seconds of exposure. So that was like, whoa, that freaked me out because of course, you know, we've talked about this, the, it was 10 to 15 minutes or 15 minutes of exposure. We've we've oh, we've evolved that over time that it's not 15 minutes in individual increments, but it's a total of 15 minutes over a period of day, you know, over one day. I know we in the U S really like numbers and algorithms to know exactly what we can do, so we can basically go, go right to that line and have our freedom and then not cross that line. So is this something that's. Quantitatively and qualitatively different with a Delta. Very, that is just so bad that if I'm with someone for five seconds I'm toast or help kind of part this in comparison to the previous 10 to 15 minute one.

Stephen Kissler:

Yeah. So I think this was, this was great. So, it's so tricky because we Essentially, I think that the danger that we have in interpreting these numbers is that we're sort of comparing two things that sound similar, but I think in fact are not. So the 15 minute rule sort of is a question of Of average of central tendency of rough probabilities where for the previous COVID variance, it was a rough sense of what's safe. Maybe 15 minutes of exposure in a room with somebody who has COVID is Where you cross some threshold of of likelihood of getting of getting infected with COVID-19, but we're then comparing that with what I think is in, in this other study, which is a lower bound, which is basically how quickly could you possibly get the Delta variant and it's within seconds, that, that was true previously too. Like you, you could get infected with COVID no matter what variant if somebody who is actively infected. Coughed in your face, like that would take right there done, you know, like you've got one second. And so, yeah. So I think that it's one of the things, and this was a lesson that I'm continuing to learn, even as a trained epidemiologist is just how much context matters. And, and sort of what's around all of these statistics because they become totally uninterpretable unless we know exactly where they were measured, how they were measured what question they were aiming to answer. And so. You know, that's, that's not just, you know, it is true that the Delta variant is absolutely more infectious. And I do imagine that, you know, if you're comparing, like with like situations in one room where you might've gotten infected in 15 minutes with the, with the vanilla variant, I don't even know what to call it. The it's it doesn't even have that Greek letter, but it's just like the standard coronavirus. Right. Maybe you'll get infected with Delta sooner. How much sooner? I don't know. Maybe 15. You know, we, we can, we can roughly work some of these probabilities out, right? If we think that Delta is maybe twice as infectious as the, as the standard variant, maybe it takes half the time, something like that. But there's some sort of weird scaling, you know, 15 to seven minutes maybe is probably a more accurate sort of comparison there. But of course, you know, no amount of time is perfectly safe. Also no amount of time is a guarantee that you'll get infected either you could, you know, we've absolutely had people, you know, spend long, long periods of time in a room with another person who's actively infectious. But if there's ventilation, if there's masking that might reduce the probability of infection down very low. So all of this matters hugely, definitely the Delta is more infectious and that does translate into a shorter period of time on average that it will take for a person to become infected with Delta. But I don't think that it's shifted. Tens of minutes to tens of seconds. It's probably, you know, tens of minutes to maybe 10 minutes.

Matt Boettger:

Great. That's helpful. It puts into perspective and that that's totally right. I It's always important to see the context. I forget it all the time you get these articles, like one is the average one is like as soon as five to 10 seconds, which of course that was in the old way as well. One small thing again, before we move on from the Delta, even though it kind of permeates all of our discussions in one way or another. There is this Delta plus very end for those of you heard of it, don't worry about it. House, put this article in the show notes. It's a, I don't know any of this. I'm just going to read the jargon. There's one small mutation. It's called the K 4 1 7 9. And apparently that is a, a number of other variants. So we can know that as being an insignificant mutation compared to what the Delta already. So no need to be alarmed. If you see this in the news, it's not that signal. Whatsoever. Okay. So if there's two articles you guys read who are listening right now, these are the biggest articles I want you to read. I'm going to throw these past Stephen because the first one is this they're both from the Atlantic. You're probably thinking I totally just am biased. The Atlantic. I don't mean to be, I just happened to just read it and I'm like, this is really good stuff. I don't, I, it could, you could, it could be one it's like blind coffee tasting tests, and I'd still end up being with the Atlantic because I just liked the way it's written and it's as well done. Both of these are from the Atlantic. I'm sorry for not being diversified in my articles, but this is, are we ready for another pandemic? This is a must read everyone. Please check it on the show notes, read it, but there's so much good stuff here about basically we're not, and the reasons why and what we could have learned from the previous one. But instead of rehashing this, I want to throw it to you, Stephen. And thinking about going forward for the next pandemic, which is inevitable. If there was the top three things that we w we at least, maybe not globally, maybe a top thing globally, and three things in the U S that really needs to have a fundamental change for us to be able to appropriately handle the next pandemic. What would they be?

