COVID-19 Vaccine Update: The Global Connection and Public Health Issues

In this second part of our COVID-19 vaccine update, GLG’s Michael Weissman, V.P. and Healthcare Content Team Leader, continues to unpack developments concerning the pandemic with three public health experts: Dr. Rachel Sherman, an infectious disease physician who most recently served as principal deputy commissioner at the Food and Drug Administration; Dr. Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a global authority on infectious diseases; and Dr. Nicole Lurie, a professor of medicine at George Washington University who served for eight years as Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services.

Edited excerpts from our broader conversation follow.

So far, our conversation has been U.S.-centric. Where do we fit in the global fight against the disease?

Dr. Osterholm: We live in a world that is highly connected. The supplies of critical drugs and other products we need come from countries that currently aren’t high on the list to get a vaccine. In fact, Oxfam recently came out with a report saying that 13% of the world’s population has now bought 50% of the vaccine doses for the immediate future. But as part of the world, we can’t isolate ourselves. It’s not only smart science but also good public policy to make sure that we all come together and work on distributing a vaccine around the world.

Dr. Lurie: To build on that point, we must remember that it’s not a given that the United States is going to have the vaccine first. If we do, it should be used for diplomatic purposes and not to start a vaccine war. We should also remember that the vaccines in development in the U.S. are on novel platforms. The companies behind them are making small batches to run their clinical trials, but scaling up for global distribution will require changing some of the technology and moving facilities. This tech transfer and scale-up is not a typical plug-and-play effort; there are always things that will go wrong just due to simple human error.

Then there’s all the logistics. It’s not unlikely that the first vaccine will require and ultra-cold distribution chain. Turns out that if the vaccine has to be shipped on dry ice, it can’t be put on passenger planes because release of carbon dioxide could asphyxiate passengers. That will be challenging internationally as well as domestically.

Dr. Sherman: We should not forget the speed with which this disease has spread and the extent to which it has spread. Each country’s response has been different, as is their level of trust in vaccines. Those factors are likely to shape the rollout of a vaccine. And since the world has learned an awful lot about treatment in a very short period of time — as well as that COVID-19 isn’t behaving the way other coronaviruses behave — that, too, may have implications for what the vaccine and future treatments look like. I don’t think we know what’s ahead of us, which, again, brings us back to the public health measures.

What do you see as the major public health issues facing us?

Dr. Osterholm: One is that young adults, particularly college students, dismiss the disease as something like the flu or a common cold. But we’re beginning to see a higher and higher proportion of people who started out with very mild symptoms, and by week six or seven are home on oxygen. It can turn out to be a long-hauler situation of severe chronic fatigue syndrome with marked changes in respiratory and heart function. So there is a public health danger in more young people getting the disease.

Dr. Lurie: Another issue is that the more than 7 million people in this country who have had COVID now have a preexisting condition, which presents many potential ramifications. For example, can they get health insurance? How much is it going to cost them? For me, that puts even more emphasis on the need for a vaccine — and the public issue of vaccination. Right now, we’re seeing polls with a lot of vaccine skepticism. That may change over the winter, when everybody predicts there will be a lot more transmission and a lot more deaths. People are much more likely to get vaccinated if they know somebody who died or somebody who’s a long-hauler.

While people can’t be forced to vaccinate, there are ways to encourage it. Maybe you have to distance learn if you’re not immune. How it plays out will depend on the epidemiology of the virus and the vaccines, but it’s going to depend on the environment of trust we have in our government science agencies to be able to tell us what to do.

There has been much talk recently about how top advisors are saying they would resign if they ever felt pressure to approve a vaccine or do something that was against science. Should that comfort the U.S. public?

Dr. Lurie: First, it’s absolutely tragic that we’ve sunk to this level of dialogue and that there is so little confidence in our science agencies. The senior people in our science agencies — the people who run the vaccines office, for example — have years and years of experience and expertise and are not readily replaceable. If they resign, the loss is incalculable. So for me, talk of possible resignations is not comforting because A, we’ve reached this point; B, we actually could lose them; and C, the Health and Human Resources Secretary, a political appointee, has authority over them. I’m not sure they signed up for getting engaged in all of these kinds of political machinations.

Dr. Osterholm: I have to note that Rachel and Nikki have provided incredible years of public service in the regulatory science and the policy side of government, and we forget sometimes how dedicated and how absolutely capable these people are and that they don’t go into it for fame or fortune. They go into it for all the right reasons, and thank God they’re there. So if we lose that level of regulatory science and policy science expertise, we suffer immeasurably.

Dr. Sherman: I, like Mike, served under every administration, Democratic and Republican, since George H.W. Bush. I’ve never seen anything like this. We’re in a very precarious position right now. Not to be too depressing, but how the next few weeks and months go will determine whether we have crippled the reputation of agencies that have garnered trust for many, many years, or whether we have managed to pull back from the precipice we’re standing on.

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This article is adapted from the September 18, 2020, GLG webcast “COVID-19 Vaccines: Policy, Access, & Guidelines.” If you would like access to this teleconference or would like to speak with Drs. Lurie, Osterholm, or Sherman, or any of our more than 700,000 experts, contact us.