Stephen Kissler:

Oh boy. It's going on three different days and you'll get three different answers and that's two different epidemiologists and none of them will agree, but but I think part of that is just because there's, there's so much to do. And it's hard to, it's hard to sort of prioritize, but there's, you know, there's one of the things that this pandemic has really done is sort of underscored that something needs to be done. And and I think that we're sort of actively working on sort of what that needs to be. So yeah. If I could take a stab at an answer at this I think that one thing is changing the way that we do surveillance and communicate about about potentially emerging biological threats and that's That sounds complicated and it's actually even more complicated than it sounds. Because so one of the issues is that, you know, we we see spillovers of infectious diseases from animals to humans. All the time. There's a, and actually spillover is probably not even the right word for it. We, we share infections with animals all the time. We, we, we acquire infections from poultry, from pigs, from whatever. But we also give them infections because there's a lot of them you know, we flew is a great example where, you know, we're, we're infecting pigs with ours or flu all the time. And vice versa to some extent, you know, and, and the same is true for other, you know, other infectious diseases and other, other animals, other animal reservoirs. So I think we need to do probably more. We need to understand the human animal interface a little bit better. We need to understand sort of what circulating in animals what's circulating in humans. What are the things that have potential to spill over? But I think that this is a really difficult problem because not everything, not every infection that a human gets from an animal. And it's going to cause a pandemic actually, you know, the, the number is the possibility that any given crossover does cause a pandemic is extremely, extremely low. And really all we end up seeing are these catastrophic events where we do see a global pandemic, but we forget that this happens all the time. So actually figuring out, you know, not only what's circulating there, what's crossing over into humans, but actually what are the things that we actually need to be concerned about and how do we become concerned about them quickly enough to do something about them, but without following up every second, Lead and completely exhausting ourselves chasing our tails is a really big open problem. And I think that's something that we're going to need to think about sort of as a global public health establishment. Okay. But what does that mean for those of us who are not epidemiologists? And for, you know, who are, you don't want to live through another COVID 19 But also aren't going to set up some global immunological observatory. That's going to test animal, you know, if that's true for sure. Further antibodies. So I think that there's I don't know how this works, but I think that sort of working on figuring out how to Just emphasize the importance of preventive medicine is going to be really key. I think here in the United States, especially we have the sense of sort of, prioritizing crisis care over preventive care. We prefer to take a pill when we're sick than to do something, to keep us from getting sick in the first place. And you know, that's. That's an oversimplification, but, but certainly I think that, that we could put more emphasis on, you know, what does it mean to keep ourselves healthy? And what does it mean for us to be agile, to an infectious disease that's beginning to spread? How do we build the infrastructure to actually have the supplies for testing? How do we build the infrastructure to regulate. Tests and new diagnostics and things that need to be rolled out in a crisis period because our whole system is sort of based off of a non-crisis period. So how do we, how do we build the resiliency into the FDA? How do we build the resiliency into our government? How do we build the resiliency into our individual behavior so that we can adapt to these sorts of things much more quickly? I don't know the answers to any of those questions. I think I have more answers to sort of the regulatory and government level things than I do to the individual level stuff. But I think that that's that's a big, big question is like, how do we just sort of become more aware that these threats are going to continue happening and how do we as individuals sort of incorporate that into our lives without sort of being crushed by this reality. But, but recognizing that you know, in some ways, I think that it's a corrective in the right direction where we can we can so easily sort of partition illness and sickness and death into some corner of our lives and, and forget that we're not immortal. And I think that this pandemic has been a real wake up call that, that, you know, in fact we are, and actually that's been a very clear realization for much of human history, but really we're kind of living in an odd period where we've been able to kind of ignore that in, in many ways and very well resourced countries. So, so how do we sort of reinforce. This healthy notion of are physical limits, this healthy notion of our limited tenure of time on this earth. Without, you know, this is, this is not a morbid thing. This is actually, you know, this is just sort of a realistic and, and I think a joyful thing that helps us to live our lives more fully in the moment anyway. But how do we, how do we do that, grace? Given all of the promise that technology has given all of the ways that we've set up our societies to make it so that we can basically ignore this fact what do we do? I don't know, but I think that that's, that's sort of the area that I think we're going to need a lot of work in the coming.

Matt Boettger:

Good. That's that that's helpful. That's great. Remind me, or just makes me think of just the idea of the, the kind of like the tomorrow bias that we not only as an individual, but obviously as a society we're we're so prone to, just to be in humans where me individually, tomorrow me is always going to be more productive, more. I'll start my diet tomorrow. I'll be more productive tomorrow. I'll sleep, I'll sleep in tomorrow. I'll, you know, I'll be kinder to my spouse and my kids tomorrow. And then today, just because, you know, there's a laundry list of the reasons why I just can't be that person that I want to be today because of the world around me is just putting pressure on me, whatever it is. And it just has that cycle has to stop it. Not to go on kind of a philosophical reality, but it just restarts with the individual, me of look, I've got to start and I want to show my kids this as well. Terrible at this, that no, the best person who can do this work, the best thing I can do is provide the best value for myself and the value that my, my family today and stop getting this vicious cycle of waiting until tomorrow. Before I do that thing a little bit better do better today. Get myself, you know, tomorrow I'll start my walks. No, if I say that and then that means I have to double my walk today. I'm going to go out for a walk today. If I get tempted down that route, then the consequences. And now I have to double my walk or double my salad and not having that piece of bread or whatever it is because I've got to teach myself that today is the best day to change my life and not tomorrow. And then of course, that just turns into. Government social. We always want to postpone the inevitable to the future, but we've got to start by the individual level as well. That's great. Okay. So read that article in the Atlantic. It's so good. Second article is, I think this is when we're going to end on this is big because this was like a game changer for me as I read this, because we've talked so much to even about the efficacy of the MRN, and I've been pushing you to talk about its nuances and it's okay. Future and what's gonna provide and how I feel like it's going to save the world. And then here Atlanta comes and bust my little bubble about MRNs saying, look there, this, this article is titled Novavax is now the best COVID 19 vaccine. So they're basically comparing Novavax to the MRNs and just saying, look, we are giving an unfair advantage. To the MRI and a vaccine that we're not seeing a clear picture at the end, they definitely hallmark MRNs. They know this is a great technology. I'm not, they're not saying this is bad. There's setups. And I want you, I want you to respond back to this. Their set up is look, marinade became the premier vaccine really by accident because. Basically Pfizer took bio. I think it's BioEnTech or whatever it is, took that and allowed that big corporation to help them move needle forward. And they happened to be able to go through their phases during really big outbreaks, which allowed it to expedite. And it was the outbreaks that expedited their, their MRI and a vaccine to come to reality. And that said, look, there were nine M RNA vaccines out there only two males. Right to the real world. Whereas here in the Atlantic, suggesting look, 13, non Emrani and vaccines have made it through trials and going through the periods. So it's not inherent to MRMA that it's success, that it's like 95% accurate. That's not inherent to MRMA. That's just happened to be a circumstance. And they're looking at, Novavax saying no, the vaccine is a traditional vaccine. That probably has a higher percentage because it's 90% in a current situation. Whereas it was closer to 96% back on the early. The, the, the, the, the first the coronavirus. So all that being said, and the base of the article is saying, look, Novavax is traditional. Probably wouldn't have scared. As many people MRMA scare a lot of people. It was new. It has higher side effects than the traditional Novavax one. The Novaks is the real winner, and that we're really giving an unfair advantage to the MRMA. Can you speak into this? What's what's what's maybe resonates with you and what maybe might be new.

Stephen Kissler:

Yeah, I think, I think this is super interesting because in some ways, you know, this this sort of commentary about the vaccine is like totally predictable and good is essentially what the, what the Atlantic is doing is they're getting ahead of the curve on the hype cycle. Are you familiar with the hype cycle? No, it's this, it's this idea. I look it up on Wikipedia. It's they've got this nice sort of graph of it. And it's sort of, it has these axes of basically enthusiasm or expectations for technology. It's time. And as you move forward, you have this new technology and it just spikes at the very beginning, everybody's super excited about this new technology. It's going to save the world, it's going to do everything it's going to, you know, and then it plateaus. And then you reach this sort of trough of disillusionment as they call it. Or it's oh no, you know, we've tried applying this to a new problem and it's actually not working and it's more complicated than we thought. And then actually it picks up again and then you reach sort of this plateau of realistic. Appropriate use of a new technology, right. Where it's it's no longer as good as it sounds like.

Matt Boettger:

That sounds like it sounds like dating Stephen.

Stephen Kissler:

Yeah. I guess that's true too.

Matt Boettger:

Best foot forward. Best foot forward. Oh. We realize who we really are. We're broken people and we plateau. Okay. We love each other for who we are now, right? Yeah.

Stephen Kissler:

There you go. Exactly. It's like deep, deep, psychological realities here. Totally. Yeah. So I think that this is, this is part of what's happening here, but I think we can break it down specifically with respect to the MRN vaccines and the other vaccines that we have available. So I love this point that the article brought up that you just mentioned about how had this Novavax vaccine been trialed at the same time as the MRN vaccines, it might have actually had higher efficacy. And so I think that what this really underscores is that these numbers of efficacy. Fixed numbers necessarily, you know, they're like, like we were talking about before they're context specific, we need to know sort of how they were measured when they were measured, why they were measured and, you know, vaccines that are being trialed now are generally being trialed against variants that didn't exist six months ago when some of the earlier vaccines were being trialed. And so if we're comparing like, In the current conditions. Yeah. They, they do seem to be pretty well on par. Of course there's some statistical uncertainty in here too, you know, depending on which geographic communities you're you're measuring this in just, you know, how many cases do you actually see? Right. You're absolutely going to get some statistical variation in these numbers as well. And so, my sense is that the confidence intervals for these efficacy rates given the current conditions do overlap pretty well with Novavax versus the MRN vaccines which is great. Other things to speak into here. So, I do still think that the MRN vaccines that Absolutely in many ways, there was luck serendipity behind why they sort of were the first ones through the gate and why they were so effective. Some of it is, does pertain to the technology itself though, too, in the sense that you know, the, the modern of vaccine. And I think, I think the Pfizer vaccine as well, We actually had vials of it within days of when the sequence of the the coronavirus was first published. Now still had to go through lots of testing. Many other companies also had vials of a coronavirus vaccine within days of that sequence being posted. But those ones didn't actually end up performing very well or they had two severe side effects or whatever. So, but one of the great advantages of the MRI. You can produce them extremely quickly. And so you, they can be part of a very agile response. And so that was part of the reason why they were first through the gate. Because just technologically speaking, and this is building off of, you know, years and years of development of other types of MRN technology. We were just sort of, at this time in history, when MRNs vaccines, we were able to produce them and something about the vaccines themselves, make them. Easier to produce quickly than other types of vaccine technology that we have available. So that's part of why they were first through the gate, but in terms of efficacy, I don't think that we can necessarily. I don't think it's necessarily true that MRN vaccines will always be super effective. That's super pathogen specific. It could just be that COVID-19 is a decently vaccine, Hubble, pathogen and some pathogens are more vaccine rubble. And so, you know, of course the canonical example here is HIV, where we still don't have a vaccine. And we've been working on that for years and years and years. Our marinade vaccine is going to finally give us a vaccine for HIV. I hope so, but I don't think there's any reason to think that that that will necessarily change the landscape there nor do I think that necessarily MRNs vaccines will be more effective against other pathogens that we already have vaccines for. I just don't know they could, and I really hope that they do. But again, when we're thinking of about COVID, it's this there's the vaccine, but it's the vaccine pathogen interaction that's really important to hear. And that can totally change depending on what the pathogen is. What body systems that pathogen interacts with all of these things. So MRA, vaccines, super exciting. There are reasons why they can be part of this agile. Response to emerging pathogens. They could really revolutionize the way that we deal with infectious diseases, but they won't necessarily. And I think that's part of what this article was getting at. Was that a lot of enthusiasm around MRNs vaccines. But I think it's worth tempering. Some of that because we still have a lot of big challenges to face. And in many ways, we're, we're lucky that they were as effective as they were against this particular pathogen. Hopefully that success will translate into other pathogens in the future. But generally speaking, when we think about medical techniques, You know, oftentimes, you know, the, the real ringer sort of emerges to the surface for one infectious disease and we think it's going to cure everything. And then we applied in a different context and it's like, yeah, it's just okay. And I think that's probably the most likely scenario is that it'll help, but we'll see what the actual impact will be.

Matt Boettger:

Great. Thanks for that, Stephen. I think we'll end there on that checkout. Novavax as well as a lot of good stuff coming with that one, obviously way more available to the, to the global community then thank you Stephen. Now again, just to re review, please do apple podcast support us patron.com/pandemic podcast or Venmo, PayPal. Realize that we may not have an episode next week. If, unless I can get mark on. The week after that I will be on vacation. There'll be some staycations, so there could be a one to two weeks sabbatical, but we'll negotiate that as time comes forward, we are still here and we're still going to be going and giving you the news on the pandemic and just general information on. The future of healthcare and disease and all that good stuff. So stay tuned, have a wonderful week. Have a great fourth if we don't, if we, if we don't come in on that week and we'll see you soon, take care. And bye-bye.